Tag: Stigma

Down and Out

In the spring of 1928, aged about 24, Eric Blair (aka George Orwell) moved to Paris, a city in which the cost of living was very low. He tried to earn a living by writing and giving English lessons, but it hardly paid. He was then stripped of his possessions and money by “a little trollop he’d picked up in a café” leaving him with very little cash. His parents back home in England were spared the knowledge of his predicament, possibly due to his concern for their middle class sensibilities. He could have returned home to Southwold, but having previously chosen to leave a career in the Imperial Indian Police in Burma, that was not an attractive path. He had little option but to work in the foul kitchens of the Hotel Lotti on the Rue de Rivoli. His final impecunious 10 weeks in Paris provided the material for his book, Down and Out in Paris and London, the first draft of which was completed in 1930. This was no journalist’s assignment, research or a gimmick.

 

The following are observations on poverty in the early chapter of the book and reveal something of the life he led.

 

“…it is altogether curious, your first contact with poverty….you thought it would be terrible, it is merely squalid and boring. It is the peculiar lowness of poverty that you discover first…the shifts it puts you to, the complicated meanness, the crust wiping.

 

You discover, for instance, the secrecy attaching to poverty…you dare not admit it, you have to pretend that you are living quite as usual.

 

You discover what it is like to be hungry…everywhere there is food insulting you in huge wasteful piles…a snivelling self pity comes over you at the sight of so much food.

 

You discover the boredom…you discover that a man who has gone even a week on bread and margarine is not a man any longer, only a belly with a few accessory organs…

 

…but you discover the great redeeming feature of poverty: the fact that it annihilates the future…

 

And there is another feeling that is a great consolation in poverty. It is a feeling of relief, almost of pleasure, at knowing yourself at last genuinely down and out. You have talked so often of going to the dogs – and well, here are the dogs, and you have reached them, and you can stand it. It takes off a lot of anxiety”.

 

(Chapter 3, Down and Out in Paris and London 1933)

 

 

Squalor, boredom, secrecy, hunger, future discounting and relief from anxiety were the key features, for Orwell, of poverty. In 1930 in Paris there was no system of welfare benefits to fall back on. In London , the casual wards (‘The Spikes’) provided some refuge, although the conditions were far from salubrious. Orwell went hungry, and at times had absolutely no money. One lack, which was sorely felt, was that of tobacco, something he again experienced on the front line in Spain when he later joined the POUM militia (Partido Obrero de Unificación Marxista, or Worker’s Party of Marxist Unification) in the civil war in Catalonia. The privations in the front line caused by the conditions and the absolute lack of resources for the militia was another form of poverty.

 

“In trench warfare five things are important: firewood, food, tobacco, candles and the enemy. In winter…they were important in that order” (Homage to Catalonia 1938, p23).

 

Winter in the Catalan trenches, Spring in Paris, but in this list we can note the reduction of human need to Maslow’s base of his hierachy of need. Apart from the ‘enemy’ in Spain the similarity is of course there to see. Orwell in both books mentions the centrality of tobacco, and of course of alcohol, in daily life.

 

It might be tempting to dismiss Orwell’s observations as belonging to another age and therefore of little relevance to the experience of poverty today in modern Welfare States. That I think would be a mistake. The psychosocial sequelae of poverty remain the same; what it does to self, self esteem and the setting of priorities.

 

The ‘secrecy’, the ‘dare not admit it’, alludes to what Erving Goffman called ‘passing’ in his theory of Stigma. People with a stigma try to ‘pass’ as normal to avoid oppressive acts.

Poverty was and is a stigmatising condition. Orwell tells of sitting in parks in Paris but being very aware of the distaste expressed by women particularly, towards him.

A source of stigma, for Goffman, arises out of an actual or perceived ‘character blemish’. Another source is membership of a ‘tribe’. Poverty provides both sources. Currently, many believe the poor to be at fault for their poverty due to their poor moral choices and character weaknesses. The Moral Underclass Discourse emphasises that the fault lies within the individual. The poor may also be seen as members of a ‘tribe’ who live apart from the deserving and hard working families; they are the chavs, the skivers, the welfare scroungers.

Poverty can be a discrediting stigma as it might have an outward appearance, or it could also be a discreditable stigma as an internal invisible ‘mark’ known only to the poor themselves. It can, of course, be a felt stigma and an enacted stigma as society exercises certain sanctions and behaviours towards the poor. Family members and friends of those on hard times may feel courtesy stigma on their behalf.

