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PubMed2004

Important to investigate the dynamics of the stigma process.

Studies have shown that the stigma of the most common mental disorder, namely depression, expose people with these disorders to a substantial amount of stigmatization in the workplace. Apart from the descriptive assessment of the magnitude of stigma, it is also important to investigate the dynamics of the stigma process. Agreeing with Dr. Stuart, three approaches to research on stigma and the workplace are proposed. The first is the dimension of social stigma, i.e., knowledge, attitudes and practices of employers. The second is the perspectives of the patients, i.e., self- stigmatization. The third is legal and policy frameworks, i.e., structural discrimination.

Humans↗

PubMed1981

Intrapsychic effects of stigma: a process of breakdown and reconstruction of social reality.

Being stigmatized has intrapsychic consequences for the individual. Two aspects of the process by which these consequences occur are described: a breakdown of the person's systems of interpretation and valuation, which may lead to reality shock; and a reconstruction of those systems that takes into account the stigmatized characteristic. The latter aspect is associated with frequently noted sequels to stigma, including identity reconstruction, changes in affiliative patterns, and revisions of long-range plans and goals. Key elements in both major aspects are the master-status character of stigma or, in other words, its being a status that takes precedence over all others; the widespread knowledge of stereotypes associated with a given stigma; and the actual and imagined responses of others. The data are from an ethnographic study of a homosexual community, but the intrapsychic processes described may occur in conjunction with any stigma acquired after normative socialization, including stigmas resulting from a characteristic viewed by others as inappropriate for a status occupied by the individual, such as a black or female professional.

Adaptation, Psychological↗

PubMed1999

The politics of counter-rejection: gay christians and the church.

This paper analyzes the accounts constructed by 60 gay male Christians in managing the stigma imposed on them by the Church. These accounts signify that they, having developed a positive self-image, are involved in the politics of counter-rejection of the Church and its official positions on the issue of homosexuality. Their counter-rejection of the Church as a moral arbiter is predicated on four bases: (1) the Church's ignorance of sex and sexuality, (2) the Church's ignorance of all sexualities as God's creation, (3) the Church's misinterpretation of biblical passages on homosexuality, and (4) the Church's fallibility. Having counter-rejected the Church by challenging its credibility, the counter-rejection of the Church's official positions is a matter of course. Their experiences highlight the ability of stigmatized social actors to invent social biographies not only to defend their moral choices, but also to challenge the credibility of sources that question and stigmatize their choices.

Adaptation, Psychological↗

PubMed1999

Status passages: the experience of HIV-positive gay men.

Data obtained in in-depth interviews with 25 HIV-positive gay men are used to expand upon the literature on status passages, specifically the processes involved in accommodating to HIV and the associated socially stigmatized identity. Experiences reported by respondents suggested that Persons living with HIV and AIDS (PHAs) may experience several status transitions as part of their HIV career, each with its own corresponding turning points and benchmarks. For the men interviewed, the processes involved in accommodating to HIV in many ways parallelled that of adapting to other stigmatized statuses, especially those related to chronic illness. Receiving an HIV-positive diagnosis can force an individual into an involuntary, irreversible and undesirable status passage. It can also lead to numerous role exits, besides that of HIV negative. Part of the status transitions experienced by the PHAs in this study involved accommodating to illness and alterations in identity. In an effort to reconstruct identity, most of the men interviewed tended to seek out similar others for information, support and affirmation. Efforts to become part of the PHA community were explained as an attempt to end personal isolation and fight the stigma associated with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Part 1: HIV as'the line in the sand'.

