Bob Williams2014.

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There are many sociological texts but I would recommend:

 Giddens, A & Sutton PW (2013) Sociology. 7th edition.

Cambridge: Polity. Russell, L (2014) Sociology for Health Professionals.

London: Sage

1. Review.

2. Why theory?

3. Goffman’s theory about stigma.

4. Stigma, sexualities, health and wellbeing.

Public health is: “…the science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society" (Acheson, 1998)

Assess population health and well-being in communities and our society.

Reducing inequalities in health in communities and wider society.

Understanding, implementing and developing policy to improve health.

Working with communities and social groups in society to improve health.

The requirement to understand and tackle the social determinants of health requires us to understand the sociological context to human health and wellbeing.

Social structures and human agency are dialectically linked.

Social structures: (eg family, gender, ethnicity, social class) constrain or enable our lives impacting on life opportunities, health and well-being.

Human agency: human beings are purposeful, creative and respond to and change social structures over time.

What’s the point of theory?

In stead of listing facts we need to provide explanations (e.g. how, why, how come?).

Helps us to be clear about the concepts we use.

Challenge commonly held beliefs and concepts to develop deeper understanding.

Theories guide research to improve policy and practice.

Equality Act:

NHS and other organisations to proactively prevent discrimination.

Erving Goffman on stigma.

Stigmatization involves an individual or a social group being indentified as ‘outsiders’ or ‘deviant’.

A stigma can be related to physical appearance.

Stigma may also not be readily observable but influence how the stigmagized may think, feel and act.

Stigmatization involves: stereotypes, false ideas, ostracisation, rejection, shunning others, violence.

Example: AIDS seen as ‘gay plague’ from 1980’s.

Virtual and actual social identity. Virtual social identify and actual social

identity.

Virtual social identity: stereotypes

Actual social identity: attributes one actually possesses.

Stigma is really a relationship between attribute and stereotype.

Discredited stigma: outsiders stigmatized e.g. child with physical disability.

Stigmatized may lose control over their identity and how they present themselves to others.

Experience shame, low self esteem, powerlessness.

Stigma may not be readily observable e.g. sexuality, epilepsy.

Stigmatized may attempt to manage perception of themselves.

A young muslim choosing to wear a hijab. Lone parents. Teenagers. White, wealthy people. Black men who have schizophrenia. People who need state benefits to pay the

rent and for food etc. Asylum seekers.

Scambler(1989): epilepsy and stigma.

Scambler’s work on people with epilepsy indicates that the stigmatized may share same values as stigmatizers and experience shame, low self esteem and still feel they are not accepted.

Felt stigma may cause the most anxiety (epilepsy).

Hidden distress

Imagined or real characteristics of a social group can be stigmatised by another social group.

Important to note as it helps us avoid seeing stigma is individualised.

Tribal stigma can be seen in how institutions work, in communities & in neighbourhoods.

Scambler (2009): see stigma as structural, about power relationships.

Reidpath et al. (2005): poverty, chronic illness, ageing and disability are linked. Stigma allows some to be seen as unworthy of investment (eg rent, benefits, services etc)

Total institution (Goffman)

Institutional ‘underlife’ can tell us more than formal policies and procedures.

Dominating and all pervasive control of prisons, asylums, children’s homes and residential homes.

Tremendous power in the hands of stigmatizers and stigmatized.

Lit review.

3 year olds endorse racist stereotypes, with older children less likely to do so.

Hypothesise about the relationships between child development, cognitive development and mental illness stigma.

What is so pleasurable about stigmatizing others?

Dehumanize others.

See others as a threat.

Have an aversion to others.

Scapegoating: stigmatized can be seen as a burden or drain on resources (Reidpath et al., 2005).

Stigmatizers gain: self esteem, sense of control, reduces anxiety by downward comparisons with others.

Some may embrace the markings of stigma as showing a moral commitment to others who are stigmatized.

Embrace stigma as form of cultural identity.

People recovering from depression talked about depression as if they were ‘coming out’ of the ‘depression closet’.

People recover by understanding depression, cope with and resist stigma.

Attempt to advocate pride and challenge shame.

Sexualities, stigma, health and wellbeing.

Sexual health: “…state of physical, emotional, mental and social wellbeing related to sexuality” (WHO, 2006).

