350-450 words excluding references, APA format and a minimum of 3 references. See attached doc.

Video trancript

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· ADINA NACK: Hi. I’m Dr. Adina Nack, Professor of Sociology here at California Lutheran University. I’m also the author of the book Damaged Goods– Women Living With Incurable Sexually Transmitted Diseases. And today I’m going to talk about illness stigma management. [Key Sociological Concepts] To begin with, some key sociological concepts will help us understand the material, in particular, how effective health benefits come from understanding social constructions of deviance, and how resulting stigma can harm both individual health

· 00:41

and threaten public health. So let’s begin with definitions of key terms, all of which are context specific, meaning that in some contexts they might be considered deviant, and in others they might be considered completely normal. The first term, deviance, simply means that which is outside the norm. [Deviance– That which is outside the norm.] And whenever we say norms, we’re talking about behavioral expectations. [Norms– Behavioral expectations.] Values would be the rationale behind the norms, why we should behave according to the norms. [Values– Rationale behind the norms and why we should behave according to them.] And then, in particular in talking about illness, we want to think about the idea of medicalization, when medical professionals define a deviant condition

· 01:16

as a sickness. [Medicalization– When medical professionals define a deviant condition as a sickness.] Now, medicalization can either increase or decrease stigma. [Typologies of Deviance] There are two main typologies of deviance, or ways of organizing types of deviance. The first is to think about whether a deviance reflects a deviant attitude, a deviant behavior, or a deviant condition. [Two Typologies– Attitudinal, behavioral, or conditional.] The second sorts out whether the deviance is viewed as ascribed– something somebody is born with– or achieved,

· 01:47

something somebody earns. [Ascribed or achieved.] So if a deviance is ascribed, it’s considered as being deviant from birth. You might think that in certain contexts, somebody’s race or ethnicity might be determined to be deviant. Somebody’s gender or congenital disability, or your height or weight might be deviant from the norms of your society. When we talk about achieved deviance, that’s where it’s earned or created. When I say created, it could be something like paralysis after an accident, or deciding to join a cult, or doing an extreme body

· 02:20

modification. So let’s apply these typologies to the illness of skin cancer that a doctor may believe to be the result of a patient having spent years tanning. In that case, if the doctor sees that patient as deviant, they might view the behavior of going to a tanning salon as deviant, as a bad choice on that patient’s part. And if we were thinking about ascribed versus achieved, we would probably say that patient has achieved the deviance of skin cancer because they chose to engage in a behavior that medical society has determined to be

· 02:52

dangerous to their health. Another helpful idea when talking about illness stigma is the concept of three general perspectives on deviance. Some people take an absolutist perspective of deviance. [Perspectives on Deviance– Absolutist] Absolutists would have to do with essentialism, that there is something innate in the act, belief, or condition that makes it different from the norm and wrong, regardless of context and social norms. The second perspective deals a little bit more

· 03:20

with the idea of social power, or conflict in a society. [Social power or conflict] And in that sense, the definitions of deviance are going to reflect the values and norms of those with the greatest social power, and they are enforced to maintain or increase the power of the dominant. When we talk about social power, it can come from economic power, political power, as well as from being a privileged status, which could be a privilege based on your race and ethnicity, based on your sex, based on your gender, your sexuality,

· 03:50

your age, your ability, your education level. All of those factors can either increase or decrease the social power somebody has in a particular society. The final of the third perspectives on deviance is what we might call a relativist perspective. [Relativist] Social constructionism is key to this perspective, in that the meanings and definitions are created, maintained, and transformed by individuals and groups. In that sense, we could say deviance is in the eye of the beholder. And sociologists like myself who study health and illness– we draw primarily on social constructionist approaches to deviance because we want to incorporate the analysis of social power

· 04:29

and the conflict perspective. When we think about illness as a deviant status, it helps to draw on Hughes’s theory of master status, and that’s when you walk into a room– it’s the one that people see you as first as being your most important status. It could be an ascribed status, or it could be achieved, but it likely determines your identity in your community. For each master status, there are certain auxiliary traits. These are the traits we commonly associate

