Conceptualizing Stigma

Author(s): Bruce G. Link and Jo C. Phelan

Source: Annual Review of Sociology, Vol. 27 (2001), pp. 363-385
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 Annu.Rev.Sociol. 2001. 27:363-85
(? 2001 byAnnualReviews.All rightsreserved
Copyright

CONCEPTUALIZING STIGMA

BruceG. Link1and JoC. Phelan2

andNewYorkStatePsychiatric
'ColumbiaUniversity NewYork,
Institute, NY 10032;
e-mail:BGLl@Columbia.edu
2Department NewYork,
ofSociology,ColumbiaUniversity, NY 10021;
e-mail:JCP13@Columbia.edu

Key Words labeling, discrimination,

stereotype, deviance
exclusion,
* Abstract Socialscienceresearch onstigma hasgrown dramaticallyoverthepast
twodecades,particularly insocialpsychology, whereresearchershaveelucidated the
waysinwhichpeopleconstruct categories
cognitive andlinkthosecategoriestostereo-
typedbeliefs.In themidstofthisgrowth, thestigmaconcepthasbeencriticized as
beingtoovaguelydefined andindividuallyfocused.In responseto thesecriticisms,
we define stigma ofitscomponents-labeling,
as theco-occurrence stereotyping,sep-
aration, statusloss,anddiscrimination-and further thatforstigmatization
indicate to
occur,powermustbe exercised. Thestigma concept weconstruct
hasimplications for
understanding severalcoreissuesin stigmaresearch, rangingfromthedefinition of
theconcept tothereasonsstigmasometimes represents
a verypersistent
predicament
in thelivesofpersonsaffected byit.Finally, becausethereareso manystigmatized
circumstances andbecausestigmatizingprocesses canaffectmultipledomains ofpeo-
ple's lives,stigmatizationprobablyhasa dramatic bearingon thedistributionoflife
chancesinsuchareasas earnings, criminal
housing, involvement,
health,andlifeitself.
Itfollowsthatsocialscientists whoareinterested inunderstandingthedistributionof
suchlifechancesshouldalsobe interested instigma.

INTRODUCTION

Erving Goffman's (1963) book Stigma: Notes on the Management of Spoiled

Identityinspireda profusionofresearchon thenature,sources,andconsequences
ofstigma.BothPsychInfo andMedlineshowdramatic increasesinthenumber of
articlesmentioning thewordstigmaintheirtitlesorabstracts
from1980(PsychInfo
14, Medline19) to 1990 (PsychInfo81, Medline48) to 1999 (PsychInfo161,
Medline114).
ResearchsinceGoffman's seminalessayhas beenincredibly lead-
productive,
ing to elaborations, and repeateddemonstrations
conceptualrefinements, of the
negativeimpactof stigmaon thelives of the stigmatized. The stigmaconcept
is appliedto literally
scoresofcircumstancesrangingfromurinary incontinence
(Sheldon& Caldwell1994) to exoticdancing(Lewis 1998) to leprosy(Opala &

0360-0572/01/0811-0363$14.00 363

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364 LINK * PHELAN

Boillot1996),cancer(Fife& Wright2000), and mentalillness(Angermeyer &

Matschinger 1994,Corrigan & Penn1999,Phelanetal 2000). Itis usedtoexplain
someofthesocialvagariesofbeingunemployed (Walsgrove1987),to showhow
welfarestigmacanleadtotheperpetuation ofwelfareuse (Page 1984),andtopro-
videanunderstanding ofsituationsfacedbywheelchair users(Cahill& Eggleston
1995),stepparents (Colemanet al 1996),debtors(Davis 1998),andmothers who
arelesbian(Causey& Duran-Aydintug 1997).
A substantialportion oftheproductive research on stigmahasbeencontributed
bysocialpsychologists whohaveusedtheinsights ofthesocialcognitive approach
tounderstand howpeopleconstruct categoriesandlinkthesecategories to stereo-
typedbeliefs.Thislineofresearch representsa majoradvanceintheunderstanding
ofstigmaprocesses,andsociologists woulddo welltoattend toitthoroughly (fora
comprehensive review, see Crockeretal 1998).Giventheseadvancesinthesocial
psychology of stigmaandgiventheaccumulated scientific
impactofresearchon
stigmamoregenerally, we proposea return tothestigmaconceptfroma distinctly
sociologicalperspective. We engageoursociologicalperspective by attending to
severalcorecriticisms ofthestigmaconceptanditsapplication. The first
ofthese
criticismsis directedtowardtheclarityof theconceptandfollowsfromtheob-
servationthatstigmais definedin different waysby different The
investigators.
secondis a setof criticisms regarding thewayin whichthestigmaconcepthas
beenappliedby someresearchers. We use thesecriticisms bothas a stimulus to
returntothestigmaconceptandas a criticalanalytic lensinconstructing a revised
conceptualization. We followourexplication of thestigmaconceptwitha more
detaileddiscussionofeach ofitscomponent parts.We endby applyingourcon-
ceptualizationtoseveralcoreissuesinthestigmaliterature withaneyetoassessing
whether ourconceptualization is helpfulin understanding thoseissues.In doing
so, we attendmoreto thenatureandconsequencesof stigmathanto itssources.
(For a reviewof someideas abouttheoriginsof stigmasee Crocker& Lutsky
1986.)

VARIATIONSIN THE DEFINITION OF STIGMA

One of thecuriousfeatures of literature
concerning stigmais thevariability
that
existsin thedefinitionof theconcept(Stafford & Scott1986). In manycircum-
stancesinvestigatorsprovideno explicitdefinitionandseemtoreferto something
likethedictionary definition("a mark ofdisgrace")orto somerelatedaspectlike
stereotyping orrejection(e.g.,a socialdistancescale). Whenstigmais explicitly
defined, manyauthors quoteGoffman's definition
ofstigmaas an "attribute
thatis
deeplydiscrediting" andthatreducesthebearer"froma wholeandusualperson
to a tainted,
discountedone" (Goffman 1963,p. 3).
SinceGoffman, alternative orelaborateddefinitions havevariedconsiderably.
Forexample,Stafford & Scott(1986,p. 80) proposethatstigma"is a characteristic
ofpersonsthatis contrary toa normofa socialunit"wherea "norm"is defined as

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 CONCEPTUALIZING STIGMA 365

a "sharedbeliefthata personoughtto behavein a certainwayat a certaintime"

(p. 81). Crockeretal (1998,p. 505) indicatethat"stigmatized individualspossess
(or arebelievedtopossess)someattribute, orcharacteristic, thatconveysa social
identity thatis devaluedin a particular socialcontext." An especiallyinfluential
definition is thatofJonesetal (1984),whouse Goffman's (1963,p.4) observation
thatstigmacan be seenas a relationship betweenan "attribute and a stereotype"
to producea definition of stigmaas a "mark"(attribute) thatlinksa personto
undesirable characteristics (stereotypes).In ourownreviewsofstigmaandmental
illness(e.g.,Link& Phelan1999),we haveaddedthecomponent ofdiscrimination
totheJoneset al (1984) definition.
Of themanyreasonsthatdefinitions of stigmavary,two seem particularly
prominent. First,as indicatedabove,thestigmaconcepthas beenappliedto an
enormousarrayof circumstances. Each one of theseis unique,and each one is
likelyto lead investigators to conceptualize stigmain a somewhat different
way.
Second,research on stigmais clearlymultidisciplinary, including contributionsby
psychologists, sociologists, anthropologists, politicalscientists,andsocialgeogra-
phers.Although thereis a greatdealofoverlapininterests acrossthesedisciplines,
therearenevertheless somedifferences inemphasis.Evenwithin peo-
disciplines,
ple approachthestigmaconceptfromdifferent theoretical orientationsthatpro-
ducesomewhat different visionsofwhatshouldbe includedintheconcept.Thus,
different framesofreference haveled todifferent conceptualizations.
Becauseofthecomplexity ofthestigmaphenomenon, itseemswisetocontinue
to allow variationin definition so long as investigators are clear as to whatis
meantby stigmawhenthetermis used. Havingsaid this,we shallalso attempt
to movematters aheadby specifying a conceptualization of stigmathatincludes
manyof theconcernsthatpeopleworking in thisarea ofresearchshare.Before
proceeding, however, itis important tonotethattheuse ofthestigmaconcepthas
been challengedby some social scientists who havefocusedon theperspective
ofpersonswhoarestigmatized (Schneider1988,Fine& Asch 1988,Sayce 1998;
Kleinmanetal 1995).Understanding thesechallengesis important forthefurther
development ofresearchon stigma, particularly froma sociologicalperspective.