There is a growing rift between HIV-positive and HIV-negative gay men, which finds expression in social, economic, structural and political divisiveness that, if not resolved, may 'kill' the "gay liberation movement." While disasters generally tend to create organizational solidarity, the AIDS crisis has operated in reverse, spawning a variety of competitive AIDS service organizations, alienating seropositive gays from the mainstream gay community, and in turn disenfranchising seronegative gay men as human and financial resources are redirected toward persons living with HIV and AIDS. Serostatus has become a social marker of societal status, operating in a bimodal discriminatory manner. Seronegative gay men experience discrimination from within the gay community as funding for and services to this sector diminish. Seropositive gay men (and the organizations that provide for some of their needs) have culturally, economically and socially dismissed the socio/psychological needs of seronegative gay men (survivor guilt, safer sex education, etc.) in favour of providing social and resource-based services to seropositive gay men. As the disparities in service and advocacy increase, the social distance between the gay movement and the AIDS movement correspondingly increases. If this trend continues, the social gap will serve further to push HIV-positive and HIV-negative gay men into polarized camps, resulting in a wider separation of the gay movement and the AIDS movement. The stigmatization of HIV-positive people will subsequently increase both within and outside the gay movement, and any ability to present a unified Gay Liberation front will correspondingly diminish. Additionally, the emergent notion within and without the gay communities that to be gay is to be HIV-positive will solidify. This will (a) further stigmatize all gay men in the eyes of the non-gay population, and (b) exacerbate the rift between HIV-positive and HIV-negative gay men within the gay community, reversing the stigma of HIV such that to be HIV-negative will be a marker of non-gay identity. In short, seropositivity will become the defining element of gayness.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Marginalization among the marginalized: gay men's anti-effeminacy attitudes.

Contemporary research has shown that a significant portion of gay men have traits, interests, occupations, and behaviors that are consistent with the stereotype of gay men as effeminate, androgynous, or unmasculine. A great number of gay men exhibit gender nonconformity during childhood; most, however, "defeminize" during adolescence, possibly in response to stigmatization and society's gender-role prescription. Only a relatively small percentage of gay men continue to be gender-nonconforming in their adulthood, often at a price, as they also tend to have lower psychological well-being. Although gay culture historically appreciated camp and drag, which subvert the gender-based power hierarchy and celebrate gender nonconformity, anti-effeminacy prejudice is widespread among gay men. Ironically, gender-nonconforming gay men may suffer from discrimination not only from society at large, but from other gay men, who are most likely to have experienced stigmatization and may have been effeminate earlier in their lives. Drawing from anecdotes and findings from various sources, this article suggests that beyond many gay men's erotic preference for masculinity lies contempt and hostility toward effeminacy and effeminate men on sociopolitical and personal levels. Two correlates of gay men's anti-effeminacy attitudes are proposed: (a) hegemonic masculinity ideology, or the degree to which one subscribes to the value system in which masculinity is an asset, and men and masculinity are considered superior to women and femininity; and (b) masculinity consciousness, or the saliency of masculinity in one's self-monitoring, public self-consciousness, and self-concept. These two variables are hypothesized to interact with gay men's self-perceived masculinity-femininity and their history of defeminization in predicting attitudes toward effeminacy. Research is underway to measure levels of anti-effeminacy attitudes and explore hypothesized correlates.

Gender Identity↗

PubMed1990

Application of coping strategies developed by older deaf adults to the aging process.

Adjustment to deafness in early life and its influence on adjustment to the aging process was a major premise for this study. Early life experiences, peer group relationships, social relations, feelings of discrimination and stigmatization, and treatment as a minority group which together have led to the development of adaptive strategies were examined. Using ethnographic research, data was gathered from 22 deaf adults aged 55 to 84. Results indicated the educational programs they attended as children had ramifications throughout their lives. The type of program they had attended was of paramount importance in the participants' development of adaptive strategies, particularly their peer-based society and lifetime friendships which maximized sociability. Participants reported feelings of discrimination, stigmatization and minority group treatment. Nonetheless, their early acceptance of their disability appeared to carry over as the deaf adults approached the aging process.

Adaptation, Psychological↗

PubMed2004

Aberration reduction by multiple relays of an incoherent image.

