Lazy, Crazy, and Disgusting: Stigma and the Undoing of Global Health

by Alexandra Brewis, Amber Wutich

Overview

How stigma derails well-intentioned public health efforts, creating suffering and worsening inequalities.

2020 Winner, Society for Anthropological Sciences Carol R. Ember Book Prize,Shortlisted for the British Sociological Association's Foundation for the Sociology of Health and Illness Book Prize

Stigma is a dehumanizing process, where shaming and blaming are embedded in our beliefs about who does and does not have value within society. In Lazy, Crazy, and Disgusting, medical anthropologists Alexandra Brewis and Amber Wutich explore a darker side of public health: that well-intentioned public health campaigns can create new and damaging stigma, even when they are otherwise successful.

Brewis and Wutich present a novel, synthetic argument about how stigmas act as a massive driver of global disease and suffering, killing or sickening billions every year. They focus on three of the most complex, difficult-to-fix global health efforts: bringing sanitation to all, treating mental illness, and preventing obesity. They explain how and why humans so readily stigmatize, how this derails ongoing public health efforts, and why this process invariably hurts people who are already at risk. They also explore how new stigmas enter global health so easily and consider why destigmatization is so very difficult. Finally, the book offers potential solutions that may be able to prevent, challenge, and fix stigma. Stigma elimination, Brewis and Wutich conclude, must be recognized as a necessary and core component of all global health efforts.

Drawing on the authors' keen observations and decades of fieldwork, Lazy, Crazy, and Disgusting combines a wide array of ethnographic evidence from around the globe to demonstrate conclusively how stigma undermines global health's basic goals to create both health and justice.

Product Details

ISBN-13:	9781421443256
Publisher:	Johns Hopkins University Press
Publication date:	02/01/2022
Pages:	288
Product dimensions:	6.00(w) x 9.00(h) x 0.75(d)
Age Range:	18 Years

About the Author

Alexandra Brewis (TEMPE, AZ) is a President's Professor in the School of Human Evolution and Social Change at Arizona State University, where Brewis founded the Center for Global Health. Brewis is the author of Obesity: Cultural and Biocultural Perspectives and is a coauthor of Fat in Four Cultures: A Global Ethnography of Weight and Extreme Weight Loss: Life Before and After Bariatric Surgery.

Amber Wutich (TEMPE, AZ) is a President's Professor in the School of Human Evolution and Social Change at Arizona State University, where Wutich now directs the Center for Global Health. Wutich is a coauthor of Analyzing Qualitative Data: Systematic Approaches, Fat in Four Cultures: A Global Ethnography of Weight, and Extreme Weight Loss: Life Before and After Bariatric Surgery.

Table of Contents

Acknowledgments
Introduction
Part I. Disgusting
Chapter 1. Dealing with Defecation
Chapter 2. Dirty Things, Disgusting People
Chapter 3. Dirty and Disempowered
Part II. Lazy
Chapter 4. Fat, Bad, and Everywhere
Chapter 5. The Tyranny of Weight Judgment
Chapter 6. World War O
Part III. Crazy
Chapter 7. Once Crazy, Always Crazy
Chapter 8. The Myth of the Destigmatized Society
Chapter 9. Completely Depressing
Conclusion. What We Can Do
Appendix. Stigma: A Brief Primer
Notes
Index

What People are Saying About This

Thomas Leatherman

Lazy, Crazy, and Disgusting tackles the important topic of stigma and the way it seeps into public global health programs. Filled at every level with grounded examples that contradict perceived wisdom, the book is a model of critical thinking. It is both readily accessible and marvelously synthetic for the way it blends biology, culture, and social experience. A must-read for medical anthropologists, global and public health practitioners, and anyone interested in stigma.

Merrill Singer

This is a magnificent, highly engaging, and ethnographically informed examination of the fateful intersection of stigma and public health. It underscores, through multiple cases, the vital lessons of social science about the adverse consequences of shaming as a means of pushing people, especially the poor and marginalized, to fit socially accepted standards of appearance and behavior.

Andrea S. Wiley

Providing a fresh look at the classic social science concept of stigma, this book adds to the literature on why humans so readily stigmatize while touching on the ways in which interventions designed to address a particular health problem may inadvertently contribute to further stigmatization and worsen health outcomes. Interesting, timely, and lucid, this provocative book makes an important contribution.

Bernice A. Pescosolido

Combining global reach with insightful depth, Brewis and Wutich forcefully counter shame-based, individually focused, and culturally unaware public health efforts. In the best tradition of social science, they document the unintended consequence of victimizing the most vulnerable. While acknowledging stigma's inevitability, this eye-opening warning offers a novel blueprint for improving population health.

