Misunderstanding stigma: A reply to Bobys

In his comment on our approach to understanding stigma (Elliott, Ziegler, Altman, and Scott, 1982), Bobys presents an interesting and provocative form of stigma: the stigma of excellence. He notes that it may be just as damaging to appear to be superior as it is to be inferior, and several lines of research quoted by Bobys provide evidence that this is indeed the case.     

Living,resisting, and playing the part of athlete: Narrative tensions in elite sport

ObjectivesTo explore: (i) How elite and professional sport culture might steer individuals towards particular stories, identities, and actions; (ii) How athletes navigate or respond to these cultural pressures.DesignCross-sectional qualitative methodology.MethodNarrative interviews and focus groups with 21 elite and professional athletes followed by a narrative analysis of structure and form.ResultsAthletes demonstrated one of three processes. Individuals who live the part of athlete story their life and act in ways that conform to a culturally dominant performance narrative. Here, identity is foreclosed, relationships sacrificed in the pursuit of success, and long-term wellbeing threatened. Over time, alternative narrative types may provoke moral reflection on their story and actions. Individuals who resist the part of athlete sustain a life story and identity that deviates from the performance narrative, drawing on alternative narrative types. Their resistance is typically overt as they publicly demonstrate actions that align with their multidimensional story. Individuals who play the part of athlete modify their story and actions depending on sociocultural context. These individuals covertly maintain a multidimensional life story, but silence this story when powerful others require performance stories.ConclusionsAlthough some elite/professional athletes' life stories revolve around performance outcomes, this is not a prerequisite for excellence. Other athletes achieve excellence while sustaining a multidimensional life story and identity. To do so, they navigate a culture that expects a performance focus, through overt resistance or covertly manipulating their public stories and actions.     

Conceptualizing Excellence: Past,Present, and Future

While an historical glance through the sport psychology literature reveals an interest in performance excellence since its beginning, a focus of personal excellence has been a more recent trend. This review will address the relationships between performance and personal excellence. More specifically, we question whether performance excellence in high-level sport, by virtue of the exceptional demands on the elite athlete, occurs at the expense of development in personal excellence or whether performance excellence is possible only through personal excellence. Furthermore, we propose that the field may reconcile these ideals in the future through an athlete-centered sport model. This model is defined by the philosophy that developmentally appropriate sport can be used as a vehicle for enhancing overall well-being and the acquisition of lifelong skills. Performance excellence, therefore, co-exists in the same environment as personal excellence. The implications of implementing an athlete-centered sport system for athletes and coaches and for the research and practice of those in sport psychology will be addressed.     

Health outcomes resulting from the quality of emotional expression in HIV/AIDS patients

IntroductionStudies on emotional expression and its impact upon health have mainly focused on quantitative aspects of interactions rather than on their quality.ObjectiveThe present study aimed to examine the interpersonal quality of interactions in the social sharing of emotions (SSE) in people living with HIV/AIDS (PLWHA), and its impact on patients’ physical and psychological well-being.MethodOne hundred and one PLWHA answered a questionnaire (Likert scale items) which assessed the following: shame, guilt, perceived stigma, perceived physical health, perceived mental health, SSE and the interpersonal quality of SSE (IQSSE). The main hypotheses were compiled into a theoretical model which was tested by a series of structural equation modeling (SEM) analyses.ResultsThe final solution resulted into a well-fit model which showed that: shame predicted IQSSE, perceived stigma mediated the relationship between IQSSE and guilt, and perceived mental health mediated the relationship between IQSSE and perceived physical health.ConclusionThese results corroborate previous findings which demonstrate that IQSSE is independent from quantitative aspects of SSE and that the way the SSE takes place is crucial to the benefits it induces.     

Le rôle de la stigmatisation dans la symptomatologie dépressive de femmes françaises en surpoids ou en situation d’obésité

IntroductionDespite the high prevalence of depressive symptoms among women being overweight or having obesity, the role of stigma and causal attributions in the expression of these symptoms in French women has been largely under-explored to date.ObjectiveThe aim of this research is to study the role of internalized stigmatization, stigmatizing experiences and causal attribution in the intensity of depressive symptoms in overweight and obese French women.MethodThese four variables were measured in 160 French women being overweight or having obesity.ResultsOur analyses highlight positive correlations between stigmatizing experiences, internalized stigmatization and depressive symptomatology. It is important to note that stigmatizing experiences seem to play a more preponderant role than internalized stigmatization in the expression of depressive symptoms.ConclusionFor women with significant depressive symptoms, it appears essential to integrate interventions aimed at reducing their level of stigma. Moreover, from a preventive perspective, it also seems essential to promote campaigns in France aimed at reducing the stigmatization in this population.     