CHALLENGESTO THE STIGMACONCEPT

Therearetwomainchallengestothestigmaconcept.The first is thatmanysocial
whodo notbelongto stigmatized
scientists groups,andwhostudystigma,do so
fromthevantagepointof theoriesthatare uninformed by thelivedexperience
ofthepeopletheystudy(Kleinmanet al 1995,Schneider1988).Forexample,in
writingabouttheexperience
ofdisability,
Schneider(1988) assertsthat"mostable-
"to theirscientific
bodiedexperts"givepriority theoriesandresearchtechniques
ratherthanto thewordsandperceptions of thepeopletheystudy."The resultis
of theexperienceofthepeoplewhoare stigmatized
a misunderstanding andthe
ofunsubstantiated
perpetuation assumptions. aboutdisability,
Writing Fine& Asch

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366 LINK * PHELAN

(1988) identify fiveassumptions: (a) thatdisabilityis locatedsolelyin biology,

(b) thattheproblemsof thedisabledaredue to disability-produced impairment,
(c) thatthedisabledpersonis a "victim,"(d) thatdisabilityis centralto the
disabledperson'sself-concept, self-definition,socialcomparisons, andreference
groups,and(e) thathavinga disability is synonymous withneedinghelpandsocial
support.
The secondchallengeis thatresearchon stigmahas had a decidedlyindividu-
alisticfocus.Forexample,according toOliver(1992),thecentralthrust ofstigma
research hasbeenfocusedon theperceptions ofindividuals andtheconsequences
of suchperceptions formicro-level interactions.Accordingto Oliver(1992), re-
searchexaminingthe sourcesand consequencesof pervasive,sociallyshaped
exclusionfromsocial and economiclifeare farless common.Interestingly, this
criticismis echoedbyatleastonerenowned studentofstereotyping, prejudice, and
discrimination. In herreviewof thesetopics,SusanFiske(1998) concludesthat
(at leastwithinsocialpsychology) theliterature on discriminationis farless ex-
tensivethanthaton stereotyping and thatmoreattention needsto be addressed
to structuralissues.In anothervein,eventhoughGoffman (1963, p. 3) initially
advisedthatwe reallyneeded"a languageofrelationships, notattributes," subse-
quentpracticehas oftentransformed stigmasor marksintoattributes ofpersons
(Fine & Asch 1988). The stigmaor markis seen as something in theperson
rather thana designation or tagthatothersaffixto theperson.In thisrespectthe
termstigmadirectsour attention differently thana termlike "discrimination."
In contrast to "stigma,""discrimination" focusestheattention ofresearchon the
producersof rejectionand exclusion-thosewho do thediscriminating-rather
thanon thepeoplewhoaretherecipients ofthesebehaviors(Sayce 1998).Thus,
thetermswe use couldlead to "different understandings ofwhereresponsibility
lies forthe'problem'andas a consequenceto different prescriptions foraction"
(Sayce 1998).
Researcherson stigmacould respondto thesechallengesby disputing their
validityor pointingto exceptionsin thenow voluminousliterature on stigma.
We findthesecritiquesto providea usefulstimulusfora reassessment of the
conceptualization of stigmaandrelatedconcepts.One wayin whichsomeofthe
issuesraisedbythecritiques canbe addressed is toproposethatstigmabe described
withreference totherelationships betweena setofinterrelated concepts.

DEFINING STIGMAIN THE RELATIONSHIP

OF INTERRELATEDCOMPONENTS

An importantprecedent tolocatingthemeaningofstigmaintherelationbetween
conceptsis availablein Goffman'sobservationthatstigmacan be seen as the
relationship
betweenan "attribute and a stereotype."
We expandthenexusof
somewhat
relationships withtheintentof capturing
a fullersetof meaningsfor

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 CONCEPTUALIZING STIGMA 367

thetermbydoingso. We stateourconceptualization as conciselyas we can and

thenelaboratethecomponents itcontains.
In ourconceptualization, stigmaexistswhenthefollowing interrelated
com-
ponentsconverge.In thefirstcomponent, people distinguish and label human
In thesecond,dominant
differences. culturalbeliefslinklabeledpersonstounde-
sirablecharacteristics-to negativestereotypes. In thethird, labeledpersonsare
placedindistinct categoriesso as toaccomplish somedegreeofseparation of"us"
from"them."In thefourth, labeledpersonsexperience statusloss anddiscrimina-
tionthatlead to unequaloutcomes.Finally,stigmatization is entirelycontingent
on access to social,economic,andpoliticalpowerthatallowstheidentification
ofdifferentness,theconstruction ofstereotypes,theseparation oflabeledpersons
intodistinct
categories, andthefullexecution ofdisapproval, rejection,exclusion,
and discrimination. Thus,we applythetermstigmawhenelementsof labeling,
stereotyping,separation,statusloss,anddiscrimination co-occurin a powersitu-
ationthatallowsthecomponents of stigmato unfold.Withthisbriefexplication
ofthestigmaconceptas background, we turnto a moredetailedexamination of
each component we identified.

COMPONENT 1-ON DISTINGUISHING

AND LABELINGDIFFERENCES
The vastmajority of humandifferences are ignoredand are therefore socially
irrelevant.Some of these-such as thecolorof one's car,thelastthreedigitsof
one's social securitynumber, or whether one has hairyears-are routinely (but
notalways)overlooked. Manyotherssuchas one's foodpreferences oreyecolor
arerelevant inrelativelyfewsituations andaretherefore typically
inconsequential
in thelargeschemeofthings.Butotherdifferences, suchas one's skincolor,IQ,
sexualpreferences, or genderarehighlysalientin theUnitedStatesat thistime.
Thepointis thatthereis a socialselectionofhumandifferences whenitcomesto
identifying differencesthatwillmatter socially.
Thefullweightofthisobservation is oftenoverlooked becauseoncedifferences
are identifiedand labeled,theyare typically takenforgrantedas beingjust the
waythings are-thereareblackpeopleandwhitepeople,blindpeopleandsighted
people,peoplewhoarehandicapped andpeoplewhoarenot.Thetaken-for-granted
natureof thesecategorizations is one of thereasonsthatdesignations likethese
carrysuchweight.Thereare,however, someobservations we canmakethatbring
tolightjusthowsocialthissocialselectionofhumandifferences is.
First,substantialoversimplification is requiredto creategroups.One example
is theassignment of individuals to categoriesof "black"or "white"whenthere
is enormousvariability withintheresulting categoriesand no cleardemarcation
between categories onalmostanycriterion onecanthink of,evenattributeslikeskin
color,parentage, orfacialcharacteristics thatarebelievedtodefinethecategories

