The Stigma Complex

Abstract

Since the beginning of the twenty-first century, research on stigma has continued. Building on conceptual and empirical work, the recent period clarifies new types of stigmas, expansion of measures, identification of new directions, and increasingly complex levels. Standard beliefs have been challenged, the relationship between stigma research and public debates reconsidered, and new scientific foundations for policy and programs suggested. We begin with a summary of the most recent Annual Review articles on stigma, which reminded sociologists of conceptual tools, informed them of developments from academic neighbors, and claimed findings from the early period of “resurgence.” Continued (even accelerated) progress has also revealed a central problem. Terms and measures are often used interchangeably, leading to confusion and decreasing accumulated knowledge. Drawing from this work but focusing on the past 14 years of stigma research (including mental illness, sexual orientation, HIV/AIDS, and race/ethnicity), we provide a theoretical architecture of concepts (e.g., prejudice, experienced/received discrimination), drawn together through a stigma process (i.e., stigmatization), based on four theoretical premises. Many characteristics of the mark (e.g., discredited, concealable) and variants (i.e., stigma types and targets) become the focus of increasingly specific and multidimensional definitions. Drawing from complex and systems science, we propose a stigma complex, a system of interrelated, heterogeneous parts bringing together insights across disciplines to provide a more realistic and complicated sense of the challenge facing research and change efforts. The Framework Integrating Normative Influences on Stigma (FINIS) offers a multilevel approach that can be tailored to stigmatized statuses. Finally, we outline challenges for the next phase of stigma research, with the goal of continuing scientific activity that enhances our understanding of stigma and builds the scientific foundation for efforts to reduce intolerance.

Contextualizing public stigma: Endorsed mental health treatment stigma on college and university campuses

“…Since Erving Goffman's (1963) seminal work on the topic, the volume of research on stigma has rapidly expanded, spawning multiple major review articles in the past two decades alone (Clement et al 2015;Corrigan, Druss, and Perlick 2014;Gulliver, Griffiths, and Christensen 2010;Link and Phelan 2001;Major and O'Brien 2005;Parcesepe and Cabassa 2013;Pescosolido and Martin 2015). This heightened attention is, in part, due to the important associations between stigma and the severity of mental illness symptoms (Andrade et al 2014;Brown 2017;Drapalski et al 2013), disclosure of conditions to friends, family, and healthcare professionals (Dew et al 2007;Donnelly 2017;Prior et al 2003), self-esteem (Corrigan 2004;Corrigan and Watson 2002;Corrigan, Watson, and Barr 2006), and treatment-seeking behavior (Clement et al 2015;Tsang, Fung, and Chung 2010;Vogel, Wade, and Haake 2006).…”

“…Stigma can operate at the micro-, meso-, and macro-levels, often conceptualized as selfstigma, public stigma, and structural stigma, respectively (Pescosolido and Martin 2015), although some debate exists regarding these labels (also see Corrigan and Kosyluk 2014).…”

“…Some suggest that public stigma "attempts to map the levels and nature of stigma in the general population" (Pescosolido and Martin 2015;94) and the concept of public stigma has been used to examine cross-national differences and changes within societies over time (Angermeyer and Dietrich 2006;Pescosolido and Martin 2007;Pescosolido et al 2013). Others link public stigma to a group or community level and suggest that this type of stigma may only apply to specific groups, locations, and periods (Livingston and Boyd 2010;Quinn and Chaudoir 2009;Vogel, Wade, and Hackler 2007).…”

Defining the research agenda to measure and reduce tuberculosis stigmas

“…[10][11][12][13] Link et al, Weiss et al, Pescosolido et al and others have described the extent of how TB stigma can be observed, felt and resisted at different levels of society. 9,[14][15][16][17][18][19] TB stigma can also be present at the level of societal discourse where cultural and social determinants may be more or less important. 14,20 We also learned from research on stigmas other than for TB, with the caveat that not everything will translate readily.…”

Stigma in the Dutch Health Care Sector: HIV-Positive Substance Users’ Experiences and Health Care Providers’ Perspectives

“…Stigmatization is a socially and culturally constituted process by which a person is labelled as different and then devalued, leading to status loss and discrimination [1,2]. There are a number of conditions that elicit negative or stigmatizing reactions from others.…”