· 04:58

with a particular master status. You can think of them as the stereotypes that we might have about somebody. Now, once we know somebody’s deviant master status, that often trumps any non-deviant status they might have. Well, why is that? If you think about it in terms of an illness, once you know, for example, that a friend has a likely terminal cancer, it becomes very hard to think of them as anything other than my friend who’s dying of cancer. So in that sense, their status before of just being your friend is now trumped

· 05:30

by that deviant master status of having terminal cancer. So let’s work through the example of hepatitis C that somebody believes they contracted from IV drug use. Once that doctor knows that that patient has a master status of IV drug user, they’re going to start to view that patient as irresponsible. They might question how educated that person is. They might question the moral character of that person, because we have a lot of negative connotations of being an IV drug user. And if you’ve contracted a blood borne pathogen like hepatitis C from IV drug use, then we also start to think of you as reckless, as somebody we wouldn’t want to trust, and all of that can really harm somebody’s social status outside the exam

· 06:12

room, as well as with their own doctor. [Deviant Identity Development] Deviant identity development often is talked about as happening in three stages. So let’s discuss the three-stage model of deviant identity development with the example of bulimia, or what oftentimes is called bulimia nervosa. In primary deviance, Lemert came to the idea that it’s the first time that person commits a deviant act, but it’s secret.

· 06:41

They’re not discovered by others. So in a sense, they’re a secret loner deviant, and most often, they want to protect that privacy. They don’t want anybody to know that they’re engaging, let’s say, in binging and purging because they don’t want to be stopped. You might think of it as somebody’s first time purging in the privacy of their own bathroom. They probably would turn on the fan to try to block out the noise. They don’t want anybody to know what’s going on in there. So that’s primary deviance, their first time doing it. They’re not caught. If we move forward then to secondary deviance, that’s when somebody has to catch the other person in the act, and then they start the seven stages of informal deviant identity, where you can think about this label of a deviant person being applied to that person with bulimia, eventually resulting in the internalization, where they start to see themselves as somebody who’s deviant, different, and in this case,

· 07:34

possibly ill. That becomes their new master status, that deviant identity. So how might this happen? Let’s say you’re talking about college students and they share a bathroom. And the roommate comes home, and they overhear their roommate purging in the bathroom. They knock on the door and they ask, “Have you been binging and purging?” If the student admits to their roommate that they have, then secondary deviance has happened. They’ve been caught. They’ve been labeled, and they will start to actually see themselves as the type of deviant

· 08:06

that the outside person now sees them as. [INAUDIBLE] talked about tertiary deviance as a next, and in some ways final, stage of deviant identity development. That case is not true for all deviance, but it’s where somebody would actually embrace their deviant identity, and they might engage in identity politics and other forms of collective stigma management to de-stigmatize their deviance. So in that case, if a student with bulimia seeks out a support group on campus to talk to other people about it and tries to do eating disorder awareness weeks and tries to raise the issue of negative body image as a cause of eating disorder behavior, they may become a eating disorder educator on their campus, and that would be a great example

· 08:50

of tertiary deviance. Now, most sociologists would say that Goffman is the godfather of all things stigma, and in that sense, he did a great job conceptualizing stigma as this label that marks a person as deviant in the eyes of society, and it often becomes part of their identity and their interactions. Now, he came up with two forms of stigma. Either it’s discredited or discreditable. [Forms of Stigma– Discredited. Discreditable] Discredited is known, or apparent.

