Stigma - social aspects, understanding illness from patient's perspective

What is the key significance of the labelling theory of deviance? A. It demonstrates how powerfully one's judgements and identity can be influenced by the perceptions and judgements of other people B. It shows how deviant behaviour is a learned activity C. It illustrates how marginalised people can have a difficult time identifying with societies norms D. It indicates the impact of labels can be easily deflected through techniques of neutralisation

A

The sociological approach to deviance: A. Focuses on external forces B. Emphasizes genetic predispositions C. Understands that such behaviour is strongly linked to low intelligence D. Assumes the existence of a personality disorder or mental illness

A - focuses on external forces

What is stigma coaching?

Advice on how patient should socially manage stigmatised illness - might contribute to stigma by encouraging concealment and hiding eg epilepsy - advised to maintain secrecy about symptoms and diagnosis

What are the 9 protected characteristics of the Equality Act?

Age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation

Some social theorists believe that deviance is A. A dysfunction B. Due to labelling C. Built into the structure of society D. Influenced by genes E. Easily correctable

B - due to labelling

What concept related to the study of deviance did Irvine Goffman develop? A. Degradation B. Stigma C. Non conformity D. Deviation

B - stigma

In social theory, to what does the term 'deviance' refer? A. The performance of disgusting or perverted acts B. Violation or a breach of social rules C. All illnesses D. Behaviour is bad enough to warrant being punished

B - violation/breach of social rules

It is possible to be diagnosed with a medical condition that is stigmatized and, in turn, have the experience that one is deviant because of that medical diagnosis. This shift in deviance A. is due to being involved with specialised health rights groups (ie AIDS activism) B. is quite rapid C. indicates that social deviance has become part of an individual's identity D. has little to do with the reactions or input of others

C - Social deviance part of individual's identity

The medicalization of deviance refers to: A. Use of lethal injections in administering the death penalty B. The castration of sex offenders C. Viewing deviance as a medical matter D. All of the above

C - viewing deviance as a medical matter

When is medically labelling particularly significant?

Can change outlook and behaviour due to label eg symptoms considered harmless or healthy - diagnosis may be positive for treatment options but negative in presenting uncertain and altered future for person who is now 'ill'

What are the strategies to cope with a discrediting label/attribute?

Choose to accept/reject stigmatising view Pass as normal, withdraw, alter appearance through surgery, compliance (or adoption of compliant facade), actively resist medical care, conform to stereotype, performance (acting more incapacitated that truth)

What is the discreditable meaning of illness?

Condition has aspects that are invisible or hidden, thus concealable and only potentially stigmatizing - eg trunk scarring

What is discredited meaning of illness?

Condition has attributes that are clearly visible or apparent -cannot be concealed, eg facial scarring following burns Discredited person must control the interaction that focuses on blemished parts

What is a recognised professional tension leading to burn out?

Conflict between how doctors are supposed to act and feel, and how one might actually act/feel Leads to burn out, critical self-evaluative thinking

What else stigmatises patients in health care?

Cultural stereotyping - gender, race, age, SE status Prejudice exists resulting in health care disparity and poor health outcomes Result of collective attitudes that groups hold towards stigmatised condition

A humane approach to dealing with social deviance is needed because: A. A measure of society is how it treats deviant behaviour B. Social deviance is inevitable C. Deviance often results from the systems of inequality D. All of the above

D - all of the above

Deviance (and conformity) result not only from what people do, but also from how others respond to those actions. This is an example of? A. Conflict B. Differential association C. Control D. Labelling

D - labelling

What is not true about the relationship between being HIV in pregnancy and poverty? A. HIV in pregnancy and poverty commonly appear together B. The stresses and stigma associated with poverty can push individuals to think and act in inappropriate ways C. HIV in pregnancy can cause poverty D. The vast majority of women with HIV had pre-existing problems with sexually transmitted infections (STI's) before they were diagnosed.

D - vast majority of women with HIV had pre-existing problems with sexually transmitted infections (STI's) before they were diagnosed.

What medical condition might conform to more than 1 category?

Dementia - personal character and social stigma of older age

What is the intention of the Equality Act?

Describes the different ways it is unlawful to treat someone - direct/indirect discrimination, harassment, victimisation, failing to reasonably adjust for disabled person Prohibits unfair treatment in workplace

What did Friedson argue relating to the sick role?

Entry into the sick role is not always guaranteed - depends on how serious/legitimate it is

What law relates to stigma?

Equality Act 2010, Public Sector duty Home Office

What is compliance?

Extent to which patient follows/completes a prescribed diagnostic, treatment or preventative procedure

What is the impact of differential treatment from HCW based on enacted stigma?

Failure to elicit patient concerns Misdiagnosis of acute illness Discouraged from wanting to attend future appointments Inadequate time on education of appropriate health-seeking behaviours Inadequate follow up from past / predicted failure to attend appointments Blame towards patient for poor health

How does the Equality Act apply to staff in the NHS?

Fair and equal treatment with patients, neither discriminating against nor harassing/victimising

What are some common moral beliefs about IV drug abuse and sexual promiscuity (associated with Hepatitis C)?

Fear of contagion (blood-borne viruses) Perceived threat to moral/religious beliefs in society - leading to societal breakdown Associations with already stigmatised behaviours and populations (prostitution, criminal) Individuals blamed/viewed as personally responsible rather than their partner

What is felt/self stigma?

