the HAES® files: Musings on Community and Stigma

by Health At Every Size® Blog

by Fall Ferguson, JD, MA

For the second year in a row, I have been asked to submit a blog post that will appear during the week of Christmas. In last year’s post, I dared to be fat and “not-jolly.” The holidays had hit me with a dull thud and left a bitter flavor in my eggnog. This year, though, I am feeling a bit more positive. I am consciously making time and space to connect with family and friends over the next couple of weeks.

Sparked by some recent reading in the health literature about the links between health and social capital, I’ve been reflecting on how fluid and tenuous our connections can be. Our communities sustain us, but we also must work to sustain them. Our individual health depends upon the health of our communities, and vice versa. Martin Luther King Jr. said:

“We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.”

When we think about nurturing our sense of connection, let’s think expansively. Yes, we need friends and family, but also we need our connections with all the supportive networks and communities in our lives. In a 1993 column in the Healthcare Forum Journal, Emily Friedman suggested that even in our “society of nomads,” we create many types of communities—“clumps we form with each other.” These include communities of location, experience, interest, values, age, and time. We need these communities to feel whole.

grinch heartIndeed, this is a time of year when we ritually remind ourselves of this fact of our existence. The Zeitgeist of the “holiday season” is replete with parables about the importance of finding or reinstating connection with others. Even Dr. Seuss reminded us how important it is to connect: “And what happened then? Well, in Whoville they say that the Grinch’s heart grew three sizes that day!”

Unfortunately, there are many who do not have access to community or social bonds. In particular, I want to talk about those for whom stigma has forged the walls of isolation from community. The process of stigmatization is, in a very basic sense, the production of the “other.” According to an article by Bruce G. Link and Jo C. Phelan in The Lancet entitled “Stigma and Public Health”, there are three forms of discrimination that are part of the process of creating stigma. The first two are familiar: (1) direct, intentional discriminatory treatment and (2) structural bias that happens on the systemic level. To the extent that someone is either intentionally excluded or systemically excluded, it is easy to understand how stigma poses a barrier to community and connection.

But it’s Link and Phelan’s third form of discrimination that I want to focus on: (3) the subtle and “insidious form of discrimination” that happens due to awkward encounters and heightened sensitivities, based on our own perceptions of how we are perceived by others. We banish ourselves from opportunities for connection because we read social cues telling us we are not welcome; we take ourselves out of the community (or never enter) because it’s just too hard, too awkward, too painful to stay. We go, even before someone “makes” us leave. There are far-reaching consequences, as Link and Phelan point out:

“The result may be strained and uncomfortable social interactions, more constricted social networks, a compromised quality of life, low self-esteem, depressive symptoms, unemployment, and loss of income.”

I’m betting that this third type of discrimination is frequently overlooked in its effects on health. Many think of it as the “fault” of the stigmatized individual or group. One can almost picture the shoulder shrugs and furrowed brows: “Geez, what’s her problem?” “No one said he had to leave.”

Many of us conceive of “stigma” as affecting health in a fairly abstract way, even those of us who have been stigmatized. I have read statements such as this from Link and Phelan: “people with greater resources of knowledge, money, power, prestige, and social connections are generally better able to avoid risks and to adopt protective strategies.” I have considered how stigma damages health via the destructive, long-term effects of the stress response. But there is another more immediate and very destructive mechanism going on here that I want to bring out.

Not too long ago, I came close to leaving a particular community because of a size bully. For a time, I felt shamed and hopeless in a way that seeped into every corner and crevice of my life. Unlike in the movies, the story neither has a “feel-good” ending nor ends in tragedy. Another community member figured out what was happening and supported me, which made a big difference. The bully is still there, but so am I, and it’s not great, but it’s workable for now. And, I (most of the time) am able to remember that it’s her problem, not mine.

I do not claim this experience as unique or special. It’s all too common. And I don’t tell this personal story because I want sympathy or cheerleading. Rather, I wish to illustrate some particular, concrete effects of stigma that don’t get talked about enough:

  • Stigma includes a visceral experience of trauma that lives in our bodies and can paralyze our capacity for connection with others. The experience of being bullied by a peer as a middle-aged woman triggered me to re-experience the shame and the “freeze” reaction that I remember from being bullied as a child.
  • Stigma, even when perpetrated in one community, feels global. I felt depressed and gloomy about life in general while my situation was playing out, and it permeated every aspect of my life.
  • Stigma can cut through other privileges like a knife. In general, I consider that I benefit from a number of privileges when it comes to connection and social capital. For example, I am white and straight, with supportive friends and family. I am a university professor. As a former attorney, I litigated discrimination cases. I have several communities of interest and experience to which I belong. And yet, my powerful first instinct was to retreat, to sever connections, to voluntarily withdraw from a community that I consider important in my life – all because of one bully.

When we talk about the importance of connection in a HAES® context, we need to remember that this is more than an idea. This is a concrete experience. And similarly, the health ramifications of stigma are not distant and abstract, but immediate and concrete. What’s more, researchers have finally begun to recognize what untold numbers have lived: the significance of intersectionality as it relates to stigma. As Link and Phelan note,

“If all stigmatised conditions were considered together and all outcomes examined we believe that stigma would be shown to have an enormous impact on people’s lives.”

We need to understand that multiple, disparate experiences of stigma may dramatically increase an individual’s sense of isolation and exacerbate a lack of access to community.