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368 LINK * PHELAN

(Fullilove1998).Thesamecanbe saidforothercategorizations likegayorstraight,

blindorsighted, handicapped ornot.
Second,thecentralroleofthesocialselectionofhumandifferences is revealed
bynotingthattheattributes deemedsalientdiffer dramatically accordingto time
and place. For example,in thelatenineteenth century, humanphysicalcharac-
teristics
suchas smallforeheads andlargefaceswereparticularly salient-these
characteristics
werethought tobe ape-like-andwerebelievedtorevealthecrim-
inalnatureofthepeoplepossessingthem(Gould 1981).And,ofcourse,cultures
varyextensively deemedsociallysignificant.
in characteristics Forexample,an-
cientMayanculturegaveunusualsignificance to beingcross-eyed andsoughtto
inchildren
createthisdesirablecharacteristic through devicesthatencouraged ba-
biestofocusonobjectsinwaysthatforcedtheireyestocross.Sociologicalstudies
ofsocialconstruction andmedicalization arealso goodexamples(Conrad1992).
Hyperactivityis muchmoresalientnow,as an indicator ofa disorder,thanitused
tobe,andthemedicaltermADHD (attention deficithyperactivity disorder) is part
ofcommonparlance.
Becausehumandifferences aresociallyselectedforsalience,wehavechosento
use theword"label"rather than"attribute,""condition" or"mark."Each ofthese
lattertermslocatesthethingthatis beingreferred to in thestigmatized person
and risksobscuringthatits identificationand electionforsocial significance is
theproductof social processes.In contrast,a label is something thatis affixed.
Moreoverin theabsenceofqualifications, termslike"attribute," "condition," or
"mark"implythatthedesignation hasvalidity.In contrast theword"label"leaves
thevalidityofthedesignation an openquestion-an optionthathas greatutility
as, forexample,whenonewishestodiscussthestigmasomewomenexperienced
as a consequenceofbeinglabeledwitches.
Withregardto thisaspectofthestigmaprocess,thecriticalsociologicalissue
is todeterminehowculturally createdcategories ariseandhowtheyaresustained.
Whyis itthatsomehumandifferences aresingledoutanddeemedsalientbyhuman
groupswhileothers areignored?Whatarethesocial,economic,andcultural forces
thatmaintain thefocuson a particularhumandifference?

COMPONENT 2-ON ASSOCIATINGHUMAN

DIFFERENCESWITH NEGATIVEATTRIBUTES

The secondcomponent of stigmaoccurswhenlabeleddifferences are linkedto

This of was
stereotypes. aspect stigma highlighted in Goffman's (1963) workand
has been centralto theconceptualization of stigma ever since.It is theaspect
has
of stigmathat beenmost salientin thepsychological literatureaboutstigma,
perhaps because it poses criticalquestions of a psychological nature aboutthe
thoughtprocessesthatfacilitateconnections betweenlabelsandstereotypes. Con-
sistentwiththisemphasisin psychology is thecentrality of thisdimensionin
definitions
psychologists' ofstigma.Forexample,Crockerandcolleagues(1998)

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 CONCEPTUALIZING STIGMA 369

definestigma, as notedabove,as an"attribute orcharacteristicthatconveysa social

identity thatis devaluedin a particular context."
Inourterms, thisaspectofstigmainvolvesa labelanda stereotype, withthelabel
linking a persontoa setofundesirable thatformthestereotype.
characteristics An
exampleofthiscomponent is evidentin a vignette experiment conducted byLink
et al (1987). The studyexperimentally manipulated labeling,tagginga random
halfofthevignettes "former mentalpatients" andtheotherhalf"former back-pain
patients." It also includeda measureoftheextentto whichrespondents believed
thatmentalpatientsingeneralwere"dangerous." Whenthevignette describeda
former back-painpatient, beliefsaboutthedangerousness ofpeoplewithmental
illnessplayedno partin rejectingresponsestowardthevignettesubject.When
thevignette describeda former mentalpatient, however, thesebeliefswerepotent
predictors ofrejecting responses:Respondents whobelievedmentalpatients were
dangerousreactednegatively to thepersondescribedas a former mentalpatient
in thevignette. Apparently, formanypeople,the"mentalpatient"label linked
thedescribedpersonto stereotyped beliefsaboutthedangerousness of people
withmentalillness,whichin turnled themto desireforsocialdistancefromthe
person.
As indicated above,thisconnection betweenlabelsandstereotypes has beena
majoraspectofthepsychological studyof stigmain recentyears,following the
socialcognitive approach(Fiske 1998).Thisintriguing andveryfruitful bodyof
research seekstoelucidatethecognitive processesunderlying theuseofcategories
andthelinkingofthosecategories to stereotypes(Crockeret al 1998).We focus
briefly on someselectedaspectsofthisextensive bodyofresearch.
Accordingto thisliterature, categoriesand stereotypes are often"automatic"
and facilitate "cognitive efficiency." The automatic natureis revealedin experi-
mentsthatindicatethatcategories andstereotypes areusedinmakingsplit-second
judgments andthusappeartobe operating preconsciously. Forexample,Gaertner
& McLaughlin(1983) conducted anexperiment inwhichonegroupofwhitesub-
jects was primedby theword"whites"and anotherby theword"blacks,"and
thenbothgroupsweretestedas tothespeedwithwhichtheywereabletoidentify
whether twostringsof letterswerebothwords.Bothhigh-and low-prejudiced
subjectsresponded morerapidlytopositivewordslike"smart," "ambitious,"and
"clean"whenprimed bytheword"whites"thanwhenprimed bytheword"blacks."
In addition tooperating ina preconcious, automaticway,somestudiessuggestthat
category usepreserves cognitive resources. Thus,forexample,ifsubjectsarepro-
videdwithlabelslikedoctor,artist, skinhead, orrealestateagentwhenaskedto
forman impression of a vignette, theyarebetterable to simultaneously perform
anothertasklike turning offa beepingcomputer thanare subjectswho are not
providedtheselabels(Macraeetal 1994).Thus,froma psychological standpoint,
culturally givencategoriesare presenteven at a preconciouslevel and provide
peoplewitha meansof makingshorthand decisionsthatfreethemto attendto
othermatters. At thesametime,otherresearchin socialpsychology revealscon-
siderablelatitudein thecognitive processesthattranspire suchthatverydifferent

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370 LINK * PHELAN

outcomesmayoccurdepending peopleemployand
onthenatureofthecognitions
inwhichpeopleareembedded(Crockeretal 1998).
thecontexts

COMPONENT 3-ON SEPARATING"US" FROM "THEM"

A thirdfeatureof thestigmaprocessoccurswhensocial labels connotea sep-
arationof "us" from"them"(Morone1997,Devine et al 1999). UnitedStates
historyandpoliticsoffermanyexamplesas established old-order Americans de-
finedAfrican-American slaves,American Indians,andsuccessivewavesofimmi-
grantsas outgroups-the"them"whowereverydifferent from"us." Few groups
wereentirely spared.Forexample,Morone(1997) providesquotesfromBenjamin
Franklin'sobservations of theimpactof Dutchimmigrants ("them")on theEn-
glishcolonists("us"). "Already theEnglishbegintoquitparticular neighborhoods,
surrounded bytheDutch,beingmadeuneasybythedisagreeableness ofdissonant
manners ... Besides,theDutchunder-live, andarethereby enabledtounder-work
and under-sell theEnglishwho are thereby extremely incommoded and conse-
quentlydisgusted" (Franklin 1752).Andofcourse,whilethegroupsrepresenting
"us" and"them"havechanged,thisseparation is stillprominent today."They"are
a menaceto "us" becausetheyareimmoral, lazy,andpredatory (Morone1997).
Thus,othercomponents of thestigmaprocess-thelinkingof labelsto undesir-
ableattributes-become therationale forbelievingthatnegatively labeledpersons
arefundamentally different fromthosewhodon'tsharethelabel-different types
of people.At thesametime,whenlabeledpersonsare believedto be distinctly
different,stereotyping can be smoothly accomplished becausethereis littleharm
in attributing
all manner ofbad characteristicsto"them."In theextreme, thestig-
matizedpersonis thought from"us" as to be notreallyhuman.
to be so different
And again,in theextreme, all mannerof horrific treatment of "them"becomes
possible.
Evidenceofefforts to separateus fromthemare sometimes directly available
in theverynatureof thelabels conferred. Incumbents are thought to "be" the
thingtheyarelabeled(Estroff 1989).Forexample,somepeoplespeakofpersons
as being"epileptics"or "schizophrenics" ratherthandescribing themas having
epilepsyor schizophrenia. Thispracticeis revealing regardingthiscomponent of
stigmabecauseitis different forotherdiseases.A personhas cancer,heartdisease,
ortheflu-sucha personis one of"us,"a personwhojusthappenstobe besetby
a seriousillness.Buta personis a "schizophrenic."

