In the first of our ‘Recalibrating Stigma’ mini-takeover, Oli Williams, Gareth M. Thomas, Amy Chandler, and Tanisha Spratt introduce the concept of anti-stigma.
In June 2025, we published the open-access edited collection Recalibrating Stigma: Sociologies of Health and Illness (Thomas et al. 2025). We argue that due to various shortcomings in social scientific inquiry, there is a need to dedicate critical attention to stigma as a concept that is too rarely defined (we previously wrote about this in The Polyphony). In our chapter ‘Recalibrating Anti-Stigma: Avoiding Binary Thinking and ‘Destigmatisation Drift’ in Public Health’, we extend our arguments about the need to recalibrate stigma to the concept of anti-stigma. This includes disrupting binary logics that often shape public health approaches to stigma, where stigma is often viewed as both a problem requiring solutions (e.g. people not accessing health services due to perceived stigma from professionals) and a solution to problems (e.g. using stigma to encourage health-promoting behaviours, such as not smoking).
These approaches tend to promote pro-/anti-stigma lobbying, in which simplistic binaries in logic and morality are used in attempts to win the argument rather than understand the complexity, inconsistency, and diversity of stigma and its effects. We must see the pro-/anti-stigma binary more critically and not deny outcomes or experiences of stigma that are inconvenient for arguing either for or against it. In our chapter, we focused on four contexts for appraising current anti-stigma initiatives: (1) mental health; (2) ‘obesity’; (3) anorexia; (4) self-harm.
Mental Health: ‘Destigmatisation Drift’
In many anti-stigma mental health campaigns, the stigma associated with a diagnosed mental illness has been blamed for matters such as poor physical health, reduced life expectancy, low rates of help-seeking, and low-/under-employment. Campaigns attempting to raise awareness and demythologise mental illness to promote help-seeking and treatment typically frame mental illness as a straightforward medical issue with available and effective treatment. Stigma is presented as the problem as it proliferates ‘misunderstandings’ about mental illness and contributes to people lacking the confidence to openly discuss it. But there is a significant mismatch between urging the public to talk about their mental health and the challenges most people face when attempting to access help. It also overestimates the public’s capacity to support people with serious mental health issues or resolve the social conditions that have led to them.
Although anti-stigma campaigns are largely seen as positive, they can cause harm. In the case of mental health, these campaigns commonly serve to individualise the issue and obscure the need to address social, political, cultural, and economic conditions that produce mental distress and lead to stark insufficiencies in relation to the provision of care and support. We conceptualise this as being part of a wider social process we call ‘destigmatisation drift’. When anti-stigma campaigns shift away from acting on the wider determinants of health and provide governments with a relatively cheap way of demonstrating a commitment to addressing public health issues, they tend to cause harm and reproduce inequalities. Pleading for shifts in hearts and minds can be warranted. This is not to suggest it is an either/or matter. Both are needed, but we must be critical when these more limited anti-stigma campaigns take precedence over and/or undermine attempts to address relevant social determinants of (mental) health.
‘Obesity’: Stigma as Contested Terrain
People of higher body weights are often portrayed as greedy and lazy, irresponsibly and immorally choosing personal comfort and pleasure over a supposed civic duty to manage their weight and avoid placing an unnecessary and costly burden on health services. While much has been written (including by us) about how and why weight stigma is unfair, unhelpful, and harmful (Spratt 2023; Williams and Annandale 2018), what anti-stigma looks like in relation to higher body weights is complex and contested. Much of the contestation corresponds to whether defining ‘obesity’ as a disease challenges or reinforces stigma.
Patient advocates/organisations and pharmaceutical companies have argued for defining ‘obesity’ as a disease. This is perceived as a de-stigmatising strategy that would shift blame away from individuals who can be recast as ‘ill’ and not entirely responsible for their body weight and, in turn help to improve the quality and availability of healthcare for people of higher weights. Alternatively, those aligned with fat activism, fat acceptance, and body positive movements argue against pathologising body weight because this is inaccurate, immoral, and an ineffective anti-stigma strategy. These different perspectives about the ‘correct’ way to define fatness/ ‘obesity’ to counter stigma are an example where different groups of stigmatised people compete against each other. Since the popular understanding of stigma is not sophisticated enough to appreciate that stigma can be subjective and contradictory, popular comprehensions of stigma and anti-stigma are instead enacted as a straightforward moral binary: you are with us or against us. Therefore, anti-stigma campaigns can ultimately end up privileging the needs and preferences of some over others and consequently reproducing inequalities and entrenching discrimination against already marginalised and under-served groups.
Anorexia: Anti-Stigma vs. ‘Pro-Condition’
People with eating disorders regularly experience harmful stereotypes, prejudice, and discrimination. However, the likes of Yeshua-Katz (2015) explore the different ways that people respond to and attempt to counter the stigma associated with anorexia, which points to blurred lines between anti-stigma and what we might call ‘pro-condition’ positions.
The ‘pro-ana’ community is a controversial example that highlights the complexity and moral ambiguity of addressing stigma. The community is not one group with a consistent standpoint. Broadly, pro-ana can be understood as a response to, and resistance of, the stigmatisation of anorexia. The communities commonly exist online, and members often claim that being pro-ana counteracts being misunderstood and/or lacking support. Yet, how members choose to counteract this differs wildly. For some, it is asserting that anorexia is a medical condition, educating others that it is not simply something someone irresponsibly chooses to do, and seeking support from others who struggle/struggled with it. For others, it involves rejecting the notion that anorexia is an illness, emphasising choice, offering ‘tips and tricks’, and positively reframing who they are and how they live. The latter approach has caused the most controversy and contributed to several popular blog-hosting services censoring content perceived to promote self-harm (including eating disorders).
