Motivation and emotion/Book/2016/Coping with stigma

Overview
Stigmatisation occurs in all societies and can cause much difficulty to many people. There are a number of characteristics that may cause an individual to become stigmatised and many of these are out of their control. Stigmatisation can cause serious health issues, and be very distressful for those dealing with stigmatisation. A common occurrence when dealing with an individual who is stigmatised is to ignore or distance one’s self from them both physically and socially. By doing this, a stigmatised person may become completely isolated from society and suffer as a result. Things such as depression, difficulty to find employment can all be the result of stigmatisation.

It is due to this that behaviours may be used in an attempt to cope with stigma. When a behaviour used to cope with stigma is positive it can be characterised as adaptive. This means the behaviour is beneficial in coping with the stigma and will have a positive impact on the individuals’ life. However, not all of these behaviours are beneficial or safe. These behaviours, that are not beneficial, are characterised as maladaptive and interfere with an individual’s ability to handle the stigma they are experiencing. By trying to find adaptive coping mechanisms for dealing with stigma while simultaneously trying to eliminate the maladaptive behaviours, a stigmatised individual may be able to have an easier time coping with stigma, and achieve a greater outlook on life.

Stigma
The term stigma was defined by the sociologist Erving Goffman in 1963 to describe characteristics that labelled people as social outcasts excluded from 'normal' society (Henslin, 2011). These characteristics made them deviants who did not obey social or cultural norms in the eyes of others, and as such classified stigmatised people as outcasts due to their behaviours and characteristics which, in many cases, they have had control over (Henslin, 2011). Some of these characteristics that create a stigma are related to mental health, physical abnormalities, or appearances that do not fit within social or cultural expectations. While many cultures share similar stigmas, the difference in cultural norms will mean that many stigmas do not cross cultural boundaries. So while something may be considered perfectly normal in one culture it may be stigmatised in another. For the purposes of this article, the primary focus will be towards Western stigmas.

Types of stigma
There are a number of different types of things people can be stigmatised for. The following is a list is of some examples.



The first being the stigmatisation of people with mental illness. This is a common occurrence and there are two competing theories as to why this may occur. The first of these is labelling theory, or an initial version of labelling theory which was first hypothesised by Scheff (1966). This theory suggested that an individual who had been labelled as mentally ill by a professional, would for one be discriminated against when trying to return to normal life and as such would begin to take on the role of patient and conform to the stereotype of mentally ill (Markowitz, 1998). Because of the reactions of others to the individual who is mentally ill, the identity of “mentally ill” is continuously reinforced leading them to continue the role. The opposing theory to this is that the stigma of the mentally ill is actually very small and the social distance is a result of the symptoms of mental illness (Markowitz, 1998).

The second characteristic that is commonly stigmatised is physical abnormalities or injuries. Physical injuries and abnormalities are usually noticeable and as such, are a common cause of stigmatisation. Some examples of physical abnormalities and injuries can include missing limbs, spinal damage, or burn scars on the body or obesity. An experiment using physical illnesses to determine an individual’s level of social rejection found that the more severe the physical disease was perceived to be the greater the likelihood of social rejection (Christian, Dallie, 1995). The study also found that the more a disease was perceived to be under personal control or the individual's fault, the greater the social rejection (Christian, Dallie, 1995). This could help to explain the social rejection towards obese individuals. As obesity is commonly seen as simple over eating and lack of exercise, it can be seen as something people are able to control and thus create social distance when it is not.

The final example of a characteristic is association. While most stigmas involve the individual to have or be doing something that does not fit with social norms, such as obesity this characteristic can be used for people who are associated with a group or individual who has broken social norms. For example, being the mother of a murderer. While having no part in the crime or socially despised action, they are still stigmatised by association.

Consequences of stigmatisation
There are many consequences to being stigmatised as well as many ways that one can experience stigmatisation. The most obvious and common way to experience stigmatisation is from wider society. This type of stigmatisation manifests itself in many ways, one of the most frequent forms is avoidance and fear. While it may not seem that being avoided is so harmful, the continuous avoidance by others can have a negative impact on an individual particularly as they become more aware of it. Another form this takes place is through discrimination. This discrimination can come in many forms ranging from mockery and insults to being seen as less capable in the workplace. A particular example of this can be found with mental illness. People with mental illnesses are more likely to be unemployed, have less income and have less social supports, some of this lack of income and inability to find employment may be attributed to discrimination by employers (Markowitz, 1998).

The second form of stigma that may be experienced is that of self-stigma or self-stigmatisation. This is, instead of being stigmatised by other members of the community, an individual stigmatises themselves. This is done by absorbing and internalising stereotypes and negative assumptions about what stigmatises them, for example mental illness or obesity, and believe it must apply to them (Drapalski, Lucksted, Perrin, Aakre, Brown, DeForge, & Boyd, 2013). This has been found to increase rates of avoidant coping as well as social avoidance (Drapalski, Lucksted, Perrin, Aakre, Brown, DeForge, & Boyd, 2013). The stigma surrounding many individuals leads them to become isolated from society and leaving them feeling unimportant, depressed and unfulfilled. A study regarding the stigmatisation of obesity perceived by different races and gender found that many of the test subjects had low self-esteem and a poor body image, and it was theorised in the research that the internalised stigmatisation could be the cause of these negative feelings (Latner, Stunkard, and Wilson, 2005).

