Martin M. AndersenpersName, Somogy VargapersName, Anna P. FolkerpersName (2022date). “On the definition of stigma.” Journal of Evaluation in Clinical Practicetitle·j.
Object of study — the Link and Phelan definitionterm·mth of stigmaterm·dom
Research question — how the Link and Phelan definitionterm·mth of stigmaterm·dom can be made more simple, precise and consistent with the empirical literature
Contribution — a revised definitionterm·mth: there is stigmaterm·dom if and only if there is labellingterm·key, negative stereotypingterm·dom, linguistic separationterm·dom and power asymmetryterm·dom
phenomenon · claim-type · cross-domain-transfer · mechanism · claim-relation · replication-status · limitation — grounded in the full text| phenomenon | stigma — “There are thousands of papers about stigma, for instance about stigma's impact on wellbeing, mental or physical health. But the definition of stigma has received only modest attention.” | |
| claim-type | critique — “The Link and Phelan definition is thorough and detailed, but includes redundant components. These are status loss and discrimination, and emotional reaction.” | |
| method — evidence | — “We first interpret, analyze and reconsider each of the six components in Link and Phelan's definition of stigma, and on the basis of these analyses, we secondly suggest a revised definition of stigma.” | |
| object of study — evidence | — “We submit the Link and Phelan definition of stigma to a systematic conceptual analysis.” | |
| research question — evidence | — “Accordingly, the aim of this paper is to submit the Link and Phelan definition to a critical conceptual analysis and contribute to the development of a definition that is more simple, precise, and consistent with the empirical literature on stigma.” | |
| contribution — evidence | — “We suggest a revised definition of stigma that is more simple, precise, and consistent with the empirical literature on stigma; there is stigma if and only if there is labelling, negative stereotyping, linguistic separation, and power asymmetry.” | |
| mechanism | stereotypes Labeled differences are linked to stereotypes as a matter of cognitive efficiency, through fast judgments based on induction. — “Now such labeled differences tend to be linked to stereotypes. We all seem to do such linking as a matter of cognitive efficiency; we make fast judgments based on induction.” | mechanisms[0] |
| mechanism | power asymmetry Labeling and stereotyping matter when done by someone with the power to discriminate against the labeled. — “When it matters to be labeled and stereotyped, it is because it is done by someone who has the power to discriminate against you and in other ways treat you badly.” | mechanisms[1] |
| builds-on | Link and Phelan (2001) — “It rests on the influential work of Link and Phelan, but is slimmed for redundances and inconsistencies.” | claim_relations[0] |
| contradicts | Link, Yang, Phelan and Collins (2004) — “Accordingly, we suggest that emotional reaction is not a component in the definition of stigma.” | claim_relations[1] |
| sense | stigma - groups, not individuals, are its target, while individuals are its victims — “We suggest that groups, not individuals, are the target of stigma, though it is individuals who may be the victims of it.” | senses[0] |
| sense | stigma - for Link and Phelan it exists as a matter of degree — “It is worth adding thatLink and Phelan maintain that stigma exists as a matter of degree.” | senses[1] |
| sense | definition of stigma - a task between a lexicographer's nominal definition and a chemist's real definition — “Defining stigma seems to be a task somewhere in between these examples. Stigma is a thing that really matters to wellbeing, mental health, and physical health. Therefore its definition is more than a linguistic practice; stigma does have some essence which its definition is supposed to capture.” | senses[2] |
| sense | discrimination - a trivial sense in which it is already implied by labeling and stereotyping — “But if this is what we mean by discrimination, then it seems redundant as a component in the definition, because it is already implied by the labeling and stereotyping.” | senses[3] |
| relation | stigma —is-a→ social phenomenon — Stigma is a social phenomenon — “But the damage is on the individual. Stigma is a social phenomenon; it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions; often, but not by definition, it leads to discrimination, and so forth.” — “Stigma is a social phenomenon” | concept_edges[0] |
| weight | stigma —is-a→ social phenomenon — 0.85 — “But the damage is on the individual. Stigma is a social phenomenon; it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions; often, but not by definition, it leads to discrimination, and so forth.” | concept_edges[0] |
| evidential status | stigma —causes→ emotional reaction — it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions — “But the damage is on the individual. Stigma is a social phenomenon; it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions; often, but not by definition, it leads to discrimination, and so forth.” — “it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions” | concept_edges[1] |
| relation | stigma —causes→ emotional reaction — it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions — “But the damage is on the individual. Stigma is a social phenomenon; it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions; often, but not by definition, it leads to discrimination, and so forth.” — “it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions” | concept_edges[1] |
| weight | stigma —causes→ emotional reaction — 0.6 — “But the damage is on the individual. Stigma is a social phenomenon; it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions; often, but not by definition, it leads to discrimination, and so forth.” | concept_edges[1] |
| evidential status | stigma —causes→ discrimination — often, but not by definition, it leads to discrimination — “But the damage is on the individual. Stigma is a social phenomenon; it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions; often, but not by definition, it leads to discrimination, and so forth.” — “often, but not by definition, it leads to discrimination” | concept_edges[2] |
