Keith Wailoo

Stigma, race, and disease in 20th century America

reducing the absolute level of bad enacted stigma (“presumably” because there are few data on how effectively law does this). Even if enacted stigma is reduced, however, people do not make decisions based on what happens, but on their perceptions of what happens. Hence the important questions include: Can law promote resistance by reducing the perceived risks of resistance and by changing self-conception? Can law facilitate activism by acting against discrimination and providing a script to guide social interactions? Can it mobilise collective action? Clearly, resistance to stigma needs to become more prominent in any thinking about how law can address the problem. Some insights may be forthcoming from studies of the Americans with Disabilities Act. Researchers are looking at how people with disabilities integrate a new protective law into their long-term coping strategies. The “disabled” label may make things worse in some ways—eg, reinforcing separate status or victimhood. Prohibition is also permission; the Act forbids discrimination against a person with a disability who can do a job with no more than minimal changes in procedures or job environment, but therefore authorises discrimination against those who need more. Stigma exemplifies the fact that law is more than just words on paper. “Laws on the books” are transformed in the course of implementation into social practices and attitudes that must be accounted for in any consideration of law’s relation, good and bad, to stigma. The stigma research agenda thus demands greater integration of health, science, and law.