Experiences of HIV-related discrimination and consequences for internalised stigma,depression and alcohol use

Objective: HIV stigma undermines health and well-being of people living with HIV (PLWH). Conceptual work on stigma mechanisms suggests that experiences of stigma or discrimination increase internalised stigma. However, not all PLWH may internalise the HIV discrimination they experience. We aimed to investigate the role of stress associated with events of HIV-related discrimination on internalised HIV stigma, as well as the downstream effects on depressive symptoms and alcohol use severity.

Design: 199 participants were recruited from an HIV clinic in the southeastern United States.

Main study measures: HIV-related discrimination was assessed using items adapted from measures of enacted HIV stigma and discrimination. Participants rated perceived stress associated with each discrimination item. Internalised HIV stigma was assessed using the internalised stigma subscale of the HIV Stigma Mechanisms Scale. Depressive symptoms were assessed with the Centre for Epidemiological Studies-Depression Index. Alcohol use severity was assessed with the Alcohol Use Disorders Identification Test.

Results: In serial mediation models, HIV-related discrimination was indirectly associated with both depressive symptoms and alcohol use severity through its associations with stress and internalised HIV stigma.

Conclusions: Understanding the mechanisms through which PLWH internalise HIV stigma and lead to poor health outcomes can yield clinical foci for intervention.     

Stigma, obesity, and the health of the nation's children

Preventing childhood obesity has become a top priority in efforts to improve our nation's public health. Although much research is needed to address this health crisis, it is important to approach childhood obesity with an understanding of the social stigma that obese youths face, which is pervasive and can have serious consequences for emotional and physical health. This report reviews existing research on weight stigma in children and adolescents, with attention to the nature and extent of weight bias toward obese youths and to the primary sources of stigma in their lives, including peers, educators, and parents. The authors also examine the literature on psychosocial and physical health consequences of childhood obesity to illustrate the role that weight stigma may play in mediating negative health outcomes. The authors then review stigma-reduction efforts that have been tested to improve attitudes toward obese children, and they highlight complex questions about the role of weight bias in childhood obesity prevention. With these literatures assembled, areas of research are outlined to guide efforts on weight stigma in youths, with an emphasis on the importance of studying the effect of weight stigma on physical health outcomes and identifying effective interventions to improve attitudes.     

Therapeutische Teams: Theorie—Empirie—Klinik (Therapeutic Teams: Theory—Research—Clinic)

Abstract

Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally led treatment to address this issue. In this article, we discuss our development of a new group-based approach to the treatment of internalized stigma which we have termed “narrative enhancement and cognitive therapy (NECT)”. We describe the treatment approach and offer an illustration of it by way of a case vignette.     

Do behavioural self-blame and stigma predict positive health changes in survivors of lung or head and neck cancers?

Survivors of lung or head and neck cancers often change tobacco and alcohol consumption after diagnosis, but few studies have examined other positive health changes (PHCs) or their determinants in these groups. The present study aims to: (a) document PHCs in survivors of lung (n?=?107) or head and neck cancers (n?=?99) and (b) examine behavioural self-blame and stigma as determinants of PHCs. We hypothesised that: (a) survivors would make a variety of PHCs; (b) behavioural self-blame for the disease would positively predict making PHCs; and (c) stigma would negatively predict making PHCs.

Methods: Respondents self-administered measures of PHC, behavioural self-blame, and stigma. Hierarchical multiple regression analysis tested the hypotheses.

Results: More than 65% of respondents reported making PHCs, the most common being changes in diet (25%), exercise (23%) and tobacco consumption (16.5%). Behavioural self-blame significantly predicted PHCs but stigma did not. However, both behavioural self-blame and stigma significantly predicted changes in tobacco consumption.