Consider a generally aberrated one-dimensional (1D) optical pupil P illuminated by quasi-monochromatic light of mean wavelength lambda. In past work it was found that, if the pupil's intensity point-spread function (psf) is multiply convolved with itself, as in an imaging relay system, and then ideally (stigmatically) demagnified, the resulting psf s(x) approaches a fixed Cauchy form s(x) = deltax( pi2x2 + deltax2)(-1), which is independent of the aberrations of the pupil. Here deltax is the Nyquist sampling interval given by deltax = lambdaf/2 with f the f/number of the pupil. This Cauchy form for this intensity psf s(x) also manifestly lacks sidelobes. The overall questions that we examine are how far do these effects carry over to the case of a circular, two-dimensional (2D) pupil, and to what extent do practical imaging considerations compromise the theoretical results? It is found that, in the presence of spherical aberration of all orders, the resulting theoretical psf of a large number of self-convolutions approaches a "circular" Cauchy form, S(r) = 2deltar[pi2r2 + (4deltar/pi)2](-3/2), where deltar is the Nyquist sampling interval lambdaf/2 with f the f/number of the (now) circular pupil. Thus, for these aberrations the 1D effect does carry over to the 2D case: The output psf does not depend on the aberrations and completely lacks sidelobes. However, when all aberrations are generally present, the output psf s(r, theta) does depend on the aberrations, although its azimuthal average over theta still preserves the circular Cauchy form, as a superposition of Cauchy functions. Imaging requirements for achieving these ideal effects are briefly discussed as well as probability laws for photons that are implied by the above-mentioned PSF's s(x) and S(r). Real-time super resolution is not attained, since the stigmatic imaging demanded of the demagnification step requires the use of a larger-apertured lens. Rather, the approach achieves significant aberration suppression.

Journal Article↗

PubMed1996

Differential influences on asthma self-management knowledge and self-management behavior in acute severe asthma.

AIM: While asthma education increases knowledge, it is less clear whether education influences actual patient behavior. To determine whether there are differences between asthma self-management knowledge and the actual behavior of patients during an acute severe asthma attack and to determine which clinical and psychosocial factors are associated with knowledge and behavior. METHODS: Validated hypothetical scenarios describing the development of life-threatening asthma and patients' reported actual behavior were scored (out of 25) using a system based on Thoracic Society of Australia and New Zealand and British Thoracic Society criteria. RESULTS: In 137 patients admitted to the hospital with severe asthma, the pattern of the index attack was slow onset (> or = 6 h) in 96%. The score for the hypothetical attack (knowledge) was 13.8 +/- 4.6, while that for the timeline (behavior) was 10.2 +/- 3.9 (p < 0.001) with 56% and 84%, respectively, having a score of less than 15 (regarded as inadequate). Certain components showed marked discrepancy (eg, appropriately seeking medical help 82% vs 52% (p < 0.001) and calling ambulance 61% vs 23% (p < 0.001). Factors such as physician-patient relationship, previous asthma morbidity, availability of peak flowmeter, action plan, and oral steroids correlated positively with both measures. Knowledge was negatively associated with being non-European, with anxiety, pessimism, and stigmatization. Behavior (but not knowledge) was negatively associated with lack of knowledge of what to do in the index attack, previous emotional counseling, and business failure. Those factors associated with the difference between knowledge and behavior scores (knowledge-behavior gap) were being non-European, anxiety, pessimism, and stigmatization, concerns about medical costs, and the only income for the household being a Social Security benefit. CONCLUSION: There are marked differences between patients' self-management knowledge and their actual behavior, particularly in terms of potentially life-saving actions. Psychological, health-care, and socioeconomic factors have a powerful and differential influence on knowledge and behavior. Improved understanding of the discrepancies between knowledge and behavior and which factors influence them may lead to more effective asthma educational interventions.

Acute Disease↗

PubMed2006

Understanding HIV-related stigma and discrimination in a "blameless" population.

HIV-related stigma and discrimination are major barriers to the successful control of HIV. Stigma is associated with the disease as well as the behaviors that lead to infection. A qualitative study was conducted to identify the reasons, sources, and types of HIV-related stigma prevalent in rural China. Eighty in-depth interviews were conducted with people living with HIV/AIDS, their family members, health care providers, and uninfected villagers. Stigmatizing behaviors were primarily associated with fear of HIV rather than with the route of infection. Uninfected villagers were the main source of discrimination, with health workers and family members also holding some stigmatizing attitudes. A primary concern for HIV-positive villagers was protecting their families, especially their children, from discrimination. Secondary stigma also extended to un- infected members of the same village. The results have been used to develop an intervention to reduce fear of casual transmission and stigma in these communities.

Adolescent↗

PubMed2004

Sexuality, color, and stigma among Northeast Brazilian women.

Despite its international image as a sexually free-spirited country, local attitudes toward morality of sexual behavior remain complex throughout Brazil, especially in rural areas and the conservative Northeast region. In addition, notwithstanding its official ideology of nonracism, African ancestry as judged through personal appearance (color) constitutes a significant social and economic disadvantage. Using Goffman's idea of "spoiled identity" as a starting point, I show how locals use sexual behavior as a multivocal symbol of moral status in women, and how spoiled sexual reputation interacts with other stigmatized statuses, especially color. I also consider how the acquisition of sexually stigmatized status jeopardizes women's well-being and that of their children.

