Characteristics of Stigma

In this section, we review the literature to identify the elements that constitute stigma and fuel it. These are based on Link and Phelan’s elements that drive stigma formation. Link and Phelan’s (2001) work constitutes the most comprehensive and recognized contribution in terms of identifying the factors that fuel the stigmatization process. They explain that stigma occurs when many elements converge to produce its components. First, the difference needs to be identified, and then a connection between the person and the stereotype is established.

Third, there is a distancing between the categories of ‘them’ versus ‘us’. Fourth, the person becomes subject to behaviors of discrimination from the dominant culture. Finally, the discriminators need to have access to power in order to reinforce their behaviors.

Power is key to experiencing stigma. It is the mean used to reinforce the social rules and sanctions (Link & Phelan, 2001). These are processes that enable the stigmatizers to achieve their objectives of exploitation, control or exclusion of their targets (Link & Phelan, 2014).

Power drives the direction of each of the elements discussed below. We argue that depending on who holds the power stigma can be reinforced or attenuated. In our collective paper on stigma, we discussed that when power is held by the stigmatized, the stigma process can be reversed and stigma hindered (Mirabito et al., 2016). For example, Turkish women have managed to change veiling from a stigmatized practice to a fashionable alternative by gaining social power (Sandikci & Ger, 2010). This implies that if the stigmatized manage to acquire the necessary power to influence the below elements backwards, they can succeed in

attenuating stigma. For example, overweight people are put in a subordinate power position

because of the social perception of fat and it’s link with disease and disability (Dickins et al., 2016). This low power is more prevalent when they encounter power holders such as doctors, the media …)

- Labeling the Stigmatized as Not Normals

Link and Phelan (2001) explain that one of the main components of stigma is related to identifying the disparities. According to this perspective, humans have a selective attention when it comes to differences. Society defines which disparities matter most and which are not worthy of attention. Once the differences are identified, they become part of normalcy and people start being categorized based on specific attributes as for example “fat” or “thin”,

“gay” or “straight”. The labels attributed to the stigmatized often carry potent negative meanings. They reflect the deviance, the flaws and the undesirability associated with the stigma (Ellen & Bone, 2008). For instance, senior citizens that use discount coupons are associated with negative labels such as “being financially dependent,” “unable to afford full price,” having “ a lower status or class” and “Undeserving of equal rights” (Tepper, 1994).

For example, there is a plethora of social discourses in western societies that moralize body size (Askegaard et al., 2014). Being thin is evaluated as “good” and “healthy” while having a fat body is evaluated as “bad” and “unhealthy”. These labels that are socially constructed are believed to be true even among health professionals despite that extant

research has discussed that health is not necessarily thinness related. In fact, being overweight and healthy is possible if one eats healthy foods and excises. On the other hand, thin people can be medically unhealthy if they have a sedentary lifestyle. Messages about the moral failings of fat people are so prevalent that they have spread globally to include populations that have historically been known to have a positive attitude towards fat (Brewis, Wutich, Falletta-Cowden, & Rodriguez-Soto, 2011). Fat or obesity are used globally to evaluate the social and personal qualities of the individual. In sum, there is global spreading of body norms and a conception of the ideal body that labels fat as “bad” and fat as “unhealthy.”

These negative associations contribute to distancing the stigmatized from normalcy.

Goffman (1963, p. 5) explains that stigma divides the “normals” in society from those that hold an “undesired differentness.” Being negatively labeled challenges people’s desire to experience normalcy and using consumption to achieve identities that are acceptable to themselves (Baker, 2006). For example, the overweight consumers who have a desire to buy

new clothes or to look fashionable, may not be able to appear as normal when they do not find fashionable clothing their size.

- Stereotypes Experience and Internalization

Stereotyping happens when the identified dissimilarity is associated with negative characteristics. Goffman (1963) was the first to identify the link between labels and stereotypes. Once the person is identified as deviant, she is associated with the cultural stereotype. Fiske (1998) asserts that this human approach is performed in an automatic way with the objective to ease “cognitive efficiency”. These categorizations exist at the

preconscious level and allow people to be quicker at decision making in order to be able to free themselves for other environmental inquiries. For example, veiled women are associated with issues and threats related to the Islamic religion (Sandikci & Ger, 2010). This puts a label on them that blocks them from taking advantage of marketplace opportunities. For instance, in France, veiled women cannot access education in public schools as the government prohibits their entry (Bowen, 2007).

Another example concerns fat stigma. Being fat is associated with ugliness, sexlessness, and undesirability (Brewis et al., 2011; Cordell & Ronai, 1999). The social stereotypes about obesity are highly prevalent and hard to change as they are portrayed as a contagious phenomenon that can be caught. Some scholars have argued that exposure to a high visibility of fatness in the social environment increases tolerance for adiposity and encourages the adoption of weight gaining behaviors (Brewis et al., 2011). These stereotypes are deeply entrenched in western societal structures. For example, when the movie Precious, featuring an obese main character, was released, its reviews focused mainly on the weight of the main actor. Writers overlooked other attributes of the movie and mainly reacted with fatphobic reviews (Stoneman, 2012).

