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Introduction

Unravelling the Contexts of Stigma: From Internalisation to Resistance to Change

CATHERINE CAMPBELL 1* and HARRIET DEACON

1 Institute of Social Psychology, London School of Economics, UK

2 Human Sciences Research Council, Cape Town, South Africa

ABSTRACT

This special edition on ‘Understanding and Challenging Stigma’ seeks to further our understandings

of the types of representations and practices through which stigma is perpetuated, the social contexts

within which they are produced and reproduced, and the possibilities for agency, resistance and

intervention. In this introductory piece, we outline three broad approaches to stigma in the existing

literature — individual, macro-social and multi-level. Aligning ourselves with the latter, we discuss

how social effects become sedimented in the individual psyche in ways that often make it difficult for

stigmatised group members to resist their devalued social status. This insight frames our discussion of

the papers in this volume — which cover various types of stigma, drawing on research in six countries.

We focus on the ways in which the papers contribute to our understandings of (i) the material,

political, institutional and symbolic contexts of stigma; (ii) the possibility of resistance to stigma; and

(iii) the types of interventions most likely to facilitate such resistance. We conclude that the fields of

social and community psychology have a central role to play in advancing the types of understandings

that are so urgently needed to inform effective multi-level stigma-reduction interventions. Copyright

# 2006 John Wiley & Sons, Ltd.

Key words: stigma; internalisation; resistance; agency; power; interventions; the Other; social

context; social change

INTRODUCTION

The editors of this special edition are keenly aware of the limited effectiveness of strategies to

reduce particular forms of illness stigma. This highlights the need for more communication

between stigma researchers across various contexts to improve stigma theory, research

methods and the planning and assessment of anti-stigma interventions. We have therefore

brought together papers that explore stigma across various categorizations—disease

Journal of Community & Applied Social Psychology

J. Community Appl. Soc. Psychol., 16: 411–417 (2006)

Published online in Wiley InterScience

(www.interscience.wiley.com) DOI: 10.1002/casp.901

* Correspondence to: Catherine Campbell, Institute of Social Psychology, London School of Economics, Houghton Street, London, WC2A 2AE, UK. E-mail: [email protected]

(diabetes, tuberculosis, AIDS), race/ethnicity, immigration status, occupation (sex work),

sexuality (gay men) and health-related behaviours (smoking), drawing on qualitative research

in Ghana, India, Zambia, Tanzania, South Africa and England. The papers deal with various

dimensions of stigma: causes, modes of expression, consequences and responses. Each seeks

to understand the complexity of the social psychological contexts within which stigma arises,

and how it might be challenged or resisted.

Goffman (1963) characterises stigma as a ‘mark’ of social disgrace, arising within social

relations and disqualifying those who bear it from full social acceptance. Marks take

various forms: ‘abominations of the body’ such as physical deformities, alleged ‘blemishes

of individual character’ such as mental illness or unemployment and ‘tribal identities’, such

as religion or ethnicity. People who possess such characteristics acquire a ‘spoiled identity’

associated with various forms of social devaluation.

Some argue that it is important to distinguish between stigma (understood as negative

ideologies or attitudes) and discrimination (negative behaviours) (e.g. Deacon, this

volume). Others define stigma as a blend of affective, cognitive and behavioural responses,

with the primacy of each factor resulting from variable interactions between the nature of

the stigma, the context in which it is encountered, and individual differences amongst

interactants (e.g. Heatherton, Kleck, Hebb, & Hull, 2003).

The stigma literature is diverse, with three broad trends: the first two representing a

polarisation between individual and macro-social levels of analysis, and the third seeking

to build bridges between these (Deacon, Stephney, & Prosalendis, 2005).

Individualistic explanations for stigma — often drawing on social cognition

approaches — examine psychological attributes of perpetuators or targets, or inter-

individual interactions between them (e.g. Herek, Capitanio, & Widaman, 2002), paying

limited attention to social power, inequality and exclusion. They tend to focus on the

stigmatiser more often than the stigmatised, and are often associated with interventions that

implicitly align stigma with ignorance, seeking to reduce stigma by providing people with

‘the facts’ about an illness or about stigmatised groups.

When attention is given to the stigmatised, this falls within individual-level models of

stress and coping (e.g. Levin & van Laar, 2006). Existing social relations are usually taken

as given. The burden of adjustment falls on stigmatised individuals — with their responses

conceptualised in terms of their individual abilities to adapt to the stress of stigma.

Individual counselling is often the associated intervention for stigmatised people.