COMPONENT 4-STATUS LOSS AND DISCRIMINATION

In thiscomponent statusloss
ofthestigmaprocess,thelabeledpersonexperiences
anddiscrimination.Mostdefinitions ofstigmado notincludethiscomponent,but
as we shallsee,thetermstigmacannotholdthemeaningwe commonly assignto
whenpeoplearelabeled,setapart,
itwhenthisaspectis leftout.In ourreasoning,

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 CONCEPTUALIZING STIGMA 371

andlinkedtoundesirable a rationaleis constructed

characteristics, fordevaluing,
and excludingthem.Thus,people are stigmatized
rejecting, whenthefactthat
theyarelabeled,setapart,andlinkedto undesirable characteristics
leadsthemto
experience statusloss anddiscrimination.
Consistentwiththis,stigmatized groupsaredisadvantaged whenitcomesto a
generalprofileoflifechanceslikeincome,education, psychological
well-being,
housingstatus,medicaltreatment, andhealth(e.g. Drusset al 2000,Link 1987).
Whilesomegroupsescapetheexperience ofsomedisadvantaged outcomessome-
times(e.g.,AfricanAmericans regarding self-esteem-seeCrocker1999),when
one considerstheprofileof all possibleoutcomes,thegeneralprincipleclearly
holdsformoststigmatized groups.How does thishappen?

StatusLoss
Analmostimmediate consequence ofsuccessful negative labelingandstereotyping
is a generaldownward placement ofa personin a statushierarchy. The personis
connectedto undesirable characteristicsthatreducehis or herstatusin theeyes
of thestigmatizer. The factthathumanbeingscreatehierarchies is, of course,
evidentin organizational charts,whositswhereinmeetings, whodefersto whom
in conversationalturn-taking,and so on. One strandof sociologicalresearchon
socialhierarchies,theso-calledexpectation-states tradition,is particularlyrelevant
to thestudyof stigmaand statusloss (Cohen 1982,Driskell& Mullen 1990).
Based on finding a reliabletendency of evenunacquainted indivdiualsto form
fairlystablestatushierarchieswhenplacedingroupsituations, researchers setout
to understand theprocessesthatproducedthisstateof affairs. Whattheyhave
foundis relevantto researchon stigmain manyways,two of whichwe shall
emphasizehere.First,thisresearchshowsthatexternalstatuses,like race and
gender, shapestatushierarchies within smallgroupsofunacquainted personseven
thoughtheexternalstatushas no bearingon proficiency at a taskthegroupis
askedto perform. Men and whitesare morelikelythanwomenand blacksto
attainpositionsofpowerandprestige-they talkmorefrequently, havetheirideas
morereadilyacceptedby others,and are morelikelyto be votedgroupleader
(Mullenet al 1989). Thesefindings areimportant to researchon stigmabecause
theyshowhowhavinga statusthatis devaluedin thewidersocietycan lead to
veryconcrete formsofinequality inthecontext ofsocialinteractions withinsmall
groups.Second,although inequalitiesin status-relatedoutcomesdefinitely occur
inthegroups,theydo notresultfromforms ofdiscrimination thatwouldbe readily
apparent to a casual observer.Insteadgroupmembers use externalstatuses(like
raceandgender)tocreateperformance expectations thatthenleadtoa labyrinth of
detailsthatinvolvetakingthefloor, keepingthefloor, referring tothecontributions
of others,headnodding,interrupting, and thelike.Thisis important to research
on stigmabecauseitshowsthatsubstantial differencesinoutcomecanoccureven
whenit is difficult forparticipants to specifya singleeventthatproducedthe
unequaloutcome.

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372 LINK * PHELAN

Discrimination
INDIVIDUAL DISCRIMINATION The standard wayofconceptualizing theconnec-
tionbetweenlabeling,stereotyping, and discrimination in thestigmaliterature
followsa relatively simplisticformulation. In thisapproach,theimportance of
attitudesandbeliefsarethought to lie in whether personA's labelingandstereo-
typingof personB leads personA to engagein some obviousformsof overt
discriminationdirectedat personB, suchas rejecting a job application,refusing
torentan apartment, andso on. Thereis no doubtthatthisrather straightforward
processoccurswithconsiderable regularity, althoughsomesocialpsychologists
withinterestsinstigmahaverecently bemoanedthefactthatdocumenting discrim-
inatorybehaviorhas notbeentheirstrongsuit(Fiske1998).Connecting attitudes
to behaviorsis, therefore,conceptualized as something thearea of researchon
stigmaand stereotyping needs(Fiske 1998). In thisregardAjzen & Fishbein's
(1980) "theoryofreasonedaction"hasbeensuccessfully appliedtotheprediction
ofmanybehaviors andmight alsobe usefulinpredicting discriminatory behaviors.
The approachtheyproposeis effective becauseit asksus to narrowourfocusto
a veryspecificbehaviorand to be attentive to theintricacies of thebeliefsand
attitudestowardperforming thespecificactinquestion.Buttheareaofstigmare-
searchneedstoexpanditsconception oftheprocessesthrough whichlabelingand
stereotypingleadtosocialinequalities inlifecircumstances. By itselfthestandard
modelthatasks"what-makes-person-A-discriminate-against-person-B" is inade-
quateforexplainingthefullconsequencesof stigmaprocesses.In fact,getting
tangledup in thenarrowintricacies ofexplaining a specificactfromknowledge
of a specificset of attitudesand beliefscould cloud ratherthanilluminate our
understanding ofwhystigmatized groupsexperience so manydisadvantages.

STRUCTURALDISCRIMINATION Theconcept ofinstitutional

racismsensitizesusto
thefactthatall manner ofdisadvantage canresultoutsideofa modelinwhichone
persondoes something bad to another.Institutional
racismrefersto accumulated
institutional
practicesthatworktothedisadvantage ofracialminority groupseven
in theabsenceofindividual prejudiceordiscrimination (Hamilton& Carmichael
1967). For example,employers (moreoftenwhite)relyon thepersonalrecom-
mendations ofcolleaguesor acquaintances (moreoftenwhiteandmorelikelyto
knowandrecommend whitejob candidates)forhiringdecisions.The samekind
ofstructuraldiscrimination is,ofcourse,presentforotherstigmatized groups.For
example,disabledpersonsmaybe limitedin theirabilityto worknotso much
becauseof theirinherent limitations
butbecausetheyareexposedto whatHahn
(1983) calls"a disablingenvironment" createdbythebarriers toparticipation
that
residein architecture we humanshave constructed (Fine & Asch 1988). Con-
sidersomepossibleexamplesofstructural discriminationfora mentalillnesslike
schizophrenia. Supposethatbecausetheillnessis stigmatized, lessfundingis ded-
icatedto researchaboutit thanforotherillnessesand less moneyis allocated
to adequatecareandmanagement. Moreover, considerthat,becauseofhistorical

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 CONCEPTUALIZING STIGMA 373

processesinfluenced by stigma,treatment facilitiestendto be eitherisolatedin

settingsawayfromotherpeople(Rothman1971) orconfined to someofthemost
disadvantaged neighborhoods in urbansettingsin communities thatdo nothave
enoughcloutto excludethisstigmatized groupfromtheirmidst(Dear & Lewis
1986). At thesame time,themostsuccessfuland accomplishedmentalhealth
personnel tendto accruemorestatusandmoneybytreating less seriousillnesses
in privateofficesin affluentareas,leavingthecareofpeoplewithschizophrenia
to a generally
less accomplished group(Link1983).To theextentthatthestigma
ofschizophrenia hascreatedsucha situation, a personwhodevelopsthisdisorder
willbe therecipient of structural
discriminationwhether or notanyonehappens
to treathimor herin a discriminatory way because of some stereotype about
schizophrenia.Stigmahas affected thestructurearoundtheperson,leadingthe
personto be exposedto a hostofuntoward circumstances.

