Owen Flanagan (2013) has recently proposed an account of addiction that includes a shame condition. “Addicted” persons interpret themselves as both failing in effective agency and not living up to their own normative standards, and their recognition of this leads to a set of negative self-regarding attitudes, central to these being shame. Flanagan thinks, and we agree, that the sources of the shame condition connect to the affected individual’s perceived inability to be an effective reasons-responsive agent, someone, as he says, who passes her own survey. However, we think that in addition to this narrow source of shame there is a wider source: the public stigmatization of addiction and of people experiencing addiction.
To be fair to Flanagan, he too includes socially sourced shame in addition to the phenomenon of shame in one’s own eyes. Indeed, he says (2013, 3) that addiction is “ … actually a person-in-a-particular-social-world disorder.” There is, however, the question of emphasis. We claim that a narrow source of shame—a loss of face for failures to live up to one’s own standards—misses much of what explains it, namely the fact that affected persons mark themselves out to themselves—they self-stigmatize—after absorbing negative social attitudes about addiction, addictive behaviour and “addicts.” Even the concept of shame in one’s own eyes, where one tries to meet some personal normative standard, is unlikely not to suffer from the leakage of social norms into personal care of oneself. These standards are derived from social learning where we quickly learn that in letting ourselves down we typically let down others who rely on us.
Importantly, we are not claiming that socially induced shame, or self-stigmatization, applies in equally robust proportions to the population of individuals affected by addiction.Footnote 1 Indeed, we are not claiming it applies to all individuals experiencing addiction. Our claim is that for a significant subset of those who experience public stigma, the process of self-stigmatization does indeed take place and this process is an element in the social construction of the addiction condition itself. Footnote 2 The burden of the paper is to explain and defend this claim, while recognizing its limits. These limits fit well with what Corrigan and Watson (2002: 36) have claimed in relation to what they call the “fundamental paradox of self-stigma” as this applies to those with a mental illness. They point out that there may be three types of response to public stigma. In addition to the group for whom public stigma leads to losses in self-esteem (the group of interest here), there are those who respond to stigmatizing prejudice with righteous indignation or even anger, and there are those who are simply indifferent to the treatment they receive as an out-group. We do not have figures on how these subgroups map onto the population of individuals affected by addiction, however, we take it as very plausible that these distinctions apply also in this domain, and so, given this, appropriate limits are placed on the scope of the proposed link between public and private stigma in the condition of addiction.Footnote 3
Our central claim is supported by a study undertaken by the authors.Footnote 4 The primary broader aim of the study was to investigate the impact of addiction on the moral self-conception, practical identity, and values of people in treatment for substance use problems. Material from the qualitative component of the study supports the view that affected individuals’ perceptions of public stigma feed into their (normative) self-conception. The case of most interest in the present context occurs when the person experiencing substance use problems identifies with the negative stereotype(s) of “addict” and related terms.
Our intention here is to make the case for how it is that there can be a link between public stigma and the development of the shame condition. Our thesis can be stated this way: public stigma figures in the social construction of addiction in a significant range of cases. The idea is that when public stigma is internalized by the person experiencing addiction (as self-stigmatization) it is a source of the shame condition Flanagan identifies. We take as our project here to unpack the move from public stigmatization to internalization of that stigma. Seeing how that process works will thus provide some support for, and understanding of, the social constructivist account.
To be clear, then, our main claim, that public stigma is an element in the constitution of addiction in a significant range of cases, is best situated within the literature that sees the phenomenon of addiction as socially constructed. Here, addiction is understood as the product of the interaction of substance, biology, individuals, settings of use, discourses, practices, and policies. It is historically and socially contingent, emerging through rather than preceding people’s and society’s understandings and experiences of it (Fraser, Moore, and Keane 2014; Granfield and Reinarman 2015). There are several studies that highlight the social situated-ness of addiction. A background starting point for these studies is the work done by Alexander and colleagues who noticed the connection between social conditions and conduciveness by rats to self-administer drugs—the famous Rat Park experiments (Alexander, Coambs, and Hadaway 1978). Then there are the studies done by Robins on Vietnam veterans who had used heroin extensively and regularly in Vietnam, yet ceased all substance use when back in the United States (Robins 1974, 1993); or the recent studies by Hart and colleagues on cocaine and opioid users in poor neighbourhoods where public stigma and police discrimination feeds into the lived experiences of addiction (Hart and Krauss 2008; Hart et al. 2000; Hart 2013). Of course we are not claiming that the internalization of stigma by some individuals is the only link between socially toxic circumstances and addiction experiences but rather that this process is central and important, and understanding how it plays out is important to any account of addiction within this tradition.
