Seniors Speak Out... About Being Stigmatized
In the Fall and Spring of 2001-2, as part of Seeking Solutions (a national project on seniors and alcohol issues funded through the National Population Health Fund), we had the opportunity to ask seniors for their views on stigmatization, a common phenomenon in the lives of many people who are experiencing alcohol problems.
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Ancient Greeks used the word "stigma" to refer to brands or body marks exposing people to be avoided. Today, the term refers to being different in some undesirable way.
When a person is stigmatized, he or she is often perceived as having a character blemish, viewed and treated as socially undesirable. For example, mental illness has been a highly stigmatized issue. [For a very good discussion of stigma and mental illness, see the article by the Canadian Mental Health Association, Ontario Division, "CMHA"]
CMHA notes "When someone appears to be different, we attach a stigma to them, we do not do it to be cruel, we simply do not understand their differences."
However, that may be putting it too gently. People sometimes react to the stigmatized person with discomfort or even hostility. A stigmatized person often internalizes these feelings, and feels this as shame.
Stigmatized persons are frequently viewed as less than fully human because of their condition. They often treated in ways that would be considered totally inappropriate ways to respond to other people.
Academics describe stigma as a "master status". By that they mean, it eclipses all other aspects of stigmatized persons, their talents and abilities. In other words, you always see the stigma first and foremost (a mental or physical disability, the drug addiction, the "problem", such as HIV positive or AIDS, being poor, being on welfare), and not the person.
They also point out that stigma is a social construct. People are stigmatized only within the context of a particular culture, historical events, or economic, political or social situations. In other words, stigmas do not have to exist.
Seniors, Alcohol, and Stigma
In the focus groups we held, seniors were very clear that stigmatization of older
people who have alcohol problems commonly occurs. Seniors dealing with an alcohol
problem had been shunned in many different ways. Those who do not
have a problem with alcohol reported seeing it happen to people they know, and
in some cases having done it themselves.
Stigmatization is closely connected to people's perceptions about how a particular problem or condition develops, and who is responsible for the results. (See Weiner, Judgments of Responsibility) Seniors discussed the shame and stigmatization of having an alcohol problem:
- "There is a social expectation for a man that he can do it himself ('fix the alcohol dependence problem'), and if you can't, 'you are a sissy'."
When we asked, "And what would happen if you
let someone know you have (or had) an alcohol problem?", their responses were:
|- "You would
be criticized like crazy."
|- "People are
very judgmental- and seniors worry about being judged."
- "If not they are not like you, they do not understand you."
Because of the stigmatization of alcohol problems in Canada, for a senior acknowledging the problem (to oneself or to others) is a risky business:
- "A senior, family member or friend may not know if a problem exists - there is also both pride and denial."
- "Part of it is the perception that seniors are 'beyond all that'- dignified".
- "The stereotype is that person must be 'on the floor'."
Negative stereotypes are very common when a person is stigmatized.
There are many inaccuracies about alcohol problems in both popular media and professional education. Common stereotypes in this area include that the person is weak, lazy (lacks "willpower"), unproductive, dirty, immoral, and/or violent.
As one senior in one focus group noted:
|- "The stereotypes are hard to understand."|
Seniors who are experiencing alcohol problems explained that they can face two types of stigmas:
a) the stigma of having an alcohol problem and
b) the stigma of now being a non- drinker ("recovering alcoholic").
Their comments illustrated, time and again, just how
isolating and stigmatizing their situation can be. A one woman noted
a. Dealing with alcohol dependence:
| "If you say to a non-drinker or a person who does not have a problem,
'I'm a recovering alcoholic', their response is often 'I
don't want to be bothered (with you)'."
| "It is like AIDS,
people are so judgmental. If you say 'I'm HIV positive', people say 'I
don't want to be with you.' "
Another woman noted that her grown children were
proud of her accomplishments (e.g. 3 years of sobriety). However, when they mentioned to their
friends "Ma is a recovering alcoholic", the friends tended to hang
around very briefly. [In stigmatization theory, this is referred to as 'fear of contagion' or 'fear of contamination'].
b. The stigma of now being a non-drinker.