Adult↗

PubMed2005

A room for reflection: self-observation and transformation in participatory HIV prevention work.

This article looks at HIV prevention projects in which established stigmatized and stigmatizing roles were actively reversed and manipulated in pursuit of HIV harm reduction. In two Norwegian projects, sex workers and drug users carried out harm-reduction activities with other drug users and sex workers. Although HIV-related harm reduction was the aim of the projects, termination or reduction of drug use or sex work was not. Such changes nevertheless occurred among the sex workers and drug users who took active part in the project. The article considers these changes in order to reflect on the meanings and roles of participation in HIV prevention work. In particular, the discussion theorizes on possible ways in which alteration of roles and subject positions may produce self-reflective effects with transformative potentials.

Data Collection↗

PubMed2003

Alcohol-related injury in the ER: a cross-national meta-analysis from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP).

OBJECTIVE: To examine the impact of usual drinking patterns and related problems on the acute use of alcohol in injury. METHOD: The impact of quantity and frequency of drinking, alcohol problems and dependence symptoms on admission to the emergency room (ER) for an alcohol-related injury (based, separately, on a positive blood alcohol concentration [BAC] and self-reported drinking within 6 hours prior to injury), compared with a nonalcohol related injury, was examined using meta-analysis, across 15 ER studies covering seven countries. RESULTS: Pooled effect size for consuming five or more drinks on an occasion at least monthly was significant but not homogeneous, with odds ratios (ORs) of 4.16 for BAC and 3.92 for self-report. Frequency of drinking among nonheavy drinkers was found to have the largest effect size (5.93 for BAC and 4.93 for self-report). Heavy drinking, controlling for frequency, was also significant (ORs of 2.08 for BAC and 1.86 for self-report), but effect size was homogeneous only for self-report. Effect sizes for consequences of drinking and dependence symptoms were also significant and homogeneous, with ORs of 4.29 and 3.55, respectively, for BAC, and 3.84 and 3.94, respectively, for self-report. In meta-regression analysis, among contextual variables the level to which alcohol use is stigmatized in the culture was most consistently predictive of heavy-drinking effect size on an alcohol-related injury, with larger effect sizes found in those studies reporting a lower level of stigmatization. CONCLUSIONS: Whereas quantity and frequency of drinking were both found to be highly predictive of an alcohol-related injury, sociocultural variables may affect observed associations of heavy drinking with an alcohol-related injury.

Adolescent↗

PubMed2002

Coding of pediatric behavioral and mental disorders.

BACKGROUND: In response to changing reimbursement and other pressures in the health care environment, many physicians have reported the use of alternate coding to substitute for certain clinical diagnoses. However, very little information is available on how physicians who care for children approach diagnosis and coding dilemmas for behavioral and mental disorders, which often present unique additional challenges. OBJECTIVE: Our study sought to describe the frequency of alternate coding, different approaches to coding, and attitudes toward diagnosis and coding practices by physician specialty. METHODS: We conducted a mail survey of 1492 physicians--497 developmental/behavioral pediatricians (DBP), 500 pediatricians (PED), and 495 child and adolescent psychiatrists (PSY). The main outcomes were survey items on frequency of alternate coding (never, rarely, monthly, weekly, daily), use of different coding strategies (use of somatic symptoms, modifiers, and substitution with other terms), and attitudes on coding practices (Likert scales of agreement). We analyzed outcomes by physician specialty and demographics using Pearson's chi2 and multivariate logistic regression. RESULTS: Overall response rate was 62% (787 of 1269 eligible physicians). The majority of physicians had used an alternate code (DBP 83%, PED 68%, PSY 58%), and many respondents reported monthly-daily alternate coding (DBP 60%, PED 36%, PSY 27%). Physicians used multiple approaches to diagnosis and a variety of coding options, which varied by physician specialty. Financial issues were commonly cited reasons for alternate coding--both to obtain patient services and to receive physician reimbursement. However, challenges of diagnostic classification and coding subthreshold symptoms were cited as frequently as reimbursement issues. Stigmatization, confidentiality, and parental acceptance were mentioned, but reported less frequently. Very few practices and providers have organized administrative methods of alternate coding (26%) or receive feedback on denied claims (46%). Most physicians believe that alternate coding is justified in the present system; however, some physicians expressed concerns that these practices may contribute to stigmatization or lead to improper management decisions. CONCLUSIONS: Alternate coding is commonly reported; however, approaches to diagnostic coding vary by provider specialty. Reimbursement issues are important, but other challenges in diagnosis and classification hold special relevance to children with behavioral and mental disorders. There seems to be a great need to reconsider the separate goals and uses of clinical diagnosis and administrative coding. Additional study is needed to assess how reported coding practices may affect administrative data, patient care, and health care economics.

