Stigma is not static. It evolves with society, reflecting the shifting tides of cultural values, historical events, and collective fears. Over time, some stigmas weaken and fade, while others emerge or grow stronger. This dynamic nature of stigma tells us as much about societal change as it does about human behavior and psychology.
This article explores how stigma has transformed throughout history, the reasons behind these changes, and why certain issues become stigmatized while others lose their negative connotations. By understanding this evolution, we can begin to identify the forces that perpetuate stigma—and how to challenge them effectively.
What Is Stigma and How Does It Arise?
At its core, stigma is a tool of social control, a mechanism for defining what is “normal” and marginalizing those who deviate from it. Sociologist Erving Goffman described stigma as a deeply discrediting attribute, one that reduces an individual “from a whole and usual person to a tainted, discounted one.”
But stigma is not applied equally or indiscriminately. It arises from societal values and beliefs about morality, responsibility, and power. For example:
- Behaviors perceived as voluntary, such as substance use, often attract harsher stigma because they are framed as personal failings.
- Conditions perceived as dangerous or unpredictable, such as certain mental illnesses, are stigmatized due to fear and misunderstanding.
- Situations associated with shame or taboo, like poverty or homelessness, are stigmatized because they challenge cultural ideals of success and self-reliance.
Stigma thrives on simplification. It reduces complex issues to moral judgments and assigns blame to individuals rather than acknowledging broader systemic factors.
Historical Shifts in Stigma
Stigma is not fixed; it evolves alongside cultural, political, and social transformations. Here are some examples of how stigma has shifted over time:
1. Mental Illness
In medieval Europe, mental illness was often attributed to demonic possession or divine punishment. Those suffering from mental health issues were confined to asylums or ostracized from society. By the 19th century, with the rise of psychiatry, mental illness began to be viewed as a medical condition rather than a moral failing. However, stigma persisted due to fear, ignorance, and media portrayals of individuals with mental illnesses as dangerous.
In recent decades, advocacy and education have chipped away at the stigma surrounding mental health. Campaigns like Time to Change in the UK and celebrities speaking openly about their struggles have reframed mental illness as a common and treatable issue. Yet, disparities remain: conditions like depression and anxiety are less stigmatized than schizophrenia or bipolar disorder, which are still linked to fear and unpredictability??.
2. Substance Use
Substance use stigma has a complex history. In the 19th century, opium use in Europe was glamorized among the elite, while working-class users were demonized. The introduction of laws like the Opium Act in the early 20th century marked the beginning of widespread criminalization and moral condemnation.
Today, stigma around substance use persists, fueled by narratives that frame addiction as a failure of willpower rather than a medical condition. However, movements toward decriminalization and harm reduction—such as Portugal’s drug policy reforms—have begun to shift perceptions, framing substance use as a public health issue rather than a moral one??.
3. LGBTQ+ Identities
Few areas illustrate the evolution of stigma more clearly than attitudes toward LGBTQ+ individuals. Homosexuality was once widely regarded as a sin or even a crime. In the 20th century, it was pathologized as a mental illness.
The turning point came in the late 20th century, with the rise of the gay rights movement and the removal of homosexuality from the DSM in 1973. Today, while stigma still exists, there has been significant progress in many parts of the world, with marriage equality and anti-discrimination laws becoming more common.
4. Physical Disabilities
Historically, individuals with physical disabilities were often hidden away or subjected to pity rather than empowerment. Over time, advocacy movements like the disability rights movement of the 1960s and the passage of legislation like the Americans with Disabilities Act in 1990 have challenged societal narratives. Today, the focus is shifting toward accessibility and inclusion, though stigma persists in subtle forms, such as workplace discrimination.
Why Does Stigma Evolve?
The evolution of stigma is not random; it is shaped by several key factors:
1. Education and Awareness
One of the most powerful tools for reducing stigma is education. When people understand the root causes of stigmatized behaviors or conditions—whether it’s the biology of addiction or the genetic basis of mental illness—they are less likely to assign blame. Campaigns that humanize stigmatized groups, such as HIV/AIDS education efforts in the 1980s and 1990s, have been instrumental in shifting public attitudes.
2. Cultural and Social Movements
Activism and advocacy play a critical role in reshaping societal norms. The civil rights movement, the women’s liberation movement, and the LGBTQ+ rights movement all challenged deeply ingrained stigmas and demanded change.
3. Media Representation
Media has the power to reinforce stigma or dismantle it. Negative portrayals of mental illness or substance use in news and entertainment can perpetuate stereotypes, while nuanced, empathetic storytelling can foster understanding. Shows like Ted Lasso, which portrays therapy as a strength rather than a weakness, are examples of how media can help de-stigmatize mental health.
4. Policy Changes
Legal and policy reforms can also drive shifts in stigma. Decriminalization of homosexuality, for example, significantly reduced public stigma in many countries. Similarly, the decriminalization of drug use in Portugal reframed addiction as a health issue rather than a criminal one, reducing stigma and improving outcomes??.
Why Some Stigmas Persist While Others Fade
Not all stigmas evolve at the same rate, and some seem stubbornly resistant to change. Why?
1. Perceived Personal Responsibility
Stigma is often harsher for behaviors perceived as self-inflicted. Substance use, obesity, and homelessness are frequently framed as personal choices rather than outcomes of systemic factors like poverty, trauma, or inadequate healthcare. This attribution of blame makes these issues more stigmatized than conditions seen as beyond individual control, like cancer.
2. Fear and Danger
Stigma is amplified when a behavior or condition is perceived as threatening. For example, mental illnesses associated with unpredictability, such as schizophrenia, face more stigma than conditions like anxiety or depression. Similarly, substances like methamphetamine are more stigmatized than alcohol because of their perceived links to violence and chaos.
3. Cost to Society
Behaviors or conditions that are seen as imposing a financial or social burden—such as substance use disorders or long-term unemployment—tend to attract more stigma. This reflects a societal focus on productivity and economic contribution.
4. Cultural Narratives
In individualistic cultures, stigma is often tied to ideas of self-reliance and personal responsibility. In contrast, collectivist cultures may stigmatize behaviors that bring shame to the family or community, such as substance use or divorce.
The Future of Stigma
As society evolves, so too will stigma. Emerging issues like climate change, artificial intelligence, and digital addiction may create new stigmas or reshape existing ones. For example, “eco-shaming” individuals for not adopting sustainable practices is a modern form of stigma tied to environmental responsibility.
The good news is that stigma can be challenged. Education, advocacy, and policy reform have proven effective in reducing stigma around issues like mental health and LGBTQ+ rights. However, sustained effort is required to address deeply ingrained biases, particularly around issues like substance use disorders, which remain heavily stigmatized.
The evolution of stigma reflects the values and fears of society at any given time. While progress has been made in reducing stigma in areas like mental health and LGBTQ+ rights, other stigmas persist, shaped by cultural narratives, fear, and systemic inequality.
By understanding the forces that drive stigma—and the factors that reduce it—we can create a more compassionate, inclusive society. Stigma is not inevitable, nor is it permanent. It is a social construct, and like any construct, it can be dismantled.
The next article in this series will dive deeper into the specific stigmas surrounding substance use disorders, exploring why certain substances are more stigmatized than others and how this affects individuals and society.
