Sketches From a Sociologist’s Career: 13 – Revisiting Stigma

Having grown accustomed to arguing for the sociological importance of social structural analysis, maybe it was unsurprising that I came to turn this lens onto my own and others’ studies of stigma. As early as 2004 I published a paper in Social Theory and Health entitled ‘Re-framing stigma: felt and enacted stigma and challenges to the sociology of chronic and disabling conditions’. In all probability, however, it was the exacting ‘external’ critique of the 1980s medical sociological paradigm portraying long-term illness and disability as ‘personal tragedies’ by disability theorists and activists that occasioned a change in my thinking. Mike Oliver was quick of the mark in espousing a ‘social model of disability’. This switched the emphasis from the persons affected to those who labelled them and saw and treated them as ‘deviants’, as persons in need of ‘normalising’. It was a powerful intervention, though one that was in its turn to become a subject of critiques. The problem, if problem there is, Mike insisted, lies in the ascription of deviance to people with disabilities. I recall inviting him one year to address the Emory University Summer Programme on Comparative Health Care. I heard him tell the students that the day he broke his back was the best day of his life. If some students looked non-plussed, the programme director that year, Terry Boswell, who had just been diagnosed with motor neurone disease, turned to me and whispered: ‘I don’t think so!’ I think Mike’s point was that his accident had given him a new identity and purpose.

I will return to Oliver’s view that people with disabilities are treated as deviants and oppressed. But first it is necessary to consider the personal tragedy approach to disability in more detail. In the 1980s Mike Bury had written of the ‘biographical disruption’ that chronic and disabling illness occasions; Gareth Williams had discussed the need for ‘narrative reconstruction’ that it provokes; Kathy Charmaz had written of the ‘loss of self’ that it can involve; and I had published my own study of the salience of felt and enacted stigma. Each of these contributions had been routinely cited in subsequent research. It is not simply that they were ‘wrong’; there is, I would argue, value in their findings: people do vary in the way they come to terms with their lot, be it positively or negatively. But they were products of a limited and ultimately misleading and damaging paradigm. Moreover, we were unwittingly complicit in – to use Oliver’s term – the oppression of people with long-term conditions and disabilities. Our studies focused on individuals to the neglect of the social, on the labelled to the neglect of the labellers. In retrospect we should have known better!

When Sasha Scambler and I edited a volume entitled New Directions in the Sociology of Chronic and Disabling Conditions in 2010, we took pains to address this issue, and also to try and bridge the gap between two divergent and diverging literatures. ‘Disability Studies’ had by this time, very understandably, become separated from and antagonistic to a medical sociology still too much in thrall to biomedicine. I might add a tangential but important general point here: there have over the years been a number of new disciplinary perspectives that have grown out of disillusionment with the parent discipline of sociology. Notable examples include those focusing on women, race and ethnicity, post-colonialism, disability, sexuality and so on. While I entirely understand that these intellectual and organisational detachments from mainstream sociology have their origins in sociology’s failure adequately to extend its reach into these areas, I disagree with colleagues who celebrate their independence. In my view, sociology’s shrinking core is to be regretted. What I’d like to see is an overhaul of the parent discipline to re-encompass areas of interest and enquiry it neglected for far too long. But back to chronic illness, disability and stigma!

Sasha and I were pleased with the contributors to our edited volume. They were a stellar group: in addition to our own chapters, there were pieces by Kathy Charmaz, Carol Thomas, Tom Shakespeare, Nick Watson, Carl May, Alan Radley, Mike Bury, Gareth Williams and Simon Williams. We had, we hoped, encourages the process of constructing a bridge between medical sociologists and disability theorists. Tom Shakespeare and Nick Watson offered a more nuanced approach to studying disability than the combative stance adopted by Oliver. And the late and much missed Carol Thomas, a skilled bridge-builder in her own right, provided a way to go beyond what she called the medico-centric ‘social deviance’ paradigm long adopted by medical sociologists and the ‘social oppression’ paradigm preferred by breakaway disability theorists. Her concluding paragraph reads as follows:

‘I offer up the sociology of disablism and impairment effects to medical sociologists – as an alternative to their traditional sociology of chronic illness and disability. In my view, the former provides an analytic framework that avoids the medico-centric assumption that: ‘we study the ways in which people adapt to their socially deviant status caused by diagnoses of chronic illness.’ Rather, the emphasis turns to the social negotiation of the lived experience of both impairment effects and with encounters with disablism. Only time will tell if medical sociologists take up the offer – laying the foundations for a closer disciplinary alliance.’

I am pleased to say that Carol, whom we later invited to give a Social Theory and Health lecture in London, found my own revised position on stigma encouraging.

So how did my theorising of stigma relations move on from its earlier personal tragedy/social deviance orientation? If the 2003 Social Theory and Health paper was a prolegomenon, a fuller and extended account was given in an article in the Sociological Review in 2018 and later in my book A Sociology of Shame and Blame. I expanded on a distinction drawn previously between stigma, denoting an infringement against norms of shame, and deviance, referring to an infringement against norms of blame. It is a distinction which is implicit in much of what Goffman writes in his Stigma: Notes on the Management of Spoiled Identity, where he distinguishes between ‘nonconformance’ and ‘noncompliance’; but I wanted to go ‘beyond Goffman’ both to incorporate the causal role of social structures like class, and to explore the dialectics of shame and blame. While I am reluctant to include more tables in these sketches, the two that follow might be helpful in clarifying the conceptual framework I came to deploy. The first table picks up on some concepts introduced in an earlier sketch.

