1 EN SITUATION PRCAIRE: POVERTY, STIGMA, AND MENTAL HEALTH IN GENEVA, SWITZERLAND By RYAN P. THEIS A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2010
2 2010 Ryan P. Theis
3 To my family and friends for their love and support, to Dorin, Nadim, and Tania for their trust and friendship, and to all in Geneva who find themselves in a precarious situation
4 ACKNOWLEDGMENTS I would first like to thank Allan Burns for his guidance as my advisor, professor, and committee chair over many years of graduate school, and as my mentor in applied anthropology. Dr. Burns and my committee, Willie Baber, William Chen, and Elizabeth Guillette, have been a valuable influence for me, and it was through their encouragement that I sought to pursue a niche between anthropology and public health, to travel and learn a foreign language, and to be resilient to the challenges of academia. There are many who, over the years, have helped me to develop as a professional and as a person, and without whom this work would not have been possible. I am grateful to Nabih Asal for his leadership as my professor and mentor in epidemiology, and Elizabeth Shenkman for her guidance in health policy and program evaluat ion. With much admiration, I thank Alice Allen, Charlie Gass, and Hal Clarendon for showing me what I am capable of, and capable of becoming, physically, mentally, and spiritually. I owe many thanks to my colleagues in Switzerland Hans Wolff, Patricia H udelson, Antoine Sthli, Nicolas Senni, and all those in the clinics and social services of Geneva who helped me to realize my doctoral work. In particular, I acknowledge the doctors, nurses, and social workers of UMSCO, the social service workers and volu nteers at CSRG, and the faculty of the University Hospitals of Geneva whose warm welcome helped to ease my transition to living in a foreign country, and whose valued input contributed greatly to this study. Credit is due to my research assistants Graldin e Bugnon and Ayari Flix for their enthusiasm, adaptability, and hard work during my final months in Switzerland.
5 I extend sincere gratitude to the many homeless and unemployed social service clients whose trust and helpfulness were critical to the succes s of this study. I thank Dorin, Nadim, and Tania for allowing me to follow them in their private lives, to witness their trials and tribulations, and to hear their stories. I gratefully acknowledge these and other informants, who, with little to gain perso nally from their participation, agreed to help out of their respect for others living in prcarit. Lastly, I thank my friends, family, and counselors who have given me constant support over the years, who encouraged me to keep trying when I was overwhelmed, and who congratulated me when I found success.
6 TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................. 4 LIST OF TABLES ............................................................................................................ 9 LIST OF FIGURES ........................................................................................................ 10 ABSTRACT ................................................................................................................... 11 CHAPTER 1 INTRODUCTION .................................................................................................... 13 Stigma and the Sociopolitical Dimensions of Poverty ............................................. 15 Study Rationale ...................................................................................................... 18 Social Exclusion and the Production of Urban Poverty .................................... 19 Poverty, Identity, and Mental Health ................................................................. 26 Geneva, Switzerland: Setting For an Ethnographic Study ...................................... 29 Study Approach and Research Questions ........................................................ 33 Dissertation Outline .......................................................................................... 35 2 STIGMA THEORY AND THE ANTHROPOLOGY OF POVERTY: TOWARD A SOCIAL, PSYCHOLOGICAL, AND CULTURAL SYNTHESIS ............................... 38 Spoiled Identity: Early Concepts of Stigma and Deviance in Sociology ................ 40 Labeling and Stigma in Social Psychology ............................................................. 47 Cultural Models of Stigma The Contribution of Anthropology and Ethnography .. 57 The Anthropology of Deviance ......................................................................... 62 Ethnographic Studies of the Poor ..................................................................... 67 Stigma in Multidisciplinary Synthesis ...................................................................... 76 3 POVERTY IN GENEVA: THE BALANCE OF STIGMA AND SOCIAL ACCEPTANCE ....................................................................................................... 78 A Visitors Snapshot of Geneva .............................................................................. 78 Po verty and Social Support in Switzerland ............................................................. 82 A Typology of Stigmatized Identities in Geneva ...................................................... 90 Homelessness and Begging ............................................................................. 90 Unemployment ................................................................................................. 94 Being an Immigrant .......................................................................................... 97 Social Support in Geneva ..................................................................................... 103 Social Assistance Organizations .................................................................... 104 Day Centers and Soup Kitchens .................................................................... 110 Homeless Shelters ......................................................................................... 113 Social Support as a Response to Stigma .............................................................. 116
7 4 RESEARCH APPROACH: QUESTIONS, INFORMANTS, PLACES, AND METHODS ............................................................................................................ 121 Research Questions ............................................................................................. 122 Informants ............................................................................................................. 124 Informant Demographics ................................................................................ 126 Informant Profiles ........................................................................................... 128 Prcaire informants .................................................................................. 129 Social servi ce informant ........................................................................... 132 Study Sites ............................................................................................................ 132 Participant Observation ........................................................................................ 135 Qualitative Interviews ............................................................................................ 141 Cultural Domain Analysis ...................................................................................... 145 Methods of Analysis .............................................................................................. 148 Field Notes ..................................................................................................... 149 Interview Transcripts ...................................................................................... 151 Stigmatizing Encounters ................................................................................. 153 Interpretation .................................................................................................. 155 5 LABELS AND STEREOTYPES OF PRCARIT ................................................. 162 Exploring Personal Labels as a Cultural Domain .................................................. 164 Free Lists ........................................................................................................ 167 Pile Sorts 34 Labels for People in Prcarit .............................................. 173 Label groupings ....................................................................................... 175 Aggregate grouping the answer key and its visualization ................... 179 Cultural consensus and competence ratings ........................................... 182 Paired Comparisons ....................................................................................... 184 Stereotypes of Prcarit in Geneva ...................................................................... 189 Stereotypes of Poor Immigrants ..................................................................... 192 Stereotypes of Alcoholics, Addicts, and Drug Dealers ................................... 196 Stereotypes of Unemployed/Underemployed State Beneficiaries .................. 197 Stereotypes of the Homeless ......................................................................... 198 6 ENCOUNTERS: OBSERVATIONS AND NARRATIVES OF STATUS LOSS AND DISCRIMINATION ........................................................................................ 206 The Anatomy of a Stigmat izing Encounter ............................................................ 210 Stigma in the Streets ...................................................................................... 217 In group Stigma .............................................................................................. 223 Stigma Against the Unemployed Sans Papiers and State Beneficiaries ..... 228 The Continuum of Responses to Stigma .............................................................. 232 Internalizing .................................................................................................... 235 Adapting ......................................................................................................... 237 Legitimizing .................................................................................................... 240 Resisting ......................................................................................................... 242 A Recursive Model of S tigma ................................................................................ 246
8 7 PATHWAYS TO PSYCHOSOCIAL DISTRESS: THREE CASE STUDIES OF POVERTY AND STIGMA ..................................................................................... 252 Dorin (In)visible in a New City ............................................................................ 253 From Romania, to Sweden, to Switzerland .................................................... 254 A Date Gone Awry .......................................................................................... 256 Nothing Else Matters ................................................................................ 258 Planetary Escape ........................................................................................... 259 Nadim Defending Nationality, Hiding Homelessness ......................................... 262 Slaving Away for Money in Switzerland ....................................................... 265 Cellars, Shelters, and Jails ............................................................................. 268 Leaving Prcarite and Finding Home ............................................................. 271 Tania The Incarceration of a Serbian Journalist ................................................ 276 Living Violence the Line between Victim and Perpetrator ............................ 278 A Mysterious Disappearance .......................................................................... 280 An Insiders Perspective on Swiss Justice and Social Support ...................... 282 Trading Prison Cells for Hospital Beds ........................................................... 286 Experiencing Discrimination, Perceiving Persecution ..................................... 288 Stigmas Place in Social Causation ...................................................................... 290 8 PRACTICALITIES: STRATEGIES FOR REMOVING STIGMA, AFFIRMING IDENTITY, AND IMPROVING MENTAL HEALTH ................................................ 292 Sourceand Subject Directed Intervention ........................................................... 292 Recommendations to the City of Geneva ............................................................. 298 Encourage Harmony among Guests .............................................................. 298 Require Sensitivity Training for Volunteers ..................................................... 300 Apply Social Service Rules in a Just and Consistent Manner ........................ 301 Final List of Recommendations ...................................................................... 302 Stigmas of Poverty in the Stress Model for Mental Illness: Future Directions ....... 303 Mental Health among the Poor ....................................................................... 305 Social Causation and Social Selection ........................................................... 307 The Stress Model Articulating Poverty, Stigma, and Mental Health ............ 309 Future Research The Cultural Epidemiology of Stigma ............................... 312 Concluding Remarks ............................................................................................. 316 APPENDIX A INTERVIEW GUIDE .............................................................................................. 319 B FREE LISTED TERMS FOR PEOPLE IN PRCARIT ..................................... 321 C PILE SORTS OF LABELS FOR PEOPLE IN PRCARIT : AGGREGATE PROXIMITY MATRIX ............................................................................................ 324 LIST OF REFERENCES ............................................................................................. 326 BIOGRAPHICAL SKETCH .......................................................................................... 338
9 LIST OF TABLES Table page 3 1 Social service locations in Geneva, 2006 ......................................................... 118 4 1 Informant demographics ................................................................................... 159 4 2 Representation of informants in observations and transcripts .......................... 160 5 1 Cultural domain analysis informants ................................................................. 200 5 2 Cultural consensus statistics, by informant group ............................................. 202 5 3 Informant competence scores in pile sorts ....................................................... 202 5 4 Paired comparisons: label ranking by severity and frequency (total) ................ 203 5 5 Paired comparisons: label ranking by severity and frequency (prcaire) .......... 203 5 6 Paired comparisons: label ranking by severity and frequency (population) ...... 203 5 7 Interview responses: the most discriminated identities .................................. 204 6 1 Stigmatizing encounters: participant characteristics ......................................... 248 6 2 Stigmatizing encounters: locations ................................................................... 249 6 3 Continuum of responses to stigmatizing encounters ........................................ 250 6 4 Distribution of encounter response types, by collection method ....................... 251
10 LIST OF FIGURES Figure page 4 1 Geneva social service locations ....................................................................... 161 5 1 MDS plot: 34 labels for people in prcarit ....................................................... 205 8 1 A recursive model of stigma and mental illness ................................................ 318
11 Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy EN SITUATION PRCAIRE: POVERTY, STIGMA, AND MENTAL HEALTH IN GENEVA, SWITZERLAND By Ryan P. Theis May 2010 Chair: Allan Burns Major: Anthropology In the Western world, stigmas against people in poverty, such as the working poor, the unemployed, and the homeless, are pervasive and often severe. Through processes of separation, labeling, and discrimination, these disadvantaged groups face daily challenges to th eir personal and social identities This study explores the production and experience of stigma in the low income communities of Geneva, Switzerland, and assesses its qualitative associations with mental health. Access to research sites was g ained through collaboration with the Unit mobile de soins c ommunautaires (UMSCO) a mobile clinic that offers health care for the uninsured and undocumented people who frequent the citys social services. I explored the lives of those who used these services from December 2005 to October 2006, triangulating methods of participant observation (N = 55), qualitati ve interviews (N = 18), and cultural domain analysis (N = 64). I collected narrated and observed instances of encounters between informants and the people or institutions that stigmatize them Using free list, pile sort, and paired comparison activities, I assessed the group understanding of labels for people en situation prcaire (in a precarious situation).
