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Introduction
It remains customary to open considerations of stigma with a more or less ritualistic acknowledgement of Goffman's (1968) pioneering explication of the concept now dating back more than a generation. Insofar as his analysis continues to impress with its subtlety, liveliness, pertinence and bite this is entirely appropriate. It is difficult to avoid the conclusion, however, that - sociologically at least - our appreciation and grasp of stigma has not advanced a great deal since Goffman's intervention; and it is undeniably the case that the last generation has witnessed substantial social change bearing heavily and relevantly on agency and structure as well as on interaction. The theme of this paper is the need to re-frame our understanding of stigma in light not only of social change, most conspicuous in the period since the mid-1970s, but also of lacunae in Goffman's original position and of recent shifts within sociology itself. It is the aim of this short contribution to lend impetus to such a reframing, with special reference to phenomena in the domain of health and health care.
There have of course been numerous attempts to apply and extend Goffman's work, not least by medical sociologists (see Link and Phelan, 2001). Rather than rehearse these again I propose to focus on a single small-scale study conducted in the mid-1970s, by chance precisely at the point of transition to global or disorganized capitalism, that trickled into print in the following years. Concentrating on my own research on epilepsy has the advantage of affording free critical license with only myself to offend. In the opening section, the background and chief components of the hidden distress model of epilepsy are examined. In the second, this model is interrogated with the advantages of hindsight. In the third section, an agenda of sorts for future sociological enquiries into stigma as applied to health problems is advanced. The paper concludes with a provisional re-working of the hidden distress model of epilepsy to accommodate the main items in this agenda.
The Hidden Distress Model of Epilepsy
The study of 'epilepsy in the community' conducted with the late Anthony Hopkins centred on in-depth interviews with a non-probability sample of 94 adults with active epilepsy (that is, with people who had either experienced...