Conclusions: Many survivors of lung or head and neck cancers engage in PHCs, but those who do not attribute the disease to their behaviour are less likely to do so. Attention to this problem and additional counselling may help people to adopt PHCs.     

Weight-based discrimination,body dissatisfaction and emotional eating: The role of perceived social consensus

Objective: Discrimination can have a negative impact on psychological well-being, attitudes and behaviour. This research evaluates the impact of experiences of weight-based discrimination upon emotional eating and body dissatisfaction, and also explores whether people's beliefs about an ingroup's social consensus concerning how favourably overweight people are regarded can moderate the relationship between experiences of discrimination and negative eating and weight-related cognitions and behaviours.

Research methods and procedures: 197 undergraduate students completed measures about their experiences of weight-based discrimination, emotional eating and body dissatisfaction. Participants also reported their beliefs concerning an ingroup's attitude towards overweight people.

Results: Recollections of weight-based discrimination significantly contributed to emotional eating and body dissatisfaction. However, the relationships between experiencing discrimination and body dissatisfaction and emotional eating were weakest amongst participants who believed that the ingroup held a positive attitude towards overweight people.

Discussion: Beliefs about ingroup social consensus concerning overweight people can influence the relationships between weight-based discrimination and emotional eating and body dissatisfaction. Changing group perceptions to perceive it to be unacceptable to discriminate against overweight people may help to protect victims of discrimination against the negative consequences of weight-based stigma.     

Recognition,Respect and Athletic Excellence

ABSTRACT

Scholars across disciplines recognize sport as an institution perpetuating sexism and bias against women in light of its masculine ideals. However, little philosophical research identifies how a masculine environment impacts women’s possibilities in sport. This paper shows that socially structured masculine ideals of athletic excellence impact recognition of women’s athletic achievements while contributing to contexts endangering respect and self-respect. Exploring athletic disrespect reveals connections to more broadly harmful sport practices that include physical and sexual violence. Thus, the practical concern is that sport’s masculine ideals might undermine women’s pursuit of athletic excellence in more harmful ways than previously recognized.     

1995 Coleman Roberts Griffith address: Profiles of excellence

Abstract

Historically circumstances that represent an extreme of the human condition attract the attention of those who record contemporary events. Perhaps one of the strongest influences on retrospectives is the achievement of excellence. Excellence is admired and hated, sought and avoided, and in a true sense rarely achieved. Excellence requires performing at the outer limit of physical, emotional and mental capacities. And even then for some this level of effort expenditure may not be enough to produce excellence. While many rationalize excellence as purely endowed or distort the concept with self-serving labels, Shin'chi Suzuki's work on developing excellence with “common” people demonstrates the various elements necessary for the opportunity to achieve excellence. Suzuki's work will be reviewed along with the profiles of selected world achievers. The prerequisites for the pursuit of excellence will be formulated and suggested along with a discussion of how the demands of achieving excellence often exceed the will to excel.     

Topless dancers: Managing stigma in a deviant occupation

This paper describes and analyzes how topless dancers manage the stigma related to their deviant occupation. It represents approximately nine months of limited participant observation and ethnographic interviewing at seven topless bars in a major metropolitan city in the Southwest with a population of approximately 1 million people. A structured interview schedule was utilized to obtain data from over 40 topless dancers in six different clubs. In addition, free‐flowing interviews were conducted with at least 20 other dancers, numerous waitresses in the clubs, one club manager, two assistant managers, and four former dancers still associated with the clubs (as bartenders, waitresses, or admission takers). This study indicates that two of the most common stigma management techniques used by topless dancers are dividing the social world as outlined by Goffman (1963) and techniques of neutralization described by Sykes and Matza (1957), especially denial of injury, condemnation of the condemners, and appeal to higher loyalties. Dancers further rationalize their participation in a deviant occupation on the basis that it is harmless, temporary, fun, good exercise, and easy money. Suggestions are made for future research on topless and nude dancing and stigma management.     