In Canadian society, consuming alcohol is the norm among adults, generally. It has increasingly become the norm among older adults. According to the 1998-9 Statistics Canada figures, 62% of women and 72% of men aged 65 to 74 are current drinkers, as are 61% of men and 45% of women aged 75 and over.
- "Drinking friends also do not want to be
bothered, and 'They feel uncomfortable'." ... "It is so cruel. "
- "My sister called me up and asked 'Are you still
on the wagon'. When I said 'Yes', she said 'Well, I was going to invite you
to a good party, but I don't think you'd want to associate with us.' People
assume that if you do not drink, that you are a party pooper."
- "We need to get past the idea that others have of 'no
drinking, no fun' (It makes it harder for us to quit)".
Seniors noted that part of stigmatization may come from other people's insecurities.
try to make themselves feel better than you are. They build themselves up
by tearing you down [by thinking] 'I'm not part of that'. they try to distant
themselves... It's that 'Holier than thou' business."
Social Expectations about Being a Non Drinker
- "My daughter and her husband don't even ask any more, they just assume I'll be the designated driver, that I'll drive them to the party, that I'll go home and wait until they are ready to come home, and call. 'We're drunk, come and get us'."
- "You are damned if you do (stop drinking), and damned if you don't. "
What Reinforces the Stigma
Seniors' observations suggested that some of the
stigmatization may reflect stereotypes and common messages the public hears
espoused (such as in A.A. approaches). As one senior noted:
"People are told, if you have that drink, you'll never be able stop. "
Stigmatization can often reflect lack of knowledge misconceptions, or simplistic generalizations.
People are often unaware of the range of diversity of alcohol problems among seniors, how alcohol problems develop, and what causes/ does not cause relapse. In one illustration given, one senior explains that her family were worried about what would happen that if they consumed any alcohol at all around her. They believed that would start her drinking again.
People who drink may also feel uncomfortable being around
who has decided not to drink. As one woman notes, she had to let her family know "Go ahead and
drink, it doesn't bother me."
Seniors found that the stigmatization of people with alcohol problem can also be reinforced by former drinkers:
"The attitude of some people who have stopped.
For example, 'There is nothing worse for a smoker than a reformed smoker.' "
In other instances, family will monitor a senior's drinking, expecting failure. Another senior gave the example of her sister (who she describes as a "controlled alcoholic" consuming a bottle a day,) who actively criticizes her drinking:
|- "They worry about your problem, when their own level of drinking is more a problem."|
Seniors also find that the popular terminology being used is also stigmatizing - "Oh you know, like, 'on the wagon' "; or "clean and sober". (They ask "Does that mean you are "dirty" if you drink, or if you are not sober?")
Stigmatization and Gender
Older women noted they felt stigmatized more than men.
|- "I was told at an AA meeting (by a young man), 'You are not supposed
to have problem, you are a woman.'
- "You are supposed to be little ladies, prim and proper... ruffles, lace."
|- " When we grew up (and our parents), women left the room when men had
their cigars, drinks."
- "I remember my father saying to his five daughters, 'I don't care how much you drink, just don't show it."
Effects of Stigmatization
The stigmatization makes it feel unsafe for the senior to alcohol concerns, or to accurately report how much she or he is drinking. The person is fearful of being judged. Stigma affects people's willingness to disclose.
- "I have lied to my doctor about how
much I was drinking. But after a certain point, you can't hide it any
Seniors also expressed surprise (and dismay) at the fact their doctors often did not ask about them about whether they drank and how much, even in light of other evidence that alcohol was becoming a problem in their lives. We have seen a similar type of stigmatized response to homosexuality in the American Armed Forces ("Don't ask, don't tell.") Stigma affects people's willingness to ask.
Seniors also offered examples of where they were trying to let their physician know they were worried about alcohol becoming a problem, and the physician was not listening to what he or she was trying to say.
Most felt this reluctance of physicians to ask and talk about alcohol reinforced the stigma, because it conveyed that it was socially wrong. It ignored the effects that the alcohol was having on the senior's health and treated an alcohol as moral problem.