STATUS LOSS AS A SOURCE OF DISCRIMINATION In keepingwithobservations

abouttherole of stigmain theloss of status,it is important to notethatlower
placement in a statushierarchy
can beginto haveeffects ofitsownon a person's
lifechances.Itis notnecessary
torevisitthelabelingandstereotyping thatinitially
ledtothelowerstatus, becausethelowerstatusitselfbecomesthebasisofdiscrim-
ination.Forexample,low statusmightmakea personless attractive to socialize
with,to involvein community orto includein a businessventure
activities, that
requirespartners whohavepoliticalinfluence withlocal politicians.
In thisway,
a lowerpositionin thestatushierarchycan havea cascadeofnegativeeffects on
all mannerofopportunities.Becausethediscrimination thatoccursis one stepre-
movedfromthelabelingandstereotyping, itis easytomissthemoredistaleffects
ofthesefactors in anyaccountingoftheeffects ofthesestigmacomponents.

SOCIAL PSYCHOLOGICAL PROCESSES OPERATING THROUGH THE STIGMATIZED

is in place, it can affectlabeledpersons
PERSON Once theculturalstereotype
inimportant waysthatdo notinvolveobviousforms ofdiscriminatory
behavioron
thepartofpeopleintheimmediate presenceofthestigmatizedperson.Forexam-
ple , accordingtoa modifiedlabelingtheoryabouttheeffectsofstigmaon people
withmentalillnesses(Link1982,Linketal 1989),peopledevelopconceptions of
mentalillnessearlyinlifeas partofsocialization
intoourculture(Angermeyer &
Matschinger 1996,Scheff1966,Wahl1995).Onceinplace,people'sconceptions
becomea lay theoryaboutwhatit meansto havea mentalillness(Angermeyer
& Matschinger 1994,Furnham& Bower1992). People formexpectations as to
whether mostpeoplewillrejectan individual em-
withmentalillnessas a friend,
ployee,neighbor, orintimate
partnerandwhether mostpeoplewilldevaluea person
withmentalillnessas less trustworthy, andcompetent.
intelligent, Thesebeliefs
havean especiallypoignant relevancefora personwhodevelopsa seriousmental
illness,becausethepossibilityofdevaluation
anddiscrimination becomesperson-
allyrelevant.Ifonebelievesthatotherswilldevalueandrejectpeoplewithmental
illnesses,onemustnowfearthatthisrejection Thepersonmay
appliespersonally.

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374 LINK * PHELAN

wonder,"Willotherslook downon me,rejectme, simplybecauseI havebeen

identified as havinga mentalillness?"Thento theextentthatit becomesa part
ofa person'sworldview,thatperception canhaveseriousnegative consequences.
Expectingand fearingrejection, peoplewho havebeenhospitalizedformental
illnessesmayactless confidently andmoredefensively, ortheymaysimplyavoid
a potentially threatening contactaltogether. The resultmaybe strained and un-
comfortable social interactionswithpotentialstigmatizers (Farinaet al 1968),
moreconstricted social networks (Link et al 1989), a compromised qualityof
life(Rosenfield 1997),low self-esteem (Wright etal 2000),depressive symptoms
(Linket al 1997),unemployment andincomeloss (Link1982,1987).Whilethis
theory has beenmostthoroughly examinedwithrespectto mentalillnesses,the
processis probablymuchmoregeneral.In keepingwiththispossibility, Pinel
(1999) hasrecently calledtheexpectation ofstereotyping "stigmaconsciousness"
andhasproposeditsapplication to otherstigmatized statuses.
A relatedbutslightly different to
approach understanding theeffect of stereo-
typesis Steele& Aronson's(1995)conceptof"stereotype threat."
According tothis
idea,peopleknowaboutthestereotypes thatmightbe appliedto them-African
Americans knowtheyaretaggedwithattributes ofviolenceandintellectual infe-
riority,gaymenknowtheyare seenas flamboyant andpromiscuous, andpeople
withmentalillnessesknowthattheyarebelievedtobe unpredictable anddanger-
ous. The insightthatSteele& Aronsonprovideis thatthestereotype becomesa
threat or challengeeitherbecauseone mightbe evaluatedin accordancewiththe
stereotype orbecauseonemightconfirm thestereotype through one'sbehavior. In
keepingwiththisidea,Steele& Aronsonhaveshownthat,controlling forinitial
differences on SAT scores,African-American students perform worsethanwhite
students on a testwhenstudyparticipants areled tobelievethatthetestmeasures
intellectualability.In contrast,
whenthesametestis notlabeledas beingdiagnos-
ticofability, African Americans scoreas wellas whites.Thisresearch tellsus that
theexistenceofa stereotype andtheadministration ofa testof"ability"can lead
to an invalidassessment oftheacademicpotential ofAfrican-American students
and thereby to discrimination againstsuchstudents on thebasis of a seemingly
"objective"test.
Notethatinboththemodified labelingtheory andtheory aboutstereotype threat,
no one in theimmediate contextofthepersonneedsto haveengagedin obvious
formsofdiscrimination. Rather,thediscrimination lies anteriorto theimmediate
situation andrestsinsteadin theformation andsustenance ofstereotypes andlay
theories. Stilltheconsequencesaresometimes severeandundoubtedly contribute
greatly todifferences inthelifechancesofpeoplein stigmatized groups.

INTERCHANGEABLEMECHANISMS The problemof stigmahas beendescribedas

a predicament or a dilemmaby Goffman and others(Ainlayet al 1986,Crocker
et al 1998). One reasonforthisis brought to lightby thesociologicalobserva-
tionthatmechanisms liketheones we have describedare bothinterchangeable
and mutually reinforcing in achievingendsthatdiscrimnate againststigmatized

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 CONCEPTUALIZING STIGMA 375

groups(Lieberson1985).Ifpowerful groupsaremotivated todiscriminate against

a stigmatized"them,"therearemanywaysin whichsuchdiscrimination can be
achieved.If stigmatizedpersonscannotbe persuadedto voluntarily accepttheir
lowerstatusand inferior rewards,directdiscrimination can be used to accom-
plishthesameoutcome.If directdiscrimination becomesideologicallydifficult,
sophisticatedformsofstructuraldiscrimination-such as teststhatinducestereo-
typethreat-canachievesomeof thesameends.The mechanisms are mutually
reinforcingas well. To theextentthatstigmatized groupsacceptthedominant
view of theirlowerstatus,theyare less likelyto challengestructural formsof
discriminationthatblockopportunitiestheydesire.Further, directdiscrimination
reinforcesthebeliefamongstigmatized groupsthattheywillbe treated in accor-
dancewithstereotypes andthereforereinforcesprocesseslikethoseexplicatedin
thecontextof modified labelingtheoryand thestereotype-threat concept.From
thisvantagepoint,stigmais a predicament in thefollowingsense-as longas
dominant groupssustaintheirviewof stigmatized persons,decreasing theuse of
onemechanism through whichdisadvantage canbe accomplished simultaneously
createstheimpetus toincreasetheuse ofanother. Thislatterobservation bringsus
tothefinalaspectofourstigmaconcept-itsdependence on powerdifferences.

