NBSS Stigma and discrimination Dr Andy Guise.pdf

Stigma and discrimination Dr Andy Guise Senior lecturer in Social Science and Health April 2024 “Soon as you mention you're an addict “I told my wife then not to mention or a recovering addict or an ex-addict, about me being an ex-crackhead. their perception of you changes, the Even tho...

Stigma and discrimination Dr Andy Guise Senior lecturer in Social Science and Health April 2024 “Soon as you mention you're an addict “I told my wife then not to mention or a recovering addict or an ex-addict, about me being an ex-crackhead. their perception of you changes, the Even though, at that point, I'd been way they treat you changes, your off crack for about four years. I'd treatment changes, everything.” been four years clean. She did mention it because I refused to have tablets, painkiller tablets. I “Yeah, it's almost always your fault didn't want any morphine tablets because there are things that you could or painkillers.” have done. There are people that you could have spoken to. There is the ego that you could've dropped and ask for help. So it's almost always like you haven't had the balls to do that thing. And that's how I feel. By end of the session: Recognise stigma as a social process Distinguish different experiences and consequences of stigma Identify implications of stigma and discrimination for health and health care Context: the social meanings of health and illness Health and Illness is more than biological It is also social – 1) it depends upon social conditions, norms and values; 2) how it is experienced reflects the different meanings it can have e.g. HIV – biologically, a specific virus that undermines the immune system; sociologically, meanings of sin and immorality, and vulnerability to HIV is shaped by patterns of poverty and exclusion Goffman (1963): Stigma He observed reactions of people to (disabling) illness and social identities Observed reactions of others to these people Core text - Stigma: notes on the management of spoiled identities Stigma: “an attribute that is deeply Erving Goffman discrediting” Stigma is socially constructed Goffman: “an attribute that is deeply discrediting, but it should be seen that a language of relationships, not attributes, is really needed” The ‘attributes’ of stigma that are viewed negatively are actually the result of how a value is attached to such ‘attributes’ through social interaction: Not an inherent characteristic but ascribed within social relations (e.g. a £5 note is, in essence, a piece of paper – the value only arises if we all agree) Evidence: stigma varies between societies and over time  Epilepsy Sacred? Possessed? Brain condition causing frequent seizures (2003). "The History and Stigma of Epilepsy." Epilepsia 44(s6): 12-14. https://onlinelibrary.wiley.com/doi/full/10.1046/j.1528-1157.44.s.6.2.x The process of stigma possession of perceived Epilepsy difference ascription of negative Understood as characteristics, that possessed, and that this devalues someone is contagious Stigma and epilepsy: Study of 94 people Low reporting of ‘enacted’ stigma High ‘felt’ stigma, aimed to conceal condition: ostories to explain not driving owitnessed seizures explained as faints o28% disclosed epilepsy to employers (1 in 20 before taking job) o31% no disclosure prior to marriage Scambler & Hopkins (1986) Sociology of Health & Illness 1986 Vol. 8 Issue 1 Pages 26-43 The process of stigma 2 possession of perceived Enacted stigma Experience of difference discrimination, avoidance & exclusion e.g. made to sit separately, denied work ascription of negative characteristics, that Felt stigma shame & fear of enacted devalue stigma; worry how others will react e.g. not telling others, burden of Enacted and/or Felt stigma silence and secrecy The process of stigma 2 + Personally mediated discrimination – unfair treatment in the context of an interaction between people Structural discrimination – when stigma is codified into laws, policies and customs, leading to differential access to goods, services and opportunities Person who is rough sleeping and using drugs in London: “I don't know, it just doesn't seem that important to me. Oh, it hurts, like fuck, it's very painful. Yeah, I should, I might, yeah, I'll give it a go. I know, it's dreadful, ain't it, what we do to ourselves.” Person currently homeless and formerly using drugs in London: “See I've always been more of a fix it myself kind of guy. Partly because of the way I get treated.” 14 The process of stigma 2 + + Internalised stigma – adopting the negative social beliefs associated with a stigmatised group Anticipated stigma – the expectation that others will stigmatise and discriminate against you  “males from an ‘Asian/Asian British’ background with profound and multiple learning disability had a median age at death of 30 years, whilst males from a ‘Black African/Caribbean/Black British’ background with profound and multiple learning disability had a median age at death of 33 years. In comparison, for ‘White British’ males with profound and multiple learning disability who died in 2020, the median age at death was 59 (Heslop et al., 2021).” Umpleby, K., Roberts, C., Cooper-Moss, N., Chesterton, L., Ditzel, N., Garner, C., Clark, S., Butt, J., Hatton, C., Chauhan, U. (2023) We deserve better: Ethnic minorities with a learning disability and barriers to healthcare. Race and Health Observatory Report. The process of stigma: intersectionality Social categories and identities intersect, creating severe systems of disadvantage Disadvantage is experienced differently according to identity when, for example, identities of sexuality, gender, race and wealth intersect For stigma: if stigmatised identities intersect then Kimberlé Crenshaw, even more severe forms of stigma possible UCLA & Columbia Crenshaw (2019 Intersectionality explained: https://www.vox.com/the- highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination Political? “Relating to the government or public affairs of a country” – and so health and health care are inevitably ‘political’ “Characterised by different ideologies and belief systems (and bias)” – which do exist in health and health care, and one response is careful analysis and clear argument Anti-stigma interventions Awareness raising, education, information Training and ‘literacy’ programmes ‘Contact’ programmes Peer support Other support to people impacted Language Policy and legal change National Academies of Sciences, E. a. M. (2016). Ending discrimination against people with mental and substance use disorders: the evidence for stigma change. Washington, DC, The National Academies Press. Cook, J. E., et al. (2014). "Intervening within and across levels: A multilevel approach to stigma and public health." Social Science & Medicine 103: 101-109. 20 Anti-stigma interventions Clair, M., et al. (2016). "Destigmatization and health: Cultural constructions and the long-term reduction of stigma." Social Science & Medicine 165: 223-232. 21 Thinking about stigma in social science Tyler I. Resituating Erving Goffman: From Stigma Power to Black Power. The Sociological Review. 2018;66(4):744-65. Summary: what is stigma? what is the impact on health? Stigma is a process of people being ‘marked’ and then understood as unacceptable or inferior What or who is marked is socially constructed (ie it doesn’t reflect anything inherent, and instead changes across space and time) Stigmatisation leads to a range of experiences: enacted stigma (discrimination), anticipated stigma, internalised stigma, and institutionalised discrimination These varying experiences of stigma impact on health through: Leading to health care avoidance Reducing quality of health care available Causes or exacerbates ill-health (physical and mental)  Questions, comments [email protected]