Stereotyping and Self-stigmatization
It is a truism that social persons judge one another, interpret and evaluate each other’s behaviour, and find ways inevitably to group each other into ready-made normative categories. In stranger–stranger encounters we tag persons into types based on how they present, filtered through our own readily available stock of characters. This takes place perhaps pending the addition of further information that might fill out their actual social identity. But sometimes further facts about this person are not forthcoming, and we then proceed in our social interactions with an information-poor picture of the person before us. Of course the process of tagged group identification occurs spontaneously and heuristically as an understandable effect of facilitating social interaction. Sometimes, for instance, it quite inoffensively makes sense to read off the character or role of a person from their self-presentation, even if just as an ice-breaker in conversation. When, for instance, I wear my team insignia I do not feel in the least bit pigeonholed by the person who assumes that I am a sports fan of a certain type; and the same is true across a range of type-castings for getting an initial fix on who I am. Alas, this is not always the case, and so what might normally be a harmless and useful social process becomes corrupted when the categories become negative stereotypes and especially when those stereotypes are highly misleading representations of their members.
Stereotypes, as we will use the concept, are memetic categories that are supposed to characterize (“typify”) a group or individual and are based on simplistic generalizations. Their transmission through a culture occurs because the meme tends to go unchallenged and because of its fittingness with other cultural categories. Our use of “stereotype” dissociates from any possibly deserved moral attribution. So “negative stereotype” may involve an attribution of disapproval, but this leaves open any question concerning whether this disapproval is justified. Almost any group or individual can be the target of stereotyping, even apparently laudable groups such as those in the professions. The act of stereotyping relativizes to groups making these attributions, and usually the groups with powerful influence over public information are the most successful at promulgating their favoured memes. So, for instance in certain social quarters being a “greenie” is a negative stereotype, but the category of environmentalist necessary to it is arguably morally laudable. It is important to the current account that the stereotype of “addict” be understood in the way just described, viz., as a category based on a simplified generalization, tending to be spread by those with an interest in its preservation and yet, as we claim, giving rise to no implication of wrongdoing, moral badness, or weakness.
The negative stereotype associated with addiction comes about from public stigmatization of addicted persons. Comments by some of our respondents illustrate their awareness of its dangers:
I mean there’s a time in my life where I’d be paranoid about sitting around other people’s possessions you know ‘cause if anything went missing generally nine out of ten people in the room would be dismissed and I’d get the blame ... there’s a lot of discomfort within yourself after coming out of that lifestyle or existence really. —TomFootnote 5
I think the further that you go into addiction the further that, you know, you’re labelled and you’re stigmatized by being an addict. And the further that you go into addiction the harder it is to get out. —Bill
How easy is it for people to access this [the interview transcript]? Like does it go into a vault or whatever? Do you know what I mean? You know how people do their doc … they do essays and all that sort of thing and do they go into this? ... Yeah. People get so easily stigmatized, that would be horrible. —Brenda
The process of self-stigmatization is pronounced in addiction (Lloyd 2013; Luoma et al. 2007). It comes about via internalization of the negative stereotype, a resultant loss of self-esteem, and acting out of the negative public image. This public image excludes affected individuals from public engagement by seeing them as, for example, unreliable or untrustworthy. Affected individuals will then exclude themselves from public life, for example, by failing to apply for work or by removing themselves from public sight; or they will cease to see themselves as responsible citizens; or they will begin to see themselves as legitimate objects of the treatment meted out to them. Above all, they will be motivated to continue to consume in order to forget, set aside, or reduce the negative feelings arising from their shame. This is an instance of what, following Hacking (1995a, 1995b) we refer to as a looping effect. The normatively loaded classification of a group—in this case “addicts”—feeds back into behaviour that exhibits the classification. In this sense public stigma of addiction has the unfortunate tendency to feed into, sustain, or exacerbate the very practices it sets out to reproach.