Empowerment as a Response to Stigma

Erving Goffman, in his now seminal work, Stigma: Notes of Management of Spoiled Identity, asserted that persons who are discredited through social stigma find ways of coping with that status. These methods have a single thing in common -- none of them change the stigma. This is because in order for stigma to change, the people holding the discrediting ideas about the status must change their attitudes and their behaviors.

This does not mean, however, that understanding these coping mechanism is not important. And the relationship between those who hold stigmatizing views and those who suffer from a "spoiled" social identity is more complex than often represented.

A new study, The Role of the Fatosphere in Fat Adults' Responses to Obesity Stigma: A Model of Empowerment Without a Focus on Weight Loss in the online journal, Qualitative Health Research explores blogging as a method of coping with fat stigma.

By way of background, blogging about fat acceptance has been around almost as long as blogging. I personally started blogging in 2001 when a friend set me up and created FattyPatties. What started as a "joint" blog ended up with me pretty much sharing my life's events on a semi-regular basis with my thoughts on being fat and fat acceptance thrown in often. Much of the writing I did on FattyPatties became the basis for Taking Up Space. I was one of the 44 bloggers who were interviewed for this study.

There is a lot that could be said about this study. It certainly is original research in that few have even asked fat people what their lives are like. Most studies about fat, fatness and even fat acceptance have centered around the effect of weight on health. Most of that research assumed the same stigmatizing assumptions that the general public has about being fat. So in that body of literature, this study is refreshing and rare.



But as a sociologist, I was also interested in this concept of empowerment in face of stigma. The dilemma for most stigmatized people is that they have little control over their social identities. Stigma "spoils" social identity because it prevents the stigmatized person from impression management. No matter what a stigmatized person does, their actions are interpreted through the stigma.

I've experienced this myself often. People are "shocked" to find out that I am smart, educated, articulate and so forth. The first impression I give is fat and all the negative things that go with it. I am praised for "bravery" when I'm simply being myself and accepting myself. And, for those who do not take the time to get to know me, I am dismissed as lazy, obsessed or defensive because I have the audacity to not fit the stereotype and to be educated about it. In short, if I deviate from the expectation of being lazy, jolly, stupid, ugly, etc., it is noted. Even those who like me do so through the lenses of the stigma as they are surprised at finding me not those things.

That is why stigma doesn't change because I don't fit the bill. All of my efforts are about my behavior and thinking, not the one who stigmatizes. I have no doubt that knowing me may change the minds and hearts of a few people, if they are open to the change. But it is they who change. Not me.

Still, it can be said that those of us who have publicly talked about our plight might be influencing those hearts and minds and empowering ourselves in the process. I find this an interesting question and one that goes beyond Goffman's theory and most of what's been written about stigma since Goffman.

Empowerment is a difficult concept sociologically. Generally, it has been psychological in nature. Basically, it has been constructed as a sense of personal identity that rises above or beyond one's social identity. From a sociological point-of-view, empowerment may not change group dynamics that much and could be seen as problematic because it can be used to ignore social dynamics. In other words, if I feel empowered but the power dynamics have not really changed, am I just reinforcing those dynamics instead of changing them?

But blogging is a different aspect of this empowerment. Blogging is social. Blogging is creating the possibility of changing the dynamic. And blogging can be a form of organizing into groups of resistance to power.

I share a portion of our book with my Soc 101 students and ask questions about stigma management in relationship to the excerpt. One of the questions is about what the author (me) can do about the fat stigma? The answer I'm looking for is "nothing" because a stigmatized person is not the one who can change it. But I often give partial credit for another answer that comes up frequently: the author is changing the stigma by challenging it, writing about it and living differently.

I like the process identified in this research. It rings true to me personally. I had several crisis moments that led me to empowerment. But I think that there is another stage that bloggers move to as it were and that is challenging power structures. In a way my movement of my writing from FattyPatties to the book to now blogging for Psychology Today is an example of that transformation from a personal experience to an empowered experience to someone who challenges the forces that set up the stigma in the first place.

