STIGMA — Take a moment to think about that word. What does it mean to you? What does stigma look like?
To me, stigma happens when others devalue a person or a group of people based on a characteristic (e.g., trait, disease, behavior, etc.). According to the Oxford Dictionary, it is defined as a “mark of disgrace associated with a particular circumstance, quality, or person.” The word dates back to the 16th century when it referred to a mark made by pricking or branding.
Upon reflecting on the word stigma, I immediately think of a favorite classic book of mine, The Scarlet Letter. If you recall, the woman in the book (Hester) has to wear an “A” on her chest for committing adultery. She is shamed, shunned by the community, and isolates herself in a small cottage on the outskirts of town. The resemblance between Hester and LGBTQ individuals is uncanny. If an LGBTQ individual is open about their sexual orientation and/or gender identity, they are in essence wearing an “A” on their chest, a “Rainbow” letter.
It goes without arguing that LGBTQ individuals are stigmatized across the entire globe (some places obviously worse than others are). The consequences of stigma are atrocious in some parts of the world. Some countries sentence LGBTQ people to death, while others do not protect (and often promote) LGBTQ individuals from being attacked, humiliated, or discriminated against. Industrialized countries are not immune to this issue. There are still many areas in the U.S. where LGBTQ individuals are attacked and/or discriminated against. In fact, many laws and policies still discriminate against LGBTQ individuals and same-sex couples. These are the consequences of stigma surrounding LGBTQ – the consequences of wearing the Rainbow Letter. They are being stigmatized based simply on a trait/characteristic.
In The Scarlet Letter book, Hester had to isolate herself because the community shamed her. Reflect on the similarities between Hester and LGBTQ individuals. Imagine wearing your Rainbow Letter in an overly conservative area of the country, or in a homophobic household, or in an unsafe work environment. Just like Hester, LGBTQ individuals will often try to hide their sexual orientation and/or gender identity to avoid being shamed or they will isolate themselves. If their Rainbow Letter is showing, they risk being rejected by family and friends, being attacked, or being discriminated against. Other consequences include the inability to access high quality health care, income inequalities and employment discrimination, poor mental health and unhealthy behaviors, and psychological distress.
Of course, stigma is not the only cause of the consequences I just described; however, it is a major contributing factor for LGBTQ individuals. How should our society address stigma around LGBTQ? Rainbow Letters are here to stay and thus we need to focus on reducing stigma and reducing the effects of stigma. Our society has made tremendous strides in reducing stigma through advocacy, policy changes, more visibility of LGBTQ people in the media, etc. A compilation of all the work that has been done across society (e.g., communities, professions, schools, organizations, etc.) is responsible for the reduction in stigma around and acceptance of LGBTQ individuals.
Although a lot of great work is still being done to reduce stigma, it will remain in our society. Thus, we cannot forget to design solutions to reduce the effects of stigma. Examples include programming offered at LGBTQ centers, Gay Straight Alliances in the school system, and the “It Gets Better Project.” We need to continue to promote these types of programs, especially to youth and other individuals who are at risk because they proudly wear their Rainbow Letter.
As an emerging researcher, I constantly remind myself that it is stigma that has resulted in the health and health care disparities among LGBTQ individuals. Being gay does not inherently put me at risk; it is the stigma society has put on my sexual orientation. It affects every area of an LGBTQ person’s life. It is now up to everyone to reduce the stigma and to reduce the effects of stigma.
I’m struck by the ways in which stigma evokes in the stigmatized person a sense of shame, which is an obstacle to wellness in that it often prevents us from seeking health interventions.
Thomas, I absolutely agree. That is why programs and interventions to reduce the effects of stigma are so important. Although it is a complex phenomenon, I think there is an “anticipatory” component to shame. Once a person been shamed in a health care setting, s/he may change their health care seeking behaviors because of the anticipation of being shamed again. I am trying to publish a manuscript of a qualitative study I recently conducted that showed exactly that (although I did not refer to this as “shame” or “stigma” in my paper).