Recalibrating Stigma

Gareth Thomas, Tanisha Spratt, Oli Williams, and Amy Chandler reflect on the 2023 symposium: Recalibrating Stigma, Sociological Perspectives on Health and Illness.

The concept of ‘stigma’ has been widely applied across academic disciplines, particularly those falling under the broad umbrella of the ‘medical humanities’. As a longstanding theoretical resource, stigma has been a familiar trope in research on mental health, HIV/AIDS, addiction, obesity, illness, and disability, to name a few. This body of work tells similar stories around the personal impact of diagnosis, the negative impact of illness and/or disability on relationships and public encounters, and the ‘outcomes’ of this (e.g., discrimination, stress, social isolation, social exclusion).

The inside gears of a pocket-watch. Its use signifies ‘recalibration’.

Our mutual feeling – as a quartet of sociologists interested in matters of health, medicine, and illness – is that scholarship on stigma frequently suffers from three major limitations. The first relates to how this body of work engages with the classic text Stigma: Notes on the Management of Spoiled Identity, by the Canadian sociologist Erving Goffman. Goffman, who is referenced in so many analyses of stigma, defined social stigma as a mark of infamy, disgrace, or reproach that can cause embarrassment and shame. Importantly, for Goffman, stigma is rooted in interactions. Rather than stigma simply ‘existing’ for certain individuals and groups, it is accomplished during face-to-face exchanges in verbal (comments, name-calling) and nonverbal (stares, glances) ways.

We believe that Goffman’s analysis of stigma is regularly cited in a limited and cursory manner, dislodged from these interactionist roots (i.e., stigma being a ‘language of relationships’ between people and as something that requires ‘management’). In some texts, Goffman’s claims are exaggerated or misattributed. Goffman is treated as somewhat of a strawman to emphasise the originality of the analysis being presented.

In addition, as the concept of stigma is used more and more within the medical humanities, and interdisciplinary work, it becomes less well-defined and applied. Stigma is used to explain all manner of things. This arguably blunts its analytical potential and obscures more than it informs. It relates to a bothersome trend in scholarship which seldom defines ‘stigma’ and instead makes assumptions on ‘what’ is stigmatising (e.g., drug use, sex work, disability, and homelessness, and so on). The success of stigma as a concept means that it is in danger of becoming ‘black-boxed’; its inner workings hidden, it becomes a vague catch-all term that does little to sharpen the critical analysis of research relating to health, illness, medicine, and bodies.

Moreover, discussions of stigma frequently focus upon people’s feelings of stigma and how they navigate this in their every day lives. Attending to people’s embodied experiences of stigma is important. Nonetheless, this work is too often dislocated from matters of power, inequity, and structure. Whilst recent scholarship attempts to confront this trend (see, for example, Imogen Tyler), stigma is repeatedly treated, within medical sociology and the medical humanities, as an individual and apolitical enterprise. There is also often an assumed passiveness among stigmatised people, who are positioned as unable to loosen themselves from the tight grip of stigma. What are the possibilities, we might ask, of resistance and subversion?

Our forthcoming edited book – ‘Recalibrating Stigma: Sociological Perspectives on Health and Illness’, to be published with Bristol University Press in May 2025 – will attempt to address these shortcomings. The book brings together early and mid-career scholars from the sociology of health and illness, and tasks them with revisiting the theoretical origins of stigma and considering the historical and contemporary limitations in how stigma is conceptualised and researched. The book aims to provide fresh thinking that will aid the recalibration of stigma as a concept in the study of health and illness. Chapters confront social issues including mental health, race and ethnicity, reproduction, homelessness, disability, sexuality, obesity, and self-harm.

As part of this work, in April 2023 we hosted a symposium (funded by the Foundation for the Sociology of Health and Illness) dedicated to revisiting how stigma is defined and applied. The intention was to address unhelpful trends that have developed and, in turn, expand on how stigma can be mobilised as a theoretical device.

Photo taken by Dr Jaime García-Iglesias.

Symposium on Recalibrating Stigma

The day began with two presenters who sought to trouble how stigma is conceived of by two different populations. First up was Jaime García-Iglesias, who drew on his interviews with ‘bug-chasing’ men (men who seek to acquire HIV through sexual activity) to show how they ‘re-signify’ HIV-related stigma. Whilst HIV-stigma is often perceived as a negative barrier to wellbeing, men in García-Iglesias’ study navigated stigma between shame or fear (e.g., of losing relationships or employment) and, importantly, pleasure and arousal. HIV-stigma was transformed, in turn, into an erotic object at the centre of their desires and bug-chasing practices.

This was followed by a presentation from Fay Dennis. Dennis talked about how, in significant moments in their lives, the stigma of being a drug addict ‘blocked’ her study participants from ‘becoming’, for example, a patient, a parent, a partner, a guest, an employee, and so on. Rather than thinking of stigma as something that happens prior to these events – as a belief system ‘out there’ with already stigmatised individuals entering the event – Dennis claimed that stigma materialised in ways that meant people who use drugs were constricted in their capacities to act outside of an ‘addict identity’. Instead of looking to anti-stigma work that claims to tackle stigmatising beliefs (see here and here), Dennis argued that we should turn to stigmatising events and ask how people’s experiences are informed by social structures (e.g. the societal drivers of inequity and discrimination).