The failure of individual-level approaches to effect widespread stigma reduction has led

to an alternative focus on the links between stigma and wider macro-social inequalities

(e.g. gender, ethnicity). Such analyses suggest that stigma is not something that individuals

impose on others, but a complex social process linked to competition for power, tied into

existing mechanisms of dominance and exclusion (Parker and Aggleton, 2003). Macro-

social analyses imply that interventions such as anti-discrimination legislation or poverty-

reduction will assist in stigma reduction. But taking this view can mean that researchers

pay little attention to the individual psychological dimensions of stigma.

It is possible to straddle individual and macro-social analyses. Link and Phelan (2001)

define stigma as the co-occurrence of: labelling, stereotyping, categorical in-group/out-

group separation, status loss and discrimination, emphasising the exercise of power as an

essential element. Rooting their explanations in psychoanalytic theory rather than social

cognition, Crawford (1994) and Joffe (1999) highlight the processes through which the

individual and social are inextricably intertwined in the construction of stigma. They argue

for a universal human fear of uncertainty and danger. Individuals project this onto

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412 C. Campbell and H. Deacon

identifiable out-groups — responding negatively towards them to distance themselves from

the threat. Whilst such ‘othering’ is common across societies, the targets of stigma often

vary, with choice of the ‘other’ reflecting wider power differentials in particular settings.

Combining macro-social and psychological analyses facilitates a better understanding of

individual compliance, change and resistance to stigmatisation. For example, Crawford’s

(1994) study of AIDS stigma in the United States analyses how the stigmatisation of people

with HIV/AIDS (compounded by the association of HIV/AIDS with marginalised out-

groups such as intravenous drug users, gay men, sex workers and ethnic minorities)

reinforces a conservative ‘middle American’ social morality — which requires people to

police their behaviour in ways that support the economic and political status quo.

Faced with multiple layers of social disadvantage, it may be difficult for people to

challenge their stigmatised status. This is particularly problematic because ‘power is

seldom conceded without a demand’ (Bulhan cited in Seedat, 2001). Social elites seldom

voluntarily give up their power without a vigorous demand from excluded groups. Given

the social and intra-psychic benefits of ‘othering’, the ‘non-stigmatised’ may have a

complex and multi-layered investment in maintaining the symbolic status quo.

The self-policing that Crawford speaks of is deeply social psychological, rooted in the

complex mechanisms through which the social becomes sedimented in the individual

psyche. Even when members of stigmatised groups are not exposed to overt and direct acts

of discrimination, individuals who carry stigmatised markers may ‘internalise’ negative

representations of their status (Goffman, 1963). This may lead to loss of confidence and

self-esteem, undermining the likelihood that they will challenge their devalued status.

What are the implications for anti-stigma activists? Here we would argue against a

simplistic view of power which regards stigmatised people as passive victims of inexorable

social forces, ignoring that where there is power, there may also be the potential for

individual/collective resistance. In certain conditions stigmatised people may contest, even

transform, stigmatising representations and practices. Much remains to be learned about

the types of representations and practices through which stigma is perpetuated, the social

contexts within which they are produced and reproduced, and the possibility of agency and

resistance. It is here that we locate this volume’s contribution.

UNRAVELLING THE CONTEXTS OF STIGMA

Each paper contributes to particular specialist literatures — perspectives too rich and varied

to summarise here. In this section we seek only to highlight how papers contribute to

understandings of the material, political, symbolic and institutional contexts that support

the stigmatisation of various groups, undermining or enabling opportunities for group

members’ agency and the development of positive, active self-definitions that might inform

individual/collective resistance to stigmatisation.

Material contexts

At the material level, poverty/deprivation are potent drivers of the stigmatisation of diabetics in

Ghana (de-Graft Aikins), of people with tuberculosis (TB) in Zambia (Bond and Nyblade) and

African migrants with AIDS in England (Dodds). The combined effects of poverty and gender

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Unravelling the contexts of stigma 413

discrimination make Indian sex workers particularly vulnerable to stigmatisation (Cornish).

Poverty also undermines resistance to stigma. The psychologically disempowering effects of

deprivation mean that working class British smokers are far less able to withstand the

stigmatisation of smokers than their middle class counterparts (Farrimond and Joffe). The

social psychology of deprivation also significantly reduces the likelihood of stigmatised group

members taking full advantage of health campaigns (e.g. anti-smoking campaigns) or

potentially life-saving HIV/AIDS treatment in South Africa (Mills).

Political contexts

Conceptualising ‘political’ in terms of the operation of power in social relations, each paper

provides insights into political contexts of stigma. The term ‘layered stigma’ highlights that

stigma may follow existing social faultlines, deepening existing divisions between, for

example men and women, rich and poor. Deacon warns against simplistic associations

between stigma and existing power differentials, however, saying that stigma may sometimes

affect members of high status groups, or create new social faultlines. As such, it is not always a

replication of existing power relations, but also sometimes a new source of power inequalities.

