Stigma: Where’s the Harm?

Posted by Dr Michelle Addison, Assistant Professor, Durham University

Stigma is a knotty, ugly problem we have in society: it marks out (often painfully) what is considered shameful, abject or contra to social norms, and impacts vulnerable and marginalised people the most. It seems intuitive to say it is unfair and unjust, but why then does it persist? 

Discussions of stigma are not new; we are all generally aware that stigma is something to be avoided and we could all very likely give some examples of it in action – benefit claimants, people who use drugs and ex-offenders are often easy targets and regularly feature in news headlines because stigma continues to be sensational – it elicits a voyeuristic feeling that is both intoxicating and a warning to us too. The use of stigma is further exacerbated by the ‘Cost of Living Crisis’, ‘Rising Interest Rates’, Fuel and Food poverty, and the withholding of the Government White Paper on Health Inequalities. We understand then that stigma is harmful, and yet we recognise it is powerful to those who can wield it.  

Erving Goffman discussed stigma using the concept of the ‘spoiled identity’ whereby certain aspects of who you are become discredited and devalued in his now infamous work Stigma: Notes on the Management of Spoiled Identity (1963/1990). This notion of a spoiled identity is also implicit in his observations of patients residing in ‘asylums’, the conditions impacting these people, and the roles of those working there (1961). Indeed, Goffman was acutely interested in the medicalisation and performance of roles in these settings and how behaviour was shaped by social expectations of ‘in-mates’, ‘guards’ and ‘medical staff’. The treatment of patients, he noted, was complexly bound up with expectations of socially acceptable roles and the reinforcement of discredited behaviours and identity.

What we learnt from this is that stigma matters in the social organisation and hierarchies of people and places in medicalised and wider social settings. But what tends to fly under the radar in early stigma research is the question of ‘in whose interests’ does stigma serve?  Professor Imogen Tyler later critiques Goffman’s work (2020) in her book ‘Stigma: The Machinery of Inequality’ for overlooking the power relations that are integral to how we understand stigma, and why indeed, stigma continues to persist. Tyler shows us that there is a ‘craft’ to how mechanisms of stigma operate and function to maintain political power and a social order that hinges on systemic and structural inequalities around class, race, gender (and not limited to) to reproduce privilege for the dominant factions. This is a hugely important step in stigma research because it draws attention upstream to how and why stigma is weaponised (Scambler, 2018) and the social harms that impact marginalised and minoritised individuals and communities in society – which is the subject of my forthcoming article (Addison, 2023). This is further evident in the recent Stigma Kills (2021, 2022) campaign launched by the NHS Addictions Provider-Alliance which gives credence in particular to the impact that stigma has on the health and wellbeing of those communities that are most harmed through health and social inequality.

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Stigma Kills. But it shouldn't have to be this way.

Introducing our new #StigmaKills campaign. https://t.co/wgVnROwb5P pic.twitter.com/Rc35eCxo1M

— NHS Addictions Provider Alliance (@NHS_APA) February 8, 2022

This growing concern about the effects of stigma on health and wellbeing, arising out of social harm, led to our recent Fuse event Inequalities, Social Harm and Weaponised Stigma: Emerging Research and future priorities which brought together academics, practitioners and the public to discuss these key issues. I presented work from my Wellcome Trust research looking at stigma and how this relates to health inequalities amongst people who use drugs. In this study I highlight how the weaponisation of stigma is harmful, negatively impacts physical and mental health, and inhibits health seeking behaviours for fear of being judged and marginalised by service providers and the wider public.

Joanne McGrath discussed her NIHR funded research into women living with multiple disadvantage and complex needs and how they access services. In this talk she highlighted how escalating problems around homelessness, stigma and deteriorating physical and mental health have a cumulative impact in women’s lives.

Our ‘expert by experience’, Margaret Ogden, shared moving insights into the effects of stigma on her own life and how her mental health was harmed as a result.