· 09:19

Discreditable is hidden, or secret. He then said there are three types of stigma. Any stigma can be categorized into one of these three types. It could be an abomination of the body, something where the actual way somebody looks or their body is perceived is viewed as deviant. So leprosy would be a really good example of a medical condition that represents an abomination of the body. The second type he came up with is a blemish of moral character. If you think about moral character as relating to the idea of sins, then obesity

· 09:54

would be linked to the sin of gluttony. And therefore, somebody might see somebody who’s obese as having a blemish of moral character. The third type would be tribal stigma, which I know sounds a little strange, but he would say it has to do with the larger group of people to which you are a member. So if we look at HIV/AIDS among gay men, we can see how when HIV/AIDS was starting up as an epidemic in the ’80s, it was a type of tribal stigma where once somebody knew you were a gay man,

· 10:22

they also started to assume that you were HIV positive. Whether or not that was true didn’t matter because they had imbued you with tribal stigma. [Individual Stigma Management] So what’s a person to do? You’ve now become a stigmatized individual. You want to manage that stigma. You want to either conceal your stigma, or once it becomes known, you want to think about how do you address the ways that the public is perceiving you? So we think about secrecy and information control as being the two key aspects of individual sigma management,

· 10:58

and secrecy has a lot of advantages, right? You can control who knows it, when they know it, and you’re always trying to figure out what harm could come to you if your secret becomes known. If you think about people who live a double life, it’s very common for somebody with a stigmatizing illness to have a certain close circle of friends who know the truth about them. But let’s say their parents might be not as understanding, or their grandparents. Well, the advantage of having that level of secrecy

· 11:27

is that there’s stress relief, right? When you’re with your close friends, you know that they know the truth about your illness. If you’re having a flare up, let’s say, you can talk to them about it. You can be honest, whereas with your other life, the one in which your deviance is secret, you don’t have to worry about constantly dealing with stigma. If you know that grandma and grandpa would have an issue with it, you don’t have to worry about them judging you because you’ve kept it a secret from them. That all sounds great until you think about the disadvantages of secrecy. It can really weigh on a person to try to remember who knows which lie and who knows which truth

· 12:02

and who’s going to talk to whom outside of your presence. There’s a lot of fear about being found out, and sometimes our lives overlap. So you might think that grandma would never hang out with your best friend, and all of a sudden they interact, and the truth could come out. So it does have its own stressors, even though it has big advantages. A lot of people with illnesses try to pass. They try to pass as healthy to not arouse suspicion. [Concealing and Managing– Passing] And so if we think about passing, again, we come up with three types

· 12:32

of passing that can be really useful for people. [Three Types of Passing– Avoid contact with stigma symbols] You can avoid contact with stigma symbols. So what could be stigmatizing? A prescription med, right? If you take your prescription medications in private and nobody sees you take them, then you have actually avoided the contact with that stigma symbol. [Use a disidentifier] You can also use a disidentifier. So an example here would be, especially in the early years of the AIDS epidemic, male hemophiliacs who were, sadly, getting infected with HIV through the blood supply– they would often keep photos of their wife and kids on their nightstand when they were hospitalized because they would

· 13:07

want everybody to know, oh, no, I’m not one of those gay men. Now, agreed, they bought into the stigma that gay was bad and wrong, but they did it for a reason. They didn’t want the health care practitioners to judge them negatively. And sadly, in the ’80s, ’90s, and sometimes even today, there are medical practitioners who are homophobic and would judge a patient negatively for being gay or bisexual. The third type of passing is what we already talked about, that leading a double life, that– you pass for healthy

· 13:37

with certain people. Other people know the truth about you. So if passing doesn’t work for you, a lot of illness patients try covering. [Covering] They come up with cover stories or lies to throw others off the real deviant truth. An example comes to mind of a woman from my STD study. She had her first terrible outbreak of genital herpes. She was walking funny, and she was scheduled to go for a hike with a girlfriend. So as she goes off on this walk, her friend notices. Why are you walking so strangely?

· 14:06

Is something wrong? And the woman says quickly, just on the spot, oh, I have terrible hemorrhoids. She didn’t have hemorrhoids, but she clearly thought that as gross as hemorrhoids might sound to somebody, it was way less stigmatizing than coming out and saying, yeah, I’m having my first horrible genital herpes outbreak. Another thing that I saw– again, with my STD interviewees– was stigma transference. [Stigma transference] So this is where somebody takes the stigma that somebody’s applied to them, and they project it onto somebody else, deflecting the stigma away