12 Poor immigrants were viewed as some of the most stigmatized people in Geneva, particularly Romanians, North Africans, and former Yugoslavs. The label profiteur (profiteer ) ranked high in both severity and frequency of use, linked to the stereotype that the poor take advantage of society Among 237 encounters collected common sources of stigma were : (1) social service workers (23 % ); (2) other people defined as prcaire ( 13% ) ; (3) p olice officers (10 % ); and (4) members of the general public (10% ) Informants reacted to encounters with a continuum of response types which had varying associations with mental health outcomes and suggested a recursive model of stigma Case studies of three key informants illustrate the different pathways that link stigma and mental illness. R ecommendations focused on three themes: (1) conflict among social service users; (2) cultural sensitivity of volunteers; and (3) the fair and consistent application of social service rules. Findings point to new hypotheses in the etiology of mental illness and new tools for measuring stigma in future studies.
13 CHAPTER 1 INTRODUCTION On the night of October 9, 2008, a homeless man named John McGraham was brutally murdered in public doused with gasoline and set on fire on a sidewalk in the Los Angeles neighborhood where he had lived for twenty years (Stateman 2008). The local residents and shopkeepers who rushed to his aid after the attack were unable to save him. These were people who had come to know McGrahams presence as part of their everyday lives, passing him in the streets, taking for granted his unkempt beard and dirty, oversized jacket, offering him food and clothing. After his death, they left candles and words of sympathy and grief at the spot where he was killed, and hundreds later honored him in a chapel at a local Presbyterian church (Stateman 2008; Roosevelt 2008; Rubin 2009). McGraham, who had once worked as a bellman at the Ambassador Hotel, suffered from depression (Rubin 2009). For two decades he resisted the efforts of family member s to get him off the streets and into treatment. His mental condition and constant outdoor exposure made him vulnerable to the deliberate and hateful act that ended his life. A 30year old man was arrested for McGrahams murder four months later, based on witnesses and forensic evidence collected at the crime scene. The Los Angeles Police Department (LAPD) deputy chief described the suspects motive as straight up personal dislike for McGraham and a little bit crazy (Rubin 2009). Unfortunately, violence of the kind that killed John McGraham is not uncommon in the United States. According to the National Coalition for the Homeless (2008a), since 1999, nearly 800 violent acts have been perpetrated against homeless individuals in 45 states across the country, as well as Puerto Rico. Nor are attacks against the
14 homeless unique to the United States. A study of homeless men and women in the United Kingdom found that over half had experienced violence in the past year, which was 13 times the rate in the general population (Newburn and Rock 2005). While much of this violence is carried out by other individuals on the street (and in cases of theft and sexual assault, with clear motives), nearly one third of attackers are members of the general public. Survey research conducted with passers by has shown that public perception of such attacks is high across Europe; in the cities of Belfast, Cambridge, and Vienna, greater than half of respondents cited public attacks as a source of danger for the homeless (Brandon et al. 2000). In the United States, the majority of attacks have been carried out by teenage boys and younger men, who cite boredom, thrill seeking, and opportunity as motives ( National Coalition for the Homeless 2008a). Furthermore, the perpetrators characteristics, motives and weaponry are similar to those of people who commit hate crimes aga inst known discriminated groups suggesting that stigma at tached to homelessness plays a role in this violence. Erving Goffman, widely credited as being the first to address stigma as a subject of sociological study, defined stigma as an attribute that reduces someone from a whole and usual person to a t ainted discounted one (1963:3). Solitary and with little social support, the homeless are especially vulnerable to the consequences of stigma, which includes becoming the object of violent acts at the hands of strangers. Despite the efforts of homeless advocat es and sympathetic local residents, such as those who helped John McGraham, people living on the streets continue to be shunned, ignored, and deemed without social status by much of the general public (Falk
15 2001:244). The stigma of homelessness may be equal in severity to that of mental hospitalization in which stereotypes of contagion and dangerousness stoke fearful responses from the public (Phelan et al. 1997). In the United Kingdom, the homeless have been subject to blatantly disrespectful offenses by strangers, including being publicly insulted, harassed, struck by thrown objects, intimidated, and urinated on (Newburn and Rock 2005). In contrast to the LAPD deputy chiefs statement that personal dislike motivated McGrahams attacker, it is more likely collective dislike that explains the rising violence confronting the homeless in developed countries today. Stigma and the Sociopolitical Dimensions of Poverty The stigma of homelessness has its roots in the broader beliefs, stereotypes, and moral jud gments about the urban poor in general, legitimized by the idea that the poor are responsible for their own c ondition, whether through criminal or deviant behaviors, laziness, or dependence on others (Waxman 1977). This stigma affects not only the homeless but the unemployed, the working poor, people living in low income neighborhoods, and people receiving welfare or disability benefits. Furthermore, through the association of poverty with certain demographic groups and social problems, it affects people o f minority or disadvantaged ethnicities, immigrants (documented or not), alcoholics, drug addicts, sex workers and those who commit petty crimes. The wide range of identities that comprise the poor suggests that the stigma attached to poverty is more accur ately conceived in the plural, as stigmas of poverty These stigmas are an integral part of the social and political dimensions of poverty in developed countries, where technological, economic, and scientific revolutions of the past three centuries have reduced the extent and intensity of material deprivation (Khusro 1999:102). In Europe and North America, the experience of poverty
16 is not simply a matter of being without sufficient income, clean water, or shelter. Limited or dysfunctional social networks disenfranchisement and obstruction of civil rights, and the deprivation of dignity and self respect that comes with social exclusion, discrimination, and status loss all qualify the lives of the urban poor reducing the potential for change and at times exacerbating existing problems. As Sundir Anand and Amartya Sen wrote for the United Nations, it is ultimately in the poverty of the lives that people can lead that poverty manifests itself (1997:5). Following this line of reasoning, many authors have recognized the importance of a multidimensional perspective in which the liv ed experience of poverty is understood through its articulation with social, political, and cultural structures and practices. While low income is an essential component of West ern poverty, of greater salience may be effects such as denial of opportunities for social achievement and integration (Sen 1992), deprivation of ordinary forms of interpersonal relationships (Townsend 1993), and the subjective feeling of being poor, eit her in absolute terms or in relation to other members and groups of society (Khusro 1999 4). Viewing poverty as multidimensional allows scholars in many disciplines ranging from the humanities, to economics and the social sciences, to the medical sciences to focus their academic and applied studies on the causes of poverty, its natural history, and solutions for overcoming it. While viewed from Marxist and development perspectives as a political, economic and social problem, the detrimental effects of p overty on communities, neighborhoods, families, and ultimately, on bodies and minds (Wilkinson 1994; ONeil 2006), stresses the urgency for its equal consideration as a medical problem.