THE DEPENDENCE OF STIGMAON POWER

Stigmais entirely dependent on social,economic,and politicalpower-it takes

powerto stigmatize. In someinstancestherole of poweris obvious.However,
theroleof powerin stigmais frequently overlooked becausein manyinstances
powerdifferences areso takenforgranted as toseemunproblematic. Whenpeople
thinkofmentalillness,obesity, deafness, andhavingoneleginsteadoftwo,there
is a tendency to focuson theattributes associatedwiththeseconditionsrather
thanonpowerdifferences betweenpeoplewhohavethemandpeoplewhodo not.
But power,evenin thesecircumstances, is essentialto thesocial production of
stigma.
In orderto reasonabouttheroleof powerin stigma,firstconsiderinstances
in whichit is clearthatsocial poweris important. To begin,taketheexample
providedearlierin whicheighteenth century EnglishcoloniststaggedtheDutch
withattributesofdisagreeableness andlow-living. Alongthesamelines,peopleof
Irishbackground werestereotyped as "temperamental, dangerous, quarrelsome,
idle and reckless"by old-order Americansin thenineteenth century. The Irish
at thetimewerelikenedto apes and wereportrayed as suchin cartoonsof the
day(Feagin& Feagin1996).In thelightofcurrent circumstances, itis clearthat
Englishcolonistsof theeighteenth century and theold-order Americansof the
nineteenth century wereable to stigmatize theDutchand Irishbecauseof their
positionsofpoweroverthesegroupsatthetime.And,ofcourse,itwas thepower
oftheNazis thatallowedtheirthorough anddevastating stigmatization ofJewish
people.

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376 LINK * PHELAN

Buthowcanwe thinkoftheroleofpowerincircumstances likementalillness,

obesity, deafness, and one leggedness?One wayis to recognizethatstigmatized
groupsoftenengageinthesamekindsofstigma-related processesintheirthinking
aboutindividuals who are notin theirstigmatized group.Considerforexample
patients in a treatment program forpeoplewithseriousmentalillness.Patientsin
sucha setting arelikelytoidentify andlabelhumandifferences in staffmembers.
Forinstance, theymighttagsomeclinicianswiththelabel"pillpusher"andapply
stereotypes connectedwiththelabels theycreatesuch as thatpill pushersare
cold,paternalistic, andarrogant. Finallytheymighttreatthepeopletheyidentify
as pill pushersdifferently in accordancewiththeconclusionstheyhave drawn
aboutthemby avoidingor minimizing communication withthem,exchanging
derogatory comments andjokesaboutthem,andso on.Thusalthough thepatients
mightengagein everycomponent of stigmawe identified, thestaffwouldnot
endup beinga stigmatized group.The patientssimplydo notpossessthesocial,
cultural, economic,andpoliticalpowerto imbuetheircognitions aboutstaff with
seriousdiscriminatory consequences.
Considerfurther thatscenariossimilarto theone just describedexistforall
sortsofothercircumstances inwhichrelatively powerlessgroupscreatelabelsand
stereotypes aboutmorepowerful groupsandtreatmembers ofthemorepowerful
group in accordance withthose Such
stereotypes. a realizationclarifies whythe
definition of stigmamustinvolvereference topowerdifferences. Without sucha
reference, stigmabecomesa verydifferent andmuchbroaderconceptthatmight
be appliedtolawyers, politicians,WallStreetinvestors,
andwhitepeople.Stigma
is dependent on power.
Because of theimportance of powerin stigmatization,it is criticalto ask the
followingsetof questions:Do thepeoplewho mightstigmatize havethepower
to ensurethatthehumandifference theyrecognizeandlabelis broadlyidentified
in theculture?Do thepeoplewhomightconferstigmahavethepowerto ensure
thattheculturerecognizesanddeeplyacceptsthestereotypes theyconnectto the
labeleddifferences? Do thepeoplewhomight havethepowertoseparate
stigmatize
"us" from"them"and to have thedesignation stick?And do thosewho might
conferstigmacontrolaccess to majorlifedomainslikeeducationalinstitutions,
-jobs,housing,and healthcarein orderto putreallyconsequential teethintothe
distinctions theydraw?To theextent thatwe canansweryestothesequestions, we
canexpectstigmatoresult.To theextent thatwe answerno,someofthecognitive
components of stigmamightbe in place,butwhatwe generally meanby stigma
wouldnotexist.

IMPLICATIONSOF THE STIGMACONCEPT

Thestigmaconceptwe havearticulatedhasimplications forhowonemight reason
aboutseveralpersistent
questionsincluding:(a) thedefinition
ofstigma,
(b) stigma
as a matter
ofdegree,(c) theoriginsof stigma,(d) theimageofthestigmatized

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 CONCEPTUALIZING
STIGMA 377

personas a passivevictimversusan activechallenger, (e) theconsequencesof

stigma,(f) stigmaas a persistent
dilemma, (g) whatwe shoulddo tochangestigma
processes,and (h) theimportance of stigmain understanding thedistribution
of
lifechances.

The Definition
ofStigma
Our explication of thestigmaconceptis revealingwithregardto whyso many
definitionsof stigmaare extantin theliterature-there are severalcomponents,
each one of whichhas been describedas stigma.We chose to definestigmain
theconvergence ofinterrelated components. Thus,stigmaexistswhenelements of
labeling,stereotyping,separation, statusloss,anddiscriminationoccurtogetherin
a powersituation thatallowsthem.Thisis a definition thatwe derived,notonethat
existsin someindependent existentialway.As such,itsvaluerestsin itsutility.
Onereasonitis helpful is thatthetermstigmais inverywideuse,andsomedegree
ofclarity willhelpus communicate abouttheconcept.Second,therearewordsthat
aptlydescribeeachofthecomponents likelabel(ormarkorstatus),stereotyping,
exclusion,statusloss, and discrimination so thattheuse of thewordstigmato
describeanyparticular aspectis notnecessary. Third,thedefinitioncohereswith
thecurrent usageofthetermas itis appliedtogroupsthatarecommonly referred
to as stigmatizedgroups.Recallthatifwe onlyusedthecognitive components of
labelingand stereotyping to definestigma,groupslikelawyers,politicians,and
whitepeoplewouldhavetobe considered stigmatized groups.Ourincorporation
ofpower,statusloss,,anddiscrimination allowstheformaldefinition we derived
to coherewithcurrent understandings ofwhata stigmatized groupis. Fourth,
we
believethatthedefinition helpsus envisionand thereby morefullyunderstand
severalimportant issuesin thestigmaliterature as describedbelow.

Stigmaas a MatterofDegree
leads to theconclusionthatstigmaexistsas a matterof
Our conceptualization
degree.Thelabelingofhumandifferences canbe moreorlessprominent. A label
canconnecta persontomanystereotypes,tojusta fewortononeatall. Moreover,
thestrengthof theconnection betweenlabels and undesirable can be
attributes
relatively
strongorrelatively
weak.The degreeof separationintogroupsof "us"
and"them"canbe moreorless complete, andfinallytheextentofstatusloss and
discrimination
can vary.Thismeansthatsomegroupsaremorestigmatized than
othersandthatsomeofthecomponents wehavedescribed canbe usedanalytically
tothinkaboutwhydifferences intheextent
ofstigmaexperienced varyfromgroup
togroup.