Sexualness: embodied desire and sexual practices.

Sexuality: identity.

Greek and Roman cultures accepted sexual relationships between men and boys (as well as relationships between men and women).

Early Christianity: sex was profane and distanced people from spiritual wellbeing, heaven and God.

Later Christianity: sex seen as legitimate but sex between men, sex between women, masturbation, oral sex, anal sex condemned.

(Kidron, 2008).

How did nineteenth century medicine understand and deal with ‘abnormal’ sexual practices?

1868 the term ‘homosexual’ conceptualised.

In Christian Europe non-monogamous sex within marriage to produce babies was seen as perverted, dangerous and pathological.

Masturbation seen as an illness that caused blindness.

‘Illicit’ sex seen as a form of mental illness.

‘Cutting’ a woman’s clitoris was treatment for ‘unwomanly’ behaviour in the nineteenth century in Europe.

(Kidron, 2008)

1940’s UK: gay and lesbian people faced unemployment, arrest, imprisonment, violent crime or even murder.

Until 1970’s gay men were still treated with ECT.

1974: being gay removed from the international manual of mental disorders (DSM).

Beach (1951):

Anthropological study of 200 societies.

Diversity in what is seen as ‘normal’ or ‘natural’ sexual behaviour

………………………………………………………………………………

Weeks (2010) review of the research concludes:

sexual identities and sexual pleasure is contextual, constructed differently in different societies and different time periods.

Comments?

What are the potential problems a lesbian mother may face when accessing healthcare?

Homophobia:

aversion, prejudice or hatred of sexual minorities and their lifestyles (Giddens, 2013).

Lee et al. (2011) found:-lesbian mothers found healthcare a hostile environment,

-researchers confirmed homophobia evident,

-however negative experiences interpreted as ‘personality traits’ of individual midwives and professionals,

-did not challenge the homophobic environment,

-protected themselves from the reality of sub-optimal care by denying significance of homophobia.

Lesbian, gay and bisexual people over 55 using GP services.

Anticipate prejudice and discrimination.

Experience discrimination, hostility or poor treatment.

LGBT 6% of UK population .

LGBT people have worse mental health than population as a whole associated with stigma and associated stresses, risk of violence, substance abuse and suicide.

LGBT people may be reluctant to disclose sexuality to health professionals.

Health professionals may assume clients are straight.

Fish (2010).

Sexuality as agency.

The emphasis on structures in sociology is misplaced.

Sexual minorities have fought for equity and against homophobia since 1960’s. However….

… one’s gender and sexuality needs to be understood as in flux, as it is a fluid concept.

Sexuality is something that is performed it is not an identity such as ‘straight’, ‘lesbian’ or ‘transgender’.

Sexuality is what people do rather than what they are. Sexuality is ‘like plastic’.

Using the terms ‘gay’ or ‘lesbian’ may be a form of stigma!

Theory.

Goffman on stigma.

Sexualities, stigma and wellbeing.

Fish, J (2010) Promoting equality and valuing diversity for lesbian, gay, bisexual and trans patients. InnovAit 3(6): 333-8

Giddens, A & Sutton PW (2013) Sociology. 7th edition. Cambridge: Polity.

 Goffman, E (1963) Stigma. New Jersey: Prentice-Hall.

Guasp, A (2011) Lesbian, Gay and Bisexual People in Later Life. London: Stonewall.

Hughey, MW (2012) Stigma allure and white anti-racist identity. Social Psychology Quarterly. X(X): 1-23

Reidpath, DD, Chan KY, Gifford, SM, Allotey, P (2005) He has the french pox: stigma, social value and social exclusion. Sociology of Health and Illness, 27(4): 468-89

Ridge, D & Ziebland, S (2012) Understanding depression through a ‘coming out’ framework. Sociology of health and illness. 34(5): 730-45.

Russell, L (2014) Sociology for Health Professionals. London: Sage

Scambler, G (1989) Epilepsy. London: Routledge.

Scambler, G (2009) Health related stigma. Sociology of health and illness, 31(3): 441-55.

Weeks, J (2010) Sexuality. 3rd edition. London: Routledge.

Intersex: sex may be difficult to categorise.

Transgender: individuals may perceive they do not fit with the social norms about gender. Maybe intersex or it may be how people identify themselves.