17 A strong case may therefore be made for holistic studies of poverty t hat lend weight to all of its dimensions an endeavor that the field of medical anthropology is well suited to address. Among the leading medical anthropologists who have taken a comprehensive and critical approach toward understanding poverty, Paul Farmer (200 3 ) points to the influence of structural violence, emphasizing the ways in which political and economic forces shape global inequalities and patterns of health. Likewise, under the rubric of critical medical anthropology Hans Baer, Merrill Singe r, and Ida Susser have sought to explain social problems associated with poverty such homelessness and drug abuse as corresponding directly to changes in the U.S economy rather than to individual failings (1997:64) and unders tood in historic context (1997: 75). In this paper, I follow the lead of these and other scholars, presenting ethnographic work that explores experiences of stigma among the homeless and poor of Geneva, Switzerland a developed city of western Europe where poverty is independently linked to both immigration and domestic social problems. While operating from the widely held view that poverty, stigma and discrimination are structural processes originating in social institutions and systems the central thesis guiding my work co ntends that it is through interaction with other individuals in society that the poor realize and make sense of their experiences of poverty and stigma. Thus, I follow the work of anthropologists who have studied problems of homelessness James Spradley ( 1970), Irene Glasser (1988), Carl Cohen and Jay Sokolovsky (1989), and Patrick Gaborieau (1993) in taking a more local and microethnographic approach, examining the interactions of the poor with other people they encounter in their day to day lives.
18 Stu dy Rationale The problem of poverty defined broadly as the deprivation of access to basic needs, such as food, water, clothing, shelter, education, and health care has been estimated by the World Bank to affect 1.4 billion people in the developing worl d alone (Chen and Ravallion 2008). The extreme poverty found in the worlds poorest countries is characterized by hunger and malnutrition, illiteracy, poor water and housing conditions, and a resulting host of infectious diseases including tuberculosis, leprosy, cholera, typhoid, diphtheria, and in the last three decades, HIV (McMichael 2001). In urban settings, poverty brings additional hardships in the form of environments that are overcrowded, unhygienic and physically precarious (McMichael 2001:252) proximity to industrial sources of pollution (Brown 1995), and the destruction of housing through urban renewal, resulting in the displacement and isolation of the urban poor (Susser 1996:417). In developed countries, the severe consequences of poverty such as hunger and malnutrition are less evident as in the developing world. Absolute poverty is replaced by relative poverty, and material deprivation is overshadowed by social exclusion a process marked by precariousness of labor and unemployment on t he one hand, and the breakdown of social bonds through the crisis of the welfare state, the rise of individualism and the weakening of primary solidarity (of family networks, for example) on the other (Bhalla and Lapeyre 1999:5). The burden of poverty in developed countries is therefore understood not only through disparities in income, but disparities in access to jobs, health care, education, and adequate housing between the richest and poorest members of society, with an emphasis on deficiencies in soci al support whether of family, friends, or public institutions.
19 Studies that focus on how social exclusion and isolation manifest socially and are experienced by the poor (specifically, as elements of stigma) have both theoretical and practical relevance. First, stigma may function as a contributing factor in the occurrence and reproduction of Western poverty through the effects of stereotypes and divisive attitudes on policies governing welfare and other social programs, of discrimination on employment and housing opportunities for the poor; and of perceived stigma on willingness to seek help. From a structural perspective, in which poverty is considered the result of social, economic and political forces beyond the individual, efforts toward poverty reduction require understanding how these forces operate and may potentially be changed. Second, stigmas of poverty may have an adverse effect on mental health decreasing self esteem among those who internalize negative stereotypes and attitudes, and incr easing symptoms of depression, anxiety, or personality disorders through the cumulative impact of experienced discrimination, harassment, or abuse. From a practice perspective, which emphasizes the individuals agency in negotiating structural obstacles, a dapting to or overcoming poverty, there is both a social and health benefit in studies that address the social and psychological resources of the individual. Research on stigmas of poverty may yield knowledge useful from both perspectives, working on the o ne hand to help reduce the production of poverty in developed countries and on the other to increase the health status and quality of life among the poor S ocial Exclusion and the Production of Urban Poverty Unemployment, considered among the key indicators of poverty in developed countries and arguably its primary cause (United Nations Development Programme
20 2007), may be viewed on the one hand as a function of individual choices and capacities, and on the other as a consequence of the interaction of human networks and institutions, of historic and geopolitical p rocesses. In the countries of W estern Europe, academic discourse has turned toward explanations that emphasize the latter, such that the term social exclusion, rather than poverty, is used to describe socioeconomic disparities (Bhalla and Lapeyre 1999). From this perspective, the unemployed are seen as excluded from the labor market, both directly and through the effects of other domains of exclusion, such as education, housing, and health care. While I will argue that stigmas of poverty play a role in the occurrence of unemployment, its initial structural causes are linked to the more impersonal cycles of capitalism. Rates of unemployment in developed countries rise and fall with fluctuations in the national product and investment activity that are inherent to freemarket economies (Khusro 1999). Economic recessions have affected industrialized societies with increasing frequency and duration since World War II, producing unemployment rates th at vary from five to ten percent of the workforce (Khusro 1999:103). In the United States, the present recession that began in December 2007 resulted in a twofold increase in the national unemployment rate, to al most 9% by April 2009 producing an overall loss of nearly 6 million jobs (U.S. Bureau of Labor Statistics 2009). When viewed in the aggregate, this burden of unemployment results primarily from nondiscriminating processes of social exclusion, which originate not from malicious or misguided practices by people or groups in power, but from the dynamics of an economic system that by nature cannot guarantee full employment for all members of society.
21 The effects of stigma on unemployment (and consequently, pover ty) are more evident when observing policy responses to unemployment and other social problems, particularly in the latter half of the 20thUn employment rates have subsequently increased in many of these countries. Citing data from the U.N. Statistical Yearbook Khusro (1999:110) shows that between 1975 and 1985, rates of unemployment increased twofold in France and Germany, and by three times in the United Kingdom. Peak unemployment in the period following the recessions of the early eighties ranged from 9.7% in the United States to 13.1% in the United Kingdom (both in 1983). Neoliberal economic policies accentuate the lines of separation between the working and nonworking members of society, as well as those between the working poor and the middle class. Through reduction or deni al of social benefits, these policies magnify the effects of periodic economic downturns and century. Bhalla and Lapeyre (1999) document the effects of global secular trends on rising unemployment rates since the ag e of Fordism (during the 50s and 60s ), when Western countries underwent significant growth in both economic productivity and wages. In response to crises of the welfare state and o f profitability in the 70s the United States, the United Kingdom, and other nations of the Organisation for Economic Cooperation and Development (OECD) began to adopt a neoliberal form of capitalism (Bhalla and Lapyere 1999:87). This new economic strategy stressed flexibility, competitiveness, deregulation, privatization and state withdrawal from economic activity. Throughout the 80s it led to an end to social compromise within firms (that had characterized Fordism) and weakening of workers rights, social benefits and labor standards (Bhalla and Lapeyre 1999:88).
22 contribute to condition s of chronic unemployment that persist even after the economy improves. As unemployment rates rise in a population, so does the percentage of people living below the income poverty line. When defined as 50% or less of a countrys median income, poverty rates among the OECD nations ranged between 4.9% in the Czech Republic to 17.0% in the United States between 2000 and 2004 ( United Nations Development Programme 2007). Even in countries where overall GNP is high, such as the United States, income disparities result in the persistence of high poverty rates. In 2007, U.S. households in the lowest income quintile shared only three percent of the nations aggregate household income, while those in the highest income quintile shared 50% (DeNavas Walt et al. 2008:9). The U.S. poverty rate defined by set income thresholds that vary by family size and composition was 12.5% in 2007, resulting in an estimated 37.3 million people living in poverty (DeNavas Walt et al. 2008:12). In turn, unemployment and low income translate to more tangible and immediate signs of poverty in Western countries. Among the most visible and troubling is homelessness, which is estimated to affect 3.5 million people in the United States in a given year (National Coalition for the Homele ss 2008b). A similar estimate 3 million homeless has been cited for the 12 member states of the European Union (Bhalla and Lapeyre 1999:89). Since the economic recessions of the early 80s the faces of the homeless have been associated not only with the deinstitutionalized mentally ill, the solitary tramp or bag lady, but also with the workingclass poor evicted from their homes, families, single mothers, and runaway youths (Glasser and Bridgman 1999). While homeless people in the United States suff er from the same health problems as
23 other Americans, their problems are magnified by the lack of social, economic and housing support, poor nutrition, and reduced access to medical services (Baer et al. 1997:66). Homelessness represents the most extreme consequence of the unbalanced politics of space that characterizes poverty in Western countries. The homeless individual is excluded from all private spaces, poor or rich, and having nowhere else to go, intrudes into the public domain (Susser 1996:417). Among the housed, the poor cluster geographically in underdeveloped, undesirable and unsafe neighborhoods, both as a function of their affordability and by actions of separation on the part of wider society. Socioeconomically disadvantaged neighborhoods, often composed of ethnic minorities, can persist for generations and are associated with high rates of criminality, single motherhood, use of public assistance, substance abuse and other mental disorders (Silver et al. 2002; Casciano and Massey 2008). Such neig hborhoods are exemplified in the urban ghettoes of Spanish Harlem, where Latino street gangs and drug dealers vie for territory and respect (Bourgois 1989), as well as the low income banlieues (low income suburbs) of Paris, long associated with juvenile delinquency among North African youths (Grewal 2007). The riots that erupted in France during November 2005 instigated by the accidental electrocution of two teenagers from a Parisian banlieue who were hiding from the police in an electrical substation h ighlighted the political nature of tensions that can arise between society and the minority residents of poor neighborhoods (Sahlins 2006). In Western countries, there is strong evidence for a relationship among economic recessions, unemployment, and inc ome poverty, producing periods in which millions of
24 people live in squalor, without work, income, or sometimes homes. These periods have occurred with increasing frequency in the last half of the 20thResearch that aims to elucidate the stigmas of poverty in developed countries is important, firstly, because stigma plays a role in the occurrence and reproduction of this burden. In freemarket economies, where full employment is not guaranteed, systems of public support are necessary to ensure that all members of society have an acceptable standard of living (Khusro 1999). Whether public spending to combat poverty comes in the form of job creation, vocational training and education, unemployment or welfare programs, community development or economic stimulus, the agencies responsible for designing and implementing these efforts are influe nced by the broader beliefs and stereotypes attached to the poor. If stigma is high against a particular subgroup of the poor, the idea of providing the funds and programs needed to serve them may be met with little enthusiasm by lawmakers or their consti tuencies. For example, as a result of stigma against the homeless, some communities have been reluctant to approve century, with the most recent recession of 2008 and 200 9 among the most severe and wideranging. Adding to the burden of periodic poverty is the chronic homelessness and persistent neighborhood poverty that disproportionately affects ethnic minorities which itself can be tied to disenfranchisement and social exclusion based on ideas of race or nationality. While of a different character than that observed in the developing world, the burden of poverty in Western countries is substantial, affects a wideranging demographic, and, given recent global economic tr ends, necessitates a timely and appropriate response from scholars, community and health workers, and policy makers.
