fattypatties

This month, I am participating in a ReVolution! -- Every Monday in January I plan to write a blog post here about my life and how Health at Every Size℠ has changed my life for better. This is the fifth and final installment of five.

IDENTITY, STIGMA AND HEALTH AT EVERY SIZE℠

Erving Goffman is said to have looked through newspapers and magazines every day, clipping items that helped him shape his ideas about how people interact with each other. Several key elements emerged in his writing.

First, he noted that people anticipate how others will view them and seek to manage that view through action, gesture, dress and facial expression. He called this "impression management." He suggested that this thing we call our "self" is actually a multitude of "selves" that are created in the moment of interaction with other people who are also presenting their "selves" in an attempt to manage our impression of them. In essence we play parts like in a play and we change our behavior and our presentation based upon who we are with and how intimate we are with that person. Questions of trust, authenticity, desire and control inevitably become part of the mix.

It is this background that helped Goffman develop his ideas about social stigma. He defined social stigma as a "spoiled identity." He suggested that those who are stigmatized by others are limited in their ability to manage impressions. When we are stigmatized, those who would view us through a single lens do not let us show them multiple layers of abilities, character traits, desires, etc. To stigmatize is to control another and to prevent them from having a useful and fulfilling social relationship.

Here's how it works. If I am stigmatized and I do something that fits the stereotype of my stigmatized social identity, I am used to prove the truth of the stigma. If I do something that is different from the stigma I am regarded as being inauthentic, faking it or trying too hard. I cannot escape the stigma and show my authentic self, or manage impressions that move away from the stigma.

Most of what has been done about stigma since Goffman has missed the point. Efforts are made to help individuals who are part of stigmatized populations to cope with the stigma and rise above it. This usually only serves to reify the stigma not end it. If stigma is to end, it must be ended by those who are stigmatizing. It is telling that English is so convoluted at this point. We do not really have a word for those who stigmatize. Bigot, maybe, but that can evoke a history that one might not want to evoke. Stigma is often regarded as the "right" attitude to have.

For example, there is a kind of reasoning that suggests that stigmatizing fat is correct because fatness is a result of laziness and a lack of self-control on the part of the person who is deemed fat. Fat people are placed into a cardboard, flat group that assumes all individuals deemed a part of the group are alike and, indeed are lazy and lacking in control. These are the only things that matter about the fat person. A fat singer, a fat Ph.D., a fat scientist, a fat physician, a fat athlete and so forth cannot exist as just a singer, Ph.D., scientist, physician, athlete. The word fat as an adjective changes the identity of the noun into something less than human.

But most people do not regard this as bigotry. This stigma is regarded as not only good but as necessary to help the fat person become thin. The stigmatizer is seen as "caring" about the "health" of the fat person.

But the stigma translates into a self-fulfilling prophecy with discrimination leading to reinforcement of the stereotypes. Fat people are insured less often and therefore put off going to doctors and getting health care, which leads to them become sicker. Fat people earn less money, making it harder for them to adequately acquire clothing and other symbols that suggest competency or diligence. Fat people are pushed to social backstage, which leads other to assume that they are unhappy with their bodies. And, of course, almost all fat people have tried to get thinner, which reinforces this belief as well.

Here's the problem. Stigma limits the life chances of human beings. It doesn't improve health. It makes it worse.

Stigma creates stress and stress creates imbalances in our physical and emotional well-being. There is ample evidence that stigma is a predictor of ill-health and there is growing evidence that this may have to do with a physiological change that surprise, surprise, leads to all those conditions that are associated with and are supposedly caused by being fat.

So I could sit here and make a health argument at this point, citing articles and studies. But I want to make a different point with this post.

Stigma is also a bad things to do to another human being. It is controlling and limiting the freedom of people. It shuns and shames people. In a word, it is just ain't right.

So I'd like to suggest in this last installment that the reason to embrace Health at Every Size℠ is because it is a stigma-free approach. Instead of treating a person as being less than human because of their size (and by the way, this happens to people on the thin end of the spectrum as well, not too mention people are considered too short or too tall), HAES℠ celebrates all bodies. Instead of dividing humans into acceptable bodies and unacceptable bodies, HAES℠ opens the door to people being judged on what they do, not what they look like.

To me, this is the most important reason to embrace HAES℠. Health is relative and there can be much debate on what is and is not good for a person. But dignity, empathy and diversity are not debatable. So often fat people, even fat activists, get caught up in justifying their existence by outlining how healthy one can be and still be fat. But that is not the issue. The issue is that weight-focused health care is stigmatized health care.

My favorite slogan, which has been co-opted from the disabilities movement is "nothing about us without us." A real test of public health policy as well as personal health care is the extent to which the voice of the patient is heard. Fat people are silenced by medicalization of their natural variation.


So listen up world. We do not need help. We do not need a cure. We do not need to be changed. We are that perfection. We have dignity. We are human. It really is that simple.

And that, to me is the essence of Health at Every Size℠.