After a short break, Andrew Guise, Simone Helleren, and River Újhadbor engaged with Imogen Tyler’s challenge for researchers of stigma to ‘study up’. They concluded that there is a pressing need to ‘study up’ in research on stigma, health, and discrimination. Thinking at the level of the structural, for Guise and colleagues, is crucial for considering how stigma is (re)produced and how we might develop new systems and structural approaches to challenging stigma. However, they told us, this is not easily achieved. The challenge, as they saw it, was in finding research methods that can elevate analyses by capturing the inner workings of the often exclusive and/or elite spaces where decisions that inform the structures of society are made.

In a related presentation, Gillian Love outlined how ‘abortion stigma’ is a central feature of individual experiences of abortion, along with being a broad, discursive, and biopolitical feature of national politics. Authors focusing on abortion, Love told us, often conceptualise stigma in individualised, psychological, and quantifiable terms. She proposes alternative conceptualisations that share an understanding of stigma as an operation of power, and that recognise its unstable, shifting, and contested nature. This involves placing abortion stigma in the context of marginalisation and oppression, through the axes of gender, race, class, and disability.

The day ended with two presentations. The first was delivered by us: Oli Williams, Amy Chandler, Gareth Thomas , and Tanisha Spratt . Led by Williams and Chandler, the presentation focused on the need to dismantle simplistic binary thinking in common accounts of stigma. Doing this, they said, helps us to depart from moral and effectual absolutes (e.g. public health policies as good or bad; anti-stigma efforts as effective or ineffective), and, in turn, to better understand what stigma is and does. Focusing on anti-stigma campaigns, and using obesity and self-harm as examples, Williams and Chandler proposed a new concept that they called ‘de-stigmatisation drift’. This is related to the phenomenon of ‘lifestyle drift’ (how policies addressing the social determinants of health ‘drift’ to individual behaviour change), and refers to when anti-stigma campaigns plea for shifts in hearts and minds (at the individual-level) rather than advocating for actual commitments to address structural determinants of (ill) health.

Finally, Kass Gibson developed an argument for cultivating a sociological theorisation of stigma in exercise and sport studies. Drawing on the work of Norbert Elias, Gibson shared his understanding of experiences of stigma as relating to people’s embodied knowledge. Gibson also referred to the concept of ‘body fascism’ to examine what he calls ‘the moral economy of exercise’, charting the historical origins of  how shame dictates people’s engagement with exercise and their attempts to avoid and repair feelings of embarrassment and stigma.

The symposium was followed by a full-day editorial meeting between us (book editors) and several contributors to our book. The intention was to ensure cohesion between chapters; each author was asked to provide feedback on another chapter. Being together in a room (in-person and virtually) also meant that we could exchange ideas and provide encouragement to colleagues. Contributing to an edited book, in our experience, can feel like an isolating and detached exercise. These events recognised that any edited book is a collaborative endeavour. More importantly, it allowed us to work collectively – as authors and with participants at the symposium – to see how we might recalibrate stigma, as a concept, within social studies of health and illness. Our book, in turn, will be an intervention to stimulate, provoke, and intensify conversations about stigma. In a context where the loose use of stigma has stifled its explanatory potential, we feel that attempting to recalibrate it is a worthwhile pursuit.

References

Goffman, E. 1963. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall.

Tyler, I. 2020. Stigma: The Machinery of Inequality. London, UK: Bloomsbury Publishing.

About the Authors

Gareth Thomas is a Reader in the School of Social Sciences at Cardiff University. He is a sociologist with an interest in medicine, disability, health and illness, reproduction, and technology. His Twitter handle is @gmt_88.

Tanisha Spratt is a Senior Lecturer in Racism and Health at King’s College London. She is a medical sociologist whose research centres on the relationship between external presentation, neoliberalism, and health outcomes amongst marginalised groups. 

Oli Williams is a Lecturer in Co-designing Healthcare Interventions at King’s College London. His research focuses on health inequalities and equitable intervention, the promotion of ‘healthy’ lifestyles, ‘obesity’ and eating disorders, weight stigma, and participatory methods. His Twitter handle is @OliWilliamsPhD.

Amy Chandler is a Professor of the Sociology of Health and Illness at the University of Edinburgh. She is a  sociologist specialising in the sociology of health and illness, with a particular focus on suicide, self-harm, mental health, and substance use. Her Twitter handle is @DrAmyChandler.

‘Recalibrating Stigma: Sociological Perspectives on Health and Illness’ will be edited by Gareth Thomas (Cardiff University), Tanisha Spratt (King’s College London), Oli Williams (King’s College London), and Amy Chandler (University of Edinburgh), and will be published by Bristol University Press in May 2025. The edited collection will be made available as an open access e-book and a relatively inexpensive softback physical book. The full list of contributors is as follows: Andrew Guise (KCL); River Újhadbor (KCL); Simone Helleren (KCL); Fay Dennis (Goldsmith’s); Gillian Love (University of Sussex); Jaime García-Iglesias (University of Edinburgh); Kass Gibson (Plymouth Marjon University); Harriet Cooper (University of East Anglia); Jennifer Remnant (University of Strathclyde); Esmeé Hanna (De Monfort University); Nicky Hudson (De Monfort University); Caroline Law (De Monfort University); Dharmi Kapadia (University of Manchester); Maria Haarmans (University of Manchester); Hannah Farrimond (University of Exeter); Mike Michael (University of Exeter)

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