25 service facilities for homeless persons in their localities a phenomenon known as the NIMBY, or Not in My Back Yard syndrome (Takahashi 1997). At the interpersonal level, certain subgroups of the poor, such as ethnic minorities from low income neighborhoods and persons with known chemical dependencies or criminal records, are subject to discrimination (both legal and illegal) when seeki ng employment or housing. By potential employers, this discrimination can promote chronic unemployment and under employment, making it difficult for the poor to secure meaningful and lasting jobs and consequently improve their quality of life. Unscrupulous real estate and lending practices such as blockbusting (misrepresentation of property characteristics) or redlining (denial of loans) can likewise lead to undesirable and dangerous neighborhood conditions among ethnic and other minorities a form of direct discrimination that affects access to housing and may function as a precursor to homelessness (Brown 1995:27). Lastly, those in extreme situations of poverty, such as the chronically homeless, may be inhibited from seeking help by their awareness of the stigmas directed against them and the shame associated with public exposure. Goffman (1963) described those whose stigmas are immediately apparent and visible to the public (as homelessness often is) as discredited marked by a discrepancy between actual and virtual social identity. Low levels of seeking care are well documented among persons with mental illness, sexually transmitted diseases, and drug addiction, whether they are fearful of being discredited by those told of their condition, or whether the notion that they are morally tainted or a mortal danger to others leads them to denial of their problems (Keusch et al. 2006:525). Similar mechanisms likely explain under utilization of social
26 services that serve the poor, such as soup kitchens homeless shelters, and welfare, disability, and unemployment assistance programs. Poverty, Identity, and Mental Health In addition to conditions that can be directly linked to structural forces, such as unemployment and homelessness, modern understanding of Western poverty also emphasizes internal factors focused on the individual specifically, the social and psychological correlates of living in poverty such as depression, violent and criminal behaviors, substance abuse, and long term dependency on social benefits (Kamerman and Kahn 1997). The relationship between chronic poverty and these social problems in academic and political debate is central to the construction of poor identities and stigmas of poverty. Proponents of the underclass concept arg ue that poverty is a problem of individual dysfunction and pathological behaviors (Kamerman and Kahn 1997), reflecting the neoliberal paradigm prominent in AngloSaxon thinking during the 1980s and 1990s (Bhalla and Lapeyre 1999:7). While valid explanati ons for any human problem will invoke both agency (the role of the actor) and structure (the role of the environment), I contend that social policy in Western countries continues to be influenced by explanations that emphasize the character and behavior of individuals for understanding how poverty occurs. Individuals whose poverty can be cleanly associated with factors considered beyond their control those classified as the new poor, single mothers, the disabled, and the mentally ill are favored over those whose poverty is complicated by problems such as criminality or drug addiction. As Paul Farmer noted, the global political agenda has never concerned itself with those popularly classified as the undeserving poor: drug addicts, sex workers, illega l aliens, welfare recipients, or the homeless, to name a few (2003 :6).
27 Whether considered by society to be deserving or undeserving of public assistance, those who are affected by both poverty and mental disorder may find themselves in a mutually r einforcing state of spoiled identity (Goffman 1963). Among the different health outcomes that affect the poor, mental illness is of special interest M ental disorders such as schizophrenia, depression, and alcoholism have been shown to disproportionately affect the poor through processes of social causation (poverty preceding illness) and social selection (illness preceding poverty) (Dohrenwend et al. 1992; Dohrenwend 2000). Stigma may function as a social cause in the development of mental illness among the poor. In turn, deficiencies in mental health can impede a persons ability to improve their life situation, thus exacerbating their poverty. Disorders that biomedicine lab els as behavioral such as alcohol and drug dependence are perhaps the most stigmatized because of their association with personal choice and moral integrity: The public deems the drug addict at fault for his or her condition, presuming poor individual choices and failure of will to be the necessary and sufficient causes. The association of alcohol and drugs with homelessness may also transform the stigma faced by some homeless people, generating a subgroup of undeserving homeless, whose condition w ould otherwise be interpreted as structural in origin. A second reason for studying Western stigmas of poverty therefore hinges upon the conceptual causative links between stigma and mental health. Epidemiologic studies have shown associations between discrimination (experienced or perceived) and symptoms of depression and psychological distress among people of minority ethnicity and sexual orientation (Krieger 1999) associations that may also occur among those in poverty. However, the effects of stig ma on mental health likely reach
28 beyond an individuals experiences of discrimination and status loss, which Link and Phelan (2001) consider alongside more wideranging social processes such as labeling, stereotyping, and separation in their definition of stigma. For the poor, deterioration of mental health may also occur from the sense of being different, from being labeled negatively by society, and from the delegitimizing effects of low social status on personal identity. From a social causation approach (Dohrenwend et al. 1992), s tigma could therefore explain high rates of mental illness such anxiety and depression that are observed among the poor. For someone in a situation of poverty whether being working poor, unemployed, homeless, a beggar, drug addict, or petty thief knowing that public opinion finds people in their situation to be repugnant or unworthy can lead to low self esteem and a sense of being alone. For those who self stigmatize who internalize the prejudices, stereotypes and other negative value judgments directed by society toward their stigma as well as those who truly have little to no social support, the effects on symptoms of depression are likely worse (Corrigan and Watson 2002). Mental illness may occur from both lived t rauma and from increased awareness of stigma when the poor are subjected to violence and discrimination, or when they observe it happening to others in their situation. Those who find themselves in poverty due to the impairment of a preexisting mental illness (the social selection approach) (Dohrenwend et al. 1992) may also experience exacerbation of their symptoms from the stigmatizing encounters that occur in their daily lives. It follows that for those with antisocial or paranoid disorders, such as schizophrenia, stigma creates more pronounced lines of separation between the
29 individual and society, perpetuating conditions of poverty that are linked to low social support, and potentially increasing the frequency of violent or antisocial acts on the par t of the individual. These acts in turn serve to reinforce the current stigmas against those in poverty legitimizing stereotypes that the poor are criminal or dangerous. In some cases, rather than internalize stigma, a person in poverty may resist acts of labeling and discrimination both physically and psychologically. Resistance is a likely response among those poor who are stigmatized more for their ethnicity, nationality, or other tribal stigma with which positive personal and group identification is common (Goffman 1963:4). Affiliation with a set of cultural practices and beliefs offers psychological resilience against stigma, and may lead to responses of indifference and protection against mental illness. Few studies have sought to explore stigmas of poverty in developed countries, particularly through the lens of a medical anthropologist. I address the topic here using a broad approach recognizing the numerous and varied identities that are affected by poverty related stigmas and the com plex, recursive nature of stigma as a social process. While stigma is viewed as a societal, system level phenomenon, it is experienced (and potentially transformed) by the individual at both institutional and interpersonal levels. Efforts toward eliminatin g or reducing the burden of stigma on those in poverty require understanding not only how stigma manifests socially and is experienced by the poor, but also how the poor respond to it whe ther through self stigma denial, resistance, or indifference. Geneva, Switzerland: Setting For an Ethnographic Study Despite certain social and economic similarities among the countries of North America and Western Europe, stigmas of poverty likely manifest differently between the