| relation | stigma —causes→ discrimination — often, but not by definition, it leads to discrimination — “But the damage is on the individual. Stigma is a social phenomenon; it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions; often, but not by definition, it leads to discrimination, and so forth.” — “often, but not by definition, it leads to discrimination” | concept_edges[2] |
| weight | stigma —causes→ discrimination — 0.6 — “But the damage is on the individual. Stigma is a social phenomenon; it is dangerous because it very often, but not by definition, leads to negative individual emotional reactions; often, but not by definition, it leads to discrimination, and so forth.” | concept_edges[2] |
| replication | not-applicable | |
| no type for this | linguistic separation → labeled differences — separation is a logical implication of labeled differences — “Separation is, in other words, a logical implication of labeled differences.” | unhoused_relations[0] |
| no type for this | status loss → negative stereotyping — status loss, all else being equal, is a consequence of labeling and stereotyping — “As such it seems right that status loss is a consequence of successful negative labeling and stereotyping.” | unhoused_relations[1] |
| no type for this | emotional reaction → stigma — emotional reaction is not a necessary component of stigma — “While this person is obviously stigmatized, we expect that she would not react emotionally to the label and stereotype, because she thinks it is accurate. But then, our conclusion must be that emotional reaction is not a necessary component of stigma.” | unhoused_relations[2] |
| limitation | The causality and quantification of de facto status loss are left outside the paper's scope. — “The notion of de facto status loss in the eyes of society raises difficult questions of causality and of quantification; what are the mechanisms behind status ranking? And how many individuals, and which particular groups, in the society must lower their ranking for it to be a status loss in the relevant sense? These interesting questions are beyond the scope of this paper.” | limitations[0] |
| limitation | The nature and quantification of power are not addressed. — “Power, however, is a complicated matter, and there are several interesting questions about its nature and quantification that we cannot speak to here.” | limitations[1] |
| limitation | The five meta-criteria are not claimed to be exhaustive or equally important. — “We do not mean to suggest that these criteria are all that matters to the plausibility of a definition, nor that they are equally important, only that they matter” | limitations[2] |
finding · quantity · variable · definition · key-term — grounded in the full text| finding | Status loss fails meta-criteria 4 and 5. — “If status loss, on the other hand, is a contingent consequence of labeling and negative stereotyping then it would be wrong to add it to the definition, because there would both be cases of stigma that have status loss as a consequence and cases of stigma that do not have status loss as a consequence. Therefore status loss fails on meta‐criterion 4 and 5.” | content_tags.findings[0] |
| finding | The discrimination component fails meta-criteria 2 and 4. — “The applicability of the concept would seem unnecessarily low. The discrimination component fails on meta‐criteria 2 and 4.” | content_tags.findings[1] |
| finding | The emotional-reaction component fails meta-criteria 2 and 3. — “The component of emotional reaction seems to fail on meta‐criteria 2 and 3.” | content_tags.findings[2] |
| finding | Screening the citing literature found only a few papers criticizing the details of the Link and Phelan definition. — “A title‐ and abstract screening left us with only a few papers that—as an indirect aim—criticized the details of the Link and Phelan definition.” | content_tags.findings[3] |
| quantity | 9,674 — — “As of August 4, 2021, it has been cited 9,674 times according to Google Scholar and 4,012 times according to Scopus.” | content_tags.quantities[0] |
| quantity | 199 — — “We searched within the 4,012 Scopus citations of the paper, and applied the following search string: “stigma AND definition AND (criticism OR critical)”, and we got 199 results.” | content_tags.quantities[1] |
| definition | stigma — “Goffman defines stigma as an “attribute that is deeply discrediting” and as something that reduces its bearer “from a whole and usual person to a tainted, discounted one.”” | content_tags.definitions[0] |
| definition | stigma — “We therefore consider Link and Phelan's (and partly Yang and Collins') definition of stigma to consist of six necessary conditions. For there to be stigma there must be labeled differences, stereotypes, separation, status loss and discrimination, power, and emotional reaction.” | content_tags.definitions[1] |
| key-terms | stigma, labelling, negative stereotyping, linguistic separation, power asymmetry, status loss, discrimination, emotional reaction, nominal definition, real definition, social phenomenon |
| concept | stigma — there is stigma if and only if there is labelling, negative stereotyping, linguistic separation, and power asymmetry — “We suggest a revised definition of stigma that is more simple, precise, and consistent with the empirical literature on stigma; there is stigma if and only if there is labelling, negative stereotyping, linguistic separation, and power asymmetry.” | concepts[0] |
| concept | labeled differences — In the first component, people distinguish and label human differences. — “Other differences, however, are somehow selected to matter, they are “(…) socially selected for salience (…).” 1 , p.368 Some differences are selected to be relevant, important, or significant. They are labeled .” | concepts[1] |
| concept | negative stereotyping — In the second, dominant cultural beliefs link labeled persons to undesirable characteristics—to negative stereotypes. — “Link and Phelan clearly state that the characteristics that form the stereotype must be undesirable . 1 , p.369 For clarity, we add that this should be understood as undesirable according to dominant societal norms and beliefs.” | concepts[2] |
| concept | linguistic separation — it is a necessary condition for a target to be stigmatized that it is commonly referred to by a name — “Accordingly, we echo the separation component given the following linguistic interpretation: it is a necessary condition for a target to be stigmatized that it is commonly referred to by a name.” | concepts[3] |