Stigmatized people can internalize the stereotypes associated with their condition and start acting in accordance with these stereotypes. For example, if an employer expects an employee who just got a life threatening disease to underperform, he/she may freeze the employee’s salary increase. This may decrease the employee’s motivation and lead to underperformance. Self-fulfilling prophecies’ research has shown that most of the time, subjects end up adopting behaviors that are in accordance with the expectations of others (Crocker & Major, 1989; Jussim, Palumbo, Chatman, Madon, & Smith, 2000).

People that internalize society’s view of the stigmatized accept the negative behavior of others and risk having a low self-esteem (E. E. Jones et al., 1984). This internalization, in the case of newly acquired stigmas, may have happened before the person becomes subject to stigma. Previous research has shown that stigmatized people who agree with the unfavorable behaviors have lower self-esteem than the ones who do not agree with them (Crocker &

Major, 1989). The internalization of opinions, labels and stereotypes held against the

stigmatized may result in self-stigma and self-hatred. Stereotypes are the basis of self stigma (Corrigan & Watson, 2002). Self-stigma is related to the reaction that stigmatized people have towards themselves. Self-stigma occurs when the negative beliefs and stereotypes are about the self. Here, the stigmatized can become as prejudicial and discriminatory towards oneself as the stigmatizing others.

Obese people often internalize the dominant negative attitudes within their

environment. They tend to concur with the moral judgments and negative stereotypes held against them. This increases their experience of indirect stigma which is associated with feelings of being stared at and evaluated and the fear of facing discrimination and humiliation (Lewis et al., 2011). When they accept the negative evaluation of the environment they develop feelings of shame, failure and inferiority for not being able to reach the ideal beauty standards set by society (Eberle & Robinson, 1980). This leads to a drop in their self-esteem and their morale and results in internal pain (Tibere et al., 2007).

- Isolating the Stigmatized from the Nonstigmatized

According to Link and Phelan (2001), the labels associated with the stigmatized imply the separation of ‘us’ from ‘them’. ‘Them’ becomes a threat to ‘us’ and justifies the negative stereotypes associated with this trait. This separation can manifest itself within societal and/or market structures. For example, the fact that overweight consumers have a hard time finding clothing their size is a form of separation. Also big size clothing stores constitute a marker for this separation because they isolate the overweight from mainstream stores. Some market actors such as the founder of the brand “Abercrombie and Fitch” have explicitly voiced this separation by refusing to make clothes for people beyond size 40.

In extreme cases, where the difference between ‘us’ and ‘them’ is significantly big,

“them” are seen as not so human which justifies all the diminishing reactions in their regard.

This promotes reactions that lead to isolating the stigmatized when elements of power come

into play. This is because the normal majority can hold the necessary power to enforce this separation. For example, the media portray messages about physical beauty that shape the cultural perception and infer the exclusion of overweight people from desirable consumption (Dittmar, 2007). Dickins et al. (2016) explain how by medicalizing fatness, the media and the weight loss industry replicate moral judgments that make the overweight feel excluded.

People conforming to the thin ideal often do not need to challenge these dominant discourses and internalize them. This results in stigmatization, social rejection and exclusion of the overweight (Crandall & Martinez, 1996; Puhl & Brownell, 2006). It jeopardizes their ability to get proper healthcare, education and to build positive relationships with others (Puhl &

Heuer, 2009)

Social isolation can also come from the stigmatized, who integrate societal stereotypes and act in accordance with the idea that the stigmatized do not belong with the normals. One example is tuberculosis patients who believed that their family and friends avoided them responded by isolating themselves (Kelly, 1999). Improving feelings of social isolation is very demanding. It implies changing the dominant societal discourses.

- Stigmatized’s Status Loss

The stigmatized are at risk of being diminished and deprived from social status. This is a direct consequence of the labeling and stereotyping of these people. Link and Phelan (2001) discuss that humans are used to classifying people according to hierarchies. Those hierarchies are not related to levels of performance but to external societal rankings. Within this

framework, members of discriminated groups are unconsciously expected to perform lower regardless of their skill level. This low status can generate discriminatory behavior as the person becomes less attractive to engage with. Hence, discrimination happens when the negative labeling impacts behavior and leads the labeler to engage in discriminatory actions.

Status loss and discriminations may generate reductive environments that actively limit the participation of the stigmatized person (Corrigan et al., 2005) and hence become threatening. For example service providers within healthcare can have a hidden bias against obese people perceiving them as responsible for their health issues, being lazy, lacking motivation and self-discipline (Puhl & Heuer, 2009). This results in a diminishing conduct from healthcare professionals such as disrespectful behavior, negative attitudes and using medical equipment that is too small for obese patients. It makes them feel like a second class

patient. This creates a threatening environment for these patients that results in delaying or avoiding to seek medical treatment.

Also, various industries and public authorities contribute to reinforcing the low status of the stigmatized through keeping their voice unheard. This is true for industries like fashion and diet as well as public health. For example, the fashion industry serves mainly slim

females. It features advertising that perpetuates the desirability of thinness by exclusively using exceedingly thin models (Saguy & Ward, 2011). While a growing plus size industry features larger female bodies, it remains a small segment within the fashion industry that lacks the necessary power to change social standards.