From the Publisher

Providing a fresh look at the classic social science concept of stigma, this book adds to the literature on why humans so readily stigmatize while touching on the ways in which interventions designed to address a particular health problem may inadvertently contribute to further stigmatization and worsen health outcomes. Interesting, timely, and lucid, this provocative book makes an important contribution.
—Andrea S. Wiley, Indiana University, Bloomington, coauthor of Medical Anthropology: A Biocultural Approach

Despite the growing interest in global mental health, the issue of stigma deserves much more attention than it gets from medical social scientists and health providers. The approach here is highly original and important. I believe there is a wide scholarly and student audience for this teachable book.
—Peter J. Brown, Emory University, coauthor of Foundations of Global Health: An Interdisciplinary Reader

This is a magnificent, highly engaging, and ethnographically informed examination of the fateful intersection of stigma and public health. It underscores, through multiple cases, the vital lessons of social science about the adverse consequences of shaming as a means of pushing people, especially the poor and marginalized, to fit socially accepted standards of appearance and behavior.
—Merrill Singer, University of Connecticut, coauthor of The Social Value of Drug Addicts: Uses of the Useless

In Lazy, Crazy, and Disgusting, two eminent scholars of stigma have provided a deeply engaging road map for understanding the unintended consequences of weaponizing shame in the service of public health and its inevitable cascades along the usual fault lines that divide the poor and excluded from the rest of the world. What is, then, the authors' deceptively simple recommendation for physicians, development workers, and policy makers? Don't do it.
—Alexander C. Tsai, MD, Massachusetts General Hospital / Harvard Medical School

Lazy, Crazy, and Disgusting tackles the important topic of stigma and the way it seeps into public global health programs. Filled at every level with grounded examples that contradict perceived wisdom, the book is a model of critical thinking. It is both readily accessible and marvelously synthetic for the way it blends biology, culture, and social experience. A must-read for medical anthropologists, global and public health practitioners, and anyone interested in stigma.
—Thomas Leatherman, University of Massachusetts, Amherst

Combining global reach with insightful depth, Brewis and Wutich forcefully counter shame-based, individually focused, and culturally unaware public health efforts. In the best tradition of social science, they document the unintended consequence of victimizing the most vulnerable. While acknowledging stigma's inevitability, this eye-opening warning offers a novel blueprint for improving population health.
—Bernice A. Pescosolido, Indiana University, coeditor of Handbook of the Sociology of Health, Illness, and Healing: A Blueprint for the 21st Century

Peter J. Brown

Despite the growing interest in global mental health, the issue of stigma deserves much more attention than it gets from medical social scientists and health providers. The approach here is highly original and important. I believe there is a wide scholarly and student audience for this teachable book.

Alexander C. Tsai

In Lazy, Crazy, and Disgusting, two eminent scholars of stigma have provided a deeply engaging road map for understanding the unintended consequences of weaponizing shame in the service of public health and its inevitable cascades along the usual fault lines that divide the poor and excluded from the rest of the world. What is, then, the authors' deceptively simple recommendation for physicians, development workers, and policy makers? Don't do it.

Editorial Reviews

The best thing about this book is that it is relatable on personal, institutional, and global levels. The book provides a timely contribution to the state of global health, especially the process of stigmatizing people with infectious disease.

Teaching Sociology

Lazy, Crazy, and Disgusting is an impeccably researched, collaborative, thought-provoking, and boundary-breaking book that should be required reading for anyone interested in public health, medicine, and anthropology.

Medical Anthropology Quarterly

Brewis and Wutich's book offers a rigorous analysis of how public global health efforts can create and reinforce stigma . . . This book is recommended for anyone with a general interest in global public health, [and for] undergraduate and postgraduate students from health-related disciplines including medical sociology. This book should be considered by health practitioners, scholars and public health professionals when designing and implementing health-related interventions.

Sociology of Health and Illness

Brewis and Wutich provide a very useful primer on stigma, which gives a succinct explanation of what stigma is in relation to global health, its different forms, and how stigmatization intersects with other population-level and individual-level effects. As an important topic for students of medicine, global health, and ethics, Lazy, Crazy, and Disgusting would be a useful recommended text.

