Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, 16th floor, New York, NY 10032, USA.
Department of Sociology, University of Maryland Energy Research Center (UMERC), College Park, MD 20742, USA.
Soc Sci Med. 2014 Feb;103:15-23. doi: 10.1016/j.socscimed.2013.10.004.
Stigma and status are the major concepts in two important sociological traditions that describe related processes but that have developed in isolation. Although both approaches have great promise for understanding and improving population health, this promise has not been realized. In this paper, we consider the applicability of status characteristics theory (SCT) to the problem of stigma with the goal of better understanding social systemic aspects of stigma and their health consequences. To this end, we identify common and divergent features of status and stigma processes. In both, labels that are differentially valued produce unequal outcomes in resources via culturally shared expectations associated with the labels; macro-level inequalities are enacted in micro-level interactions, which in turn reinforce macro-level inequalities; and status is a key variable. Status and stigma processes also differ: Higher- and lower-status states (e.g., male and female) are both considered normal, whereas stigmatized characteristics (e.g., mental illness) are not; interactions between status groups are guided by "social ordering schemas" that provide mutually agreed-upon hierarchies and interaction patterns (e.g., men assert themselves while women defer), whereas interactions between "normals" and stigmatized individuals are not so guided and consequently involve uncertainty and strain; and social rejection is key to stigma but not status processes. Our juxtaposition of status and stigma processes reveals close parallels between stigmatization and status processes that contribute to systematic stratification by major social groupings, such as race, gender, and SES. These parallels make salient that stigma is not only an interpersonal or intrapersonal process but also a macro-level process and raise the possibility of considering stigma as a dimension of social stratification. As such, stigma's impact on health should be scrutinized with the same intensity as that of other more status-based bases of stratification such as SES, race and gender, whose health impacts have been firmly established.
污名和地位是两个重要社会学传统中的主要概念，它们描述了相关的过程，但却是相互独立发展的。尽管这两种方法都有很大的潜力来理解和改善人口健康，但这一潜力尚未实现。在本文中，我们考虑将地位特征理论（SCT）应用于污名问题，以期更好地理解污名的社会系统性方面及其对健康的影响。为此，我们确定了地位和污名过程的共同和不同特征。在这两种情况下，具有不同价值的标签通过与标签相关的文化共享期望，在资源上产生不平等的结果；宏观不平等在微观互动中得到实施，而微观互动又反过来强化了宏观不平等；地位是一个关键变量。地位和污名过程也有所不同：高地位和低地位状态（例如，男性和女性）都被认为是正常的，而污名化的特征（例如，精神疾病）则不是；地位群体之间的相互作用受到“社会排序图式”的指导，这些图式提供了相互同意的层次结构和相互作用模式（例如，男性主张自己，而女性则顺从），而“正常”和污名化个体之间的相互作用则不受这种指导，因此涉及不确定性和紧张；社会排斥是污名化的关键，但不是地位过程的关键。我们将地位和污名过程并列，揭示了污名化和地位过程之间的紧密相似之处，这些相似之处导致了按主要社会群体（如种族、性别和 SES）进行系统分层。这些相似之处使污名不仅是一个人际或内在的过程，而且是一个宏观层面的过程，并提出了将污名视为社会分层的一个维度的可能性。因此，污名对健康的影响应该像 SES、种族和性别等其他更基于地位的分层基础一样，受到同样的关注，因为这些基础的健康影响已经得到了确立。