Of course, glance at the comments and you can see that I still am stigmatized in writing about fatism. But with the new media and the ability to be "out" in much more public ways, perhaps it is time to expand Goffman's ideas and challenge the concept that the discredited cannot find a voice in social discourse. It is, of course, a complex question.

What a Day--Stigma is alive and well

I wrote a little blog entry on Psychology Today yesterday and today all hell broke lose and I spent the day being attacked on a number of personal levels, including threats to my job at CSN.

As a description of the blog I wrote:

Judging character, work ethic, health or worth on the basis of how somone looks is ALWAYS prejudice. No one should be treated as "less than human" because of their body size.FATISM is a matter of cultural stigma. This blog is about cultural and social issues, not a health debate.

Talk about a prophecy. First controversy and the judgements about my character, my work ethic, my health and my worth were all over the place.

I think the thing that interests me most as a sociologist is that I was considered "obsessed" because I have written about this. These persons were defending themselves on the basis of credentials and a body of work, but as a stigmatized person I was considered "biased," "obsessed" and "deaf to other points of view" because I, too, had a body of work.

I have never seen a more beautiful example of what Goffman meant by spoiled identity. If I wrote and researched the topic, I am obsessed. If I am uniformed and unwilling to change, I am ignorant and need help. My body was code for "stupid," "unhealthy," "lazy," and "incompetent." It makes me wonder what they would have used if I had been thin.

I have written in other places about my reluctance to be a "professional fat person." Today was a reminder of both why I became one and why I hate it.

It remains my hope, however, that having become one, I can use the example of fat stigma to end all stigma. Stigma is a horrible cultural practice and one that hurts both individuals and society.

I Take Up Space: New Blog on Psychology Today

I'm excited about kicking off a new blog at the Psychology Today website. The blog is called "I Take Up Space" and is about the consequences of fatism. The site has millions of visitors each month, so I'm hopeful that it will become an outlet for discussing Fat Studies as an emerging field and promoting sociological perspectives on these issues as well.

I write about the failure of New Year's Resolutions and the Moral Panic of the War on Obesity in my first effort.

(Please forgive my cross-posting if you read me in more than one place.)

7 Ways Health Care Could Be Improved in the US

So after a year of debate that was full of backroom deals, posturing and ultimately the demise of anything resembling bipartisanship, we have a radical but weakly constructed Health Care Insurance reform law aptly and anemically named: The Affordable Care Act.

Okay, before I discuss what I hate about this bill, let me make some concessions to my liberal friends:

• Yes, this goes way further than anyone has gone before;
  
  
• Yes, it is good to do away with the discriminatory practices of the predatory health insurance industry such a pre-existing conditions and dropping insurance when one is sick;
  
  
• Yes, there are some immediate benefits that are helping some people; and
  
  
• Yes, this will most likely result in some improvements both in the cost and delivery of health care.

But this is a drop in the proverbial bucket and Michelle Obama's anti-childhood obesity campaign tells me all I need to know about how much this administration knows they have failed to produce real change. Just like the Clintons in 1994, blaming fat people is a great way to blow smoke and use mirrors to make the failure disappear.

So why am I profoundly disappointed in this bill?

• First, no public option other than some lame expansions of Medicaid and some temporary fixes like High Risk pools which will go away when the full non-existing condition prohibition goes in effect in 2014.
  
  
• Leaving these lame expansions in the hands of states and demanding that states provide matching funds. Nevada's a-hole of a governor (and my boss--I'm technically a state employee) Jim Gibbons had decided that it is better to sue the federal government than provide the extra medicaid and high risk pools. Thus, a beggar-thy-neighbor affect has already begun. And yes, he's acquiescing but it is really too little too late.
  
  
• No effort has been made to even begin to address social inequities inherent in medical relationships or to ask the hard questions about the money and power held by hospitals, pharmaceuticals, physicians, insurance companies and other big-time players in the system. (Like, I don't know, maybe a regulatory system that allows patient's complaints to be heard.)
  
