Stigma is a mark separating individuals from one another based on a socially conferred judgment that some persons or groups are tainted and “less than.” Stigma often leads to negative beliefs (i.e., stereotypes), the endorsement of those negative stereotypes as real (i.e., prejudice), and a desire to avoid or exclude persons who hold stigmatized statuses (i.e., discrimination, Corrigan, Markowitz, Watson, Rowan, & Kubiak, 2003
; Link & Phelan, 2001
). There is no shortage of categories in health and medicine in which concerns of stigma have been applied directly (e.g., obesity, HIV-AIDS, leprosy). Further, concerns have been raised about how membership in other stigmatized categories (i.e., homosexuals, minority racial or ethnic groups) amplifies the negative effects of stigma associated with health problems.
Perhaps most clearly, however, socio-medical scientists turned their attention to analyses of the stigma associated with mental illness to understand and illustrate stigma’s causes and consequences. Recent research continues to show that individuals fear and avoid persons with mental illness, even as psychiatry claims dramatic increases in effective treatments and social scientists document greater levels of public acceptance of medical theories about underlying biological and genetic causes of mental illness (Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000
; Martin, Pescosolido, & Tuch, 2000
; Pescosolido, Monahan, Link, Stueve, & Kikuzawa, 1999
; Stuart & Arboleda-Florez, 2000
). Moreover, negative attitudes and experiences of rejection and discrimination continue to affect the quality of life for persons with mental illness and their families (Katsching, 2000
; Wahl, 1999
). Stigma also occupies a central place in explanations of low service use, inadequate research funding and treatment infrastructures, and hindered progress toward recovery from mental illness (Estroff, 1981
; Markowitz, 2001
; Sartorius, 1998
Yet, despite these findings on the pervasive existence and impact of stigma, coupled with a long tradition of research on mental illness, we know relatively little about the sources of stigmatizing attitudes. Given the recent research and policy resurgence in attention to stigma (e.g., see Keusch, Wilentz, & Kleinman, 2006
), we propose that now is the time to rethink the contributions of the social sciences to better understand the underlying roots of stigma. Elsewhere, we proposed one step in that direction (Martin, Pescosolido, Olafsdottir, & McLeod, 2007
; Pescosolido & Martin, 2007
). But that attempt was designed to organize what we already know about the different factors (e.g., attributions, socio-demographic and illness characteristics) that influence the prejudice and discrimination associated with mental illness.
Here, we step back to offer a more general framework which looks across disciplines and different levels of society to bring together insights on stigma, prejudice and discrimination. Like Goffman (1963)
, we argue that stigma is defined in and enacted through social interaction. However, because stigma is socially constructed in and through social relationships, its essence lies in the “rules” which guide behaviour at particular points in time and place by defining it as acceptable, customary, “normal,” or expected (Merton, 1957
; Nisbet & Perrin, 1977
). As such, the foundation for “differences” that become solidified in stigma are normative, and thus the organizing focus for our framework.
While social interactions take place at the individual level, theoretical advances over the last two decades have integrated insights across the social sciences to understand the myriad of forces exerted on individuals. Individuals do not come to social interaction devoid of affect, values and motivation; and, they exist in larger political, cultural and social contexts which shape their expectations on all of these issues (Coleman, 1990
; Pescosolido, 1992
). Further, social interactions take place in a context where organizations and institutions structure norms that create the possibility of marking and sharing notions of “difference.” Concepts from labelling theory, social network theory, the limited capacity model of media influence, the social psychology of prejudice and discrimination, and theories of the welfare state, as well as theories of the micro-macro link, offer the opportunity to begin the development of a framework to unravel the complex web of expectations shaping stigma.
Such a framework is necessarily complicated and perhaps aspirational, but ignoring the complexity of stigma does not allow for appreciation of the textured understandings, policies, or interventions necessary to match the reality. An overall framework sensitizes researchers to the broad range of forces that might be in operation. As a theoretical frame, it would spin off multiple models, tailored to particular health and illness problems, to specify and operationalize substantive concerns, processes and issues (Pescosolido, 1992
). Our long-term goal is two-fold: To further the understanding of the theoretical and empirical roots of stigma; and to help establish a broad science base to identify targets of intervention to decrease stigma.