Lazy, Crazy, and Disgusting

Book excerpt: 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.