Evidence for blatant dehumanization of mental illness and its relation to stigma

ABSTRACT

People with mental illness face stigma, and due to their low social status, they may also face blatant dehumanization that denies their status as fully evolved human beings. In the current research, three studies documented the existence of blatant dehumanization of mental illness. Study 1 (N = 112) showed that participants rated people with mental illness in general as being significantly less human than other dehumanized social groups such as Mexican immigrants and Muslims. Study 2 (N = 158) showed that dehumanization occurs for specific mental disorders but that the level of dehumanization varies widely among disorders. Study 3 (N = 223) documented significant correlations between dehumanization of mental illness and standard measures of stigma such as fear, pity, and social distance. Overall, the results establish the relevance of blatant dehumanization to mental illness stigma and suggest new directions for understanding stigma.     

Education for democracy

Abstract

This article takes it cue from John Dewey and his views on the interrelationship between democracy and education. The basic premise is that education and democracy are inextricably linked and that in a free society the link is severed only at our peril. Education must be both public and democratic if we wish to preserve our democracy’s public spaces. We should resist calls for ‘excellence’ if this means educating only ‘the best’ and excluding those most likely to fail. On the other hand, we should likewise resist the tendency to jettison excellence (or just plain competence) in the name of educational equality.     

Ethnicity,Life Satisfaction,Stress, Familiarity,and Stigma Toward Mental Health Treatment

The authors examined the relative contribution of ethnicity, life satisfaction, level of stress, familiarity with mental health treatment, and self- and public stigma on attitudes toward mental health treatment among a diverse sample (N = 632) of adults. Results indicated that ethnicity, stress, familiarity, and self-stigma of mental illness were significant predictors of attitudes. Additionally, familiarity with mental health treatment moderated the relationship between public stigma and attitude.     

Experiences with stigmatization among transgender individuals after transition: A qualitative study in the Netherlands

Abstract

Background: Transgender individuals belong to one of the most stigmatized groups in society. Although the social stigma of transgender individuals has been examined many times, post transition stigma experiences among transgender individuals have received limited research attention. The aim of this study was to examine experiences with stigmatization among Dutch transgender individuals after their transition.

Method: Ten trans women (age: M?=?58.50, SD?=?9.49) and 10 trans men (age: M?=?42.90, SD?=?13.62) participated in face-to-face semistructured interviews. Grounded theory was used to conceptualize and analyze the data. We examined the positive and negative reactions that transgender individuals experienced in the period after their transition. Furthermore, we explored differences between experiences of trans men and trans women. Finally, we examined differences between cisgender men and women regarding their reactions toward transgender individuals.

Results: Participants reported improved psychological well-being since transition. However, they still experienced different forms of stigmatization. Trans women appeared to experience stronger social stigma than trans men. Trans women also experienced lower social status after their transition. They mainly experienced negative responses from cisgender men. Participants emphasized the importance of social and peer support.

Conclusion: The current study findings demonstrate the presence of stigmatization after transition and argue for psychological aftercare. Social and peer support appeared to be important for coping with stigmatization, and improving the social network of transgender individuals is beneficial. Health providers and researchers are recommended to promote the development of constructive coping skills for transgender individuals with interventions especially targeting trans women.     

Internalised HIV-stigma,loneliness, depressive symptoms and sleep quality in people living with HIV

Objective: People living with HIV (PLWH) commonly report sleep disturbances which are associated with long-term health consequences, including disease progression. PLWH also experience internalised stigma as a result of their HIV status, which can be associated with increased loneliness and depression. Little attention focuses on the impact of these factors on sleep. Therefore, we examined whether internalised HIV-stigma was indirectly related to poorer sleep quality through higher levels of loneliness and depressive symptoms.

Design: 181 PLWH from across the United States completed an online survey.

Main Study Measures: Internalised HIV-stigma was assessed using the HIV-Stigma Scale, loneliness was assessed using the UCLA-Loneliness Scale-Short Form, depressive symptoms were assessed with the Center for Epidemiologic Studies–Depression Index, and Sleep Quality was assessed using the Pittsburgh Sleep Quality Index.

Results: Internalised HIV-stigma was indirectly associated with poorer global sleep quality and daytime sleep dysfunction through both loneliness and depressive symptoms.

Conclusions: PLWH who experience HIV-related stigma may experience greater feelings of loneliness, which are related to increased depressive symptoms and poorer sleep quality. Interventions focused on improving sleep in PLWH should focus on multiple factors that influence sleep, including psychosocial factors such as stigma, social isolation and depressive symptoms.