Disease avoidance as a functional basis for stigmatization

Abstract

Stigmatization is characterized by chronic social and physical avoidance of a person(s) by other people. Infectious disease may produce an apparently similar form of isolation-disease avoidance-but on symptom remission this often abates. We propose that many forms of stigmatization reflect the activation of this disease-avoidance system, which is prone to respond to visible signs and labels that connote disease, irrespective of their accuracy. A model of this system is presented, which includes an emotional component, whereby visible disease cues directly activate disgust and contamination, motivating avoidance, and a cognitive component, whereby disease labels bring to mind disease cues, indirectly activating disgust and contamination. The unique predictions of this model are then examined, notably that people who are stigmatized evoke disgust and are contaminating. That animals too show avoidance of diseased conspecifics, and that disease-related stigma targets are avoided in most cultures, also supports this evolutionary account. The more general implications of this approach are then examined, notably how it can be used to good (e.g. improving hygiene) or bad (e.g. racial vilification) ends, by yoking particular labels with cues that connote disease and disgust. This broadening of the model allows for stigmatization of groups with little apparent connection to disease.

The Link Between Everyday Discrimination, Healthcare Utilization, and Health Status Among a National Sample of Women

“…Additionally, some medical conditions common to this age group of women are more socially stigmatized than other (e.g., mental illness, infectious diseases, cancer), which may further contribute to discrimination and marginalization, even by healthcare staff. [44][45][46][47][48][49] While several sociodemographic factors in our study, including younger age, lower levels of education and income, and democratic political affiliation, were associated with greater perceived discrimination and to a lesser extent greater healthcare use, race/ethnicity was not. These findings are in contrast with a few studies by Thorburn and Bogart examining racebased discrimination among African American women in receipt of family planning services.…”

Experienced and Anticipated Discrimination in Persons with Physical Disabilities in Serbia

“…or "Have you been treated unfairly in making or keeping friends?") In the second part (questions [22][23][24][25], the anticipated discrimination was explored. Participants were asked how often they had stopped themselves from doing things because of anticipated social responses.…”

Proactive strategies to avoid infectious disease

“…This propensity can be most readily seen in the stigmatization of people with facial abnormalities wrought by injury or non-infectious illnesses such as psoriasis, eczema or acne [18]. This propensity to avoid individuals who bear apparent signs of disease has led several authors to suggest that it offers a powerful explanation for many types of stigmatization as Oaten et al outline here [19].…”

“…Unfortunately, this process of moralization, which involves yoking the emotion of disgust to particular behaviours or groups of individuals (e.g. smokers), has also been used for malicious political ends by labelling particular ethnic groups as lice or vermin, for example [19]. The use of moralization via disgust to change behaviour is also emerging as a useful tool to promote hand washing.…”

“…As described above, disease avoidance may lead to new insights into stigmatization [19], racial vilification, mental health [21], interpersonal violence and conflict [25]. It may also improve our understanding of risky sexual choices and promiscuity [7] through identifying the apparent failures of disease avoidance in sexual decision-making [28].…”