| concept | status loss — de facto status loss, that is, in the eyes of society — “Accordingly, we interpret the criterion of status loss as de facto status loss, that is, in the eyes of society.” | concepts[4] |
| concept | discrimination — discrimination that is morally (or juridically) wrong, or objectionable — “For discrimination to be relevant, however, it should be discrimination that is morally (or juridically) wrong, or objectionable. 14” | concepts[5] |
| concept | power asymmetry — the asymmetrical power relation between the stigmatizer and the stigmatized — “It is the asymmetrical power relation between the stigmatizer and the stigmatized that makes the labeling and stereotyping matter.” | concepts[6] |
| concept | emotional reaction — not defined in this paper's own words; the sixth component that Link, Yang, Phelan and Collins added to the 2001 definition in 2004 — “Interestingly, in “Measuring Mental Illness Stigma” from 2004, Link, Yang, Phelan, and Collins expand the 2001 definition by adding a component of (individual negative) emotional reaction (on the stigma).” | concepts[7] |
| concept | internalize stigma — they come to believe and apply to themselves stigmatizing suppositions and stereotypes linked to the mental disorder — “A number of studies indicate that a significant proportion of people with mental disorders internalize stigma, meaning that they come to believe and apply to themselves stigmatizing suppositions and stereotypes linked to the mental disorder.” | concepts[8] |
| concept | social phenomenon — in the sense that it is entire groups, not just some individuals in the group, that may or may not be stigmatized — “In fact, we mean to suggest that stigma is a social phenomenon in the sense that it is entire groups, not just some individuals in the group, that may or may not be stigmatized.” | concepts[9] |
| concept | definition — a statement that aims at expressing the essential nature of X in a way that includes all instances of X while excluding all instances that aren't really X — “The definition of X is a statement that aims at expressing the essential nature of X in a way that includes all instances of X while excluding all instances that aren't really X.” | concepts[10] |
| concept | nominal definition — which offers us a clearer view of our uses of the word “cool” — “Or, put in Lockean terms, the lexicographer should aim at providing a “nominal definition”, which offers us a clearer view of our uses of the word “cool”, while the chemist should aim at offering a “real definition”, which aspires to give an account of what ‘gold’ is independent of our practices.” | concepts[11] |
| concept | real definition — which aspires to give an account of what ‘gold’ is independent of our practices — “Or, put in Lockean terms, the lexicographer should aim at providing a “nominal definition”, which offers us a clearer view of our uses of the word “cool”, while the chemist should aim at offering a “real definition”, which aspires to give an account of what ‘gold’ is independent of our practices.” | concepts[12] |
| concept | precision — all redundant and ambiguous parts should be eliminated — “Accordingly, here are five selective meta‐criteria of what a definition of stigma and many other social concepts, in our opinion, ought to satisfy. We do not mean to suggest that these criteria are all that matters to the plausibility of a definition, nor that they are equally important, only that they matter: (1) the extent to which the definition matches its target, that is the thing it refers to; (2) the extent to which the definition is applicable; (3) the extent to which the definition matches the ordinary and/or scientific use of the concept; (4) precision, meaning that all redundant and ambiguous parts should be eliminated; and (5) consistency, meaning that the definition cannot have incompatible implications.” | concepts[13] |
| concept | consistency — the definition cannot have incompatible implications — “Accordingly, here are five selective meta‐criteria of what a definition of stigma and many other social concepts, in our opinion, ought to satisfy. We do not mean to suggest that these criteria are all that matters to the plausibility of a definition, nor that they are equally important, only that they matter: (1) the extent to which the definition matches its target, that is the thing it refers to; (2) the extent to which the definition is applicable; (3) the extent to which the definition matches the ordinary and/or scientific use of the concept; (4) precision, meaning that all redundant and ambiguous parts should be eliminated; and (5) consistency, meaning that the definition cannot have incompatible implications.” | concepts[14] |
Full text — tagged
On the definitionterm·mth of stigmaterm·dom Abstract There are thousands of papers about stigmaterm·dom, for instance about stigmaterm·dom's impact on wellbeing, mental or physical health. But the definitionterm·mth of stigmaterm·dom has received only modest attention. In “Conceptualizing stigmaterm·dom” from 2001, Link and Phelan offer a thorough and detailed definitionterm·mth of stigmaterm·dom. They suggest that there are six necessary conditions for stigmaterm·dom, namely labelled differences, stereotypes, separation, status lossterm·dom and discriminationterm·dom, power, and emotional reactionterm·dom. This definitionterm·mth is widely applied in the literature but is left mainly uncriticized.
We submit the Link and Phelan definitionterm·mth of stigmaterm·dom to a systematic conceptual analysisterm·mth. We first interpret, analyze and reconsider each of the six components in Link and Phelan's definitionterm·mth of stigmaterm·dom, and on the basis of these analyses, we secondly suggest a revised definitionterm·mth of stigmaterm·dom.
The Link and Phelan definitionterm·mth is thorough and detailed, but includes redundant components. These are status lossterm·dom and discriminationterm·dom, and emotional reactionterm·dom.
We suggest that groups, not individuals, are the target of stigmaterm·dom, though it is individuals who may be the victims of it. We suggest a revised definitionterm·mth of stigmaterm·dom that is more simple, precise, and consistent with the empirical literature on stigmaterm·dom; there is stigmaterm·dom if and only if there is labellingterm·key, negative stereotypingterm·dom, linguistic separationterm·dom, and power asymmetryterm·dom.