Adolescent Psychiatry↗

PubMed2002

The differential effects of face-to-face and computer interview modes.

OBJECTIVES: This study assessed the differential effects of face-to-face interviewing and audio-computer assisted self-interviewing (audio-CASI) on categories of questions. METHODS: Syringe exchange program participants (n = 1417) completed face-to-face interviews or audio-CASI. The questionnaire was categorized into the groups "stigmatized behaviors," "neutral behaviors," and "psychological distress." Interview modes were compared for questions from each category. RESULTS: Audio-CASI elicited more frequent reporting of "stigmatized behaviors" than face-to-face interviews. Face-to-face interviewing elicited more frequent reporting of "psychological distress" than audio-CASI. CONCLUSIONS: Responding to potentially sensitive questions should not be seen as merely "providing data," but rather as an activity with complex motivations. These motivations can include maintaining social respect, obtaining social support, and altruism. Ideally, procedures for collecting self-report data would maximize altruistic motivation while accommodating the other motives.

Adult↗

PubMed1984

Playing doctor, seriously: graduation follies at an American medical school.

In American medical schools, the period of time between the announcement of internships and graduation is known as FYBIGMI, for "Fuck You Brother I Got My Internship." At University Medical School (pseudonym), as at most American medical schools, this period culminates in an elaborate musical comedy (attended by faculty and relatives) in which faculty are abused, patients are represented in terms of stigmatized stereotypes, and the students demonstrate a profane familiarity with cultural taboos. Using the analytic methods of cultural anthropology, this examination of the FYBIGMI performance at U.M.S. focuses primarily on the seniors' presentation of their newly acquired professional identity, which is constituted in the skits by recurring oppositions to socially stigmatized, medically self-destructive patients. In this oppositional logic, racial stereotypes play a particularly large role. In addition, the seniors establish their new social status by inverting their relationship to their (former) supervisors on a personal basis, and by confronting the audience with their professional ability to treat cultural taboos with profane familiarity. The FYBIGMI theatrical, and its representation of professional identity, is analyzed in relation to a proposed model of the underlying structure of the process of medical education, that is, an escalating dialectic of intimidation and self-congratulation.

Black or African American↗

PubMed2006

Physical recovery after acute myocardial infarction: positive age self-stereotypes as a resource.

We considered whether positive and stable self-stereotypes of stigmatized group members can influence functioning (in contrast, stereotype threat theory suggests these influential self-stereotypes are limited to ones that are negative and situational). Specifically, we examined older individuals' positive age stereotypes after a life-threatening event, an acute myocardial infarction (AMI). Sixty-two persons, aged 50 to 96, participated. As expected, positive age stereotypes were found, even immediately after an AMI, and they did not significantly change over the next seven months. Also as expected, these self-stereotypes predicted physical recovery, after adjusting for potentially relevant covariates. Recovery expectations acted as a mediator. These findings suggest the importance of understanding the role that positive stereotypes may play in the health of stigmatized group members.

Age Factors↗

PubMed1987

Social identity in later life: a situational approach to understanding old age stigma.

Social identity is a product of emergent definitional processes occurring in socially defined situations. This article presents a situational approach to understanding an aspect of social identity in later life-the social stigma of old age. Social stigma is conceptualized as an attribute which is perceived to be discrediting, incongruent with expectations, and non-pivotal in regard to the cluster of attributes associated with a specific social category. A typology of situations, based on their potential for producing the stigmatization of old age, is presented. Additionally, stigmatization in these situations is influenced by the following: commitment and legitimation, generational contacts, performance norms, and gender. Implications of a situational approach to the investigation of old age are discussed.

Aging↗