Adaptive
Adaptive coping behaviours can be defined as those which; would allow an individual to adapt to a situation they are in, in a positive way. In regards to stigma this would mean finding a behaviour, method, or activity that allows them to; reduce social distance, decrease risk of depression or dysphoria and potentially remove the stigma they have. To be classed as an adaptive behaviour must be proven to not harm the individual and to, in some way, improve the individual's ability to cope with their stigma and the consequences of having a stigma. An example of a minor adaptive behaviour would be meditation. While it is only small and would not have any significant impact on social distance, by meditating when feeling stressed from stigmatisation an individual can both relieve stress and improve at the task they are doing. This is supported by research conducted into the use of meditation with radiologic technologists, who after meditating were less stressed and found greater client satisfaction (Dunlop, 2015). Another, potentially more effective adaptive coping behaviour would be seeking and participating in therapy. By participating in therapy, particularly behavioural therapy, an individual may be able to relieve stress, improve their outlook on life and find other beneficial coping strategies for dealing with stigma and the related stress and negative aspects.

Maladaptive


Maladaptive behaviours can be defined as; those that increase a certain problem or keep it at a similar level, exacerbate adjustment problems or have a negative impact on an individual who is trying to cope with a stigma, or stigmatisation (Kochenderfer-Ladd, 2004). While not all forms of maladaptive coping are “negative” per se, they are all none beneficial. An example of a non-harmful but still maladaptive coping response to the stress of stigma could be playing with their hair. While this is hardly likely to injure or increase the social distance put on a stigmatised individual, it will also not assist them in any way. However, it may also develop into a more aggressive coping habit such as aggressive hair pulling. This would become more dangerous as it could result in scalp damage, and is an example of how a maladaptive coping behaviour, while mild, may still be harmful. A more dangerous, but still common way of dealing with stigma and the related issues it causes is through the use of alcohol or other substances. While consumption of alcohol in moderation is not unusual or considered deviant, when it begins to effect the individual's personal, social, or occupational life it is now in itself another stigmatised characteristic (Weiten, 2013). Alcohol consumption also has a negative effect on an individual’s health, with alcohol being linked to nearly 88,000 deaths annually in the United States along with the economic burden it can carry ("Alcohol Facts and Statistics | National Institute on Alcohol Abuse and Alcoholism (NIAAA)", 2016). This is a more severe form of a maladaptive coping behaviour that an individual may use to cope with stress.

Adaptive vs maladaptive
Adaptive coping often is seen to be confronting the issue and trying to find a solution, while maladaptive is often the opposite, having an association with avoidance and running away. When comparing the characteristics of adaptive and maladaptive coping it becomes clear that there is a vast difference between the outcomes of both. When allowed to continue or not countered by an adaptive behaviour, maladaptive coping causes a negative impact on an individual dealing with stigma. A study into coping with obesity found that most individuals had some form of coping behaviour to deal with the distress they felt from being obese (Myers, and Rosen, 1999). Of these coping habits many were found to be maladaptive, these included; self-criticism, and avoidance which all increased levels of distress. The counter to this was, the individuals who displayed more adaptive coping, such as; not hiding who an individual is, accepting who they are and reducing self-blame, also displayed less distress. This is an example of the difference between the outcomes of adaptive and maladaptive coping for dealing with stigma. It is clear that adaptive coping strategies are far superior to those of maladaptive. Further research also supports these results: a study in 2010 on adaptive coping in the presence of maladaptive coping found that when adaptive coping was low the presence of depressive symptoms was high with the opposite being found when adaptive coping was high (Thompson et al., 2010). This research suggests that even when maladaptive coping is present the presence of high levels of adaptive coping is enough to reduce the negative impact of maladaptive coping behaviours. Some of the consequences of failing to remove maladaptive coping or not introducing can include; increase to the risk of depression, increase in distress and an increase in social distance. However, when adaptive coping is introduced there is a decrease in the risk of depression, the in potential to reconnect and reduce the social distance with regular society and to improve overall life satisfaction even when dealing with stigma (Thompson et al., 2010).

While in most cases adaptive and maladaptive coping is easy to differ, for example avoidance tends to be maladaptive while acceptance tends to be adaptive, this is not always the case. Some coping strategies that are perceived to be adaptive in nature; such as positive self-talk, when implemented by men were found to relate to higher levels of depressive symptoms (Puhl, & Brownell, 2006). While what is often seen as maladaptive coping; such as crying and ignoring the situation, showed lower levels of depression. Further study into why what causes these commonly considered adaptive coping strategies to, in fact be maladaptive is need to determine the reason behind such an anomaly.

Conclusion
While maladaptive behaviours may appear to relieve the difficulties of dealing with stigma, they are in fact either useless at coping or in some cases dangerous. The benefits of adaptive coping behaviours are vast and far superior to those of maladaptive. By analysing the behaviour it can be determined whether or not it is maladaptive or adaptive, by seeing if it; allows for improvement or keeps the individual in the same mood and mental state, is dangerous or productive and will be beneficial to the individual or not. The reasons and importance for finding positive and adaptive methods for coping with stigma is clear and important. Due to the potential for serious health risks from both the consequences of being stigmatised and those of maladaptive coping behaviours. By researching more ways to implement adaptive coping behaviours, there is a chance to increase the quality of life for those who are stigmatised and reduce the potential for depression and social distance. However, if maladaptive coping is allowed to continue it maybe manifest itself into more dangerous behaviours. This may cause greater social distance, and greater risk to the individual. It is because of this that adaptive coping behaviours should be encouraged and action taken against maladaptive behaviours.