The Lancet: Diabetes and Endocrinology

This engaging book . . . fills a significant gap in the literature by providing a wake-up call to scholars and practitioners unfamiliar with the topic. And it reminds me that we should all be working together to avoid any unintended consequences of promoting health.
—Nature

Lazy, Crazy, and Disgusting is an impeccably researched, collaborative, thought-provoking, and boundary-breaking book that should be required reading for anyone interested in public health, medicine, and anthropology.
—Medical Anthropology Quarterly

Brewis and Wutich provide a very useful primer on stigma, which gives a succinct explanation of what stigma is in relation to global health, its different forms, and how stigmatization intersects with other population-level and individual-level effects. As an important topic for students of medicine, global health, and ethics, Lazy, Crazy, and Disgusting would be a useful recommended text.
—The Lancet: Diabetes and Endocrinology

Brewis and Wutich's book offers a rigorous analysis of how public global health efforts can create and reinforce stigma . . . This book is recommended for anyone with a general interest in global public health, [and for] undergraduate and postgraduate students from health-related disciplines including medical sociology. This book should be considered by health practitioners, scholars and public health professionals when designing and implementing health-related interventions.
—Sociology of Health and Illness

The global perspective and illuminating detail in Lazy, Crazy, and Disgusting bring the social, cultural and structural elements of stigma into focus for the reader . . . This text is both academic and accessible, making it an engrossing read for those interested in medicine and public health, anthropology and sociology. I would argue it is also incredibly relevant to those who experience, resist or perpetuate stigma: each and every one of us.
—Organization

The book provides an accessible, synthetic, and critical examination of the health effects of shame and stigma, one that was already long overdue when the book was published in 2019. That was before the onset of the current pandemic. The topic is of even more pressing concern now, when the public's health depends so much on the behavior of individuals.
—American Scientist

The best thing about this book is that it is relatable on personal, institutional, and global levels. The book provides a timely contribution to the state of global health, especially the process of stigmatizing people with infectious disease.
—Teaching Sociology

This is a social justice–informed and critically important book for students, scholars, professionals, and policy makers in public health, medical anthropology, health-related social work, and health justice.
—Affilia: Journal of Women and Social Work

From the Publisher

This is a social justice–informed and critically important book for students, scholars, professionals, and policy makers in public health, medical anthropology, health-related social work, and health justice.

Affilia: Journal of Women and Social Work

This engaging book . . . fills a significant gap in the literature by providing a wake-up call to scholars and practitioners unfamiliar with the topic. And it reminds me that we should all be working together to avoid any unintended consequences of promoting health.

Nature Lib

The global perspective and illuminating detail in Lazy, Crazy, and Disgusting bring the social, cultural and structural elements of stigma into focus for the reader . . . This text is both academic and accessible, making it an engrossing read for those interested in medicine and public health, anthropology and sociology. I would argue it is also incredibly relevant to those who experience, resist or perpetuate stigma: each and every one of us.

Organization

The book provides an accessible, synthetic, and critical examination of the health effects of shame and stigma, one that was already long overdue when the book was published in 2019. That was before the onset of the current pandemic. The topic is of even more pressing concern now, when the public's health depends so much on the behavior of individuals.

American Scientist

"This engaging book... fills a significant gap in the literature by providing a wake-up call to scholars and practitioners unfamiliar with the topic. And it reminds me that we should all be working together to avoid any unintended consequences of promoting health."

Nature

"Lazy, Crazy, and Disgusting is an impeccably researched, collaborative, thought-provoking, and boundary-breaking book that should be required reading for anyone interested in public health, medicine, and anthropology."

Medical Anthropology Quarterly - Emily Mendenhall

"Brewis and Wutich's book offers a rigorous analysis of how public global health efforts can create and reinforce stigma... This book is recommended for anyone with a general interest in global public health, undergraduate and postgraduate students from healthrelated disciplines including medical sociology. This book should be considered by health practitioners, scholars and public health professionals when designing and implementing healthrelated interventions."

Sociology of Health and Illness - María Jesús Vega-Salas

"The global perspective and illuminating detail in Lazy, Crazy and Disgusting bring the social, cultural and structural elements of stigma into focus for the reader... This text is both academic and accessible, making it an engrossing read for those interested in medicine and public health, anthropology and sociology. I would argue it is also incredibly relevant to those who experience, resist or perpetuate stigma: each and every one of us."

Organization - Karly Nygaard-Petersen

"This engaging book... fills a significant gap in the literature by providing a wake-up call to scholars and practitioners unfamiliar with the topic. And it reminds me that we should all be working together to avoid any unintended consequences of promoting health."

Nature - Julie Pulerwitz

"Brewis and Wutich provide a very useful primer on stigma, which gives a succinct explanation of what stigma is in relation to global health, its different forms, and how stigmatization intersects with other population level and individual-level effects. As an important topic for students of medicine, global health, and ethics, Lazy, Crazy, and Disgusting would be a useful recommended text."

The Lancet: Diabetes and Endocrinology - Fiona Mitchell