Keywords: metaphysics, philosophy of medicine, practical reasoning, public health INTRODUCTION In a landmark article from 2001 titled “Conceptualizing stigmaterm·dom”, Bruce G. Link and Jo C. Phelan note a “dramatic” increase in the number of papers that contain the word stigmaterm·dom in their titles or abstracts from 1980 to 1999, 1 and the growth of stigmaterm·dom research has since continued. 2 , p.25 Researchers in sociology, psychology, and public health investigate the micro‐ and macro‐level causes of stigmaterm·dom, its impact on the welfare, 3 mental health, and physical health of individuals, 4 , 5 its role in maintaining social hierarchies, and the nature of measures that carry the potential to assist destigmatization. 6 Given the amount of research being generated to explore stigmaterm·dom, it is somewhat surprising that the definitionterm·mth of stigmaterm·dom has received only modest attention. In “Conceptualizing stigmaterm·dom”, Link and Phelan offer a thorough and detailed definitionterm·mth of stigmaterm·dom, and their paper has become the standard reference in much of the literature. As of August 4, 2021, it has been cited 9,674 times according to Google Scholar and 4,012 times according to Scopus. We searched within the 4,012 Scopus citations of the paper, and applied the following search string: “stigmaterm·dom AND definitionterm·mth AND (criticism OR critical)”, and we got 199 results. A title‐ and abstract screening left us with only a few papers that—as an indirect aim—criticized the details of the Link and Phelan definitionterm·mth. Moreover, we also applied the search string “stigmaterm·dom AND definitionterm·mth” in Philpapers on August 4 and got six results, the title and abstract screening of which, however, left no papers critical toward the Link and Phelan definitionterm·mth. Several scholars have noted that the concept of stigmaterm·dom is defined inconsistently throughout the literature, and that it is measured with different instruments, 7 , 8 , 9 , 10 but a systematic conceptual analysisterm·mth is missing. While the Link and Phelan definitionterm·mth is both thorough and novel, we believe it can be significantly improved. Accordingly, the aim of this paper is to submit the Link and Phelan definitionterm·mth to a critical conceptual analysisterm·mth and contribute to the development of a definitionterm·mth that is more simple, precise, and consistent with the empirical literature on stigmaterm·dom.
THE LINK AND PHELAN DEFINITIONterm·mth OF STIGMAterm·dom Interestingly, Link and Phelan's motivation for suggesting their definitionterm·mth is “(…) the observation that stigmaterm·dom is defined in different ways by different investigators.” 1 , p.364 As they note, since the publication of Goffman's Notes on the Management of Spoiled Identity back in 1963, the literature on stigmaterm·dom has grown significantly. Link and Phelan rightly point out that researchers tend to deploy different definitionsterm·mth of stigmaterm·dom and that the situation calls for a comprehensive and thorough definitionterm·mth.
Goffman defines stigmaterm·dom as an “attribute that is deeply discrediting” and as something that reduces its bearer “from a whole and usual person to a tainted, discounted one.” 11 , p.3 The point of Link and Phelan is not that Goffman is wrong (on that), but rather that his definitionterm·mth only insufficiently captures the nature of stigmaterm·dom. Instead, Link and Phelan offer the following conceptualization: (…)stigmaterm·dom exists when the following interrelated components converge. In the first component, people distinguish and label human differences. In the second, dominant cultural beliefs link labeled persons to undesirable characteristics—to negative stereotypes. In the third, labeled persons are placed in distinct categories so as to accomplish some degree of separation of “us” from “them.” In the fourth, labeled persons experience status lossterm·dom and discriminationterm·dom that lead to unequal outcomes. Finally, stigmatization is entirely contingent on access to social, economic, and political power that allows the identification of differentness, the construction of stereotypes, the separation of labeled persons into distinct categories, and the full execution of disapproval, rejection, exclusion, and discriminationterm·dom. 1 , p.367 Notably, it takes five components to converge for there to be stigmaterm·dom. For them to “converge”, we take it that each component is a necessary condition for stigmaterm·dom. It follows that there is no stigmaterm·dom if not all of the five components are satisfied: To the extent that we can answer yes to these questions, we can expect stigmaterm·dom to result. To the extent that we answer no, some of the cognitive components of stigmaterm·dom might be in place, but what we generally mean by stigmaterm·dom would not exist. 1 , p.376 Interestingly, in “Measuring Mental Illness Stigmaterm·dom” from 2004, Link, Yang, Phelan, and Collins expand the 2001 definitionterm·mth by adding a component of (individual negative) emotional reactionterm·dom (on the stigmaterm·dom). 12 , p.513 We therefore consider Link and Phelan's (and partly Yang and Collins') definitionterm·mth of stigmaterm·dom to consist of six necessary conditions. For there to be stigmaterm·dom there must be labeled differencesterm·dom, stereotypes, separation, status lossterm·dom and discriminationterm·dom, power, and emotional reactionterm·dom. It is worth adding thatLink and Phelan maintain that stigmaterm·dom exists as a matter of degree. 1 , p.377 The degree of separation can be more or less complete and the labeling can be more or less prominent, involving few or many, more or less negative, stereotypes, and these factors will have an influence on the extent of the resulting status lossterm·dom and discriminationterm·dom.
Now, we will first look into, interpret, and analyze each of these six components. On the basis of these analyses, we subsequently suggest a revised definitionterm·mth of stigmaterm·dom.
First and second component: Labeled differencesterm·dom and stereotypes “Why is it that some human differences are singled out and deemed salient by human groups while others are ignored?” 1 , p.368 This fundamental sociological question frames the first component of Link and Phelan's definitionterm·mth of stigmaterm·dom. For there to be stigmaterm·dom there must be a social selection of human differences. There are countless differences between humans and their possessions, for instance in the number of fake Claude Monet paintings, eye colour and whether one likes to eat potatoes. Such differences seem harmless. Other differences, however, are somehow selected to matter, they are “(…) socially selected for salience (…).” 1 , p.368 Some differences are selected to be relevant, important, or significant. They are labeled .
Now such labeled differencesterm·dom tend to be linked to stereotypes. We all seem to do such linking as a matter of cognitive efficiency; we make fast judgments based on induction. When we have observed 50 white swans, we tend to expect the 51th swan to be white too. When we have seen four drunken homeless men, we tend to link homelessness to alcohol abuse. It is an open question when we are epistemically justified in such inductive reasoning. Sometimes we are, often we are not, but as we understand Link and Phelan, this is not important here. What is important is the effect on the homeless if we automatically associate them with alcohol abuse, if we automatically associate obesity with lack of will power, and so forth.