Thus, as a highly stigmatising condition, those who today are in poverty may wish to hide away or use ‘maladaptive coping mechanisms’ such as smoking, drinking or drug taking. Orwell’s continual descriptions of the need for and centrality of tobacco illustrates this point. Many today would see tobacco as a dangerous luxury. His fixation with food illustrates the shifting of priorities, and the collapse of time to orientate to the present. Future discounting might explain why the dangers of smoking and the future threats to health just do not impact on present behaviour.  It also clearly illustrates is the exercise of one’s personal agency being highly mediated by (and mediating) the culture and the social structures one lives in. It may seem to today’s sensibilities that tobacco use would or should be resisted if poor. However, Orwell makes it plain to see how one’s psychological state gets reduced and focused in both time and space. His ‘annihilation of the future’ and ‘boredom’ are telling. It might explain why we make what seems to be irrational decisions in the face of hardship. Orwell of course would have a way out, but if one believes that the future is set, the discounting of the future to deal with the present may be a highly rational strategy.

The fear of poverty disappearing, because one is actually poor, is another seemingly irrational mind set. But if the dogs have turned up you at least know you can sink no lower. There is no such thing as status anxiety, or keeping up with the Jones’. The ‘psychosocial comparison’ thesis of poor health outcomes no longer applies to you because the fear of being compared and of comparing has been assuaged by the surety of the lowliness of status. What is left is survival today, not tomorrow, because tomorrow never comes.

Before we thus rush to judgment on the choices the poor make, or provide theories of why there is poverty based on individual failure, Orwell’s exposition provides a window into their world and might make us think twice.

 

 

 

 

 

 

 

 

 

Stigma – a narrative.

“ Hello, my name is John , and I am an alcoholic”

John (aged 46) lives alone in a bedsit in a less than salubrious part of town. He looks in the mirror each morning and thinks to himself …nothing. He just feels numb. Divorced, he does not know where his children are and now isolated as his employer now reckons he can do “without his services”. His previous landlord had given him notice to quit about 3 months ago.

The landlord had stated at that time that John was not quite what he expected, his demeanour and appearance had deteriorated from when he first moved in. John had  Undesired different-ness from what I had anticipated when I first took him in as a tenant”.

John had carried his few belonging to the new place feeling that now as far as anyone else was concerned he was now “reduced from a whole and usual person to a tainted, discounted one”.

John as was drinker. When drunk his alcoholism was out there for all to see, it became a visible discrediting condition. Those around him could see and avoid him. In the mornings before his first drink he carried his alcoholism inside. He used to be able to function at work quite well, his drinking was invisible known only to John (if he thought about it) as a discreditable condition that he was able to pass off.

Throughout his life he had struggled with feelings of self hate and worthlessness. The drink was a friend. However, he knew it was not the friend it once was. He felt different, unwanted, alone. As life got more difficult he could see the stares even when pissed. Being turned down for jobs and housing when his condition became known was increasingly hard to take. Employers and landlords saw him and acted according to the label ‘alcoholic’. His wife eventually had left him unable to take the shame of having a pissed husband turn up at parties making a fool of himself. She had the courtesy of feeling the shame on his behalf.

It was not as if he had visible skin disfigurements or limbs missing, what some have called ‘abominations’ of the body’ this was not why he felt different. After all when sober he had been fairly well presented and in his younger years quite a good looking man. No, the issue now was that others thought of him as weak, unable to control himself, a laughable character, with a character blemish. It was all to do with who he was as a person, it was not his family’s fault and he could not even argue he faced ethnic discrimination living as he did among his own tribe.

His felt socially worthless life was his fault. He was seen as responsible for his drinking. If he could just put the booze down things could be better. However, some had seen him get worse over the years and though there was nothing that could be done, the drinking was progressively worse and possibility incurable. Many friends and work colleges had of course heard about alcoholism and many had drinking habits of their own which may be problematic. However, few had really understood what alcoholism actually was, how it arises, how it affects people beyond seeing the drunk, and of course being drunk was often hard to conceal.