The OriginsofStigma
Ourpaperhasbeenfocusedon thenatureandconsequencesofstigmaratherthan
its sources.Nevertheless providessomeideas abouthow
ourconceptualization

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378 LINK * PHELAN

to thinkabouttheoriginsof stigma.As we indicatedat theoutsetof thispaper,

a greatdeal of attention
in theliterature on stigmahas beendirectedtowardthe
cognitiveprocessing ofstigma-relevant information. As crucialas theknowledge
gainedfromthisliterature is, it is not a sufficient
basis forunderstanding the
originsof stigma.As we havepointedout,groupsbothwithand without power
labelandformstereotypes abouttheothergroup-members ofeachgroupengage
in thekindsofcognitive processesthatare studiedin thenowvoluminous social
psychological literature.
But whatmatters is whosecognitions prevail-whose
cognitionscarrysufficientcloutinsocial,cultural, economic,andpoliticalspheres
toleadtoimportant consequencesforthegroupthathasbeenlabeledas different.
Hereis wherethesociologicalstudyofstigmaisbadlyneeded-forwhilecognitive
processesmaybe necessarycauses fortheproduction of stigma,theyare not
sufficient
causes.We needto further understand thesocial processesthatallow
one group'sviewsto dominateso as toproducerealandimportant consequences
fortheothergroup.

PassiveVictimVersusActiveChallenger
One of themosttroublesome issuesin thestudyof stigmaemergeswhensocial
scientists seek to articulatethereal constraints thatstigmacreatesin people's
lives,andin doingso theyendup portraying membersof thestigmatized group
as helplessvictims(Fine & Asch 1988). Ironically, thisproducesmorelinesin
thelistof undesirable attributesthatformthestereotype aboutthestigmatized
group-theyareadditionally "passive,""helpless,"or "acquiescent."Because of
this,therearefromtimetotimearticlesthatremind us thatpeopleartfully
dodgeor
constructively challengestigmatizing processes(e.g. Reissman2000). Theseare
veryimportant reminders, andthemessagetheydeliverneedstobe incorporated
intoourunderstanding ofstigma. Atthesametime,thesimplefactthattheseforms
ofresistance existsuggests thereis something outtheretoavoidandthatthereare
powerful constraining forcesat work.How can we reasonaboutthesecontrasting
imagesandportray constraint andresistance inresearchaboutstigma?Here,our
emphasison theimportance ofpowerdifferences in stigmaand ourobservation
thatstigmais a matter of degreeare helpful.Specifically, theseallow us to see
issues of constraint and resistancein thecontextof a powerstruggle. We can
see thatpeoplein stigmatized groupsactivelyuse availableresourcestoresistthe
stigmatizing tendencies ofthemorepowerful groupandthat,totheextent thatthey
do,itis inappropriate toportray themas passiverecipients ofstigma.Atthesame
time,to theextentthatpowerdifferences exist,resistencecannotfullyovercome
constraint.Theamountofstigmathatpeopleexperience willbe profoundlyshaped
bytherelative powerofthestigmatized andthestigmatizer.

The OutcomesofStigma
Our conceptualization
of stigmademandstheassessmentof multipleoutcomes,
notjustoneortwo.We cannotassesstheextentofstigmatization
whenwe assess

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 CONCEPTUALIZING
STIGMA 379

justone outcome,whether thatsingleoutcomebe self-esteem, housingstatus,or

accesstomedicalcare.Fromonevantagepoint,thisis an odd stricture toimpose
onthestudyofstigma. Ifwe adopta narrow conceptualization ofstigma, forexam-
ple as a labellinkedto a stereotype, we mightexpectspecificity in theoutcomes.
We mightidentify theelementsof thestereotype and then,based on whatthe
stereotype entails,predictwhichoutcomesmightbe affected. If thestereotypeis
mathincompetence, thenwe mightexpectthepersontobe excludedfromendeav-
orswheremathcompetence is required.As important as thiskindof theorizing
mightbe forunderstanding someaspectsofstigma,itwillcloudourvisionofthe
fullconsequencesifitis theonlyapproachwe employ.
Amongthereasonsourconceptualization of stigmacalls forthescrutiny of
manyoutcomesare threewe considerhere.First,stigmainvolvesstatusloss-
a downwardplacementin the statushierarchy. To theextentthatthisoccurs,
we can expectmembers of stigmatized groupsto accrueall mannerofuntoward
outcomesassociatedwithlowerplacement in a statushierarchy,ranging fromthe
selectionof sexualpartners to longevity.Second,structural discriminationcan
producenegativeoutcomesthathavelittleto do withthestereotyped beliefsthat
initiallymotivated thestructural discrimination. Forexample,theNotIn MyBack
Yard(NIMBY) phenomenon resultedintreatment forpeoplewithmental
facilities
illnessbeinglocatedinrelatively poorandpowerlessareasofthecitythatwerealso
crimeriddenanddangerous (Dear & Lewis 1986).As a consequence, peoplewith
mentalillnessare muchmorelikelyto be victimizedthanotherpeople.Third,
people's efforts to cope withstigmamayhaveuntoward consequencesthatare
seemingly unrelated to thestereotype (Jameset al 1984,Smart& Wegner1999).
For example,socialepidemiologist ShermanJamesputsforward theconceptof
whathecalls"John Henryism"-the tendency forsomeAfrican Americans towork
extremely hard and with to the
greatpressure disprove stereotype oflazinessand
inability.According this
toJamesetal (1984),undersomeconditions copingeffort
bearscostsin theformofhypertension. In short,a comprehensive of
exploration
thestigmaconceptmakesitclearthatstigmacaninvolvemanyoutcomesandthat
anyfullassessment mustlookto a broadrangeofsuchoutcomes.

Stigmaas a Persistent
Predicament
As previously mentioned, makesreference
theliterature to stigmaas a predica-
mentor dilemma.Our conceptualization draws to one way in which
attention
is a
stigma persistent predicament-why negativeconsequencesofstigmaare
the
to
so difficult eradicate.Whenpowerful groupsforcefullylabel and extensively
stereotype a less the
powerfulgroup, range of mechanisms forachievingdis-
criminatory outcomesis bothflexibleandextensive.We mentioned threegeneric
of
types mechanisms-individual structural
discrimination, and
discrimination,
discrimination thatoperatesthroughthestigmatizedperson's beliefs
and behav-
iors.But lyingbelow thesebroad-band are a wholemultitude
designations of
specificmechanisms-there aremanywaysto achievestructural discrimination,

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380 LINK * PHELAN

manywaystodirectly discriminate, andmanywaysin whichstigmatized persons

canbe encouraged tobelievethattheyshouldnotenjoyfullandequalparticipation
insocialandeconomiclife.Moreover, ifthemechanisms thatarecurrently inplace
areblockedorbecomeembarrassing touse,newonescanalwaysbe created.This
is themainreasonthatstigmais sucha persistent predicament. Whenpeoplein
a stigmatized grouptakeactionto avoida negativeconsequence, theyfrequently
do so bycounteracting (e.g. confronting oravoiding)thespecificmechanism that
leadstotheundesirable outcometheyseektoescape.Butwhentherangeofpos-
siblemechanisms is broad,thebenefit is onlytemporary becausethemechanism
thathas beenblockedoravoidedcanbe easilyreplacedbyanother.
A secondandrelatedreasonthatstigmais a persistent predicament is thatthere
are a multitude of associatedoutcomes.One can exertgreateffort to avoidone
stigma-related outcome, likediscrimination inmedicalinsurance orinjury to self-
esteem, butdoingso cancarrycosts.Forinstance, thecopingeffort canbe stressful,
as inthecase ofJohnHenryism andhypertension levelsamongAfrican Americans
(Jameset al 1984). In thatexample,theeffort to eliminateone bad outcome
ironically producesstrainthatleadstoanother. Also,focusing particular attention
on oneoutcomemeansthatless attention is availabletodeal withotheraspectsof
life.As a result,
whilebenefits mayaccrueinonedomain,concomitant harmsmay
resultin others.It is theexistenceof multiplestigmamechanisms and multiple
stigmaoutcomesthathelpsexplainwhystigmais a persistent predicament-why,
on average,members ofstigmatized groupsaredisadvantaged in a broadrangeof
lifedomains(e.g. employment, socialrelationships, housing,andpsychological
well-being).
We end ourdiscussionof stigmaas a persistent predicament witha pointof
First,to say thatstigmais a persistent
clarification. predicament is notto say
thateveryindividual in a groupsuffers thesameoutcome.Individualdifferences
in personal,social,andeconomicresourcesalso shapethelifecircumstances of
in
persons stigmatized groups, thereby producing substantialvariation within stig-
matizedgroupsin anyoutcomeonemightconsider.Thus,no one is fullytrapped
in a uniform disadvantaged position.All of theothercharacteristics of persons
influence an outcomein thesamewaytheyinfluence outcomesforpersonswho
arenotmembers ofthestigmatized groupinquestion.Thepersistent predicament
referstoa generalpattern ofdisadvantage thatis connected tostigmaprocessesof
labeling,stereotyping, statusloss,anddiscrimination.