Thus, the basis of stigmaterm·dom lies in the linking of labeled differencesterm·dom to stereotypes. This also matches Goffman's definitionterm·mth. It is worth considering the fact that some labeled differencesterm·dom are linked to positive stereotypes, not negative. For instance, being tall is linked to power, and speaking French is linked to being sophisticated. But these, of course, are stereotypes; not all tall people have power, and not all French speakers are sophisticated. Importantly, such positive stereotypes cannot be components of stigmaterm·dom. Link and Phelan clearly state that the characteristics that form the stereotype must be undesirable . 1 , p.369 For clarity, we add that this should be understood as undesirable according to dominant societal norms and beliefs. Thus, it lies in the concept of stigmaterm·dom that it is an unpleasant thing, at least for those who are the victims of it. We agree with the first and second components of stigmaterm·dom as suggested by Link and Phelan.
The third component: Separation The third component of stigmaterm·dom requires the label to connote a separation of “us” from “them”. Link and Phelan suggest that “(…) the linking of labels to undesirable attributes (…) become the rationale for believing that negatively labeled persons are fundamentally different from those who don't share the label (…).” 1 , p.370 While this component seems intuitive at first, a closer look suggests that it is actually superfluous, because it is already entailed in the labelled differences component. To label differences necessarily implies some separation of us and them, at least in a linguistic sense. We separate brown‐eyed from blue‐eyed, the tall from the short, the men from the women, the English from the French, and so forth. Separation is, in other words, a logical implication of labeled differencesterm·dom. But perhaps Link and Phelan are gesturing toward something narrower, like a particular type of separation. So, when more precisely does a labeled differenceterm·dom satisfy the component of separating us and them? Link and Phelan suggest that: Evidence of efforts to separate us from them are sometimes directly available in the very nature of the labels conferred. Incumbents are thought to “be” the thing they are labeled (Estroff 1989). For example, some people speak of persons as being “epileptics” or “schizophrenics” rather than describing them as having epilepsy or schizophrenia. 1 , p.370 The distinction between having X as an attribute and being X is rhetorically very powerful. Potato‐eaters might have been stigmatized during history, but those who enjoy potatoes have not. Giving names to labeled differencesterm·dom linked to negative stereotypes seems evidence that the labeled differenceterm·dom is one that really matters. If someone really is your enemy, if you really want to distinguish yourself from someone, then you give them a name! Those who smoke are not the target of potential stigmaterm·dom, but the smokers are. Accordingly, we echo the separation component given the following linguistic interpretation: it is a necessary condition for a target to be stigmatized that it is commonly referred to by a name. Empirically, it can somewhat easily be verified if this component is satisfied in some social context.
Fourth component: Status lossterm·dom and discriminationterm·dom The fourth component in Link and Phelan's stigmaterm·dom definitionterm·mth is status lossterm·dom and discriminationterm·dom . It is unclear why this is one and not two components, so let us look at status lossterm·dom first and discriminationterm·dom second.
Status lossterm·dom Link and Phelan explain that: “An almost immediate consequence of successful negative labeling and stereotyping is a general downward placement of a person in a status hierarchy.” 1 , p.371 We humans create social hierarchies and evaluate one another from the perspective of such social hierarchies. We form social hierarchies on the basis of human differences that we consider relevant: level of education, income, age, looks, weight, height, and so forth. It is reasonable to think that the human differences we consider relevant when forming social hierarchies also are human differences that are socially salient and thus capable of constituting stigmaterm·dom. If one can be stigmatized because of one's weight, it is because weight is socially salient. And if weight is socially salient, it is also one among several other parameters that we use to form social hierarchies. Thus, echoing other papers of the same authors, the building blocks of status hierarchies seem to be the same as the building blocks of labeling and stereotyping. 5 , 13 As such it seems right that status lossterm·dom is a consequence of successful negative labeling and stereotyping. However, a detail is worth considering.
Link and Phelan suggest that a consequence of labeling and stereotyping is “(…) a general downward placement of a person in a status hierarchy.” Elsewhere, however, they suggest that: “(…) people are stigmatized when the fact that they are labeled, set apart, and linked to undesirable characteristics leads them to experience status lossterm·dom and discriminationterm·dom (our underline).” 1 , p.371 So, is it the experience of or the de facto status lossterm·dom that is the relevant currency? Well, a firefighter might feel stigmatized. But she isn't. At least not for being a firefighter , in any country we know of. The mere feeling of being stigmatized, whatever the reason, does not imply de facto stigmatization. And on the contrary, a homeless person with an alcohol abuse disorder might very well be stigmatized in many countries that we know of, but what if she does not feel the stigmaterm·dom? Would it then be stigmaterm·dom? Well, in 2004, Link, Yang, Phelan, and Collins expands the 2001 definitionterm·mth by adding a component of ‘emotional reactionterm·dom’. Therefore, if the feeling of the stigmaterm·dom matters to stigmaterm·dom (we will consider this question when considering the component of emotional reactionterm·dom), this seems to be accounted for by this added component. Accordingly, we interpret the criterion of status lossterm·dom as de facto status lossterm·dom, that is, in the eyes of society.
The notion of de facto status lossterm·dom in the eyes of society raises difficult questions of causality and of quantification; what are the mechanisms behind status ranking? And how many individuals, and which particular groups, in the society must lower their ranking for it to be a status lossterm·dom in the relevant sense? These interesting questions are beyond the scope of this paper. We should note, however, that even though someone is stigmatized, status lossterm·dom is not necessarily entailed. This is so because many elements constitute our status. If, for instance, BMI > 35 is stigmatized, then persons gaining weight to BMI > 35 will lose status, all else being equal . But some of these individuals might at the same time change in ways that are status beneficial. If, for instance, some unemployed with BMI > 35 suddenly gets a new well‐paid job, then she will benefit status‐wise from the latter while losing status from the former. Therefore, we should say that status lossterm·dom, all else being equal , is a consequence of labeling and stereotyping. Let us now consider if de facto status lossterm·dom really is a necessary condition for stigmaterm·dom.