Late recognition of the problem is often the result of this stigmatization. that, in turn, often means a damaged social life or career, a broken family, increased risk of poor health, and diminished independence or an early death (Simerson et al., 1983)
We have found that stigmatization also leads to older adults being denied fundamental services in emergency wards, hospitals, and even being denied admission to long term care facilities when their health needs are clearly evident. Stigmatization leads to overt discrimination.
Stigmatization, the stereotypes associated with alcohol or medication use problems, as well as the lack of understanding about the nature of substance dependence can create almost inhumane and professionally indefensible responses at times. Consider for example, the real life situation of an older woman who did not have an anaesthetic during her dental and her stomach surgeries because a nurse told her if she did, she would become addicted to the drugs.
Supports Groups and Stigmatization
Peer support groups can be very helpful for many seniors in dealing with stigma.
Directly and indirectly, support groups carry out the important functions of providing members with information that can help seniors cope with stigma and its effects. Researchers on stigma find the salience of the stigma itself is greatly reduced in some kinds of support groups. Psychologists and others social scientists researching stigma explain that the support group is a good place to share the stress of being stigmatized. In the group, the person also sees evidence of effective coping strategies and people coping successfully.
At the same time, it is important to understand the feelings of the older person who does not want to join a support group --it can put the label and stigma of alcohol problems right in his or her face.
"A Rose by Any Other Name"
According seniors, the name of a program or support groups is very important in normalizing and destigmatizing their situation. Programs specifically designed for seniors experiencing alcohol problems typically use acronyms or non-stgmatizing names, such as COPA, LESA, Age -Wise, VISTA, SWAP, OPUS-55 or SAILL.
As one senior noted:
|- "It is much more socially
acceptable to have a name like LESA (Lifestyle Enrichment for Senior
Adults, which is an Ottawa
outreach program with support groups for seniors).
Saying to other people 'I'm going to LESA' is better than
[saying] 'I'm going to an AA meeting'".
Other issues have been heavily stigmatized in the past. For example, divorce, disabled children, diseases such as cancer, and living common law or having children without marrying seems much less stigmatized now than 40 or 50 years ago. For example, in previous generations, people whispered in shame about cancer in the family and referred to it as the "C" word. No one talked about breast cancer.
The seniors' group was asked "How did these changes in attitudes happen? How did these other issues become less stigmatized?" Here are some the elements the seniors noted:
- Frequency of the matter: "Divorce is very common now- that makes it less unusual."
- "Lessened effect of the church- casting fear on their parishioners."
- Availability of resources: "There are more resources around to help handicapped people now."
- Social Change: "Women's liberation, it was another big social change."
- Changes in social structure, as shown in popular music and its effect on people's thinking. "The caste system lost its effect-- 60s and 70s as the hippie generations-'"let it all hang out'- a lot of things became less secret, secretive."
- Visibility: Having high profile examples of other people dealing with the issue (e.g. "the Kennedy's with their retarded child").
- Education: "People are better educated now. They have a better understanding of why certain things (like cancer) happen."
The seniors' observations closely parallel what the researchers have found. Destigmatization in some areas has resulted from better information, positive role models, changing norms and values, and people actively addressing the stigmas.
References and Readings
Stigmas have primarily been researched during the 1980s.
(1986) The Dilemma of Difference: a multidisciplinary view of stigma S. C.
Ainlay, B G. Becker, & L.M. Coleman eds. Plenum Press New York.
(1984) Social Stigma: The psychology of marked relationships. W.H. Freeman & Co. New York
(1995) Weiner, B. Judgments of Responsibility. Guilford Press, New York.
Simerson, G.R., Brannas, V.A., Pizzuti, A., & Inskeep, R. (1983) Project ears: ALMACA listens to salaried alcoholics. EAP Digest, 3(6):14-23.
Statistics Canada: http://www.statcan.ca/english/Pgdb/People/Health/health05b.htm.
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Page last updated Wednesday June 01, 2005
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