ChangingStigma
If stigmais a persistent
predicament,how can it be changed?One approachis
to focuson a particular
behaviorin a particular
group.For example,one might
targethiringpracticeswiththeaim of increasingtheemployment chancesfora
stigmatized groupsuchas people withmentalillnesses.One could thentryto
changeemployers'beliefsaboutand attitudes towardhiringpersonswithsuch
illnesses.Thisapproachis veryappealingbecauseit breaksdownthemorassof
interconnecting intoa moretractable
stigma-facets problem.Ifoneweretodevelop

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 CONCEPTUALIZING STIGMA 381

an intervention,one couldtarget theintervention tothespecificbeliefs,attitudes,

and behaviorsof employers, thereby increasing thelikelihoodof an apparently
successfuloutcomefortheintervention researchstudy.But whatis appealing
aboutthisapproachis also whatmakesit such an inadequateresponseto the
broaderproblemof stigma.The intensefocuson one specificbehaviorin one
specificgroupleavesthebroadercontextuntouched and as a consequenceeven
theverypositiveoutcomesof an unusuallysuccessfulprogramwill erodewith
time.Thiswilloccurforreasonswe havestated:Thereexistsa flexiblepackage
ofmutually reinforcingmechanisms linkingtheattitudes andbeliefsofdominant
groupsto an arrayofuntoward outcomesforstigmatized persons.
Ourconceptualization leads us to focuson twoprinciples in considering how
to reallychangestigma.The first is thatanyapproachmustbe multifaceted and
It
multilevel. needs to be multifaceted to address the many mechanisms thatcan
lead todisadvantaged outcomes, anditneedstobe multilevel to addressissuesof
bothindividual andstructural discrimination. Butsecond,andmostimportant, an
approachto changemustultimately the
address fundamental cause of stigma-it
musteitherchangethedeeplyheldattitudes and beliefsofpowerful groupsthat
lead to labeling,stereotyping,settingapart,devaluing, and discriminating, or it
mustchangecircumstances so as to limitthepowerof suchgroupsto maketheir
cognitions thedominant ones.In theabsenceof fundamental changes,interven-
tionstargeted at onlyone mechanism at a timewillultimately fail,becausetheir
effectiveness willbe undermined bycontextual factorsthatareleftuntouched by
sucha narrowly conceivedintervention. Thus,in considering a multifacetedmul-
tilevelresponseto stigma,one shouldchooseinterventions thateitherproduce
fundamental changesin attitudes and beliefsor changethepowerrelationsthat
underlietheabilityofdominant groupsto acton theirattitudes andbeliefs.

Understanding ofStigmaProcesses
theInfluence
ofLifeChances
on theDistribution
A core concernof sociologyis to understand thedistributionof lifechances,
whether thoserefer
tocareers,earnings,socialties,housing,
criminal involvement,
health, orlifeitself.Webelievethatstigmaprocesseshavea dramatic andprobably
a highlyunderestimated impacton suchlifechances.Mostresearchproceedsby
examiningthestigmaassociatedwithone circumstance at a time(e.g. AIDS,
obesity, mentalillness,minorityracialstatus,femalegender, homosexuality, etc),
and mostalso assessesonlyone outcomeat a time(e.g. earnings, self-esteem,
housing,socialinteractions, etc.).Whenthisoccurs,researchers oftenfindsome
levelofeffect fora particular
stigmatizedgroupona particular outcome.However,
itis also usuallytruethatmanyfactors otherthanthestigmaprocessesinquestion
influence theoutcome,leavingstigmaas just one factoramongmany.This can
lead to theconclusionthatstigmamatters butthatitseffectis relativelymodest
comparedto otherfactors.This accounting is misguidedfortworeasons.First,
in seekingto understand theimpactof stigmafora particular circumstance, one
mustkeepin mindthatitcan affect manylifechances,notjustone. Thus,a full

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382 LINK * PHELAN

accounting mustconsidertheoveralleffect on a multitudeofoutcomes.Second,

therearea hostofstigmatizingcircumstancesthatneedtobeconsidered instudying
outcome.A fullassessment
a particular oftheimpactofstigmaonsuchanoutcome
mustrecognizethatmanystigmatizing circumstancescontributeto thatoutcome
and notjusttheone selectedfortheparticular studyin question.Whenviewed
broadly,stigmaprocesseslikelyplay a majorrole in lifechancesand deserve
scrutinynotjustbyinvestigators whohappento be interested in stigmabutbya
varietyof social scientists
who are interested
in thedistributionof lifechances
moregenerally.

CONCLUSION

Almostforty yearsafter thepublicationofGoffman's bookon stigma, werevisited

theconceptinlightofresearch thathasbeenundertaken intheinterim. Attending
to criticismsof theconceptand its applicationby researchers fromGoffman to
thepresent, we constructed a revisedconceptualization of theterm.In ourdef-
inition,stigmaexistswhenelementsof labeling,stereotyping, separating,status
loss,anddiscrimination co-occurin a powersituation thatallowstheseprocesses
tounfold.After developing thisdefinitionandexplicatingitscomponent parts,we
founditusefulinproviding a substantiallydifferent
perspectiveon severalcrucial
issuesin theliterature on stigma.Moreover, ourconceptualization suggeststhat
stigmais likelyto be a keydeterminant of manyof thelifechancesthatsoci-
ologistsstudy,frompsychological well-beingto employment, housing,and life
itself.A propitious avenueforfuture researchwouldinvolvetheincorporation
ofstigmaconceptsandmeasuresin community-based surveyresearchthatseeks
to understand thesocial determinants of a broadarrayof lifechances.Such an
undertaking wouldgreatly advanceresearch on stigmabecauseitwouldassessthe
linkagebetweenstigmaandoutcomesthatclearlymatter inpeople'slives,thereby
overcoming thecriticism we alludedtoearlierregarding theoveremphasis on mi-
crolevelinteractions in stigmaresearch.At thesame time,theincorporation of
stigmaconceptsandmeasuresin researchfocusedon lifechanceswouldprovide
investigatorsin manyareasof sociologicalresearchwithadditionalpossibilities
forunderstanding thesocial distributionsof theparticularoutcomesthatarethe
focusof theirattention. Mostimportantly, however, suchan endeavorwouldtell
us muchmorethanwe alreadyknowabouttheconditions underwhichstigmais
relatedtountoward outcomesinreallifesituations. Knowledgeofthissortshould
formthebasisforthekindsofmultifaceted multilevelinterventionsthatrepresent
ourbesthopeforproducing realchangein stigma-related processes.

ACKNOWLEDGMENTS
WethankPatrick BruceDohrenwend,
Corrigan, DavidPenn,andElmerStruening
forvaluablecomments
on an earlierversionofthispaper.

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 CONCEPTUALIZING STIGMA 383

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