30 continents owing both to cultural differences and to the wider range of nationalities and ethnic groups that thrive in Europes smaller, more densely populated area. Immigration, poverty, and homelessness are closely related in many Western European countries, where immigrants are segregat ed, suffer high unemployment rates, work menial jobs, and live in poor housing and neighborhood conditions (Daly 1996). Lack or inadequacy of legislation to address homelessness and immigrant rights in these countries may be considered a symptom of the gr owing polarization between average citizens and those without full rights and the mounting sense of xenophobia that comes with secular increases in poverty (Daly 1996:11). Middle and working class citizens who lose their jobs and social benefits during economic recessions often turn their resentment toward the presence of foreigners, who they may blame for their own condition of poverty. This public sentiment is reflected in the rising popularity of right wing political groups and consequent changes to national immigration policies in the region, including pressures to restrict immigration and deport foreigners. Limits on the legal rights of immigrants have been increasing since the mid1970s, with the harshest measures directed at religious, ethnic or racial minorities (Daly 1996:12). In the countries of the European Union, foreigners arriving from nonmember states, particularly those of Eastern Europe and Africa, are perhaps the most widely affected. Like many cities in Western Europe, Geneva, Switzer land has a high percentage of foreigners among its residents approaching 40% of the cantonal population ( Office Cantonal de la Statistique 2009) and is located in the countrys Frenchspeaking region, which tends to have higher poverty rates (FerroLuz zi et al. 2006). For these
31 reasons, Geneva functions well as a case study of the local effects of European trends in immigration, homelessness, and poverty. Despite Switzerlands reputation as a wealthy country, its population claims a substantial share of socioeconomically disadvantaged people and families. In 2005, one million people or oneeighth of the Swiss population were estimated to live in poverty ( Tribune de Genve 2005). While many are of foreign origin the most common migrating from the co untries of North Africa, Eastern Europe, Central and South America Swiss citizens are also vulnerable, their poverty reflecting the domestic problems faced by other Western nations. Of recent interest in Swiss social research and public policy are those who live in hidden poverty referring to poor residents who have the right to social assistance but do not receive it (Rossini 2002). The poor of Geneva represent this duality in Swiss poverty. Based on the population of patients seen at a mobile community health care unit ( UMSCO ), the citys poor may be classified into two groups: (1) the grands prcaires (severely marginalized), who are mostly men, often with psychiatric or substance abuse problems ( onethird of Swiss nationality ) ; and (2) the sans papiers (undocumented immigrants), consisting mostly of women from Latin America, the majority employed as domestic workers and having no health insurance (Wolff et al. 2005). To these may be added immigrants who figure prominently in the public eye, but who are less likely to seek care specifically, young North African men, frequently associated with drug dealing and petty theft, and Roms (Romani), known in popular discourse as gitans (gypsies), who are known for their role as street musicians. It is part ly for this heterogeneity the
32 plurality of social identities that comprise the poor and which to a certain extent mirror those found in the United States that Geneva was chosen as the site for my study. With regard to stigma, Switzerland may also funct ion as a model for the separation, labeling, stereotypes, and discrimination directed against the poor and homeless in Western Europe. Sociological research has documented high levels of misanthropy, xenophobia, and rightwing extremism in Switzerland (Catt acin et al. 2006). Nationality, religion, and ethnic origin are among the most frequent reasons for discrimination, much of which is directed against Muslims. The rising trend of xenophobia in Western Europe is reflected in recent Swiss legislation in pa rticular, the popular success of an immigration law (passed by twothirds of the popular vote) that restricts access to the labor market for certain categories of immigrants and makes penalties against undocumented immigration more severe (Office Fdral d es Migrations 2007). Concerns of nationality aside, other stigmas against the poor are also prevalent in Switzerland, as evidenced by public attitudes regarding the homeless. Cattacin et al.(2002) found that onethird of the Swiss population rejected homel ess people who beg in the streets, and onequarter felt that the homeless should be taken away from pedestrian zones. While the poor and homeless of Geneva face high levels of stigma originating from the public and political domains, they also benefit locally from a comprehensive network of social and health services (Wolff 2004). In 2006, Geneva counted 26 distinct establishments that offer reception, shelter, food, medical care, employment assistance or other services for the poor. Among these were 12 hom eless shelters including both public institutions such as the Abri PC (a high capacity municipal winter shelter) and
33 charitable institutions such as the Salvation Army. The university run UMSCO clinic proactively provides healthcare to those without health insurance by sending health providers nurses, doctors, and social workers to consult with clients of the citys different social service locations. In Geneva, the prcaire identity to which the poor are relegated is therefore one imbued with contradiction simultaneously involving sentiments of exclusion and acceptance by the larger society. Study Approach and Research Questions Because stigmas of poverty remain, in large part, uncharted territory in the social and health sciences, scant knowledge is available for developing and testing hypotheses regarding their natural history, structure, and effects on the individual and society. Whether these stigmas are considered an outcome or determinant of chronic poverty (epidemiologic approach), a fact or in the transformation of poor identities (social and psychological approaches), or a problem requiring medical or policy interventions (applied approach), qualitative work is first necessary to identify the populations at risk of stigma and the factor s and constructs most relevant to the culture being studied. In this paper, I take the approach of applied medical anthropology, exploring stigmas of poverty using ethnographic methods and research questions formulated to advance both theory and practice. Through this work, I hope to contribute an anthropological voice to present conceptualizations of stigma, poverty, and mental health, as well as provide the qualitative data needed to inform social and medical intervention. Ethnography, in which the fieldworker interacts with and follows groups and individuals within a culture over an extended period of time, is uniquely appropriate for describing events that may otherwise go unnoticed. Among other methods in the social
34 sciences, ethnography captures the r ange of experiences and encounters that occur in the daily lives of informants. By observing, participating with, and learning from informants in natural settings in this case, soup kitchens, homeless shelters, streets, parks, and other locations the poor normally frequent the fieldworker becomes privy to not only routine events in their lives, but also periodic and uncommon occurrences. Researcher participation and repeated, long term contact are especially important when dealing with marginalized populations such as the homeless or drug addicts, whose low levels of trust make them more reluctant to participate (Becker 1963). A comprehensive description of the kind offered through ethnographic work should address which groups among the poor are most af fected and vulnerable to stigma, the stereotypes and labels most commonly associated with them, the origins and enactment of these stigmas within the broader cultural context, and the immediate sources of poverty related discrimination and status loss, whether such encounters are individual or structural in nature. More focused research questions may be theoretical or applied in orientation derived in either case from the connections discussed above between social exclusion and urban poverty, and among st igma, identity, and mental health. This study was guided by the following five sets of research questions: 1 Who are the poor of Geneva, and in what social contexts do they experience stigma in their daily lives? Where, when, against whom, and by whom does stigmatization occur? 2 How do the poor respond to affronts to their identity, and to what degree do they express internalization of or resistance against their stigmas? 3 Among the poor, which groups experience a greater burden of stigma, and which are more s usceptible to its detrimental effects? 4 To what extent does stigma, specifically discrimination and mistreatment, occur in Genevas social service settings?
35 5 Through what personal and cultural pathways can poverty related stigma lead to mental disorder in vulnerable persons or groups? To adequately address these questions using ethnographic methods, a study of long duration (approximately one year) was necessary one that would allow me to improve my Frenchlanguage proficiency, integrate into Genevas social service settings, and establish close and repeated contact with informants. While the UMSCO clinic functioned as my point of entry to the study setting and population, during the course of one year I conducted the majority of this research as both a volunteer and guest at a city run soup kitchen Club social rive gauche (Left Bank Social C lub) Finally, in addition to the soup kitchen and other social service locations, I observed and interacted with the poor in public locations such as streets, parks, a nd public transport. This broad approach to the study setting allowed for the inclusion of those likely to have had exposure to stigma in social service locations, as well as those who may have chosen to avoid social services because of stigma. Dissertatio n Outline This dissertation begins with two review chapters that provide the theoretical basis for my work on stigmas of poverty in Geneva. Chapter 2 discusses the origins of the stigma concept in identity and labeling theory, synthesizing work in sociolog y, psychology, and anthropology, and presents new directions for stigma research elucidated through ethnographic studies of poverty, homelessness and soup kitchens. Chapter 3 focuses on the study setting, providing a description of poverty and social support in Switzerland, a typology of stigmatized identities in Geneva, and an inventory of the citys social assistance institutions, soup kitchens, and homeless shelters.