Dodds shows how AIDS stigma ‘overlaps’ with other sources of social marginalisation

in the UK, including homophobia, xenophobia and racism. Layers of stigma preserve

social structures in the on-going constitution and reconstitution of ‘insider’ and ‘outsider’

groups. Dodds’s findings highlight the complexity of overlaps and their effects — showing

how the positioning of people with AIDS in other social hierarchies shapes the extent and

type of stigma that they faced. For example, whilst the experiences of gay white men with

AIDS are extremely negative, the experiences of black African migrants with AIDS are

even worse in the face of additional layers of marginalisation resulting from lack of access

to British nationality, citizenship and cultural integration.

Institutional contexts

Several papers show how institutional contexts facilitate stigmatising representations and

practices. The public health system plays a key role in perpetuating TB stigma in Zambia

through its overly zealous isolation of TB sufferers (Bond and Nyblade). Posters depicting

smoking as a disgusting habit may unintentionally reduce the likelihood of working class

smokers quitting. They may play into the complex processes that undermine the confidence

and self-esteem of deprived groups in England, and their sense of control over their

health — with well-intentioned campaigns more likely to perpetuate than remove health

inequalities (Farrimond and Joffe).

However just as institutions create stigmatising contexts, they also open up spaces for

resistance and social change. The success of the Indian Sonagachi Project shows the role a

well-networked NGO can play in challenging stigma in conditions of poverty and

exclusion (Cornish). The church plays a key role in stigmatising people with HIV/AIDS in

Tanzania, yet it also opens up spaces within which people are starting to problematise this

stigmatisation (Hartwig et al.). These insights echo Foucault’s warning against simplistic

and unidimensional accounts of power and oppression, keeping us alert to ever-present

possibilities for resistance even in unexpected places (Foucault, 1980).

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414 C. Campbell and H. Deacon

Symbolic contexts

Using the term ‘symbolic’ to refer to the frameworks of understanding within which people

make sense of their life experiences, each paper throws light on the symbolic contexts

within which stigma is constructed, internalised or resisted. Mills’ discussion of non-verbal

gestures used to communicate about peoples’ HIV/AIDS status in South Africa reveals the

rich seam of metaphors through which stigma is expressed — reminding us not to limit

explorations of the symbolic to the verbal realm alone.

De-Graft Aikins maps out the representational field in which people make sense of

diabetes in Ghana — including wider representations of unhealthy lifestyles and the

supernatural. She highlights the interpenetration of the symbolic and the material, showing

how poverty shapes how people give meaning to illness. The symbolic-material link is also

emphasised in Cornish’s account of how representations of ‘rights’ are mobilised by

activists to redefine the occupation of sex work in a less stigmatising way, whilst

emphasising that calls to ‘rights’ are most likely to lead to effective collective action when

accompanied by the possibility of real material changes to peoples’ lives.

Disease stigmas may be multiplied when layered with other stigmatised conditions.

Bond and Nyblade highlight how TB stigma is exacerbated through its link with AIDS in

Zambia. Whilst the symbolic link between TB and AIDS reflects the biomedical reality of

co-infection, the biomedical co-existence of diabetes and AIDS is less common. However,

diabetes is often incorrectly linked to AIDS through the shared symptom of weight loss.

This leads to equally distressing and debilitating consequences for people with

uncontrolled diabetes in Ghana, as de-Graft Aikins demonstrates in her contextualisation

of diabetes experience within interlocking cycles of biophysical disruption, financial

destitution and psycho-social neglect.

AGENCY AND RESISTANCE

Howarth argues that in certain conditions stigmatised people may contest and even

transform stigmatising representations and practices — and that a social psychology of

stigma needs to take account of human capacity for agency, and to allow for the possibility

of resistance and change. She emphasises that social knowledge is ‘always in the

making . . . constantly reworked, resisted and transformed as we find new ways of mastering our constantly changing realities’. Stigmatising representations are not always

internalised. Negative representations may jar with an individual’s or group’s experience of

themselves, leading to resistance and the renegotiation of previously stigmatising

representations in a more positive light.

Furthermore, stigma will not always be a disadvantage. Stigmatised identities might

even become a platform for group mobilisation and resistance. In exceptional

circumstances, people might even gain status if they ‘come out’ with a stigmatised

characteristic, for example, in the South African Treatment Action Campaign, with its

assertive ‘HIV positive’ message (Deacon).