First, if the building blocks of labeling and negative stereotypes are the same as the building blocks of our social hierarchies, namely the same human differences, then one might think that status lossterm·dom is a necessary consequence—a logical implication—of labeling and negative stereotypes. But, following the spirit of Occam's razor, if it is a necessary consequence, then there seems to be no reason for including it in the definitionterm·mth. Indeed, this consequence could be relevant for understanding the problem of stigmaterm·dom, but in the definitionterm·mth it would be redundant. By analogy, it is a necessary consequence of being obese that one does not have a body mass index (BMI) < 20, but there is no reason for including this implication in the definitionterm·mth of obesity.
Second, status lossterm·dom could be a contingent consequence of labeling and negative stereotypingterm·dom. If so, however, it would be wrong to add it to the definitionterm·mth. It would namely mean that there are both cases of stigmaterm·dom that have status lossterm·dom as a consequence and cases of stigmaterm·dom that do not have status lossterm·dom as a consequence. But if there are cases of stigmaterm·dom that do not have status lossterm·dom as a consequence, then status lossterm·dom is not necessary to stigmaterm·dom; it is not part what stigmaterm·dom is.
In sum, de facto status lossterm·dom is, all else being equal, either a necessary consequence (a logical implication) or a mere contingent consequence of successful negative labeling and stereotyping. In either case it seems we should leave it out of the definitionterm·mth.
Discriminationterm·dom The second part of the fourth component of stigmaterm·dom is discriminationterm·dom . Unfortunately, discriminationterm·dom itself is a complex concept and therefore it is not clear how we should understand this component. For, on the one hand, there is an obvious but also trivial way in which it seems right that the stigmatized are discriminated against. When a human difference is labelled, say, obesity, and linked to undesirable stereotypes, say, being lazy and having a lack of willpower, it seems to hold true that those who uphold this label and this stereotype look at the obese in light of this label and this stereotype. And as others, those who are not obese , will not be looked at in light of this label and this stereotype, there is discriminationterm·dom; the obese are treated, at least looked upon, differently than the not‐obese . But if this is what we mean by discriminationterm·dom, then it seems redundant as a component in the definitionterm·mth, because it is already implied by the labeling and stereotyping.
On the other hand, if Link and Phelan want more from the discriminationterm·dom component than this, we need first realize that in one sense we are all discriminated against for one reason or another. We (the authors of this paper) are not nominated for any Oscar, but some filmmakers are, nondisabled persons are not welcome to compete against persons with disabilities at the Paralympic games, and so forth. For discriminationterm·dom to be relevant, however, it should be discriminationterm·dom that is morally (or juridically) wrong, or objectionable. 14 For instance, it is not an interesting case of discriminationterm·dom when people cannot receive unemployment benefits while being gainfully employed. But it is, when men and women at the same level of qualification receive unequal payment for the same work. This distinction holds true for the otherwise stigmatized too: when an obese person is simply unable to fit the standard airplane seat and is therefore offered a larger one, it is discriminationterm·dom—the nonobese are not offered a larger seat—but hardly discriminationterm·dom in any objectionable way. If unequal seat sizes are offered because of unequal sizes, not because of stereotypes, then it does not seem morally objectionable. On the other hand, if the best qualified for the job does not get the job because of obesity, then it is morally objectionable discriminationterm·dom. However, it is a matter of deep disagreement what morality more precisely requires and therefore which discriminatory acts would count as morally wrong or objectionable. Link and Phelan suggest that a definitionterm·mth of stigmaterm·dom does not exist “(…) in some independent existential way. As such, its value rests in its utility.” 1 , p.377 This seems right. But it seems to count against its utility if our conceptualization of stigmaterm·dom hinges upon our agreement on when discriminationterm·dom is morally objectionable and when it is not. This seems much too demanding.
So, should discriminationterm·dom be left out of the definitionterm·mth of stigmaterm·dom? We suggest it should, though it is probably true that stigmatized people are very often discriminated against in morally (or juridically) objectionable ways. But there are thousands of empirical papers on the impact of stigmaterm·dom on wellbeing, mental health, and physical health. Only very few of them, if any, would be able to lift the burden of showing that the otherwise stigmatized are discriminated against in a morally (or juridically) objectionable way. If discriminationterm·dom in any nontrivial sense is part of the stigmaterm·dom definitionterm·mth, then we cannot really know if it is stigmaterm·dom that all those studies are measuring. Thus, scientific utility seems to count against the component of discriminationterm·dom, and as Harriet Deacon puts it in an indirect critique, separating discriminationterm·dom from stigmaterm·dom “allows us to think more clearly about negative consequences of stigmaterm·dom (…).” 10 , p.421 Fifth component: The dependence on power The fifth, and in the 2001 paper the last, component of stigmaterm·dom is power: “Stigmaterm·dom is entirely dependent on social, economic, and political power—it takes power to stigmatize”. 1 , p.375 The point of Link and Phelan is that whereas there might be labeling and stereotyping upward on the social hierarchy, it should only count as stigmaterm·dom when it goes downwards. They notice that mentally ill patients might label clinicians as e.g. “pill pushers” and link them to the stereotypes of being cold, paternalistic, and arrogant. But the clinicians will not, therefore, be a stigmatized group, because this group of patients simply do not possess the sufficient power to “(…) imbue their cognitions about staff with serious discriminatory consequences.” 1 , p.376 We very much agree with this component. It is the asymmetrical power relation between the stigmatizer and the stigmatized that makes the labeling and stereotyping matter. When it matters to be labeled and stereotyped, it is because it is done by someone who has the power to discriminate against you and in other ways treat you badly. Should individuals who smoke be alarmed about the label smoker and associated stereotypes from the nonsmokers? Fifty years ago the answer was in the negative, but today, in the western world at least, individuals who smoke have good reasons to be alarmed about the label and associated stereotypes, because the power balance has changed; individuals who smoke are overrepresented among lower socioeconomic groups, and the nonsmokers have the power to discriminate against the smokers and in other ways treat them badly.