Concepts of Stigma and Deviance

The second table builds on this framework to postulate four categories of persons, three of which have severely negative connotations.

Stigma and/or Deviance, Shame and/or Blame

The negative trio of labels here might seem over the top, but on reflection I still think not, for all that they seem graphic and unforgiving: each announces and ‘performs’ abnormality. The essence of my argument was that there occurred a shift in government social and health policy, paradigmatically in relation to people with disabilities, as welfare state capitalism gave way to ‘Thatcherite’ rentier capitalism. Those with disabilities found avenues and options closed during the Thatcher years, and there was little let up in the Blair/Brown years: Blair launched the work capability assessment (WCA) in 2008 in an attempt to cut the benefits bill (conveniently redefining disability to this end). The Cameron coalition government from 2010 to 2015 contracted out this process to ATOS, to scandalous effect due to a mix of incompetence and profiteering. While these vindictive measures mobilised disability activists it was, and has remained, an uphill battle. It was in precisely in this context that I wrote of the weaponizing of stigma.

This phrase summoned the thesis that in rentier capitalism, stigma (norms marking an ‘ontological deficit’, nonconformance or shame) has been redefined as deviance (norms marking a ‘moral deficit’, noncompliance or blame). In other words, people who might in past eras have been treated as ‘rejects’, or imperfect outsiders, are now condemned for their difference as ‘abjects’, or morally beyond the pale. And if people can be effectively rendered abject in the popular imagination, there are few constraints on how badly governments can treat them. There is very solid evidence that people with disabilities, like other socially marginalised groups (eg asylum seekers), have been systematically ‘punished’ by the state for their putative abjection.

I went on in these publications to suggest that what I called the ‘class/command dynamic’ was a critical causal factor in the emergence of this ‘stigma deviance dynamic’. A more comprehensive introduction and analysis of these and other causal or generative mechanisms or dynamics will have to wait for a future summative sketch of the ‘fractured society’, but a brief paragraph is indicated at this point. The class/command dynamic, as alluded to in an earlier sketch, captures the growing tendency in rentier capitalism for the small, global and nomadic hard core of the capitalist executive active in the UK (well under 1% of the population) to be able to afford to buy policy from the power elite at the summit of the state apparatus. This dynamic underpins the weaponizing of stigma in my view. How? It helps structure, without structurally determining, cultural norms like those of stigma and deviance that inform, reinforce and, if class push comes to political shove, police prescriptions of shame and blame. Hence the expedient state-sanctioned for-profit abandonment of inconveniently costly ‘abjects’ like persons with disabilities. I would emphasise that I think these dynamics a vital part of any credible sociological explanation of the current treatment of people with disabilities, but they are of course only part of a complex story. 

I have often regurgitated my contention in these sketches that it is important for we sociologists to explore the inter-relations between macro-, meso- and micro-social phenomena. I have emphasised the salience of Habermas’ theories in this connection. In my A Sociology of Shame and Blame I pursued this theme, not only in relation to disability but also around other marginalised fragments of the population, such as asylum seekers, sex workers and foodbank users. Taking my cue from Kayleigh Garthwaite’s Hunger Pains published in 2016, I attempted to show how the dialogues between foodbank clients and staff can only be comprehensively – that is, sociologically – grasped if the wider societal context is factored in. On the face of it, staff/client relations are typically manifestations of communicative action oriented to consensus; they appear contained within and constrained by lifeworld norms and practices. Staff, many of them volunteers, are present to meet as well as they can despairing requests on the part of anguished clients already undermined by felt stigma and/or deviance. They are a last resort. However, this is only part of the story. Distorted communication – indicating the manipulation of clients in accordance with system imperatives – is doubtless rare. Systematically distorted communication – denoting the pursuit of system imperatives notwithstanding staff and clients each conversing in good faith – is by contrast far from exceptional. Making this point shifts our perspective away from Goffman’s focus on micro-phenomena to meso- and macro-theories.

Felt stigma and felt deviance are both detectable in the apparently just and solidary exchanges reported in Garthwaite’s disturbing study. By coming to the aid of people who are homeless or otherwise caught between a rock and a hard place in twenty-first century Britain, foodbank staff provide compensation and cover for the politics of post-2010 austerity and its associated welfare cuts, culminating in the introduction of Universal Credit (the deepest cuts predictably impacting the abject). These processes of compensating and covering ameliorate people’s suffering whilst simultaneously taking the sting out of government policy initiatives. At the same time, they are becoming institutionalised as part and parcel of a neoliberal, neo-Victorian or ‘Poor Law’ approach to welfare. Garthwaite herself highlights the risk of foodbanks being consolidated as an accepted mode of delivery, as part of the system, as it already has in other countries. One step further towards macro- or ‘big’ sociology returns us to the class/command and stigma/deviance dynamics derived from a critical realist approach to sociological explanation via the discernment of real social structural causal or generative mechanisms. It is these dynamics that I would still argue are pivotal not only for understanding/explaining the emergence of our finance-dominated rentier capitalism, but also for understanding/explaining routine conversations between foodbank staff and their increasingly numerous, bewildered, vulnerable and hope-less clients.