Stigma

Summary

Stigma is a mark of social disgrace that reduces a person from full social standing to a tainted, lesser status in the eyes of others. The word comes from ancient Greek practice: slaves and criminals had signs cut or burned into their skin to warn people away. Sociologist Erving Goffman, writing in 1963, transformed the concept into an analytical tool for social science. He showed that stigma is not a fixed property of a person but a gap between who others expect you to be and who they discover you actually are. People manage this gap in two main ways: those whose difference is visible must handle the tension it creates in social encounters; those whose difference is hidden must manage information, deciding constantly whether to disclose, conceal, or selectively reveal. Stigma shapes healthcare experiences profoundly, from the avoidance of mental health diagnoses in cultures where such labels shame entire families, to the way medical institutions can worsen chronic illness through stigmatizing practices.

Origins and Definition

The word “stigma” reached the modern world from ancient Greece, where it referred to a bodily sign cut or burned into the skin to advertise that its bearer was a slave, a criminal, or a traitor — a person ritually polluted and to be avoided, especially in public.(Goffman, Erving, 1963) Over time the term shifted: the disgrace itself, not its bodily evidence, became what stigma named, and it came to be applied broadly to any attribute that deeply discredits a person in the view of others.(Goffman, Erving, 1963)

The classical sociological treatment of stigma is Erving Goffman’s 1963 monograph Stigma: Notes on the Management of Spoiled Identity. By the time Goffman wrote, social psychology had already built more than a decade of substantial work on stigma — on the situation of the individual who is disqualified from full social acceptance — and clinical studies had extended the framework to ever new categories of persons.(Goffman, Erving, 1963) Goffman, a Canadian-American sociologist who made his reputation studying the microscopic structure of social interaction, aimed to extract what earlier social psychology and clinical literature had produced about stigma and organize it within a single conceptual scheme — and to clarify the relationship between stigma and deviance more broadly.(Goffman, Erving, 1963) His key methodological move was to treat stigma as a problem of social information: the information the individual directly conveys about himself through his bodily presence in the immediate company of others.(Goffman, Erving, 1963)

Goffman’s definition rests on a distinction between virtual social identity — the attributes others anticipate and expect an individual to possess — and actual social identity — the attributes he can in fact be demonstrated to have. Stigma is constituted by a discrepancy between these two: the discovery of a disqualifying attribute reduces the individual from a whole and usual person to a tainted, discounted one in the minds of those who encounter him.(Goffman, Erving, 1963) The attribute is not inherently stigmatizing; it becomes so only in relation to the norm against which it is measured.

The Three Types

Goffman identified three broad categories of stigma, which differ in their sources but share the property of producing this discrediting discrepancy.(Goffman, Erving, 1963)

Abominations of the body are the various physical deformities — disfigurements, disabilities, and visible departures from bodily norms that others take to signal something wrong about the person’s worth or status.

Blemishes of individual character are stigmas inferred from a known record of, for example, mental disorder, addiction, imprisonment, alcoholism, homosexuality, unemployment, suicidal attempts, or radical political behavior. These are attributed as evidence of weak will, unnatural passions, treacherous beliefs, or dishonesty — moral failures read back from history into character.

Tribal stigma refers to the stigma of race, nation, and religion — attributes transmitted through lineages that contaminate all family members equally, making the stigma hereditary rather than individual.(Goffman, Erving, 1963)

What these three types share is a common social mechanism: the “stigma theory” that normals construct around the stigmatized person’s attributed inferiority. Normals use the original discrediting attribute to impute a wide range of additional imperfections to the stigmatized person, and sometimes also to attribute curious or undesired supernatural qualities — a “sixth sense,” special understanding, or compensatory gifts — thereby transforming a specific failing into a total identity.(Goffman, Erving, 1963)

Virtual and Actual Social Identity

The distinction between virtual and actual social identity is the theoretical engine of Goffman’s framework. When someone enters a social setting, others immediately begin to impute a social identity to them — anticipating, on the basis of appearance and initial information, what category of person they are dealing with and what attributes they must therefore possess. These anticipations harden quickly into normative expectations. When it is subsequently discovered that the person possesses an attribute that departs from these expectations in a discrediting direction, the encounter is retroactively spoiled.