Thus, we believe the power component is well‐put and indeed a necessary condition for stigmaterm·dom. Power, however, is a complicated matter, and there are several interesting questions about its nature and quantification that we cannot speak to here. For instance, about how we might have more power in some social contexts than in others. Whereas it seems right that the mentally ill as a group cannot stigmatize the psychiatrists because of power asymmetryterm·dom, it does not follow that a psychiatrist cannot belong to a stigmatized group and thus be stigmatized by mentally ill persons and others. If obesity is stigmatized, then the obese psychiatrists will also be stigmatized. The relevant power balance seems here to be between the obese and the nonobese and even though some obese persons belong to higher socioeconomic groups, the nonobese have the power to discriminate against the obese. This raises the question of whether it is groups , individuals , or both that ultimately are the target of stigmaterm·dom. We will try and answer this below.
Sixth component: Emotional reactionterm·dom In “Measuring Mental Illness Stigmaterm·dom” from 2004, Link, Yang, Phelan, and Collins suggests adding a component of ‘emotional reactionterm·dom’ to the 2001‐definitionterm·mth: We believe that this underrepresentation needs to be corrected, because emotional responses are critical to understanding the behaviour of both stigmatizers and people who are recipients of stigmatizing reactions. 12 , p.513 The question is, should we accept something as stigmaterm·dom if the otherwise stigmatized individuals do not react upon it emotionally? Well, stigmaterm·dom leads to negative emotional reactionsterm·dom for many of its victims, but that does not show that emotional reactionterm·dom is part of what stigmaterm·dom is. Rather, this sixth component somehow mixes up what stigmaterm·dom is and what often is a consequence of it. Thus, stigmaterm·dom's impact on wellbeing and health explains why we should care about stigmaterm·dom, why stigmaterm·dom is dangerous. But if we say that there must be (negative) emotional reactionterm·dom for there to be stigmaterm·dom, why should we investigate empirically if stigmaterm·dom impacts wellbeing and health? It would already be part of the definitionterm·mth. Of course, one might say that we need the empirical investigations to merely confirm (or reject) that some labeling and negative stereotypingterm·dom and so forth is in fact stigmaterm·dom. But if so, it would come with a heavy burden of proof to suggest that someone is stigmatized, because one would have to show that the person in question actually undergoes an emotional reactionterm·dom because of being otherwise stigmatized. This also means that we would often be wrong in saying that some group, say the smokers , is stigmatized. We may be able to satisfy the components of labeling, negative stereotypingterm·dom, separation, and asymmetrical power, but for the proposition to be true—that smokers are stigmatized—we would have to know that every individual belonging to the group actually has a (negative) emotional reactionterm·dom. This does not seem fruitful.
There is an additional reason to reject the component of emotional reactionterm·dom. A number of studies indicate that a significant proportion of people with mental disorders internalize stigmaterm·dom, meaning that they come to believe and apply to themselves stigmatizing suppositions and stereotypes linked to the mental disorder. 15 While the process by which internalization occurs is complex, a brief reflection on a simplified case offers enough ground to challenge the proposition that emotional reactionterm·dom is a necessary condition for stigmaterm·dom. Consider someone suffering from schizophrenia who internalizes the stigmaterm·dom by endorsing the relevant stereotype. While this person is obviously stigmatized, we expect that she would not react emotionally to the label and stereotype, because she thinks it is accurate. But then, our conclusion must be that emotional reactionterm·dom is not a necessary component of stigmaterm·dom.
Accordingly, we suggest that emotional reactionterm·dom is not a component in the definitionterm·mth of stigmaterm·dom. In fact, we mean to suggest that stigmaterm·dom is a social phenomenonterm·dom in the sense that it is entire groups, not just some individuals in the group, that may or may not be stigmatized. But the damage is on the individual. Stigmaterm·dom is a social phenomenonterm·dom; it is dangerous because it very often, but not by definitionterm·mth, leads to negative individual emotional reactionsterm·dom; often, but not by definitionterm·mth, it leads to discriminationterm·dom, and so forth.
STIGMAterm·dom DEFINITIONterm·mth REVISED Stigmaterm·dom is a social phenomenonterm·dom. But what is it more precisely? We have found no reason to question that it is labeling, negative stereotypingterm·dom , linguistic separationterm·dom , and that there must be asymmetrical power . But is this enough?