· 14:37

from themselves. So again, with a woman in this case, she was infected with human papilloma virus, HPV. She talked about how when she was feeling really negative about herself and really judged by other people, she would point out the guy. She was pretty sure she knew who had infected her with it, and he was the one who was lying. He was irresponsible. He was out there infecting lots of women. She painted him as the one who really bore the brunt of the stigma, rather than herself, who had already been stigmatized as a woman who

· 15:05

was living with HPV. Another type of individual stigma management that can work really well for people is avowal. [Avowal] And that’s where they’re totally open and actually positive, framing themselves in a positive light for having this type of stigma. So in that case, they want to really challenge the norms. They want to assert there is a very positive reason for their type of deviance. So an example of avowal would be that there are conferences for people who are infected with different STDs, whether HIV

· 15:33

positive, infected with genital herpes or genital HPV. And at these conferences, they engage in a lot of avowal. They might be really open, get good at telling their stories. They might have speed dating where they get really clear with people about having this infection but still wanting to go on to have a happy and healthy love life. So they get used to framing themselves as infected but not off the market, as it were. The final type I want to talk about here

· 16:00

is the idea of disclosure, and that’s really straightforward. [Disclosure] It’s coming out. You think about coming out of the closet. There are illness closets that people come out of when they have a stigmatizing disease, and it’s potentially dangerous because somebody might not keep your deviant stigma a secret. You can either come out for two reasons. So you can have a preventive disclosure, where you want to prevent harm from coming to somebody else– and if you think about that with a contagious illness, you want to do a preventive disclosure to somebody who you might have already infected or might infect if you

· 16:34

have new exposure to them. The other way to do a disclosure is for therapeutic reasons, and this is where if you think about the burden that comes from keeping that secret– you might want to get it off your chest. You want to relieve your stress by sharing it with an important significant other. So a lot of the women I talked with who had herpes and HPV– it was their best friend that they went out to. They said this is what I have just been diagnosed with. And it really helped them to deal with a treatable but medically incurable STD, and to give them that strength and support when

· 17:06

they were going forward with their treatments. [Individual Deviants] Now I want to talk a little bit more about a term I used earlier when I was talking about somebody with bulimia, that that person was probably a loner deviant, an individual deviant who did not want anybody to know about this. In that case, they are almost always secret deviants, and concealment is key. Now, if you think about this, if a loner deviant is isolated, they’re also naive about the best or safest ways to pursue their deviance, and they can often

· 17:38

have a trial and error period of learning the techniques. A loner deviance usually doesn’t come out of the blue. Most times, somebody thinks hard about all the legitimate ways, all the socially acceptable ways, to go about managing their stigma. And in the end, they realize no, I want to keep with my deviant behavior. They might think that the first deviant act is a temporary solution, and they promise themselves they’re never going to do it again. I’m never going to binge and purge again.

· 18:06

This is a one-time thing. But if we think about this with not just eating disorders, but also people who self-injure– you might hear them referred to as cutters. But often, loner deviants in this case are reacting to a crisis or a long-term trauma, something that happened where the pain is so intense inside of them that they want to externalize it by cutting, or they want to escape it by engaging in a full-on binge and purge that really distracts them from their emotions. Now, these are not psychologically or physically healthy alternatives, but for that loner deviant,

· 18:41

it feels like a solution to dealing with that trauma. They haven’t been raised, though, to think that this is OK, so there’s a big struggle that goes on for most of them, feeling that it’s OK for them to commit that first deviant act, that it really is something that they feel good about doing. So it often is the start– that first act is the start of a lonely process of learning how to resolve these feelings of guilt and shame. [Defining Deviancy Down] Switching topics slightly, I want to look at the idea Durkheim came up with, defining deviancy down, that he said in a society, even if there was a society of saints, we would need

· 19:23

to see some people as being criminal and deviant. But at the same time, a society can only recognize so much deviant without feeling overwhelmed and overrun. This really works out well when you talk about generational norms of change, that if we keep seeing something as deviant– and let’s say we’re talking about premarital sex, non-marital sex. When current generations have decided it is so normal that the majority are engaging in premarital or non-marital sex, it would be too much for a society to continue to think that all those people are