Central to this process is the observation that stigmatized people typically hold the same identity beliefs as the wider society. The stigmatized person usually sees himself as a normal human being deserving fair treatment, yet perceives — generally correctly — that others do not accept him on equal grounds. Because he has internalized the same standards as everyone else, he is intimately alive to what others see as his failing, and this awareness produces what Goffman called shame: the central psychological possibility of the stigmatized situation, arising from the person’s perception of one of his own attributes as a defiling thing to possess.(Goffman, Erving, 1963)

The normal, by contrast, constructs an ideology to explain the stigmatized person’s inferiority — a set of stigma terms (cripple, moron, bastard) that circulate in ordinary speech as sources of imagery and metaphor, usually without conscious reference to their original function as tools of exclusion.(Goffman, Erving, 1963)

The concept of courtesy stigma extends the analysis: stigma tends to spread from the stigmatized individual to those associated with him. The loyal spouse of the mental patient, the parent of the disabled child, the friend of the ex-convict — all risk being treated as partly discredited by association. This tendency explains why close relationships with stigmatized persons are frequently avoided or terminated.(Goffman, Erving, 1963)

Information Management: Passing and Covering

The most practically significant distinction in Goffman’s framework separates the discredited person — one whose stigma is known or apparent in any given encounter — from the discreditable person — one whose stigma is neither known nor immediately perceivable. These two situations generate different management problems. The discredited person faces a problem of managing the tension produced by a known imperfection; the discreditable person faces a problem of managing information, deciding constantly whether to display or conceal, to tell or not to tell, to lie or not to lie — and in each case, to whom, how, when, and where.(Goffman, Erving, 1963) When stigmatized and normal individuals do meet face to face and attempt to sustain a joint encounter, the stigmatized person may feel unsure of how normals will identify and receive him — uncertain whether perceived attributes will be taken as defects, curiosities, or as nothing at all.(Goffman, Erving, 1963)

Goffman distinguished several dimensions of visibility relevant to this management problem. The visibility of a stigma (how readily it is perceived by others in an encounter) must be separated analytically from its known-about-ness (whether others already have prior knowledge about it from other sources), from its obtrusiveness (how much it disrupts the flow of interaction once perceived), and from its perceived focus (which specific life domains it is felt to impair).(Goffman, Erving, 1963) The “social information” at stake in these encounters has a specific character: it concerns the individual’s enduring attributes — not moods or passing states — and is reflexive and embodied, conveyed by the very person it concerns through bodily expression in immediate presence.(Goffman, Erving, 1963)

Passing refers to the strategy of managing undisclosed discrediting information by not revealing it — presenting a normal identity to others while concealing the attribute. Goffman described a natural cycle of passing, moving from unwitting passing (where others do not notice and the passer himself may be unaware), through passing in non-routine contexts such as travel, through passing in routine daily life, to complete “disappearance” — total passing in all areas of life, with the secret known only to the passer.(Goffman, Erving, 1963)

Passing carries substantial social costs. The passer is subject to in-deeper-ism: pressures to elaborate and maintain an increasingly complex concealment, elaborating lies to prevent any single disclosure from unraveling the whole. He may become subject to blackmail by those who know his secret. He is cut off from ordinary social ease, becoming a heightened scanner of situations — hyperaware of dangers and contingencies that normals move through without thought.(Goffman, Erving, 1963)(Goffman, Erving, 1963) Those who pass must also manage their spatial world carefully, often “living on a leash” — never straying too far from the places where they can maintain or repair their concealment.(Goffman, Erving, 1963) The spatial world of the person with a secret stigma divides into three kinds of places: “forbidden” places where exposure means expulsion, “civil” places where the stigma is treated with careful disattention, and “back” places where the stigma is freely acknowledged among those who share the condition or who know.(Goffman, Erving, 1963)

Close relationships create particular difficulties: intimacy demands disclosure of private facts precisely to those from whom concealment is often most urgently sought.(Goffman, Erving, 1963)

Stigma symbols and disidentifiers operate within this management problem. Goffman distinguished between prestige symbols (signs conveying honorable social position), stigma symbols (signs that draw effective attention to a debasing identity discrepancy), and disidentifiers (signs that cast doubt on a negative virtual identity by pointing in a positive direction).(Goffman, Erving, 1963) Underlying these symbol types is the concept of personal identity — not psychological selfhood but the unique combination of biographical facts attached to an individual through identity pegs (positive distinguishing marks), which accumulate like “candy floss” into a sticky substance of biographical material that can be used to identify and track a person across social situations.(Goffman, Erving, 1963) Documented biographical facts — employment records, hospital discharge stamps on insurance cards, gaps in work history — also constrain the available strategies: one cannot pass where the record speaks first.(Goffman, Erving, 1963)

In addition to passing and covering, some stigmatized persons make a more direct attempt to eliminate the objective basis of their failing — through plastic surgery, medical treatment, remedial education, or psychotherapy. Whether the method is a genuine practical technique or something that amounts to fraud, the often-secret quest demonstrates the extremes to which the stigmatized can be driven by the painfulness of their situation.(Goffman, Erving, 1963)

Covering is a more modest strategy than passing: not concealing the stigma but reducing its obtrusiveness in mixed encounters, minimizing the extent to which it dominates the interaction. It is what most stigmatized people practice most of the time.(Goffman, Erving, 1963) Goffman identified two poles warned against in professional advice to the stigmatized: minstrelization (ingratiatingly acting out the negative attributes imputed to one’s kind before normals) and normification (careful covering that presents ideal normalcy while denying any real difference at all).(Goffman, Erving, 1963)

The Moral Career

The moral career is the sequence of social learning experiences through which stigmatized individuals come to understand both the broader norms against which they are measured and their own personal position as someone who falls short of those norms.(Goffman, Erving, 1963) The concept captures the way that stigma is not simply inflicted from outside but is internalized through a patterned developmental process that changes the person’s self-conception.