Feelings like shame that interfere with person asking for help The fear/shame that individual/group have that they and their condition will be negatively viewed

What are the 3 common forms of stigma?

Felt or self stigma Enacted stigma Cultural stereotyping

How can the stigma situation be improved at an individual level?

Focus on how patients rationalise their own illness (personal, social meaning) Avoid assumptions, see from patient's perspective, act to avoid stigmatising judgements Recognise diagnosis may bring unwanted baggage of societal attitudes Manage personal stress/anxiety and pressure to ensure giving the best care

What are some historical, classic and contemporary examples of conditions that have been stigmatised?

Historical - TB, leprosy, epilepsy Classic - HIV/AIDS, mental illness Contemporary - chronic illness, lifestyle diseases (obesity), non-organic (eg chronic fatigue)

What does Parsons (1951) describe?

Illness as a form of deviance on the grounds that it disrupts social system - by inhibiting people's performance of normal or customary roles Work on sick role - link when people are ill, not required to meet social obligations, need to minimise societal disruption

What are some possible reasons for non-compliance or non-adherence?

Individual factors associated with chaotic lifestyle Communication failure (doctor-patient) Poor experience of treatment by patients Lack of belief in diagnosis/prognosis Attempt to maintain sense of personal autonomy Absence of compliance culture Stigmatizing of patients (labelled irrational or obstructive due to deviation from norms)

Why might HCW treat people differently?

Judgements made about person's background or behaviour - judgements reflect social beliefs and understandings that exist in society about person's position or behaviour Patients might anticipate they will be judged

What is the definition of stigma?

Label/stereotype that links person to unfavourable characteristics - negatively defined attribute/trait/condition/behaviour conferring 'deviant' status - which is socially, culturally and historically variable

What people are commonly subject to abuse, exclusion, harassment or victimisation (by society or individuals)?

Learning disability, infectious diseases (HIV/AIDS), obesity, substance abuse, mental illness, physical disability and those with marginalised gender (e.g. trans gender issues), ethnicity, age, and social- economic status

What are the different legitimate statuses of diseases?

Legitimate illness - society perceived as real Incurable illness (cancer) - person cannot act to get well - therefore access to sick role is unconditionally legitimate Conditional - if feasible for person to get well and disease is treatable Illegitimate - if illness is stigmatised

What negative experiences were reported by IDUs in enacted stigma research by Neale et al (2008)?

Made to feel not worthy of receiving help, wasting valuable hospital resources Hospital staff treated them differently - eg sent home prematurely, no information about what would happen in hospital Heroin users - lack of adequate substitute medication received whilst inpatient

What is medical labelling?

Medicine has a role in contributing to stigmatisation of disease by labelling (ie diagnostic categories to describe behaviour)

What was the reported impact of enacted stigma on IDUs?

More reluctant to use hospital services subsequently, non-attendance at outpatients

What are some examples of enacted stigma in health?

Patients treated differently to other people - eg groups like epilepsy, infectious disease (HIV/AIDS), obesity, substance abuse, mental illness, physical disability

What medical conditions are an example of each Goffman classification?

Physical - acne, amputation, cerebral palsy Social - obesity, autism Personal/character - HIV, menopause

What 3 categories does Goffman classify stigma into?

Physical Stigma - eg Mental health problems or criminal behaviour Social Stigma - eg Belonging to a particular ethnic group or sexuality Personal/Character stigma - eg Blemishes or deformities

How can the health service and society improve stigma?

Plan services accessible to marginalised groups Recognise inverse care law (Hart, 1971) - good medical/social care varies inversely with population need Review social and moral bases of programmes of treatment and care Influence policy

Why is medical labelling both positive and negative?

Positive - diagnostic label is helpful - expectation know how to treat them Negative - labelled as mentally ill, haemophilic, diabetic, drug addict, cirrhosis - labels might assume deviance, can link to other stigmatised or negative stereotypes (eg alcohol)

What issues to stigmatised people suffer?

Restricted access to resources and opportunities Overt form - discrimination and abuse

What is excluded from protection in the Equality Act?

Social class not specifically protected Allows trans-sexual people to be barred from gender-specific services Some exclusions related to immigration

What does stigma impact?

Social, political, personal implications Effect on nations, communities, families and individuals (therefore global health initiatives) - impacts patient care and experience of care

How is stigma variable?

Socially and historically variable - what is discouraged/perceived negatively can be affected by when/where you live

What is courtesy stigma?

Stigma not felt directly by person with illness - but may be experienced by a carer who feels ashamed/embarrassed Ie stigma spreads to others close to the person who is directly affected (eg parent taking autistic child to restaurant)

What is coping?

The processes by which a person learns to tolerate or put up with effects of stigma and illness - involves maintaining a sense of value and meaning in their life

What is stigma derived from historically?

When a physical mark was placed on slaves to identify and separate them from general culture

When does felt or self stigma occur?

When people internalise enacted stigma - ie believe enacted stigma focuses on them eg visiting GUM clinic for the first time

What is enacted stigma?

When person/group is shunned, denied protection under the law or dehumanised The actual first-hand experience of stigma

What is the concept of deviance (as related to stigma)?

When we do not act as society expects, we can be subject to sanctions Stigma can result when having a disease means people do not conform to expected ways people should act