Later, Mark Adley discussed his Doctoral work (which is funded by the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC)) and his recently published paper which explores stigma within-groups towards people who use the drug Spice. In this talk, Mark showed how intersections of identity mattered and how increased contact with people who used Spice helped to reduce levels of stigma. He highlighted the role of education programmes within service provision to help draw attention to the harms arising out of stigma and how practitioners might mitigate these effects.

This event was also an opportunity to launch our new Palgrave edited collection Drugs, Identity and Stigma (Addison, McGovern and McGovern, 2022). Our book calls attention to the impact of stigma experienced by people who use illicit drugs, and through this we show that stigma is powerful: it can do untold harm to a person and place with longstanding effects. Through an exploration of themes of inequality, power, and feeling ‘out of place’ in neoliberal times, this collection focuses on how stigma is negotiated, resisted and absorbed by people who use drugs. Dr Kelly Stockdale, a contributor to the book, spoke at our Fuse event and shared insights from our research into the challenges of navigating a custodial environments (prison and police) and the impacts of stigma from the point of view of people who use novel psychoactive substances (NPS). Collectively, our work in this area brings together a range of frameworks and data and draws attention to the damaging effects stigma can have on health inequalities, recovery, mental health, recidivism, and social inclusion.

Our knowledge and understanding of the harms that stigma does to health and wellbeing is still growing – as such, it is critical that developing stigma research becomes a priority in future inequalities research agendas, against a backdrop of political and economic crises. Whilst the social determinants of health are often tangible and measurable, providing the much-needed evidence base to tackle widening health inequalities, it is imperative that we think differently and critically about how stigma operates. In my own research I have tried to show that stigma operates at a symbolic level meaning it is not possible to treat stigma as something which is material and objective, to say ‘here is stigma’ – we must think more deeply about stigma as inscribed with meaning that becomes apparent through its effect on and between people (see also Addison, McGovern and McGovern, 2022).

I called this blog ‘Stigma: Where’s the harm?’ to be a little provocative to you, reader – on the one hand, stigma is so normalised in our society that we forget to see it, so I encourage you to pause and reflect on where the harm resides – like a million little paper cuts, stigma is painful and gets under the skin doing very real harm. On the other hand, my question is also a call to action to understand how and why stigma is weaponised, and how it leads to social harm amongst under-heard and underserved people. It is my strong belief that this is vital work if we are to tackle and reduce widening health and social inequalities right now.  

 

References:

Addison, M. (forthcoming, March 2023) ‘Framing Stigma as an Avoidable Social Harm that Widens Inequality’ in Emery, J., Powell, R., and Crookes, L. (eds.) The Sociological Review Special Issue

ADDISON, M., MCGOVERN, W. & MCGOVERN, R. E. (eds.) (2022) Drugs, Identity and Stigma, Houndsmill, Basingstoke and Hampshire, Palgrave Macmillan.

ADLEY, M., ATKINSON, A. M. & SUMNALL, H. R. (2022). Including the multiply excluded: a mixed methods study exploring intragroup stigma towards people who use synthetic cannabinoid receptor agonists. Drugs: Education, Prevention and Policy. DOI: 10.1080/09687637.2022.2025766

GOFFMAN, E. (1990) Stigma: Notes on theManagement of Spoiled Identity, London, Penguin Books

GOFFMAN, E. (1961) Asylums: Essays on the Condition of the Social Situation of Mental Patients and Other Inmates, London, Penguin Books

SCAMBLER, G. (2018). ‘Heaping blame of shame: 'Weaponising stigma' for neoliberal times’. The Sociological Review Monograph, 66, 766 - 782.

SINGH, S. (2019) available at: https://samiasingh.com/

TYLER, I. (2020). Stigma, The Machinery of Inequality, London, Zed Books.

Images:

1) Artwork by Samia Singh, https://samiasingh.com @samiasingh_art

2) Book: Drugs, Identity and Stigma, © 2022 Springer Nature Switzerland AG. Part of Springer Nature, ISBN : 978-3-030-98285-0, https://link.springer.com/book/10.1007/978-3-030-98286-7#about-this-book

What is the recipe for a happy retirement?