Goffman identified four distinct patterns depending on when stigma-relevant socialization occurs.(Goffman, Erving, 1963) Those born with stigmatizing conditions learn what it would mean to be normal at the same time as they learn they are not normal — acquiring the standards against which they fall short while simultaneously being measured against them. Those who develop normally but are sheltered within a protective family capsule may not encounter the standards’ full force until school entry, when the wider world’s norms impinge for the first time. Those who acquire stigma late in life — through accident, illness, or changed circumstances — must rebuild a self-concept around an attribute that contradicts their prior normal biography. And those who are initially socialized within an alien community (an ethnic enclave, a deviant subculture) and then must learn a dominant second identity face the deepest form of identity contradiction.

The moral career also shapes the stigmatized person’s relation to organized community. Stigmatized individuals who form advocacy organizations develop publications, political platforms, and professional spokespeople — but representatives are rarely genuinely representative of the full range of people who share the stigma.(Goffman, Erving, 1963) The professional adviser — whether aligned with in-group militancy (political, separatist, identity-affirming) or with out-group adjustment ideology (psychiatric, normalizing, maturity-emphasizing) — shapes the moral career in ways that serve institutional as much as individual interests.(Goffman, Erving, 1963)(Goffman, Erving, 1963)

Underlying the moral career is a tripartite model of identity that Goffman drew partly from Erikson. Social identity and personal identity are both functions of how others define and record the individual. Ego identity, by contrast — the subjective sense of one’s own situation, continuity, and character arising from social experience — is a reflexive matter felt by the individual himself, not a social product imposed from outside.(Goffman, Erving, 1963)

Stigmatized individuals also exhibit characteristic identity ambivalence toward others who share their condition: those who are less visibly stigmatized tend to adopt toward the more visibly stigmatized the same distancing attitudes that normals adopt toward themselves, stratifying their own kind by degree of apparent stigma.(Goffman, Erving, 1963) The person can neither comfortably embrace his group nor fully let it go.(Goffman, Erving, 1963) In-group professional advocates often frame the stigmatized person’s “real” group as fellow-sufferers, structurally encouraging a militant or separatist identity politics; yet such separatism risks reproducing the dominant culture’s values precisely because there is no independent cultural base from which to resist them — the more the stigmatized person separates structurally from normals, the more he may become like them culturally.(Goffman, Erving, 1963)

Stigma in Medicine

Mental Illness

The medical domain where stigma has been most extensively analyzed is mental illness. The stigma of psychiatric diagnosis is not merely social embarrassment; in many cultural contexts it carries severe structural consequences. Kleinman’s work on neurasthenia in China documented that mental illness stigma in Chinese culture affects not only the diagnosed person but the entire family, which is regarded as carrying a hereditary taint of moral failure and constitutional vulnerability — a stigma with implications for marriage, employment, and social standing across generations.(Kleinman, 1988) This family contamination is analogous to Goffman’s courtesy stigma but operates with greater institutionalized force, giving patients powerful reasons to accept somatic illness labels (neurasthenia, weakness, exhaustion) rather than psychiatric ones that would trigger the family-level consequences.(Kleinman, 1988)

The symbolic loading that certain diagnoses carry in a given culture is variable and historically produced. Kleinman observed that in late twentieth-century America, cancer carried a culturally powerful stigma — symbolizing not only mortal danger but the failure of technological control, the unpredictability of the human condition, and feared contamination from invisible environmental pollutants.(Kleinman, 1988) Similar symbolic burdens have attached to tuberculosis, leprosy, epilepsy, and HIV/AIDS in their respective historical moments.

Healthcare institutions can themselves perpetuate and intensify stigma. Kleinman argued that medical organizations frequently exacerbate chronicity through double-bind dynamics and stigmatizing practices that alienate patients from care precisely when they most need it.(Kleinman, 1988) The clinical encounter becomes a site where stigmatized illness attributes are confirmed rather than challenged — where the patient’s narrative of suffering is recoded in diagnostic language that strips away the meaning while adding a new identity burden.

