There is extensive research showing that certain identities that are often stigmatized in our society can lead to disparities in health and longevity. But, when we talk about the detrimental health correlation between groups of people, researchers are generally studying physical attributes that are plain to see: race, gender or physical disabilities. Studies often conclude this is a result of the way certain patients are treated within health care settings.
There is growing research, however, about the health effects of stigmas that are not so easy to see: mental illness, sexual preference or a history of addiction, for instance.
Stephenie Chaudoir, Ph.D., assistant professor in the psychology department at the College of the Holy Cross in Worcester, Mass., has spent years looking at these concealable stigmatized identities.
Her most recent research, looking at how stress around disclosing a stigma can affect physical health, could lead to a change in how we see health disparities across the board and, more importantly, how we as a society look at inclusion and equality.
New England Psychologist’s Catherine Robertson Souter spoke with Chaudoir about her work and its potential for creating change.
Q: Your work focuses on concealable stigmatized identities. What does that include?
A: Concealable stigmatized identities or CSIs for short, are a class of experiences, identities and characteristics that are often socially devalued but can be concealed. That might be things like mental illness, a history of childhood abuse or sexual abuse, past criminal activity, abortion, drug addiction, etc. Sometimes these are identities also, like sexual minorities.
Obviously, there is a lot of variability, for example in the experience of living as a gay man or having past traumatic experience, but what these all have in common are varying degrees of concern about that part of themselves and the potential to be stigmatized.
One of the main differences between living with a visible stigma and a concealable stigma is disclosure. To some extent, you have control over who knows about this identity but the ironic part is that because you have control, it can create more of a burden because you have to make these very difficult decisions about who to come out to, where, when, why. On top of that, if you are in this proverbial closet about mental illness or sexual orientation or whatever, you also are closed off from social support.
Q: How did you first begin working with this topic?
A: Personally, part of it was a theoretical interest in how our understanding of stigma is limited because of an over focus on visible at the expense of concealable stigmas. The other part is more practical: there is an entire portion of the human experience that we don’t know that much about. In our modern culture, we value diversity and creating inclusive environments or at least many of us do, but there is an entire layer of diversity we don’t see or talk about. So, it was part theoretical interest and part is that I want my work to give a voice to people who typically don’t have one.
Q: You are currently working on a three-year grant from the National Science Foundation studying Worcester-based college students. Can you tell us about that research?
A: We are looking at disclosure and how our communities and chronic concerns about rejection impact health. The study involves over 100 students from Worcester Polytechnic Institute, Clark University and Holy Cross and we combine a variety of measures and self-report surveys to ask about experiences of rejection and worries about stigma and measures of physical and mental health functioning. We also survey the rest of the community to get a sense of how devalued and how stigmatized that identity is in that context, on that campus.
Q: What are you hoping to show in this current research?
A: My working theory is that how stressful this experience is, is most likely a product of both the person and their culture. Assuming we have people who have similar concerns about rejection, the culture will matter. It is probably easier to disclose your sexual orientation if you are on a campus that is LGB affirming.
Part of the reason that we include so many identities in this work – from abortion to drug addiction to mental illness and beyond – is because each is devalued by varied degrees in different communities. That way, we can start to piece apart whether it is more stressful to disclose if you have an identity that is more devalued.
We have some very preliminary results that would suggest that overall health is lower among students who have one or more concealable stigmas.
Q: Health disparities between social groups have been well documented. How does that relate?
A: There is a lot of existing data in the U.S. in terms of health disparities but they tend to occur along the lines of race and class. For example, African Americans’ average life span is four years shorter and they are eight times as likely to be infected by HIV even though there is no data to suggest that their behaviors are riskier.
We are also starting to see data showing health disparities that follow along the lines of concealable stigmas. In the last five years, we have seen data showing that sexual minorities experience significant health disparities. They are much more likely to experience anxiety or mood disorders, to have ever attempted suicide and even to be vulnerable to certain types of cancer or other infectious diseases.
So we are at this interesting time where this data are coming out saying that social inequality can be creating health disparities even when these identities are relatively concealable. That is interesting because, up until now, most of our work has focused on identifying how discrimination is a big contributor to health disparities. For instance, black Americans are treated more poorly in their everyday lives than white Americans and that discrimination is also happening in health care settings. But if your identity is concealable, that may not fully explain why health disparities are occurring.
Q: There may be other factors in addition to discrimination?
A: Yes and, in light of those data, I am trying to understand in my research how this very specific stressor of having to disclose one’s identity over time can actually be contributing to some of these health disparities.
Q: Why is this important research and why now?
A: We have growing rates of economic and social inequality in our country and it is fair to say that social inequality is contributing to significant health inequality. We spend more on our health care per person than any Western country, but we are stressed out and have poor health and are paying a lot to manage it. My research is not going to be a silver bullet to identify the one cause of poor physical health but I do think that it suggests that we have to refocus our energies on the basics of life, our social relationships, the way we treat each other.
The way we choose to create inclusive environments, or environments of intolerance or stigma, impacts our health. In a culture that tends to want to focus on pharmaceutical intervention and focus on biology as medicine, I think we would be well served by changing the narrative.
By Catherine Robertson Souter