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Musings on Community and Stigma

by Fall Ferguson, JD, MA

For the second year in a row, I have been asked to submit a blog post that will appear during the week of Christmas. In last year’s post, I dared to be fat and “not-jolly.” The holidays had hit me with a dull thud and left a bitter flavor in my eggnog. This year, though, I am feeling a bit more positive. I am consciously making time and space to connect with family and friends over the next couple of weeks.

Sparked by some recent reading in the health literature about the links between health and social capital, I’ve been reflecting on how fluid and tenuous our connections can be. Our communities sustain us, but we also must work to sustain them. Our individual health depends upon the health of our communities, and vice versa. Martin Luther King Jr. said:

“We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.”

When we think about nurturing our sense of connection, let’s think expansively. Yes, we need friends and family, but also we need our connections with all the supportive networks and communities in our lives. In a 1993 column in the Healthcare Forum Journal, Emily Friedman suggested that even in our “society of nomads,” we create many types of communities—“clumps we form with each other.” These include communities of location, experience, interest, values, age, and time. We need these communities to feel whole.

grinch heart

Indeed, this is a time of year when we ritually remind ourselves of this fact of our existence. The Zeitgeist of the “holiday season” is replete with parables about the importance of finding or reinstating connection with others. Even Dr. Seuss reminded us how important it is to connect: “And what happened then? Well, in Whoville they say that the Grinch’s heart grew three sizes that day!”

Unfortunately, there are many who do not have access to community or social bonds. In particular, I want to talk about those for whom stigma has forged the walls of isolation from community. The process of stigmatization is, in a very basic sense, the production of the “other.” According to an article by Bruce G. Link and Jo C. Phelan in The Lancet entitled “Stigma and Public Health”, there are three forms of discrimination that are part of the process of creating stigma. The first two are familiar: (1) direct, intentional discriminatory treatment and (2) structural bias that happens on the systemic level. To the extent that someone is either intentionally excluded or systemically excluded, it is easy to understand how stigma poses a barrier to community and connection.

But it’s Link and Phelan’s third form of discrimination that I want to focus on: (3) the subtle and “insidious form of discrimination” that happens due to awkward encounters and heightened sensitivities, based on our own perceptions of how we are perceived by others. We banish ourselves from opportunities for connection because we read social cues telling us we are not welcome; we take ourselves out of the community (or never enter) because it’s just too hard, too awkward, too painful to stay. We go, even before someone “makes” us leave. There are far-reaching consequences, as Link and Phelan point out:

“The result may be strained and uncomfortable social interactions, more constricted social networks, a compromised quality of life, low self-esteem, depressive symptoms, unemployment, and loss of income.”

I’m betting that this third type of discrimination is frequently overlooked in its effects on health. Many think of it as the “fault” of the stigmatized individual or group. One can almost picture the shoulder shrugs and furrowed brows: “Geez, what’s her problem?” “No one said he had to leave.”

Many of us conceive of “stigma” as affecting health in a fairly abstract way, even those of us who have been stigmatized. I have read statements such as this from Link and Phelan: “people with greater resources of knowledge, money, power, prestige, and social connections are generally better able to avoid risks and to adopt protective strategies.” I have considered how stigma damages health via the destructive, long-term effects of the stress response. But there is another more immediate and very destructive mechanism going on here that I want to bring out.

Not too long ago, I came close to leaving a particular community because of a size bully. For a time, I felt shamed and hopeless in a way that seeped into every corner and crevice of my life. Unlike in the movies, the story neither has a “feel-good” ending nor ends in tragedy. Another community member figured out what was happening and supported me, which made a big difference. The bully is still there, but so am I, and it’s not great, but it’s workable for now. And, I (most of the time) am able to remember that it’s her problem, not mine.

I do not claim this experience as unique or special. It’s all too common. And I don’t tell this personal story because I want sympathy or cheerleading. Rather, I wish to illustrate some particular, concrete effects of stigma that don’t get talked about enough:

  • Stigma includes a visceral experience of trauma that lives in our bodies and can paralyze our capacity for connection with others. The experience of being bullied by a peer as a middle-aged woman triggered me to re-experience the shame and the “freeze” reaction that I remember from being bullied as a child.
  • Stigma, even when perpetrated in one community, feels global. I felt depressed and gloomy about life in general while my situation was playing out, and it permeated every aspect of my life.
  • Stigma can cut through other privileges like a knife. In general, I consider that I benefit from a number of privileges when it comes to connection and social capital. For example, I am white and straight, with supportive friends and family. I am a university professor. As a former attorney, I litigated discrimination cases. I have several communities of interest and experience to which I belong. And yet, my powerful first instinct was to retreat, to sever connections, to voluntarily withdraw from a community that I consider important in my life – all because of one bully.

When we talk about the importance of connection in a HAES® context, we need to remember that this is more than an idea. This is a concrete experience. And similarly, the health ramifications of stigma are not distant and abstract, but immediate and concrete. What’s more, researchers have finally begun to recognize what untold numbers have lived: the significance of intersectionality as it relates to stigma. As Link and Phelan note,

“If all stigmatised conditions were considered together and all outcomes examined we believe that stigma would be shown to have an enormous impact on people’s lives.”

We need to understand that multiple, disparate experiences of stigma may dramatically increase an individual’s sense of isolation and exacerbate a lack of access to community.

So, there you have it, another cheery holiday post. The good news is that building community is possible. Examining our consciences and our behaviors for the sources of stigma is possible. As a health educator, I understand that facilitating community and empowering people to make connections with each other in all contexts are more important that delivering “facts” about health.

I don’t make New Year’s Resolutions, but I do like to set intentions. This year, I am going public with my intention. I intend to participate in and to facilitate community. This includes:

  • exploring how I may be participating in the creation of stigma against self or others,
  • attending to the lived experience of all, and
  • seeking to remove barriers where I discover them.

They say go big or go home, right? I’m going big.

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