A number of interventions have been developed to help people who are at risk of being stigmatised due to a difference in their appearance. Most have focused on the individual, but some have attempted to change societal attitudes and behaviour.
One approach is to reduce the visibility of a stigmatising mark. There is good evidence that cosmetic surgery (Sarwer et al., 1998) and cosmetic prostheses can help people feel better about themselves and their appearance. With respect to skin conditions, skin camouflage creams can be used to disguise skin blemishes such as scars and vitiligo. Kent (2002) found that clients who consulted the British Red Cross Skin Camouflage Service felt more confident in and exhibited less avoidance of social situations after their appointment than before. Although there was no measure of enacted or felt stigma in that study, qualitative comments indicated that clients were less preoccupied by how others would react to them. Laser treatment can also be helpful for those with port wine stains (Troilius et al., 1998), as is medical treatment for a variety of skin conditions including acne and eczema (Kurwa & Finlay, 1995; Kellett & Gawkrodger, 1999).
Other approaches are more psychologically based. Some aim to help people forestall stigmatisation. In social skills training people are encouraged to develop ways of displaying their social competence to others, so that the stigmatising condition is less pertinent to social interactions. Robinson et al. (1996) assessed the effects of a social skills workshop on the well-being of patients with a variety of disfiguring conditions. The package included instruction, modelling, role-play, feedback and discussion. Although there were improvements in levels of anxiety and social avoidance, again there were no measures of stigmatisation. Other approaches aim to help people to cope with stigmatisation when it occurs. Papadopoulous et al. (1999) used a cognitive-behavioural approach. They included an intervention intended to buffer the negative effects of stigmatisation by encouraging clients to engage in positive self-talk when anyone made a negative comment and to reframe staring as an indication of curiosity rather than rejection (Langer et al., 1976). They found a significant improvement in participants' quality of life, self-esteem and a decrease in negative automatic thoughts post-treatment, compared to a non-treatment comparison group.
However, these types of interventions concentrate on changing the appearance or the behaviour of the stigmatised individual, and do not address the wider issue of stigmatisation directly. The comparison would be with more recent approaches to physical disabilities; rather than locating problems of mobility with a person who uses a wheelchair, for example, it has become clear that there are central issues of physical access to the built environment. Just as changes in the physical environment can greatly reduce the disability of wheelchair use, changes in attitudes and behaviour of those who stigmatise could improve the well-being of those whose appearance is noticeably different.
People with visible differences sometimes take on this type of work themselves, seeking to inform others about the nature of their condition:
'Many years ago I went to a local swimming pool. After I had changed into my costume I entered the pool. As I walked toward the water I was approached by an attendant who asked what was wrong with my skin. He suggested that I shouldn't enter the water. I asked to see the manager and told him that his staff need better training'.
Unfortunately, there have been few formal attempts to make changes in these respects. Frances (2004) provides a detailed description of the interventions, supported by the UK charity Changing Faces, to assist children at school. Employing many of the same strategies that are used in anti-bullying programmes, Frances aims to develop school communities that are fully inclusive of children with visible differences. These interventions involve parents and teachers as well as children themselves. Cline et al. (1998) attempted to alter schoolchildren's attitudes and knowledge towards disfigurement by adding a theme into the school curriculum. Although the programme affected knowledge about and awareness of disfiguring conditions in the intervention schools as compared to control schools, there was no difference in the children's commitment to help others with disfigurements. There was no direct test of the effect of the intervention on behaviour.
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