  
• Health care coverage is still tied to work. This is a ridiculous idea and it belies the latent function of health care in America: keeping the working class compliant. This is not a natural fit at all and all the celebration of tax credits is a perfect example of politicians pretending they are doings something when they are not.
  
  
• In fact, the health care tax credits for personal income tax is essentially making school loan debt, tax debt and non-payment or being behind in child support payments a death sentence. If you don't have enough money to pay these things, you probably are not going to have enough money to buy insurance. If you get the tax credit to supposedly help pay for insurance, it goes to pay these other debts, which means you have no money to pay for the insurance the government requires. This in turn means you will owe more taxes because of the penalty and therefore you will be further in debt and the cycle continues.
  
  
• But the biggest reason I find this law to be distasteful is that millions of Americans who have been bullied and mistreated by the nation's health insurance industry are now going to be forced to buy insurance from that same group of people. You see the dirty little secret is that the insurance industry knew they were in a win-win situation.
  
  OOH, if reform failed, their unbridled profiteering at the expense of our health and well-being would continue unimpeded. OTOH, if reform passed without a public option, then a whole new group of people would be forced to buy insurance. Not that wonderful group they hate -- the sick, but that wonderful group they love -- the young folk who rarely get sick.
  
  Now let me make this clear -- for a universal system to work, mandatory insurance has to be a part of it. The whole concept is that everyone buys in whether they are sick or not, then the cost for all is lowered and the protection for all is in place. But that is only valid IF everyone receives the same protection. This bill leaves in place all sorts of stratification, meaning that young people and their parents (till they are 26) are going to get the short end of the stick, or in other words, the stick is going to be stuck someplace where the sun don't shine.

If I believed that people in Washington really saw this as a first step towards true reform, I'd be more excited. But as near as I can tell they are all celebrating the victory or mouthing off about repeal and no one is discussing the next move.

The fact is no one has really faced some fundamental truths about for-profit health care systems, and as long as lobbying and corporate money flows unimpeded, they are probably not going to face those facts. As Upton Sinclair once said, "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"

So not ever wanting to be simply "anti" anything, I offer some specific Ways to Improve Health Care in the United States. Some of these are shifts in perspectives, while others are downright practical:

1. True reform must begin with understanding the collective nature of health care. Germs do not care which bodies they infect. The water, soil, air and environment surround us all. Our well-being is collective and pretending this is an individual's business only is costing us. All health care is public health care. This basic fact is radical because it is the crux of the whole debate. When other countries debated how to achieve universal health care they took this as a given and then discussed reform. Americans are still pretending that they are in total control of their lives and it is costing them their health, their well-being and their livelihoods. This paradigm shift has to happen or we will never achieve good health care that is sustainable.
   
   
2. We must eliminate the primacy and monopoly that allopathic medicine and the physicians who practice it have on our health. What little regulation through licensing and academic accreditation that we have gives a virtual monopoly on this form of medicine and it is to our peril. The reason chronic illnesses are on the rise in the United States is that practitioners who have methods to address these conditions are systematically pushed aside in favor of the "magic pill" form of medicine. I love what surgery and pharmaceuticals can do. I'm alive because of advances in these areas, but I am, along with millions of others, in daily pain and disabled because these are the only advances that have been encouraged. Any reform that does not get rid of the monopoly of the allopathic doctor and overblown reward that monopoly affords him or her is going to fail. We need multiple modalities and we need to be rewarding these modalities and allowing them flourish.
   
   
3. We need to allow more locally based systems in the practice of medicine while finding ways to use economies of scale in the acquisition of resources. In other words, local communities should have more control over their clinics and practitioners but acquisition and distribution of equipment and medicines should be organized in such a way that lowers costs. Such organizational schemes are not without precedent but they are often defeated by monied interests. There should be no reason we cannot have medical boards in a community that oversee the practices of health care providers locally and still have vaccinations, medical supplies and equipment bought on a national scale and distributed according to local needs.
   