Independence, identity, planning and staying socially connected says Anastasiia Fedeeva, Postgraduate Researcher, from Northumbria University

For the last two and a half years, I have been working on a PhD that aims to promote wellbeing and physical activity in retirement. Over this time some people have asked me whether I ever felt too young to understand what retired people might need to live their lives better. I must admit that is a fair question but not just because of the potential age difference with my target population.

 

First, before designing and implementing any initiatives to promote wellbeing or physical activity, it is recommended that you have a good knowledge of the people that you want to help; their needs, preferences, and feelings (Laverack, 2017). Furthermore, retirement itself is a unique and complex phenomena. Retirement experiences vary considerably between individuals and are influenced by a variety of contextual factors, for example the characteristics of a job, personal health, social networks, or whether a spouse is working (Wang, 2007). Therefore, it is important to understand the gaps in what can predict positive retirement (Amabile, 2019; Van Der Zwaan et al., 2019). One way to explore retirement more comprehensively is by conducting qualitative research to find out about the experiences of retirees, as this allows us to identify the key ways in which people adapt to a successful retirement in connection with individual and contextual factors. That’s why I spent several months last year conducting focus groups and individual interviews in order to better understand psychological predictors of retirement adjustment such as people’s attitudes, feelings, and behaviours.

 

To understand what is so good and bad about retirement, it is important to recognise what people leave behind after quitting their jobs. Work brings a lot of positives to our lives and this is not only limited to our finances. Among the most common benefit is the feeling of belongingness and connectedness with our colleagues. Retired people can be very concerned about losing valuable connections from their previous employment. For some, work may be the main source of social interaction, and those people might feel particularly vulnerable in retirement. 

 

Another positive aspect of work is in giving us an identity. If you ask people: “Who are they?”, very often the first answer would be related to the person’s work role. As people leave employment, they can no longer define themselves by their professions, and it brings the question: “Who are they now?” Although work identity can be substituted with other roles, such as those that are family or hobby-related, this process might take some time and individual effort. For those with a particularly strong attachment to work, such identity transition can be very challenging. 

 

However, one benefit associated with retirement that many look forward to, is increased freedom and independence. Most are excited to have the opportunity to finally live in accordance with their own preferences and choices, free from work-associated obligations and routines. This desire for independence seems to develop beyond just freedom from work commitments. Retired people value independence in other areas of life as well, and sometimes this even takes precedence over the importance of social connections. One reason can be that people of retirement age have already had all variety of commitments, including work and family responsibilities, and retirement is viewed as a relief from that. Another possible reason is that retirement is seen by many as the beginning of ‘old age’. As individuals acknowledge age-related health decline, they start appreciating physical and mental independence more than ever.

 

Additionally, some recently retired people see creating a new routine as another restriction to their freedom but planning day-to-day activities can be beneficial for wellbeing in the long-run. Planning seems to enable a better use of this increased freedom by helping retirees to participate in different activities of their choice. Thus, establishing new routines can be remarkably empowering as they foster feelings of control, sense of purpose and self-value, that “I’ve got my life back!”. 

 

As such, regardless of the differences in experiences and expectations, social connectedness, independence, successful identity transition, and planning activities in retirement appeared to be important for the vast majority of my participants. These findings supported and added to our ideas on how to promote healthy retirement. 

 

Personally, I feel privileged to have shared in the stories of retired adults. This has made me feel much closer to them – they aren’t ‘just participants’ anymore but real people who have gone through life’s joys and struggles. I have realised even more that despite the generational, cultural, and life experience gaps, we might just be looking for the same things that contribute to our happiness and wellbeing after all.