John sat among the group feeling shame for his past behaviour and a little concerned about how this group would judge him. He had enough experience of how other people had treated him recently and so felt apprehensive about the value judgments they would make and actions that this group would take. He was new to AA and had no idea how this worked, he hoped that as the others had been (or still were) drinkers then maybe they would not judge him so?

His last employer, Mark Taylor, had been particularly hard on him. John’s fellow workers had felt however that Mark had some issues of his own which made the relationship between the two even more difficult. Some had even suggested that Mark was a little self obsessed and was difficult to work with. It was felt that he found it difficult to put the needs of others before his own. This only made his attitude towards John even worse. Mark’s narcissistic personality, it was felt, had just made issues worse. Mark’s stigmatization and harsh treatment of John involved dehumanization, threat, aversion and depersonalization into stereotypic caricatures. For Mark, this served to increase his own self esteem, enhanced his control and allowed “anxiety buffering”, through downward-comparison, i.e.comparing himself to John. This process increased his own subjective sense of well-being and therefore boosted his already over inflated sense of self-esteem.

 

John’s illness experience was being constructed in quite a negative way. His appearance and behaviour singled him out as socially deviant, subject to discrimination, prejudice and stereotyping. His alcoholism was a condition of societal deviance as most people accepted that this was apersonal failing, a sign of moral weakness and lack of control. This was only slightly ameliorated by it being also being seen as a disease. However Johns experience was not that of a patient with an illness that needs medical care, he felt outcast, alone and dirty. It was as if society had two definitions: alcoholism as disease for which John should play the sick role, and alcoholism as deviant behaviour that requires punishment or avoidance.

 

John thus felt ostracized, devalued, rejected, scorned and shunned. He experiences discrimination, and only thinly disguised insults. He began experience psychological distress expressing suicidal ideation as a result of viewing himself with contempt. The drink paradoxically made that feeling go away. It was both savior and nemesis.

 

John’s experiences over the past few years had an effect on his behaviour in that he often started to act in ways that others expect of them. In social situations he learned to withdraw as a result of the avoidance behavior of others. This therefore it not only changed his behavior, but it also shaped his emotions and beliefs. Thus his experiences put his social identity into threatening situations, such as low self esteem. He became more aware of the label alcoholic and thus began to act as he though alcoholics were expected to act. He had nothing to lose, people expected it anyway. He knew that he was not being treated the same way as ‘normals’ and knew he would probably be discriminated against.

 

Post script

Alcoholism – a fault with self?

Not everyone is comfortable with the term stigma or its connotations.  Critics have argued that stigma focuses too much on the characteristics of the stigmatized, and not enough on the social and structural mechanisms that create discrimination and entrench social oppression. http://stigmaj.org/announcement/view/5

To what extent is alcoholism a personal trouble? To what extent is it a public issue? What social structures are involved in ‘creating’ this as a personal and social problem? What is occurring in the 21st century in certain societies that frames the alcoholic experience in particular ways? What discourses are used to describe alcoholism – biomedical. psychiatric, criminal justice, public health, social? How does each discourse frame the issue? Is there a nursing discourse on alcoholism?

 

© Benny Goodman 2011

Goffman on Stigma

“Undesired different-ness from what we had anticipated”.

“reduced in our minds from a whole and usual person to a tainted, discounted one”

1. Medical conditions which give rise to stigma can be:

·         Discrediting conditions (visible).

·         Discreditable conditions (invisible).

2. The experience of stigma can be:

·         Felt – your subjective experience.

·         Enacted – when discrimination takes place, moral judgments made.

·         Courtesy – when friends and family are involved and feel the discrimination or stigma.

3. Sources:

·         ‘Abominations’ of the body.

·         Blemishes of character. weak will, domineering or unnatural passions, treacherous and rigid beliefs, or dishonesty. Blemishes of character are inferred from, for example, mental disorder, imprisonment, addiction, alcoholism, homosexuality, unemployment, suicidal attempts, or radical political behaviour.

·         Tribal, e.g. arising from race, nation and religion. beliefs that are transmitted through lineages and equally contaminate all members of a family.

4. According to Goffman, diseases associated with the highest degree of stigma share common attributes:

·         The person with the disease is seen as responsible for having the illness.

  • The disease is progressive and incurable.
  • The disease is not well understood among the public.
  • The symptoms cannot be concealed.

Goffman, E. (1963) Stigma: Notes on the management of spoiled identity. Englewood Cliffs, Prentice Hall.

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