The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health

Abstract

Stigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the "stigma system" as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.

Keywords: divide and rule; domination; resistance; scapegoating; stigma; struggle; subordination.

Figure 1.

The Stigma System as an Interactive Dialectic of Multilevel Processes

Figure 2.

A social psychological or small group perspective on stigma

Figure 3.. Stigma production/scapegoating: A concretization of how the Power Theme discussed in Figure 1 works

Note: The term “capital” may be unfamiliar to some readers. There are many definitions. In this paper, “capital” refers to institutions and organizations of whatever kind that invest in order to make profits.

Figure 4.. The Stigma System as a Concrete Whole

Downward-facing arrows represent ways in which powerful actors create and institutionalize scapegoating and thereby divide populations in order to rule them. Upward-facing arrows represent various ways in which the resistance and opposition of the oppressed and stigmatized manifest themselves in creating the Discontent Theme referred to in Figure 1. This Figure does not illustrate two other important parts of this dialectic: 1. That pre-existing stigmatization of part of the population by another part of the population creates lines of division that can be used by local, national or international power-holders or aspiring power-holders to win support via scapegoating; nor 2. That ideologies of individual blame and meritocracy facilitate “blaming the victim” and thus scapegoating.¹⁵⁵