· 19:55

sinners and horrible people and degenerate, right? So society adjusts. We define the deviancy down, and we start to de-stigmatize things. A great example of this is if you look back at the ’60s and the founding and use of the birth control pill, at first, that was seen as horribly deviant. Why would any good young woman want to actually be able to have sex and not get pregnant? That was surely going to lead to the downturn of society. But we saw that as generations have passed, the birth control pill has become a very normal and socially accepted way for people

· 20:32

to plan their reproduction. So defining deviancy down usually comes from three reasons. You could do it for altruistic reasons. For the good of those who’ve been labeled as deviant, we now view them as not deviant. And if you think about the removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders, that’s a huge example of altruistic defining deviancy down. For the good of people who are homosexual,

· 20:59

we are no longer going to label them as mentally ill. Another reason to define deviancy down would be opportunistic. [Reasons to Define Deviancy Down– Altruistic. Opportunistic] So there’s a growth in a particular level of deviance, and somebody can see a profit to be made if we remove the stigma. You can think about this in terms of pre-diabetes medications, that we’ve defined the deviancy down of taking prescription medications for conditions that could be addressed by changes to diet and exercise. So some doctors won’t engage in this. If somebody is pre-diabetic, they

· 21:30

will refuse to give any of these pre-diabetes medications. They will just say diet and exercise changes, that’s going to be your ticket to avoiding diabetes. But again, a society that has increasingly normalized what it is to take prescription medications and normalized all of the side effects– pre-diabetes medications are a booming business right now. The third reason to define deviancy down would be normalizing, and that’s what we were talking about before with generational change, that there are such high rates

· 21:59

of a particular type of deviance that we become desensitized. What we once thought was horrible is totally common. So if we think about injuries and fatalities from gang violence, once upon a time, gang wars and gang violence were rare and worthy of headlines. But now, sadly, in most of our urban and even suburban and rural areas, gang violence is so common that we couldn’t stand to experience every gang murder as a national tragedy. So in most of our communities, injuries and fatalities from gang violence are just viewed as a sad but normal part of life, especially in areas with lower

· 22:31

socioeconomic status. [Conclusion] So to sum things up, I went over some key terms and concepts when it comes to deviance and illness stigma. [Summary– Key terms and concepts. Theorizing deviance to explain stigmatizing illnesses] We discussed theorizing deviance and ways that explain how a stigmatizing illness can affect a person. We talked about conceptualizing and managing illness stigma. [Managing illness stigma] And then we went over types of deviance, with a focus on loner and individual deviance when it comes to particular types

· 23:01

of illness stigma. [Loner or individual deviants] And we just discussed defining deviancy down. [Defining deviancy down] So here are some questions you might want to reflect on at this point. How does the material in this presentation either match or contrast with what you knew before about illness stigma? [Reflective Questions– How does the material in this presentation match or contrast with what you knew about illness stigma?] What do you think are the likely patient-level consequences of being stigmatized by that patient’s friends and family, by their health care providers, even by themselves if they believe that they deserve to be

· 23:30

stigmatized by their illness? What’s going to be the health consequences? [What are likely patient level consequences of being stigmatized by their friends and family, health care providers, and by themselves?] And then, what are the likely individual-level and public health benefits for defining the deviancy down of illness conditions which are currently stigmatized? What do we have to gain for that individual person living with the stigmatizing illness, and for the greater public society who’s dealing with illness stigma? [What are likely individual level and public health benefits for defining the deviancy down of illness conditions which are currently stigmatized?] And finally, when might it be beneficial to the public health to maintain an illness stigma? Why? In what ways can stigma actually motivate positive changes

· 24:01

in health-related behaviors? [When might it be beneficial to public health to maintain illness stigma and why?

Instruction

This video transcript above will review the concept of deviance.

Define the concept of deviant behavior in accordance to criminology and bring in a case example of deviant behavior;

describe the deviant behavior of the offender involved in the crime.

350-450 words excluding references, APA format and a minimum of 3 references.