36 The study methodology is detailed in Chapter 4. I begin with a formal presentation of my ethnographic research questions and a general description of the people and places important for the study. I provide a cross sectional description of 55 informants, detailing selected profiles of those who appear frequently in the study results. Next, I describe my methods of data collection, which included participant observation, qualitative interviews, and a cultural domain analysis of the personal label prcaire. Lastly, I describe my metho ds of data analysis and interpretation. The study results are presented in two chapters. Chapter 5 presents results from the cultural domain analysis, including free lists, pile sorts, and paired comparisons of personal labels for the poor in Geneva, both stigmatizing and acceptable. Associated with these terms are popular stereotypes regarding the most stigmatized groups in Geneva, as elicited through participant observation and qualitative interviews. Chapter 6 provides a descriptive analysis of stigmatizing encounters that the poor experience in relation to others and their environment, using grounded theory to analyze field notes and interview transcripts. I identify and discuss the most salient categories of encounter participants, places, actions, and responses, and provide both thematic and statistical inter pretation. From my findings I describe a recursive model for stigma that involves the interaction of stigma, response, and outcome. Finally, two discussion chapters offer interpretation of the study results and potential applications for practice focusi ng specifically on the links between stigma and mental health among the poor. Chapter 7 presents three case studies from my ethnographic work in Geneva each exemplifying a different pathway by which stigma may lead to mental disorder, and contributing theoretically to a model of psychosocial
37 distress. Chapter 8 describes the practicalities of my study the application of findings for improving the lives of the poor. I discuss the implications of sourceand subject directed intervention for various categ ories of the poor, and document a set of recommendations for improving social service practices in Geneva. Lastly, I review the concept of poverty as a promoter of disease (and specifically mental illness), covering the descriptive epidemiology of mental i llness among the poor, the social and psychological theories posited to explain these associations, and stress theory as a unifying concept for negotiating between explanations of social selection and social causation. Based on the articulation of the stress model and the recursive model of stigma, I present future research directions using ethnography to inform the measurement of stigma and develop hypotheses for testing the relationships among poverty, stigma, and mental health.
38 CHAPTER 2 STIGMA THEORY AND THE ANTHROPOLOGY OF POVERTY: TOWARD A SOCI AL, PSYCHOLOGICAL, AND CULTURAL SYNTHESIS At its most fundamental, the concept of identity refers to a persons sense of self the ever changing set of attributes with which the person identifies in both self reflection and outward expression. In response to the most existential of questions Who am I? humans tend to articulate identity in ways that are both deeply personal and inextricably social. Certain elements of identity are present fro m birth, including both physiologic or genetic traits (such as the color of ones skin or their sex) and cultural traits (such as a persons ethnic, religious, or family heritage). However, the majority of what constitutes identity is acquired throughout l ife as an individual passes from childhood to adolescence and adulthood, in rites of passage that mark points of transition to new social and economic vocations. As the social behaviorist George Herbert Mead wrote, the self is not something a person is born with, but rather something that arises in the process of social experience and activity (1934:135). It is ultimately through life experiences and the self reflection of ones experiences through the lens of his or her social group that identity i s constructed and redefines itself over time From the perspective of psychology, Erik Erikson linked the formation of identity with the various stages of human development (1959). Erikson described ego identity as the sense of self that forms when a developing individual takes on new abilities, roles, and statuses (such as learning to speak or walk), resulting in the conviction that the ego is learning effective steps toward a tangible collective future, that it is developing into a defined ego within a social reality (1959:23). Based on the work of Mead, Erikson, and others, identity in the social sciences has been conceived in two
39 broad categories personal identity and social identity (Goffman 1963; Caughey 1980). The first refers to a persons conti nuous experience of a conscious I the product of a string of memories in which self is the constant and necessary focus and to which are closely linked the phenomena of personality, temperament and character. Personal identity is that which differentiates a person from all others, defined by the unique record of social facts that anchor the person as an object of biography (Goffman 1963:62). Social identity more frequently the object of study among anthropologists refers to the dynamic plurality of roles, groups, and ideologies with which an individual identifies. Unlike personal identity, which is unique to the individual, social identity is generic ascribed to classes of individuals and frequently subject to generalizing beliefs and attitudes o n the part of wider society. A persons ethnicity, nationality, occupation, and various relational roles (both familial and social) all comprise different components of his or her social identity components that can change over time, and subsequently lead to changes in a persons sense of self. In my study, I focus on social identity specifically, the varied social identities of people living in poverty. Throughout my work, I have sought to elucidate the most salient categories of social identity among the poor and to document how these identities are constructed, understood, and expressed in the larger sociocultural context. Special focus is placed on the ways in which social identity shapes the nature of interpersonal relations. The different social positions delimited by identity labels have little meaning outside their relationships with others. As Caughey notes, social identities are based on rules of conduct that specify what someone in one social capacity owes to and can demand from someone in an other social capacity
40 (1980:174). The concept of exchange, whether material or symbolic, is therefore important for interpreting the role of identity in social interactions, and is one that returns in the more structured analysis of observed and narrated encounters to follow. In turn, I will argue that the relationship between identity and social interaction is recursive: J ust as the respective social identities of individuals determine how they will interact, so may these interactions transform their sens e of self, generating new ways in which identity is both experienced and enacted. Spoiled Identity: Early Concepts of Stigma and Deviance in Sociology Certain aspects of identity deviate from social norms to the extent that they produce disadvantages for those who possess them. People born with physical deformities, who become disabled from physical injuries or illness, or who work in low status occupations must embrace social identities that are looked upon as inferior or limiting by the general populati on identities that are stigmatized by society. The word stigma has its origins in ancient Greece, where the term referred to physical marks put on criminals and slaves to brand them into lower class social positions (Goffman 1963; Falk 2001). It has si nce been operationalized for study in the social sciences, initially through the work of Erving Goffman, who defined stigma as a personal attribute that reduces someone from a whole, usual person to a tainted, discounted one (1963:3). Goffman wrote tha t this process has a discrediting effect on the identity of people whose appearance, behavior, temperament, or status deviates from the norm. Having a stigma can generate discrepancies between a persons virtual and actual identity, spoiling their soci al identity in a way that removes them from both society and self (1963:19).
41 The impact of stigma on a persons opportunities for social participation, quality of life, and psychological well being depends largely on the attribute in question. Goffman out lined three general types of stigmas: (1) physical defects or differences ; (2) deviations of individual character; and (3) the tribal stigmas of race, nation and religion (1963:4). Most stigmatized attributes may be either inborn or acquired, depending on the individuals life circumstances. In the case of physical deformities, the origin of the attribute (whether the result of a congenital defect or an injury or disease later in life) has little effect on how the public perceives the affected individual. For other attributes that Goffman classified as character based such as imprisonment, addiction, alcoholism, and unemployment those possessing them are considered to have acquired such traits by their own volition and may be regarded more severely, co nsequently experiencing a greater burden of stigma. Since the publication of Goffmans work, new character based stigmas have emerged. Of special interest are certain diseases, such as lung cancer (Chapple 2004) and HIV/AIDS (Berger 2001), which have a behavioral component to their etiology. Individuals with HIV/AIDS are shunned by the public not only from fears of contagion (implying risk or detriment to society), but because they are considered at fault for their illness through their highrisk sexual pr actices (implying personal culpability). In Western societies where the poor have rights to welfare and unemployment programs, a large conservative segment of the public shares the view that such programs are harmful to society (risk/detriment) generating tax increases and wasteful public spending, and serving only to promote a beneficiarys dependence on others. T hose who receive social benefits are also seen as largely responsible for their poverty (personal
42 culpability), whether through idleness, abuse of alcohol or drugs, or other life choices, and are accused of m aintain ing their poverty in order to gain access to state benefits. Goffman (1963) further classified stigmas according to three characteristics that affect the persons relationship with others: (1) visibility how perceptible the stigma is to people who would not know otherwise; (2) obtrusiveness how much it interferes with the flow of interaction; and (3) perceived focus the sphere of life activity for which the persons stigma disq ualifies him or her in a normative framework. People whose stigma is obvious and recognizable as is the case of the most destitute homeless are considered to be discredited (Goffman 1963:41). Because their stigma is both visible and highly obtrusive, the discredited homeless are more likely to experience neglect and unprovoked acts of mistreatment or violence on the part of the general public. They are disqualified from many spheres of life activity considered to be basic by the rest of society from having access to housing, employment, and regular nutrition, to having supportive friendships and relationships with family members. While there is a clear need to address issues of stigma for the recognizably homeless person, whose social isolation is of ten compounded by mental illness and substance abuse, stigma also affects those among the poor whose problems are not as visible. Most people living in poverty are capable of concealing their stigma, self consciously calculating the impression they make wi th others through the process of stigma management (Goffman 1963:51). One form of stigma management, known as passing, involves efforts on the part of the stigmatized to appear normal a practice that may be enacted in some circumstances and not oth ers. Sex workers, beggars, and drug addicts may engage in selective passing on a daily basis, keeping their failings
43 secret to one class of persons (e.g., the police), while systematically exposing their stigmas to other classes (e.g., clients, passers b y, or drug dealers) (Goffman 1963:73). Goffman also introduced the concept of the moral career an internal process encompassing the learning experiences and changes in conception of self that occur among persons with a particular stigma (1963:32). A mor al career is comprised of two phases: (1) learning and incorporating the identity beliefs of wider society, and (2) learning that one possesses a stigma and the consequences of possessing it, which socializes the individual to disadvantage. Those who becom e stigmatized later in life, such as many of the homeless and unemployed, may encounter problems reidentifying with themselves and with people they knew prior to acquiring their stigma. Common life events that mark turning points in a moral career include learning that members of ones newly acquired group are quite like ordinary human beings, and seeing prestigma friends deny the humanity of those one had by then learned to see as full fledged people (Goffman 1963:39). A moral career can also involve affiliation cycles in which the newly stigmatized person supports, identifies with, and participates with others who share his or her stigma. The likelihood of affiliation depends on the degree of social exclusion experienced by a stigmatized group. For the most severely marginalized and isolated homeless people there is no ingroup with which to affiliate and little to counter the negative effects of stigma on identity (Goffman 1963:112). On the other hand, a person with a tribal stigma su ch as one of minority ethnicity, frequently associated with chronic poverty shares with other members of his or her group a well defined community and a legitimizing conception of differentness. Affiliation is most pronounced
