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Lecture 5

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University of Toronto Scarborough

Lecture 5 Stigma, Cholera, Leprosy What is Stigma? - Many different definitions (all are good, just different) - Original term from Greek o A permanent mark that brands someone as a criminal/traitor/slave Goffman (1963) was first (sociologist): - “An attribute that is deeply discrediting.” - “When a person is characterized by society in a way that differs from the characteristics that person actually possesses.” - “Process of negative discrimination against people with certain physical, behavioral, or social attributes.” - A person is reduced from a whole to someone who is tainted, discounted. - The way OTHERS interpret the characteristics is important. - A person may start to see themself as they are stigmatized and identify with stigmatized status (called “internalization”) Jones et al (1984), social psychologists o “A mark that describes how society identifies a deviant condition that initiates stigma process.” o The mark makes a person flawed, spoiled, contaminated o It is something observable and it is a mark. That mark makes somebody flawed, it is a negative thing to have a birth mark. It isn’t a group of people, it is an individual. o Stigma is a very individual thing  Six Dimensions of Stigma 1. Concealability – how noticeable characteristic is 2. Course – is characteristic reversible 3. Disruptiveness – how big is effect on interpersonal interactions 4. Aesthetics – extent to which stigmatizing characteristic evokes disgust 5. Origin – how condition came into being; level of perceived responsibility 6. Peril – feelings of danger induced in others Crocker et al (1998), social psychologists: - When an objective characteristic of a person leads to negatively valued social identity.” - How a person sees themselves depends largely on social context “Kurzban and Leary (2001), evolutionary psychologists: - Based on natural selection - We’re evolved to look for obstacles to successful reproduction - We would avoid interaction (reproduction) with people who have characteristics that signal lower survival - This one is very different from the others 1. Individuals who provide little social benefit 2. Outgroups that are inferior 3. People with contagious diseases o Stigma is adaptive Link and Phelan (2001), sociologists o Focus on six interrelated components (societal forces) 1. Labeling – seeing something as different 2. Sterotyping – connect differences with negative characteristics 3. Cognitive separation – exclude stigmatized (“us” vs. “them”) 4. Emotional reaction – both in stigmatizers (fear) and stigmatized (shame) 5. Status Loss/Discrimination – stigmatized less valued by society, treated unfairly 6. Power imbalance – one group has power (social, economic, political) to hard stigmatized Consequences of Stigma - This is very good exam question. - You start to see yourself negatively because people tell you what you have is bad. - The person being stigmatized begins to have to performance anxiety and then assumes that role that you are giving them. Ex. Failing the driving exam and then performing really bad the next time because you think you are a bad driver - You develop the behaviour the people say you have. - Internalization: person starts to see themself as they are treated. o Stigmatized may be worried about being judged so perform less well o Stigmatizers assume role because everyone else does - Negative stereotypes are reinforced - People distance themselves from stigma as coping strategy o Ex: not getting a promotion – say it’s due to racism not lack of ability o Ex: leprosy – dissociate themselves from limbs - Delay health-seeking behaviours, treatment o Ex: stopping antibiotic treatment in case someone notices o Increases spread, progression of disease - Devaluation of Stigmatized - The people who are being stimgatized are being forced into the edge of society so you become invisible o By themselves  Intentional (leprosy, self-mutilation)  Unintentional (learned helplessness) o By society  Stigmatized forced to margins of society  Become “invisible” - Distrust of health authorities o Ex: “non-compliance” in cholera epidemic in Brazil (more on this later) - Unequal treatment of groups o Ex: psych disorders not covered by insurance - Distorts risk perceptions o Can lead to mass panic, misallocation of health resources - We don’t have as much support for psychiatric disorders. - It can distort risk perception. If you think that the stigmatized group is very dangerous and they start to worry about the big stuff like worrying so much about swine flu whereas we should be afraid of getting influenza because it is much more common. It can lead to panic and lead to misallocation of health resources so you start to waste money Most Stigmatized Diseases HIV/AIDS: - Because transmission is sexual or from needle-sharing, there’s moral dimension to illness - Perceived as “voluntary” - Course perceived to be unalterable - Contagious (therefore dangerous) Psychological Disorders - On one hand seen as dependent, helpless - On the other: difficult, unpredictable - One hand people with psychological disorders are seen as dependent and helpless - On the other hand they are seen as difficult and unpredictable such as schizophrenia - What to do about Stigma? 