Stigma as a Barrier to Self-Understanding

This blogpost is written by Alexander Edlich and Alfred Archer, writing about their recent paper in Social Epistemology entitled 'Rejecting Identities: Stigma and Hermeneutical Injustice'.

To seek, and accept, medical help, it is often necessary to realize that one needs it. Sometimes, however, people refuse to accept they need help, and this disables them from accessing medical resources. This refusal need not be due to stubbornness but can be the result of unjust social factors. In particular, we suggest that stigma can unjustly prevent people from making sense of their situation, including stigmatized illnesses. 

Take, for instance, the American writer Caroline Knapp’s account of her struggle to accept the idea that she was an alcoholic in her memoir Drinking: A Love Story. She describes how at times she was so drunk that she would ‘drive home with one eye shut, to avoid double vision’ (p. 54). 

After being advised by her therapist that she should stop drinking, she decided to attend an Alcoholics Anonymous meeting. Once in the meeting though, she felt a strong revulsion to accepting that she belonged there. As she describes it, she “looked around at the dingy room with the old men sipping coffee from foam cups and I thought, No way. No way in hell I’m doing this. This is not me. I do not belong here’ (pp. 190–191).

For Knapp to accept that she was an alcoholic would mean ‘owning up to flaws and imperfections and depths of confusion I was too ashamed to reveal’. This shame that she felt about her alcoholism was a response to the social stigma attached to it. Even when she had accepted her alcoholism and stopped drinking, Knapp continued to be very careful about which people she would discuss it with ‘for fear of being judged’ (p. 244). 

What prevented Knapp first from accepting and even longer from communicating about her situation was the stigma attached to alcoholism, and thus a social factor burdening those suffering from it. This made it harder for her to seek help.

The cover of Knapp's book

Knapp is far from alone in struggling with this, the stigma attached to alcoholism is a significant barrier to people seeking out medical assistance. This difficulty in accepting one’s addiction is a major problem, given that this acceptance is crucial for overcoming the addiction and also for seeking help in the first place.

While medical professionals are aware of the importance of reducing the stigma attached to medical conditions like addiction, the impact of stigma on self-understanding is not only practical, but, we argue, also creates a particular type of hermeneutical injustice: those whose experiences are stigmatized are unjustly made to reject helpful descriptions of their situation.

Hermeneutical injustice is the label philosophers use, coined by Miranda Fricker, to describe cases where the social practices of knowing, learning, and communicating are unjust so that persons in particular social positions are deprived of the means to make sense of their experiences. In paradigmatic cases, this occurs because dominant discourses do not include concepts that are needed to make sense of the experiences of marginally situated agents.  

For example, Fricker argues that before the development of the concept ‘sexual harassment’ people who experienced unwanted sexual attention in the workplace were not able to properly name their experiences. In this case, they were unfairly prevented from fully understanding the situation they were in because they lacked the concepts needed to articulate what it is they were experiencing, which, consequently, also disabled them from sharing their experiences. 

The stigma related to addiction (and other stigmatized experiences, like homosexuality or suffering intimate partner violence) also unfairly prevents people from making sense of their experiences but does so in a subtly different way. Here the conceptual resources are available to people. The concept of an alcoholic or an addict was available to Knapp and once she accepted that it applied to her, she was able to access the resources she needed to manage her addiction, including a supportive community of people struggling with the same problem. 

What prevented Knapp from accessing these resources was not the absence of a concept but the stigma that was attached to it. Knapp denied herself access to the hermeneutic resources that go with the label ‘alcoholic’ because of the stigma attached to this identity, which led her to refuse to accept that the label applied to her. In this way, stigma can unjustly cause people to reject helpful descriptions of their situation or identity.

To come to terms with a condition like addiction and to seek help about it, it is important to understand one’s situation and to accept it. Some people refuse such acceptance, and they can suffer gravely from it. This is a problem for medical practice, but, importantly, it can also be a problem of justice: to offer help, but also to treat people justly, we must make sure that stigma does not stand in the way of self-understanding.

Alexander Edlich completed his PhD at Ludwig-Maximilians-Universität Munich in 2023, where he then was a postdoctoral researcher. He works on moral responsibility (specifically blame, protest, and apology), the philosophy of emotions, and feminist and LGBTQ ethics.

Alfred Archer is Associate Professor of Philosophy at Tilburg University. He is interested in ethics, social philosophy, philosophy of sport, and moral psychology. He is the co-author of Honouring and Admiring the Immoral: An Ethical Guide (Routledge 2021), Why It’s OK to be a Sports Fan (Routledge 2024) and Extravagance and Misery: The Emotional Regime of Market Societies (OUP 2024).