Читать книгу Health Psychology - Michael Murray - Страница 75

Stigma refers to unfavourable reactions towards people when they are perceived to possess attributes that are denigrated. Stigmatization is universal; it is found in all cultures throughout history. The majority of people will experience it at some time, as both the young and the elderly are stigmatized groups. In addition, people can be multiply stigmatized, as in the case of HIV infection and AIDS, which is associated with certain highly stigmatized groups (e.g., homosexuals, sex workers, intravenous drug users) and adds a further source of stigma as well as intensifying existing stigma(s) (see Chapter 22). Stigma involves a pattern of discrediting, discounting, degradation and discrimination, directed at stigmatized people and extending to their significant others, close associates and social groups. Link and Phelan (2014) used the term ‘stigma power’ to refer to instances whereby exploitation, control and exclusion of others enable people to obtain what they want. They argued that stigmatization is most effective in achieving its prejudiced aims when it is hidden or ‘misrecognized’.

Stigmatization devalues the whole person, ascribing them a negative identity that persists (Miles, 1981) even when the basis of the stigma disappears (e.g., when someone recovers from mental illness they remain characterized forever as a person who had mental health problems). It is a form of social oppression and operates to disqualify and marginalize stigmatized individuals from full social acceptance and participation. Health care professionals are as likely to stigmatize as any other group, influencing their behaviour and decision-making in the provision of health care. The consequences of stigma include physical and psychological abuse, denial of economic and employment opportunities, non-seeking or restricted access to services, and social ostracism. It is not surprising, then, that individuals frequently expend considerable effort to combat stigmatization and manage their identities, including passing (acting as if they do not have the stigmatized attribute), covering (de-emphasizing difference), resistance (e.g., speaking out against discrimination) and withdrawal. They may also internalize the stigmatization, feeling considerable guilt and shame and devaluing themselves. Kadianaki (2014) argued that coping with stigma could be seen as a meaning-making effort to enable those who are being stigmatized to transform the way they see themselves and to orient themselves in society.

The pervasive Western idealization of physical perfection, independence and beauty may play an important role in the constant devaluation of disabled people and people who are ill. Particular characteristics of illness or disablement increase stigmatization, including perceptions that the condition is the person’s own fault (e.g., obesity), is incurable and/or degenerative (e.g., Alzheimer’s disease), is intrusive, compromises mobility, is contagious (e.g., HIV infection and AIDS) and is highly visible.

The lower value placed on the lives of disabled people can be seen in the way disabled people are segregated from the general population, including in education, housing, employment and transportation. It is also apparent in the way crimes against disabled people are minimized (e.g., discourses of abuse rather than theft/fraud/rape; acquittals and light sentences in cases of ‘acceptable’ euthanasia). For both disabled people and those with severe or terminal illness, stigma may be central to debates around suicide/euthanasia and abortion (see below). Stigma is a powerful determinant of social control and exclusion. By devaluing certain individuals and groups, society can excuse itself for making decisions about the rationing of resources (e.g., HIV antiretroviral drugs), services (e.g., health insurance exclusions), research funding/efforts and care (e.g., denying operations to individuals who are obese) to these groups. In terms of the social model of disablement, stigmatization may be the main issue concerning disablement.

Multidisciplinary research is needed to further explore how stigma is related to health, disablement and social justice. Why is recognition of the similarities between stigmatized and non-stigmatized individuals overridden and obscured by perceived differences that are devalued? How do different stigmas, particularly health-related stigmas, interact? How is stigma manifested by health care professionals and what interventions might mitigate the negative effects of stigma?