1. Protest - Boycott negative portrayals in media 2. Education - Replace inaccurate beliefs with facts - Public announcements, lectures, books, movies - Help stigmatized with strategies to deal with shame 3. Contact - Meet someone from a stigmatized group, see them functioning - Tends to be most effective method Cholera - It is a fairly curable disease - It could be so severe may be the losses of essential fluids, that the patient may lose the equivalent of his entire body weight over 2-3 days. These high losses of liquid may, in extreme cases, lead to severe dehydration, with shock in 4-12 hrs and death - Caused by the bacterium Vibrio cholerae - Up to 90% of cases are either mild or no symptoms (but can spread to others) - 5-8% of cases experience moderate diarrhea - 2-5% “cholera gravis” o severe, profuse watery diarrhea o rapid loss of fluid, electrolytes o Cramps, convulsions, shock, death if not treated - Without treatment: about 50% of cases die - With treatment: 1-2% case fatality - If you have chronic heartburn, then you suffer worse effects from cholera - Death happens within a couple of days Mechanism: - Bacteria produces a toxin in intestines that interferes with body’s water regulation - Fluid seeps into intestines and out of body - Spread through CONTAMINATED WATER - Relationship with stomach acid: people with low acid (elderly, children, people on antacids, malnourished people) have worse effects from cholera Treatment: - Oral Rehydration Therapy (ORT): • mix of sugar and salts to restore electrolyte balance • Keep person alive long enough to let natural immunity take over - Intravenous Therapy (IV): • Requires trained personnel • Not necessary, difficult to find a vein in advanced cases - Antibiotics (ex: tetracycline) • Not necessary but can lessen severity and duration of symptoms - ORT – Gatorade does the same thing. It requires clean water. - IV – Putting in IV but that requires medical personnel. As the disease gets more advanced, your blood gets thick so it is so hard to find a vein. - Antibiotics – You can treat cholera without it. It reduces the total volume of fluid loss and shortens the duration of both illness and carriage of vibrios in the feces. - The oral rehydration solution, is fed continuously to the patient during the diarrheal episode, obviating the need for intravenous rehydration, which is an effective therapy - Prevention: - The best way to prevent cholera is to give people clean water. - Know NPI – Instead of giving someone antibiotics, it is best to fix poverty and access to clean water - Vaccines o Some exist (relatively new), not super-effective - Quarantine o Not the most effective method - Non-Pharmaceutical Interventions (NPI) best o Drink uncontaminated water *requires presence of uncontaminated water!! o Hand washing, hygiene, sanitation o Reduce poverty: increase literacy, education, economic situation, decrease discrimination against women, ACCESS TO CLEAN WATER Cholera Pandemics - First recorded pandemic started 1817 o Cholera probably existed earlier but no concrete evidence o Started in Bengal (near Calcutta) - Six major pandemics between 1817-1923, all caused by O1 type - 1926-1960 … world was free of cholera - You don’t need to know when all the pandemics occurred. The general trend is important - It is likely that cholera existed before that but we don’t know that. - It is the subtype 01 that causes the problem. - In 1800’s not a lot of effective treatments, high mortality rate (50%) - In London, cholera tended to break out in late summer - People drank water without boiling it because they were hot and thirsty - Water supply from Thames (contaminated with sewage) - In dry years, flow of Thames may actually reverse, allow salt into river, better growing conditions for Vibrios - SEVENTH PANDEMIC: 1961 o New “El Tor” strain of Cholera (more asymptomatic carriers) o Linked to transatlantic shipping, ballast discharge, El Nino/plankton blooms, poor sanitation in developing world th o All the previous ones were caused by 01 and now the 7 pandemic is caused by “El Tor” o It flared up because of transatlantic shipping, if you took up a bunch of water from India and then released in Canada, now you brought Cholera. o If the conditions aren’t right then it can become dormanent. o Shellfish is a potential reservoir - In 1992 cholera reached Peru, first time i
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