44 for professionals who take a n in group standpoint, such as spokespersons for the rights of the disabled, the gay, lesbian, and transgender communities, and people who are HIV positive. These are individuals who strive to remove stigma from the differentness recognized by society, w hich can have the secondary effect of politicizing their lives rendering their lives even more different from those they were initially denied because of their stigma (Goffman 1963:114). While Goffman (196 3) acknowledged the existence of ingroup affili ations, his approach toward the problem of stigma remains focused on the influence of normative beliefs and practices. The classic stigma concept may therefore be interpreted as describing a oneway dynamic one in which the stigmatized person is passivel y subject to the divisive consequences of social norms, or at best, adapts to mitigate the consequences. To account more fully for the role of agenc y in understanding stigma, I turn to the work of Howard Becker (1963), whose studies of deviance place emphasis on the perspective of the outsider and the contextual nature of deviant acts. Beckers focus on rulebreaking and deviant behaviors (in contrast to Goffmans more general theory on all stigmas) also makes his work relevant for research on the stigmas of poverty. Because many of the stigmas discussed in this paper are behavioral in nature including stigmas of homelessness, begging, drug and alcohol abuse the theory that grounds this work must address more explicitly the role of the actor. Becker defined outsider as one who cannot be trusted to live by the rules agreed on by the group (1963:1). He considered the term to be doublebarreled, meaning that rulebreaking outsiders may not consider those who judge them to be either competent or l egally entitled to judge, and may feel instead that the judges are
45 the outsiders Unlike Goffmans stigmatizing attribute, which is treated as fixed in relation to the norms of society, Beckers concept of deviance defines a sense of differentness that changes on a caseby case basis. For example, with regard to law breaking, the extent of being outside depends on the severity of the crime. For infractions that are treated tolerantly, such as traffic violations, those who commit them are not considere d very different from the rest of society. However, those who commit infractions that carry greater penalties, such as theft, are regarded by society as less similar, while those who commit the most serious of offenses, such as murder, rape, or treason, ar e viewed as true outsiders (Becker 1963:3). Becker (1963) was concerned less with the personal and social traits of people labeled as deviant and more with the process by which deviant persons come to be thought of as outsiders and their reaction to such judgments. Social groups create deviance by making the rules whose infraction constitutes deviance and by applying those rules to particular people and labeling them as outsiders (Becker 1963:9). Becker recognized this process as relativistic; rather than operating exclusively as a practice of normal society an artificially homogeneous group possessing a single set of rules the construction of deviance occurs through the interaction of multiple social groups that are differentiated along class, ethnic, occupational and cultural grounds, and which possess different sets of rules. The labeling of a trait or behavior as deviant depends on the perspective from which the labeling occurs; likewise, the concept of what is normal will also shift. Many g roups considered to be deviant by the general public, such as Beckers dance musicians (1963:82), possess their own culture of shared words, rules, and values. Those who associate exclusively with other members of the deviant group
46 will consider their dist inguishing behaviors and practices to be normal, and instead label as outsiders those who do not conform to the group. Reflecting the work of Goffman, Becker (1963) also proposed the concept of a career through which a person adopts deviant behavi ors and identities. Beckers career occurs as part of a sequential model, in which patterns of behavior develop in an orderly sequence (1963:24). Steps in the sequence include an individuals opportunity to engage in deviant behavior, his or her willingness and motivation to try the behavior, and continuation of the behavior until it becomes a regular practice. Each step represents the individuals movement toward a new personal and social identity; by the final stage, one who repeatedly commits deviant acts, who makes deviance a way of life organizes his identity around a pattern of deviant behavior (Becker 1963:30). This transformation occurs through interaction with others in a social context, such that the individual learns to participate in a subc ulture organized around a particular deviant activity (Becker 1963:31). The career model can be useful for understanding the experience of stigma among certain subgroups of the poor and homeless for example, runaway, squatter, and punk youths, drug us ers and drug dealers whose level of organization, shared practices and value systems offer a contrasting sense of legitimacy to identities considered to be deviant by wider society. More recent research on stigma places these relativistic assumptions into context by focusing on the lines of separation that stigma produces between social groups and the social structures responsible for the construction of stigmatized categories. As it applies to American culture, Falk defines stigma as: An invisible si gn of disapproval which permits insiders to draw a line around outsiders in order to demarcate the limits
47 of inclusion in any group (2001:17). On the one hand, stigma is perpetuated in societies by concepts of essentialism a Platonic concept whereby all worldly phenomena have an inherent essence that classifies them into a specific and unchanging category. For example, through essentialist thought, the categories that divide people of different skin color into inferior and superior races are legiti mized, promoting the social reproduction of racist beliefs and practices. On the other hand, stigma is challenged by the idea that such categories are socially constructed. Such is the case in critiques of the notion of biologically determined races, whi ch are based on the recognition among human biologists that it is impossible to determine the number of genetic or physical characteristics used to define racial categories; the term race is instead seen as a historic artifact from an archaic biology (Br own 1998:259). When deviance is viewed as socially constructed, the categories of identity that form the basis of stigma are delimited through the use of labels. Labeling theory, which originated in the work of John Kitsuse, Howard Becker, and Albert Cohen, asserts that the labeling of individuals whose behavior is perceived as deviant by society further marginalizes them, preventing them from engaging in certain forms of social participation and encouraging them to consider themselves as deviant (Freilic h et al. 1991). The stigma process is therefore conceived as self perpetuating: As stigmatized individuals are labeled, they are confined to reproduce even more deviant patterns of behavior, and in so doing prove the original basis for their exclusion by society. Labeling and Stigma in Social Psychology Becker argued that labeling places the actor in circumstances that make it harder to continue normal routines of everyday life, thus provoking the individual to abnormal actions (1963:179). Three years following the publication of Beckers work on deviance,
48 the sociologist Thomas J. Scheff (1966) used the concept of labeling to explain deviant behaviors and symptoms among the mentally ill advancing a labeling theory of mental illness that later became an important subject of study in sociology and social psychology. This section discusses the history and more contemporary theory of labeling and stigma of the mentally ill, which is important for grounding work on stigma among the poor because of the relevance that mental illness has for many who live poverty. Even for those who do not suffer from symptoms of mental illness, the pervasiveness of stereotypes of the poor and homeless as mentally ill makes them suscep tible to mental illness stigma. In Sc heffs theory, the labeling of a person as mentally ill puts into motion a set of social expectations and pressures, which eventually lead to a regular pattern of deviant behavior that conforms with cultural stereotypes of mental illness (Link and Phelan 1 999). Stigma results as a form of punishment experienced by people with mental illness when they attempt to break out of the mental patient role (Link and Phelan 1999: 482). Labeling is therefore considered to exacerbate or in some cases originate the sy mptoms of mental illness, introducing social causation as an important theoretical complement to biological and psychiatric models of mental disorder that focus on the individual (Scheff 1999). Critics of Scheffs theory argue against the position that labeling is a prime determinant of mental illness and deny that labeling induced stigma has detrimental effects on jobs, social networks, self esteem, or the course of mental disorder (Link and Phelan 1999:483). Among the most vocal of these critics, Walter G ove published several articles in the 1970s and early 1980s claiming that there was little evidence of
49 social rejection of the mentally ill, and that such stigma, when it did occur, was due to their deviant behavior rather than to the mental illness label itself (Scheff 1999; Link and Phelan 1999). Gove relied on three main types of evidence to support his argument: (1) studies of social distance among members of the public that found no evidence of prejudice against those labeled as mentally ill; (2) exper imental studies that showed behavior to be a stronger determinant of rejection than labeling; and (3) surveys of people with mental illness that reported few concrete and severe instances of rejection (Link and Phelan 1999). Although Gove (1980) suggest ed from this evidence that the labeling theory of mental illness should be abandoned, since the publication of his critique many of the studies on which it was based have been questioned for their validity (Link and Phelan 1999), and a large number of studies have been published that consistently report labeling effects (Scheff 1999:15). Link and Phelan (1999) present four lines of argument to challenge Goves claim that stigma is inconsequential in the lives of the mentally ill. First, prior studies of soc ial distance were likely biased due to the undisguised nature of the questions, since people respond in a socially desirable way when reporting their own attitudes toward a group they have learned they should accept, such as mental patients (Link and Phelan 1999:484). Second, more recent studies have compared mental illness with other known stigmatized conditions, revealing a hierarchy in which mental illness stigma falls at the same level of severity as that of epilepsy, prostitution, alcoholism, drug addiction, and ex convict status. Third, real instances of practiced discrimination have been observed in studies that investigate situations in which people are personally involved in scenarios with labeled mental patients. Lastly, experimental
50 studies in social psychology have refuted the claim that deviant behavior, rather than labeling, is the main determinant of rejection largely through evidence that labeling can affect responses even when no deviant behavior is involved. These studies show a self fulfilling prophecy effect, in which labeling actually promotes the behavior that leads to rejection (Link and Phelan 1999:485). Further research has shown that a mental illness label activates beliefs about dangerousness, with beliefs determining how much social distance is desired from a labeled person regardless of his or her behavior (Link and Phelan 1999:485). The stereotypes associated with particular labels, therefore, act as mediating factors in the relationship between labeling and discriminat ory practices, while deviant behaviors come into play rather as the basis (frequently erroneous) on which these stereotypes are grounded. Link and Phelan argue that the labeling/behavior dichotomy is overly simplistic, because labeling can both produce behavior in the labeled person that leads to rejection and provide an interpretive context that changes the meaning of behaviors (1999: 486). Simple behaviors, such as a high level of hand and leg movement, may be interpreted as innocuous in a person labeled as ordinary, yet perceived as evidence of dangerousness in a person labeled as a formal mental patient. Following these new lines of evidence, in the late 1980s Link and colleagues proposed a modified labeling theory, in which the mentally ill ex perience culturally induced expectations of rejection that lead to negative consequences for self esteem, job procurement, and the development of social networks (Link and Phelan 1999:488). Modified labeling theory is based on the premise that people for m conceptions of what others think of mental patients long before they become mental patients themselves.
