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Towards a unitary theory of stigmatisation

Published online by Cambridge University Press:  02 January 2018

R. Haghighat*
Affiliation:
Adult Department, Tavistock Clinic, 120 Belsize Lane, London NW3 5BA
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Abstract

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Copyright © 2001 The Royal College of Psychiatrists 

I thank Crisp (Reference Crisp2001) for his editorial on my paper and am pleased that he agrees with a range of propositions in the unitary theory of stigmatisation (Reference HaghighatHaghighat, 2001). Yet, his overemphasis on evolution as the foundation of stigmatisation raises a pivotal question. If stigmatisation is so biologically determined, what is the point of anti-stigmatising campaigns which essentially imply belief in the determining roles of cultural, political and socio-economic factors? Would this overemphasis not somehow respond to our despair in tackling stigmatisation, in that it allows its attribution primarily to something deeply ingrained?

Historically, the intensity of stigmatisation has varied in response to socio-economic and political contingencies — the genetic evolutionary machinery being inhibited or stimulated by these environmental factors. By analogy, milk is necessary for inducing the production of lactase but for this the genetic evolutionary machinery giving rise to lactase is not necessarily any more fundamental than the presence of milk in the environment.

As the title of my paper implies, one of its targets is to define routes to destigmatisation. Crisp questions why I distinguish constitutional from evolutionary factors. I do so to work towards this target. Constitutional factors involve rather ‘primitive’, ‘vegetative’ and ‘spontaneous’ responses less, or perhaps differently, amenable to anti-stigmatising interventions (if at all) while evolutionary factors involved in, for example, whether to let your sister marry someone with mental illness, are more amenable to conscious reflection and decision-making and are therefore subject to different types of anti-stigmatising interventions.

In finding the aetiology of stigmatisation one should not be misled by the form of a discourse but explore its raison d'être and motivating factors. Crisp seems to miss the fact that the same discourse can serve very different purposes for different social groups. The discourse of free will and self-infliction in addictions, when deployed by a conscientious doctor, social worker or family member, is likely to serve to induce feelings of responsibility in the patient. The same discourse used by the public is likely to have been primarily devised to allay their guilt faced with suggestions that they are stigmatisers. Patients with addiction, despite their indisputable relative responsibility in causing their condition, are attributed a wider range of imperfections than they deserve and are thus stigmatised. The discourse of self-infliction is an example of the ‘Just World hypothesis’ already discussed in my paper.

Crisp refers to Hughes' (Reference Hughes and Crisp2000) consensual psychoanalytic proposition: people use projection as a defence against dysphoric mood. Yet, in order to remain evidence-based and not to rebuff those not dynamically oriented, my theory had to rely, as much as possible, on experimental facts of social psychology (e.g. Reference Gibbons and GerardGibbons & Gerard, 1989). I agree with Crisp that the tendency to stigmatise depends on robustness of the stigmatiser's personality — those with high self-esteem are less likely to derogate others (Reference NunnallyNunnally, 1961) and so gain psychologically — but it is, at the same time, likely to depend on the importance and self-interest value of what is at stake.

Crisp suggests that I have not considered links between psychological and socio-political factors seriously. Yet, in my paper I alert the reader that not all core issues related to stigmatisation could be discussed because of space limitations. Factors involved in stigmatisation are of course all interconnected. In a decision to reject a partner whose control of resources is poor, the mind may be weighting negative attributions more than positive ones — the allocation of ‘badness’ to another can yield psychological gain, the decision can prevent loss in socio-economic competition and finally the evolutionary need to distance poor reproductive bets can be satisfied. As another example, the choice of a certain political ideology favouring strict division between social groups, classes and persons is likely to respond to a psychological need to distance, dominate or control as opposed to a wish to share and to promote compassion, equality and interdependence. At the same time, this is likely to involve mind categorising and labelling and to profit the protagonists through a differential system of social privileges as well as responding to a primitive evolutionary urge.

Finally, Crisp observes that while I have taken a categorical approach I have ended up extolling a monistic philosophy. You can use different fields of enquiry to delve into the same phenomenon and endeavour to sum up the partial visions provided into the synthesis of a picture as the best possible approximation of reality. What I call constitutional or economic or other ‘origins’ are routes of enquiry into domains in which stigmatisation shows its face. If you asked what was the origin of the production of energy in the body, dietetics would refer mainly to food and calories, cellular biology primarily to mitochondria, biochemistry to the Krebs cycle or oxidative phosphorylation, physics to thermodynamics, etc., while these are all aspects of a single, ultimate mechanism. By the same token, all versions of the origin of stigmatisation, although divided and labelled by our brain as related to a distinct branch of knowledge, refer to a unitary, ultimate source: the pursuit of self-interest. When trying to understand stigmatisation we must not fall into the same trap that makes us stigmatise. The paradigms of physics, chemistry, sociology, politics, etc., all have human dimensions, such as our tendency to divide, partition and parcel out — they are labels we have found to name the branches of what used to be called philosophy before we decided to carve it up into pieces. We did so because of our brains' lack of capacity to cope with the extent and volume of the accumulated knowledge and now none of these branches can give us a global picture of reality. But we have the capacity to free ourselves from the same reductionism by recognising the limitations of our categorisations and by looking at the shared core of different versions of reality that these branches of knowledge present — where these versions overlap is likely to be the nearest to where we can reach in grasping the essence of reality.

References

Crisp, A. (2001) The tendency to stigmatise. British Journal of Psychiatry, 178, 197199.Google Scholar
Gibbons, F. X. & Gerard, M. (1989) Effects of upward and downward social comparison on mood states. Journal of Social and Clinical Psychology, 1, 1431.CrossRefGoogle Scholar
Haghighat, R. (2001) A unitary theory of stigmatisation. Pursuit of self-interest and routes to destigmatisation. British Journal of Psychiatry, 178, 207215.Google Scholar
Hughes, P. (2000) Stigmatisation as a survival strategy: intrapsychic mechanisms. In Every Family in the Land (ed. Crisp, A. H.). www.stigma.org.Google Scholar
Nunnally, J. (1961) Popular Conceptions of Mental Health: Their Development and Change. New York: Holt, Rinehart & Winston.Google Scholar
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