   
4. We need to divorce health care from wage slavery. This is not a natural marriage. It has a specific and sordid history and if we really want to have health care for all, this marriage must die. As long as health care is connected to employment we are enslaved by both systems. It's just that simple.
   
   
5. We need to recognize that it IS NOT and it NEVER CAN BE a level playing field between health care provider and sick person. This means it should never be "for-profit." The provider is always going to have far more information than the sick person. The sick person is in desperate straights when ill and therefore does not have time or ability to seek out good information and shop for the best price, best service and so forth. Thus, the opportunity for price gouging and fraud is always present. It cannot help but be corrupted and therefore it can never be a free market. Pretending that the patient is a "client" is ridiculous. In our current system, we cannot trust our providers. How do we know they have our best interest at heart? We cannot truly know if a doctor is prescribing a drug because we need it or because he owns stock in the company that produces it. We cannot know if the procedure the doctor suggests is because it is the best thing for us or if he just needs to pay for his daughter's tuition this month. We think we trust our doctors, but how can we know the purity of their motives when they make more money when we are sick than when we are well?
   
   
6. We need to recognize that social ills create much of our personal ills. If we really wanted to lower our health care costs we would be working towards the end of poverty, we would be working towards a better ecological balance and we would be working towards the end of war and violence. Corruption, pollution, violence and lack of access to care are the leading causes of ill health. We will not be serious about improving our health and well-being until we are seriously trying to change these things.
   
   
7. Finally, related to #6, but not quite the same thing, is we need to end stigma and the medicalization of prejudices. Far from improving our collective well-being, the unintended consequences of many public health programs is to reinforce stereotypes, prop up bullying and paternalistic behaviors of bigots and mark people as less than human because of who they are or who they associate with. There is beginning to be ample evidence to support the notion that stigma leads to ill-health. Creating programs that continue to stigmatize, even if it is "unintended" will make true health care reform impossible.

Yeah, I know, if you made it this far, you are probably saying, "Yeah, but..." Well, reform is supposed to be change. Reform is supposed to be something radical. The so-called reform we have to date is just same ole, ahem, well you know. If we really want change, if we really want reform, we are going to change our core values. Right now we care more about profit than people, we care more about ideology than truth and we care more about getting our way and not having to make any sacrifices than we do about life and the future. There is a price to be paid for everything we believe that is not true. The price this time might be our lives, our children's lives, our civilization, and our planet. We cannot afford anything but reform.

Grand Challenge of the 21st Century -- End Stigmatization

So I got a tweet from @whitehouse yesterday and again today regarding President Obama's call for submissions regarding Grand Challenges of the 21st Century. Aside from the grammatical error (I think it should read "Your Ideas Welcomed"), this is basically a call for ideas to aid Obama's White House in creating their highly touted "Strategy for American Innovation."

Okay, I'm pretty cynical, or at least, skeptical, when it comes to these things, but I decided to take them up on the challenge because it is a bad strategy in life to assume that nobody wants to hear your ideas ever.

So I submitted a grand idea: a comprehensive, well-funded program to end stigmatization. It is too long to post here (4 pages), so click on the link to read the .pdf.

When I taught about race and ethnicity, I have challenged my students to find ways to end stigmatization. My parameters for them were to come up with ideas that they can implement in their own daily lives, ie, no funding, no government support, no charity. They have done surprising well with great ideas about staging public events, posting youtube videos, selling tee-shirts and so forth.

This is a little different but it is in the spirit of the assignment. Most people who address stigma do so by telling stigmatized persons how to cope with the stigma. This is unacceptable and is essentially a losing strategy. It is saying that the bigot doesn't have to change, we do. But stigma originates from the bigoted idea, not the characteristic used as an excuse for the bigotry. It is not under the control of the stigmatized, it is under the control of those who stigmatize others. So if we want a tolerant society. If we want bigotry, xenophobia, discrimination, bullying as so forth to end, we should be starting with the source and not teach people to cope.

Let me know what you think of my idea. Or better yet, if you like it, you might send an email to challenge@ostp.gov and second the proposal.