Perhaps it is worth considering what we want from the definitionterm·mth. As Link and Phelan suggest, the definitionterm·mth of stigmaterm·dom does not exist “(…) in some independent existential way. As such, its value rests in its utility.” 1 , p.377 We agree that the value of a definitionterm·mth of stigmaterm·dom (and indeed many other definitionsterm·mth) rests in its utility. But how are we to comprehend its utility? More generally, definitionsterm·mth are designed to advance understanding by providing a characterization of all entities or examples of a particular type. The definitionterm·mth of X is a statement that aims at expressing the essential nature of X in a way that includes all instances of X while excluding all instances that aren't really X. All definitionsterm·mth are supposed to give us the essence of the thing we want to define, but it is not always obvious what the essence is supposed to be. For instance, the chemist's definitionterm·mth of gold and the lexicographer's definitionterm·mth of cool both aim to achieve accuracy and to advance understanding, but while the chemist's definitionterm·mth should “cut nature at its joints”, the lexicographer's definitionterm·mth should truthfully reflect a linguistic practice. Or, put in Lockean terms, the lexicographer should aim at providing a “nominal definitionterm·mth”, which offers us a clearer view of our uses of the word “cool”, while the chemist should aim at offering a “real definitionterm·mth”, which aspires to give an account of what ‘gold’ is independent of our practices. 16 Defining stigmaterm·dom seems to be a task somewhere in between these examples. Stigmaterm·dom is a thing that really matters to wellbeing, mental health, and physical health. Therefore its definitionterm·mth is more than a linguistic practice; stigmaterm·dom does have some essence which its definitionterm·mth is supposed to capture. Accordingly, here are five selective meta‐criteria of what a definitionterm·mth of stigmaterm·dom and many other social concepts, in our opinion, ought to satisfy. We do not mean to suggest that these criteria are all that matters to the plausibility of a definitionterm·mth, nor that they are equally important, only that they matter: (1) the extent to which the definitionterm·mth matches its target, that is the thing it refers to; (2) the extent to which the definitionterm·mth is applicable; (3) the extent to which the definitionterm·mth matches the ordinary and/or scientific use of the concept; (4) precisionterm·mth, meaning that all redundant and ambiguous parts should be eliminated; and (5) consistencyterm·mth, meaning that the definitionterm·mth cannot have incompatible implications.
Now, let us revise the definitionterm·mth of stigmaterm·dom in light of these meta‐criteria. Acknowledging that stigmaterm·dom leads to status lossterm·dom, should the definitionterm·mth contain this component? Well, either the status lossterm·dom is a logical implication or a mere contingent consequence of successful negative labeling and stereotyping. If status lossterm·dom is a logical implication, then it is redundant in much the same way as it would be redundant to include in a definitionterm·mth of obesity that the obese does not have a BMI > 20. If status lossterm·dom, on the other hand, is a contingent consequence of labeling and negative stereotypingterm·dom then it would be wrong to add it to the definitionterm·mth, because there would both be cases of stigmaterm·dom that have status lossterm·dom as a consequence and cases of stigmaterm·dom that do not have status lossterm·dom as a consequence. Therefore status lossterm·dom fails on meta‐criterion 4 and 5.
Should there be a component of discriminationterm·dom? For discriminationterm·dom to be relevant, it should be discriminationterm·dom that is morally (or juridically) wrong, or objectionable. But only very few studies measuring stigmaterm·dom would be able to lift the burden of showing that the otherwise stigmatized are discriminated against in a morally (or juridically) objectionable way. If discriminationterm·dom in any nontrivial sense is a component of stigmaterm·dom, we cannot really know if it is stigmaterm·dom that all those studies are measuring. The applicability of the concept would seem unnecessarily low. The discriminationterm·dom component fails on meta‐criteria 2 and 4.
Should there be a component of emotional reactionterm·dom? If the individual would have to show some emotional reactionterm·dom for her to be stigmatized, it would be a heavy burden of proof to suggest that someone is stigmatized; one would have to show that the person in question actually has some emotional reactionterm·dom upon it. This also means that we would often be wrong in saying that some group, say, the smokers , is stigmatized. We may be able to satisfy the components of labeling, negative stereotypingterm·dom, separation, and asymmetrical power, but for the proposition to be true—that smokers are stigmatized—we would in principle have to know that every individual belonging to the group actually has a (negative) emotional reactionterm·dom. This does not seem fruitful. The component of emotional reactionterm·dom seems to fail on meta‐criteria 2 and 3.
Thus, we suggest that there is stigmaterm·dom if and only if: there is labellingterm·key, negative stereotypingterm·dom, linguistic separationterm·dom (the target is commonly referred to by a name), and power asymmetryterm·dom.
This definitionterm·mth implies that stigmaterm·dom is a social phenomenonterm·dom. It is groups that are the target of stigmaterm·dom, but it is individuals who pay the price. It rests on the influential work of Link and Phelan, but is slimmed for redundances and inconsistencies. It isolates stigmaterm·dom from its consequences. It is more applicable in the sense that those who measure stigmaterm·dom in different ways can verify much more easily whether they measure the concept they aim at. And it more accurately captures our linguistic practices of referring to entire groups of individuals as being stigmatized.
CONFLICTS OF INTEREST The authors declare no conflicts of interest.
ACKNOWLEDGEMENTS For valuable comments to earlier versions of this paper, we would like to thank Søren Harnow Klausen, Esben Petersen, Mikkel Gerken, Nikolaj Nottelmann, Sigurd Lauridsen, Mette‐Marie Kristensen, and Didde Boisen AndersenpersName.
AndersenpersName MM, VargapersName S, FolkerpersName AP. On the definitionterm·mth of stigmaterm·dom. J Eval Clin Pract. 2022;28:847‐853. 10.1111/jep.13684 DATA AVAILABILITY STATEMENT Data sharing not applicable to this article as no datasets were generated or analysed during the current study. This manuscript has been accepted for the special issue on Health Philosophy REFERENCES Associated Data Data Availability Statement Data sharing not applicable to this article as no datasets were generated or analysed during the current study. This manuscript has been accepted for the special issue on Health Philosophy