Boero and Pascoe (2012) show, in their research, how demonstrating authenticity is central to pro-ana communities and vital for another key feature: policing membership. Policing is not primarily to provide ‘safe spaces’ that protect members from outsiders enacting stigma/abuse, as is more usual in anti-stigma work. This policing, instead, establishes who the ‘real’ or ‘true’ ‘pro-ana anorexics’ are and who can be excluded and denigrated based on being a ‘wannarexic’. So, unlike other anti-stigma practices, a central feature of many pro-ana communities is shaming others (Boero and Pascoe, 2012). Therefore, it could be argued that the stigmatised become the stigmatisers. Nonetheless, the pro-ana community might counter that this is a vehicle for members to resist and reverse stigma, not by attempting to stop others from stigmatising anorexia, by ascribing value to, and actively encouraging, it.
Thus, what it means to be ‘anti-stigma’, in relation to anorexia, is unclear. Can someone be anti-stigma if they are not pro-ana? Can anti-stigma practice encompass exclusionary and abusive spaces that actively promote and facilitate harm? More generally, anti-stigma practice is focused on harm reduction/eradication. Pro-ana challenges this and highlights that what it means to be anti-stigma requires more attention.
Self-Harm: Is Destigmatisation Normalisation?
Self-harm is a practice often characterised as inherently ‘stigmatised’. This has been met with routine attempts to tackle self-harm stigma, frequently as part of anti-stigma campaigns for mental health. The assumption guiding these campaigns seems to be that, if only people understood both self-harm and the negative impacts of stigma better, their behaviour/attitudes and, relatedly, the lives of those who self-harm, would improve. This is questionable.
Tensions surrounding self-harm were starkly illustrated in 2018 when Instagram began to moderate self-harm-related posts, in response to concerns that viewing such content caused harm to ‘vulnerable people’. The moderation extended to removing images showing self-harm scars as well as more confronting images of wounds/cuts. Stirling and Chandler (2020) contend that people who self-harm often benefit from communicating openly about self-harm online, including sharing images (especially of healed/healing scars). Concerns have been raised about the ban exacerbating stigma, deeming self-harmed bodies as clearly taboo, to be hidden and ashamed of. In contrast, fears were shared about the potential for such images and communication to encourage self-harm in others and normalise it. This reflected a shift from framing self-harm not only as a stigmatised practice, but towards viewing the self-harming person as a ‘risk to others’ as well as themselves. By showing images online and normalising self-harm, they may inadvertently prompt (‘vulnerable’) people to engage in the practice.
As we acknowledge in our chapter, charities and researchers often call for a balanced approach that recognises the potential for online content to be helpful or harmful for different people. However, what this approach looks like in practice is unclear. What might an ‘anti-stigma’ approach to self-harm look like if it did not also include some aspect of ‘normalisation’? This is a hugely contested area, with stark disagreements among people with lived/living experiences of self-harm, clinical professionals, researchers, and policymakers.
Recalibrating Stigma and Anti-stigma
What these examples demonstrate is the need for more critical attention to be directed to how we conceptualise both stigma and anti-stigma. We need to move away from simplistic ideas that imply there is a straightforward moral binary and present anti-stigma as the good that combats the bad of stigma. Acknowledging this complexity can be the first step towards better understanding what stigma is and does and addressing the detrimental impacts it can have.
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The chapter ‘Recalibrating Anti-Stigma: Avoiding Binary Thinking and ‘Destigmatisation Drift’ in Public Health’ is freely available for anyone to read here. It is part of the edited collection Recalibrating Stigma: Sociologies of Health and Illness which is available as an open access e-book (i.e. free to read and download) via the Bristol University Press website. You can receive a 25% discount on all Bristol University Press and Policy Press books by signing up to their newsletter.
About the authors
Oli Williams is Lecturer in Co-designing Healthcare Interventions at King’s College London, UK. His research focuses on weight-related health, including ‘obesity’ and eating disorders, stigma, health inequalities, equitable intervention, and participatory research methods. @oliwilliams.bsky.social
Gareth M. Thomas is Reader in the School of Social Sciences at Cardiff University, UK. He is a sociologist with an interest in disability, medicine, health and illness, and reproduction. @gmthomas.bsky.social
Amy Chandler is Professor of the Sociology of Health and Illness at the University of Edinburgh, UK. She specialises in qualitatively driven studies of mental health, suicide, and self-harm. @amychandler.bsky.social
Tanisha Spratt is Senior Lecturer in Racism and Health at King’s College London, UK. Tanisha’s research centres on racial inequalities in health outcomes in the UK and the US, and specifically the role of neoliberalism in promoting and sustaining understandings of personal responsibility, deservedness, and grievability with respect to experiences of illness, death, and dying.
References
Boero, N. and Pascoe, C.J. (2012) ‘Pro-anorexia communities and online interaction: Bringing the pro-ana body online’, Body and Society, 18(2): 27–57.
Spratt, T. (2023). ‘Understanding “fat shaming” in a neoliberal era: Performativity, Healthism and the UK’s “obesity epidemic.” Feminist Theory, 24(1): 86-101.
Stirling, F. J. and Chandler, A. (2020). Dangerous arms and everyday activism: A dialogue between two researchers with lived experience of self-harm. International Review of Qualitative Research, 14(1): 155–70.
Thomas, G.M., Williams, O., Spratt, T. and Chandler, A. 2025. Recalibrating Stigma: Sociologies of Health and Illness. Bristol: Bristol University Press.
Williams, O. and Annandale, E. (2020) ‘Obesity, stigma and reflexive embodiment: Feeling the ‘weight’ of expectation’, Health, 24(4): 421–41.
Yeshua-Katz, D. (2015) ‘Online stigma resistance in the pro-ana community’, Qualitative Health Research, 25(10): 1347–58.
