WE live in a chaotic world. A world of constant change and a place where nothing is certain. Humans therefore need a stable environment, a symbolic framework for ordering social reality (Scott 1992).

This symbolic universe gives a sense of order in the funny universe we live in (Berger and Luckmann 1966). The symbolic universe 'hardens' and 'thickens' with habits and experience to take on a sense of objective reality.

Deviance is the pimple on the face of social order and something that's hard to put up with. There are two types: ascribed and achieved. 'Ascribed' is when the people don't really have a choice e.g. blindness and 'achieved' is an earned status e.g. muggers.

How do we deal with deviance? The ultimate superiority of the symbolic universe has to be asserted. We can force them to behave normally (normalisation). If that fails or isn't appropriate, the madman must be rendered harmless. The deviants are usually locked away, thus demonstrating the power over those that can't or won't change.

However, like alcohol, deviance isn't totally bad. In low doses it can preserve the stability of social order by defining the boundaries of normality.

Right, so how do ascribed deviants threaten social order? Well, firstly they don't conform to standard identities. It's actually what they are rather than how they act. They are 'imperfect' in the eyes of the social order. Secondly, they violate social interactions by generating uncertainties - a prime example is when people don't know how to act towards someone with a disability.

Stigma is what you get when you're diagnosed with an illness and find that suddenly people start treating you as if you were socially inferior. (See Semester 3 Case 1 Handout)

The visibility (i.e. how obvious is) is different from the obtrusiveness of an illness. Take a businessman in a wheelchair. You can see he's disabled but around a conference table, it doesn't intrude into his communication. Next look at a bloke with a speech impediment. At first sight, he doesn't look disabled but it soon gets in the way in a situation where intercourse (verbal, that is) is important.

Someone with a stigma has to go through three stages to establish relationships with other people. First, there's fictional acceptance where they have to put up with the stereotypes that get forced on them. The next stage is breaking through - they are accepted as 'normal' people. But that's not the end of it because they have to make sure that the 'normal' label sticks (consolidation).

Of course, as Scambler rightly points out, this doesn't always happen. For example blind people may not get accepted as normal and will have to find different ways to cope (as described in the Semester 3 Case 1 Handout).

You could say that a diagnosis of, say, epilepsy, turns someone into an epileptic in that it gives them that social status. This is a huge burden - it distances them from normal folk and can lead to rejection.

People with stigma perceive lay people as ignorant, intolerant and discriminatory. In fairness, though, they perceive their condition as stigmatising using their own concepts of the disorder - and rarely by actual encounters of negative discrimination.

Some of the best things in life come in pairs, but perspectives on illness aren't on the list. There are, however, two of them: medical and lay. The medical diagnosis would expose the patient to lay prejudices and that's why some patients actually refuse to accept their doctor's diagnosis.

Time for a quick summary: stigma disrupts routine life and threatens our mastery of nature. We've got two choices: make stigmatised folk more 'people-friendly' or hide them away - a case of out of sight out of mind.

There has been a change of views over time. For example, homosexuality was once illegal, but gradually became looked upon as an illness. Tolerance to this deviation has increased, but it is still officially frowned upon. It now falls upon the medical experts to 'make them better' and this reinforces the negative attitude. Medical experts have thus become agents of social control.

Do the medical experts have a choice? To some extent they have, but they are also dependent on lay people for certain resources.

When you've got a patient visiting a doctor and you stick them both in the same room, it's kind of inevitable that a doctor-patient relationship will form. Parson (1951) essentially sees this relationship as passive on the part of the patient. The patient goes to the doctor to seek help from a 'professional authority' so that they can be 'put right'. However, Friedson (1961) argues that doctors and patients have different expectations and these clash. Patients tend to develop their own perspectives of illness, so the relationship is therefore interactional and not passive. They can even reject or question the doctor's diagnosis because the stigma isn't the greatest thing to carry about with you for the rest of your life.

Finally, medical experts are often accused of not being very sympathetic towards the poor souls they've labelled with the stigma. They (the doctors, that is, not the patients) don't have the time, motivation or training to provide support. By not talking about their condition, the medical experts are actually reinforcing the stigma. Scambler thinks it's a good idea that this whole situation should be looked into and improved. Let's all wish him luck.

We live in a chaotic world. A world of constant change and a place where nothing is certain. And you know what? I love it!

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