The Sick Role and Medicalization

Illich’s critique of medicalization intersects with the analysis of stigma in a specific way: social iatrogenesis operates, in part, by labeling those who suffer, grieve, or heal outside the patient role as deviant.(Illich, 1975) When medicine establishes the patient role as the only legitimate mode of suffering, those who resist it — through self-care, alternative healing, or simply stoic endurance — are marked as non-compliant, irrational, or dangerous to public health. The expansion of diagnostic categories creates new stigmas while simultaneously promising to relieve them, since every newly medicalized condition produces a new population of “sick” persons distinguishable from the normal majority.(Illich, 1975)

Illich observed that the medicalization process “breeds ever new categories of patients” — labeling the handicapped as unfit and disqualifying people angered by industrial conditions from political struggle by recasting their situation as a medical rather than social problem.(Illich, 1975) From this vantage point, the production of medical stigma serves a social control function: it manages populations by directing discontent and suffering toward therapeutic rather than political remedies.

Stigma as a General Social Process

One of Goffman’s most important theoretical moves was to insist that stigma is not the exceptional situation of exotic marginal persons but a general feature of social life.(Goffman, Erving, 1963) Because virtually every person falls short of the full composite of desirable attributes that society holds up as normal — Goffman famously sketched this composite as “a young, married, white, urban, northern, heterosexual Protestant father of college education, fully employed, of good complexion, weight, and height, and a recent record in sports” — virtually everyone has some potential stigmatizing attribute, actual or concealed.(Goffman, Erving, 1963)

This leads to the claim that “normal” and “stigmatized” are not fixed categories of persons but perspectives — roles generated in social situations during mixed contacts by virtue of unrealized norms that play upon the encounter. Stigma management, therefore, is a general feature of society, a process occurring wherever there are identity norms.(Goffman, Erving, 1963) Goffman pressed this insight further: stigma itself involves not a fixed division of persons into two piles but a pervasive two-role social process in which every individual participates in both roles — in some connections and some phases of life — confirming that the normal and the stigmatized are perspectives, not persons.(Goffman, Erving, 1963) The stigmatized and the normal share the same mental equipment; experimental evidence — subjects who temporarily assumed disabilities spontaneously began exhibiting characteristic stigmatized behaviors — illustrates the depth of this shared structure.(Goffman, Erving, 1963)

The historical character of stigma follows from its relational nature: when attributes lose their force as stigmas (Goffman cited divorce and Irish ethnicity as examples), a process unfolds whereby the former definition is first challenged in comedy, then in mixed public encounters, until it ceases to control what may be attended to and what must be concealed.(Goffman, Erving, 1963)

Sources of Social Support

Against the pressures of stigma, Goffman identified two principal sources of support for the stigmatized person. The first is “the own” — those who share the stigma and who can provide instruction in managing it, a circle of acceptance and moral support, and the comfort of being treated as a fully normal person rather than a reduced one.(Goffman, Erving, 1963) The second is “the wise” — people who are normatively “normal” but whose particular situation has made them intimately acquainted with the life of the stigmatized and sympathetic to it, and who are therefore accorded a kind of courtesy membership in the stigmatized community.(Goffman, Erving, 1963) Both figures point toward the social ecology of stigma: the individual does not manage stigma alone but within a network of others whose knowledge and attitudes shape the conditions of possibility.

Contemporary Significance

Goffman’s framework drew together work from social problems, race and ethnic relations, criminology, and social pathology to show that all these fields share a common underlying structure — and that this structure could be extracted and analyzed with a small set of assumptions about human nature.(Goffman, Erving, 1963) The practical yield of this synthesis is considerable: it provided a shared vocabulary for analyzing the situations of physically disabled persons, psychiatric patients, ex-prisoners, ethnic minorities, the poor, and anyone else whose identity is routinely discounted. In-group deviants, social deviants, minority members, and lower-class persons all encounter the stigmatized person’s characteristic situation in face-to-face dealings with service organizations — where courteous uniform treatment is formally expected but where concern about invidious valuations based on a virtual middle-class ideal persistently arises.(Goffman, Erving, 1963)

In public health, the consequences of stigma have been documented most extensively in mental health and infectious disease. Stigma reduces help-seeking, increases diagnostic avoidance, creates barriers to treatment adherence, and in contexts where stigma affects the family as a whole, may make individuals actively prefer somatic to psychiatric diagnoses even at the cost of appropriate treatment.(Kleinman, 1988) The dynamic Goffman called “passing” — concealing a stigmatized health condition to protect social position — remains a central mechanism of health disparities, since it delays diagnosis and care.

The analytical scope of stigma also extends to what Goffman identified as the “constantly precarious” and “occasionally precarious” — showing that occasional vulnerability to stigmatization is the common condition, not the exception.(Goffman, Erving, 1963) This positions stigma as a structural feature of any society organized around identity norms, not a pathology of particular groups, and demands attention to the institutional and normative conditions that generate it.

See Also

• medicalization
• deviance
• chronic-illness
• mental-illness
• disability
• social-identity
• moral-career
• sick-role
• total-institution
• medical-authority

Sources