 

  

References:

1. Laverack, G. (2017). The challenge of behaviour change and health promotion. Challenges, 8(2), 25. Retrieved from: https://www.mdpi.com/2078-1547/8/2/25
2. Wang, M. (2007). Profiling retirees in the retirement transition and adjustment process: Examining the longitudinal change patterns of retirees’ psychological well-being. Journal of Applied Psychology, 92, 455-474. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/17371091 
3. Amabile, T. M. (2019). Understanding Retirement Requires Getting Inside People’s Stories: A Call for More Qualitative Research. Work, Aging and Retirement. Retrieved from: https://academic.oup.com/workar/article/5/3/207/5521007
4. Van der Zwaan, G. L., Hengel, K. M. O., Sewdas, R., de Wind, A., Steenbeek, R., van der Beek, A. J., & Boot, C. R. (2019). The role of personal characteristics, work environment and context in working beyond retirement: a mixed-methods study. International archives of occupational and environmental health, 92(4), 535-549. Retrieved from: https://link.springer.com/article/10.1007/s00420-018-1387-3
   

Image:

1. "Your father's opted out of a dignified retirement." by Grizelda Grizlingham via University of Kent, British Cartoon Archive (Reference number: GGD1456, Published by: Spectator, 02 Mar 2018, with thanks to Copyright holder: Grizelda Grizlingham): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=GGD1456&pos=23

Brands, bottles and breastfeeding: sharing stories of early motherhood

Introduced by Nat Forster

Guest post by Justine Gallagher, Lecturer at Northumbria University

My own story of infant feeding is based in a community where breastfeeding was, and still is, not the norm. I was the first in my immediate family to breastfeed and I struggled with it in various ways. My breastfeeding journey ended much sooner than I had originally planned, when my son was just six weeks old. Two years later, my own sheer determination helped me to feed my second child, a daughter, for nine months.

Justine's first steps into motherhood

Later, in a professional capacity, I worked supporting families in my role as Community Development Worker in Sure Start Children's Centres. I worked with mothers who had similar feeding stories to my own, as well as many women who had never breastfed. They, like most of the people around me, never had any intention to breastfeed.

The guilt I felt for breastfeeding my first child for a short time stayed with me for a long time. I did not understand why it had such an impact. Why did I feel the need to breastfeed when others around me did not appear to give breastfeeding a second thought? When the opportunity came for me to undertake PhD research, my choice of topic was never in doubt.

My research, which is supervised by Dr Deborah James from Northumbria University, is focused on the infant feeding stories of nine women who live in an area where breastfeeding rates are low. All of the women’s stories are equally important however, for the purposes of this blog I would like to introduce you to Claire (names have been changed to preserve anonymity), who formula fed her baby Sophia from birth.

Claire, her parents and grandparents have lived in the same local area all of their lives. Claire was a single parent and lived with Sophia’s grandparents when her daughter was first born. Sophia’s grandmother took an active part in her care. She looked after Sophia for two nights a week when she was first born, reducing this to just one night per week as time passed. Following a biographical narrative approach, which allows participants to tell their stories without interruption, I asked Claire for her story with the use of a single question;

"So, please can you tell me the story of your experiences of feeding milk to your baby?"

"Well I started when I was pregnant, erm, I’ve always wanted to bottle feed her er, cause there was pink bottles that I wanted to get her erm and also knew the milk that I wanted to put on her erm, and just bottle feeding become very easy to us."

Claire’s story was dominated with discussion of branding and consumer goods. The pink bottles and the various brands of infant formula Claire gave to Sophia reveal the way media and advertising can influence infant feeding practice. Claire demonstrates that she was careful with her bottle-feeding choices. These choices were not arbitrary; she made clear decisions between brands and bottles. Claire wanted me to know that she had made the right choices for her and her daughter.

It was also quite clear that Claire’s identity, as the mother of a daughter, was an important part of her story. The ‘pink’ bottles represent this in a very visible way, she could perform her identity as a mother of a daughter with the right choice of bottle. Claire’s relationship with her own mother was important to her and she appeared keen to demonstrate that this mother-daughter bond would continue for another generation.

These stories help us to understand why some women breastfeed and others do not. Upon reflection, for me, I feel that breastfeeding was about being the best mother I could be, which explains the guilt I felt when I stopped. For Claire, feeding her baby was also about the same thing, only for Claire, being a good mother was about making the right consumption choices. In my thesis, I expand on how Claire’s choices were based on the social norms, the unwritten rules of how to be a mother, in the culture around her.