In some cases, agency and resistance may arise spontaneously. However where stigma

overlaps with other forms of social devaluation, external support or intervention may be

necessary to facilitate resistance by devalued groups. For example, an ‘external change

agent’ of some sort may work with members of stigmatised communities to develop the

skills, support networks and resources that enable them to (i) think critically about their

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Unravelling the contexts of stigma 415

negative social representation; (ii) develop a sense of confidence and capacity to challenge

it; (iii) collectively negotiate locally appropriate and realistic individual and collective anti-

stigma strategies; and (iv) identify and build the types of strategic alliances most likely to

facilitate effective action (Campbell, Nair and Maimane, forthcoming).

FROM ANALYSIS TO ACTION

Elsewhere, we have lamented the mismatch between the copious research into ‘what

stigma is’, and minimal research on ‘what to do about it’ (Deacon, Stephney, &

Prosalendis, 2005). Several papers in this volume seek to address this problem,

commenting on implications of their findings for stigma-reduction interventions.

De-Graft Aikins supports her argument for multi-faceted interventions through her

account of the interplay of factors (biophysical, economic, symbolic, social psychological

and structural) that drive diabetes stigma. In addition to health education and improved

service delivery, she highlights the potential for self-help groups to help provide psycho-

social support for diabetics. However, the most fundamental driver of stigma in her context

is material: poverty and under-resourced health services. She highlights two recent

‘landmark’ developments in Ghana — a National Insurance Scheme providing medical

cover for chronic illnesses, and a Disability Bill providing the disabled with free access to

medical care (following a rights-based approach).

Focusing on small-scale church-based interventions, Hartwig et al. emphasise the value

of workshops in providing space for reflection in a complex and contradictory

environment, and for the construction of narratives about ways in which individual

religious leaders have created opportunities to challenge stigma.

Cornish provides a detailed social psychological account of the processes through which

the Sonagachi Project has successfully challenged the stigmatisation of sex work. She

shows how the social psychological realm is deeply penetrated by the material and

symbolic in ways that open up the possibilities of resistance and change, with skilful

facilitation, and under exceptional circumstances. The project challenged the fatalism

undermining women’s agency in conditions of poverty and many-layered social

devaluation through a double pronged approach. Efforts to facilitate alternative and

positive self-understandings went hand in hand with the possibility of real material changes

in peoples’ daily lives, such that the material and symbolic were intertwined as

‘complementary aspects of a single process of politicised change’.

Stigma is a quintessentially social psychological topic: a phenomenon rooted in the

individual psyche, yet constantly mediated by the material, political, institutional and

symbolic contexts referred to above. Community psychology has a key role to play in

advancing our understandings of the possibilities for collective resistance and for stigma-

reducing psycho-social change. Much remains to be learned about the mechanisms through

which individuals and communities may resist stigma, and the contexts which facilitate or

hinder this process — we hope this volume contributes to this challenge.

ACKNOWLEDGEMENTS

The authors thank Flora Cornish and Ama de-Graft Aikins for their comments.

DOI: 10.1002/casp

416 C. Campbell and H. Deacon

REFERENCES

Campbell, C., Nair, Y., & Maimane, S. (forthcoming). ‘Dying twice’: A multi-level model of the roots of AIDS stigma in two South African communities. Journal of Health Psychology.

Crawford, R. (1994). The boundaries of the self and the unhealthy other: Reflections on health, culture and AIDS. Social Science and Medicine, 38(1), 1347–1365.

Deacon, H., Stephney, I., & Prosalendis, S. (2005). Understanding HIV/AIDS Stigma: A theoretical and methodological analysis. Cape Town: Human Sciences Research Council.

Foucault, M. (1980). Power/knowledge: Selected interviews and other writings. London: Harvester Wheatsheaf.

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs: Prentice Hall.

Heatherton, T., Kleck, R., Hebb, M., & Hull, J. (2003). The social psychology of stigma. New York: Guilford.

Herek, G., Capitanio, J., & Widaman, K. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92: 371–377.

Joffe, H. (1999). Risk and the other. Cambridge: Cambridge University Press. Levin, S., van Laar, C. (Eds.) (2006). Stigma and group inequality: Social psychological perspectives. New Jersey: Lawrence Erlbaum.

Link, B., & Phelan, J. (2001). Conceptualising stigma. Annual Review of Sociology, 27, 363–387. Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual

framework and implications for action. Social Science and Medicine, 57, 13–24. Seedat, M. (Ed.) (2001). Community psychology: theory, method and practice. Cape Town: Oxford

University Press.

DOI: 10.1002/casp

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