Managing stigma together: Relationality in the wound clinic

Abstract

Our paper contributes to studies of stigma and dirty work by asking ‘how can workers and clients of dirty work manage stigma together?’ With the purpose of appreciating the worker/client relational dynamics in an organisation characterised by stigma, we conducted an ethnography in a wound healing clinic where clinicians do the dirty work of caring for patients with socially stigmatising wounds. To guide and subsequently interpret our ethnographic observations, we developed an original theoretical framework informed both by realist social theory and by extant studies of how people cope with dirty work through techniques of refocusing, reformulating and recalibrating stigma. Our findings point at three types of patient-clinician relationships: of familiality, scripted compliance and obstruction. For each type of relationship, we trace the conditions of possibility (theorised as a relational configuration) and the plausible effects (theorised as relational goods and evils) on patients’ and clinicians’ capacity to cope with stigma together. Overall, we find that the types of relations threaded by workers and clients over time can be a powerful resource (or obstacle) for managing stigma together. Our paper points to future avenues for research on the materiality of social relations and on the significance of the broader sociological context in which specific relationships are threaded between relational subjects.