So, there you have it, another cheery holiday post. The good news is that building community is possible. Examining our consciences and our behaviors for the sources of stigma is possible. As a health educator, I understand that facilitating community and empowering people to make connections with each other in all contexts are more important that delivering “facts” about health.

I don’t make New Year’s Resolutions, but I do like to set intentions. This year, I am going public with my intention. I intend to participate in and to facilitate community. This includes:

  • exploring how I may be participating in the creation of stigma against self or others,
  • attending to the lived experience of all, and
  • seeking to remove barriers where I discover them.

They say go big or go home, right? I’m going big.

6 Comments to “the HAES® files: Musings on Community and Stigma”

  1. “Stigma, even when perpetuated in one community, feels global.” Wash! Rinse! Repeat! I LOVE this statement and will use it as my rallying call in 2014! Thank you for another insightful and inspiring post Fall! You are amazing!

  2. Fall, this was one of the most powerful essays that I have read on the experience and impact of stigma, and on our responsibility not only to fight stigma, but to build community that is resistant to its practice. I am especially appreciative of your “New Year Intensions:”

    •exploring how I may be participating in the creation of stigma against self or others,
    •attending to the lived experience of all, and
    •seeking to remove barriers where I discover them

    I hope that you don’t mind my borrowing them as my own. If I do implement them over the coming year, it indeed will be a year worth living.

    Thank you for this post.

  3. P.S., Just linked to this essay on our Go Folic! website homepage and blog…

  4. Thank you.

    Y’know, when I was a kid being stigmatized for being fat, my parents interrogated me with questioning fit for a suspected felon.

    How do you KNOW that nobody wants to sit with you? Did you actually ASK every single one of them that question? Did they actually SAY that? EVERY ONE of them said exactly the same thing? WHO said it? What, EXACTLY did they say?

    All I could do was helplessly keep insisting that even though I couldn’t PROVE or identify particular individuals who’d actually SAID particular WORDS that clearly and unambiguously SAID that nobody wanted to be friends with me and nobody wanted me to be anywhere near them at lunch or at recess … that I still wasn’t making this up in my own head.

    My parents’ view was that if I couldn’t finger, prove and convict particular individuals, then my “belief” that they didn’t want anything to do with me was “all in my own head” and the only thing necessary was for me to change my own allegedly inaccurate beliefs about how much my peers hated me.

    I knew it wasn’t “only” all “in my own head” but I never had the analytical skills (as an 8 year old or a 10 year old) to be able to explain how I KNEW my body was stigmatized even if I couldn’t point to actual WORDS that individual classmates had actually SAID on individual particular occasions.

    Thank you for this.

  5. Thank you for taking the time to discuss stigma. The stigmatize locally sting globally is something I relate to and until now had not seen mentioned.

    I was a happy girl growing up, parents were a bit narcissistic and needy, but school went swimmingly. As an adult I attended graduate school and began to hear whispers that I looked like a man, was laughed at publicly and people openly speculated about my sex. Even on Mother’s Day when out to brunch with my husband and his parents two men loudly suggested that I was a product of a botched sex change operation. What amazed/hurt me most was that people in a variety situations/locations of all ages and sexes commented either directly to my face or loud enough for me to hear.

    As a result my once innocuous life has been altered to the point of never being able to put the stigma down. I have been reduced to excessive mirror checking and steely resolve just to leave the house. Everyday I am under stress and have to dig up a confidence that I used to reserve for public speaking. At one time I used to be a chatty friendly person with people in stores and now I find myself ignoring and despising everyone. I perceive all stares as threatening and assume the whispers between couples are about me. How very self absorbed stigma has made me and destructively so.

    Recently, I have decided that if I am to be healthy I have to make going out less complicated, less about the people who will attempt shame and stigmatize wherever they go. It takes all I have to remember that I don’t agree with those people, that my self image does not line up with their’s. It takes all that I have to remember that my day cannot be defined by someone who thinks they are better than me or someone who is hurting so much that it seeps like an oil spill.

    Thank you again for writing this post and inspiring me to adopt your New Year Intentions.

  6. Thank You Fall,

    As a fat therapist working with people on eating issues I often feel my colleagues and friends “unspoken” disbelief. I experience it in the lack of interest and questions about my work and my writing on the subject. This makes me feel illegitimate and makes me want to withdraw – but I don’t because I know if it has a place to land, it’s because of my velcro. One of my intentions for the New Year is to have “the talk” with them about this so that I stay connected to my community.

    I recently returned to dancing after a several year absence and when I walked in the room the teacher said, oh you missed the beginner’s class – I am probably 100 lbs larger than any woman there and the only white woman, also at least 40 years older. Part of me wanted to run away but my recall of the love of dance helped me stay put. By the end of this very difficult class – I may have been out-of-breath but had done all the advanced steps. The teacher announced his apology to me to the class and we all had a good laugh. I remembered that I had met this same teacher 13 years ago. At that time when I walked into his class, I was thin but still older and white and it was a latin dance class taught in Spanish (which I don’t speak), and he said the same thing to me. By the end of the class he recanted. In the face of discrimination whether over race, fat, age or just fear of rejection and embarrassment, it would have been easy to leave. Losing dance for the last 5 years because of health was out of my control. Leaving again would be as a volunteer not a victim and that I won’t do. So I will reenter the latin dance community “as is” and reclaim my connection. I feel absolutely inspired by your blog.

    Happy New Year!

    Sandi Feinblum

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