51 After a person first develops symptoms of mental disorder, this internalization of cultural beliefs, attitudes, and stereotypes brings expectations of rejection that strain the persons interactions with others and lead to strategies for minimizing anticipated rejection, such as social withdrawal. Thus, labeling and stigma can have reflexive psychological effects in the absence of experienced discrimina tion; as Link and Phelan remark, people can be harmed by labels even when there are no direct negative reactions from others (1999: 488). The process of i nternalization fall s into two categories perceived stigma and self stigma The first, perceived s tigma is defined as the belief held by persons with mental illness that others will devalue and discriminate against them (Link et al. 2001, Sirey et al. 2001). In recent years, perceived stigma has been used as a measurable construct in studies that expl ore the relationships among stigma (both labeling and discrimination effects), self esteem, mental illness symptoms, and other factors relevant for treatment and social functioning (Link et al. 2001, Perlick et al. 2001, Pyne et al. 2004, Sirey et al. 2001). Various studies have found measures of perceived stigma to be associated with: (1) low self esteem among me mbers of a clubhouse for people with mental illness (Link et al. 2001); (2) poor social adjustment among people admitted to inpatient or outpatient services with bipolar affective disorder (Perlick et al. 2001); (3) depression severity among veterans in an outpatient mental health clinic (Pyne et al. 2004); and (4) treatment discontinuation among older adults receiving outpatient treatment for major depression (Sirey et al. 2001). By extension, perceived stigma is likely to have similar effects among people living in poverty particularly with regard to willingness to seek social assistance.
52 The concept of self stigma was introduced by Goffman (1963) to explain feelings of shame and low self esteem experienced by stigmatized individuals who hold the same beliefs about identity as the wider society. In an early formulation of the link between stigma and mental health, Goffman suggested that belief in ones own inferiority, sustained by a persons experience of daily social isolation, leads to chronic feelings of insecurity and anxiety (1963:13). Unlike perceived stigma, which may affect individuals who are aware of stereotypes directed against them b ut do not consider such stereotypes to be legitimate (those who take an ingroup stance), self stigma represents the extreme endpoint of internalization one in which the individual is both aware of and subscribes to negative stereotypes. Self stigma th erefore affects those with mental illness who, living in a culture steeped in stigmatizing images, may accept these notions and suffer diminished self esteem and self efficacy as a result (Corrigan and Watson 2002:35). In a review of the social psycholo gy literature, Corrigan and Watson (2002) describe a situational model of responses to mental illness stigma, in which individuals who are faced with a heavy burden of negative collective representations, who consider such representations to be legitimat e, and who do not identify or associate with others who share their stigma are the most likely to experience low self esteem. Conversely, those who reject the legitimacy of stereotypes directed against them and who identify with the larger group of individuals with mental illness are energized by prejudice and experience what the authors refer to as righteous anger (2002: 35). Synthesizing two decades of work on the stigma of mental illness, Link and Phelan (2001) propose a new definition of the stigma concept that can be applied to a wider
53 range of traits and identities. In recent years, a number of other life circumstances have been studied through the theoretical framework of stigma, including, but not limited to: (1) medical conditions such as urinary incontinence, leprosy, cancer, and physical disabilities; and (2) poverty specific situations such as unemployment, welfare use, and being in debt (Link and Phelan 2001:364). While the expansion of multidisciplinary work on stigma is promising, Link and Phelan seek to address current challenges to this work such as the tendency for social scientists to be unfamiliar with the lived experience of the people they study and the continued theoretical representation of stigma as an individual attribute rather than a tag that others affix to the person (2001:366). According to Link and Phelan (2001), stigma occurs with the convergence of four interrelated components labeling, stereotyping, separation, and status loss/discrimination in situations marked by differential access to social, economic, and political power. Recognizing the influence of prior work accomplished by Goffman (1963), Becker (1963), and others, my study is grounded in the four part stigma concept advanced by Link and Phelan (2001) acknowledging the role of both lived experience and internalization in shaping the identities of people whose behaviors, practices, and life situations are considered by larger society to be deviant. The first component labeling involves the sel ection of human differences that are socially relevant and their linkage with personal identifiers (labels), which, in essentialist tradition, are often taken for granted as natural rather than socially constructed (Link and Phelan 2001). Applying a uniquely cultural perspective to the concept, the authors add that the salience of labeled attributes can differ according to time and place. Given that cultures vary extensively in characteristics deemed socially
54 significant, the authors prefer the term label over attribute, condition, or mark (Link and Phelan 2001: 368). The second component stereotyping involves the linkage of a person with a set of negative attributes via the labeling process. Stereotypes have been central to the conceptuali zation of stigma since Goffmans (1963) work and represent the most commonly studied aspect of stigma in the psychological literature (Link and Phelan 2001:368). Recent studies following the social cognitive approach have found that stereotypes are automatic; they are used in making split second judgments about others and therefore appear to operate unconsciously (Link and Phelan 2001:369). Labels and stereotypes operate in cooccurrence to produce stigmatizing interpersonal exchanges, generating the conditions in which people may practice discrimination or otherwise behave in ways that isolate, exclude, or demean those who are labeled and stereotyped. The third component of stigma separation refers to a more abstract social process whereby those who are labeled and stereotyped are conceived as fundamentally different from those who do not share the label (Link and Phelan 2001). The conceptual separation of us from them provides a rationale for stereotypes and offers legitimacy to the stigmatizing p ractices that result. In extreme cases, a labeled person may be considered to be so different as to be inhuman, and all manner of horrific treatment of them becomes possible (Link and Phelan 2001:370). Focusing on the production of stigma in a local co ntext and through social interaction, my study was not designed to assess larger scale processes of separation. Certain beliefs and stereotypes about the poor, however, may offer a measure of the degree to which
55 separation occurs; it is presumed that those of marginalized ethnicity or nationality, representing those who are most different from a cultural perspective, may be the most affected. The fourth component of stigma status loss and discrimination consists of practices that result in the devaluation, rejection, and exclusion of those who are labeled and stereotyped (Link and Phelan 2001). Status loss refers to the general downward placement of a stigmatized person in the social status hierarchy. In the context of social interactions within small groups, external statuses such as race and gender are used by group members to create performance expectat ions that then lead to a labyrinth of details that involve taking the floor, keeping the floor, referring to the contributions of others, head nodding, interrupting, and the like (Link and Phelan 2001:371). Discrimination refers to practices that also lea d to inequalities in income, education, psychological well being, housing status, and health, but which are more apparent to the casual observer and hold more meaning in the everyday lives of those who are labeled. Two types of discrimination are relevant for understanding stigma: (1) individual discrimination, in which a person engages in some obvious form of overt discrimination, such as rejecting a job application or refusing to rent an apartment (Link and Phelan 2001: 372); and (2) structural discrimination in which elements of social structure or the built physical environment lead to disadvantages for labeled people in the absence of individual prejudice or discrimination. Link and Phelan (2001) consider these elements of stigma to be interchangeable, mutually reinforcing, and dependent on differentials of social, economic, and political power. Dominant groups have the capacity to stigmatize others because of the power
56 they hold over them. This power is often economic, based on differences in wealth an d the ability to purchase goods and participate in economic life. In these cases, stigma is expressed through both individual and structural pathways, as the immigrants and poor face rejection by individuals and exclusion through their lack of income. The consequences of stigma can be devastating when power differentials are expressed through political and military control, the extreme of which is exemplified in history through the subjugation and genocide of the Jewish people, the disabled, and other groups by the Nazis during World War II. Considering power as an essential element to stigma places the stigma concept at the core of many long standing human problems that involve the separation of groups through struggles of power, including poverty, slavery, racism, urban crime, and ultimately, armed conflict. Reflecting the relativistic perspective on deviance taken by Becker (1963), Link and Phelan recognize that stigmatized groups, such as the mentally ill, may engage in the same kinds of stigmarelated processes in their thinking about individuals who are not in their stigmatized group (2001:376). Patients in a treatment program for mental illness, for example, may label some clinicians as pill pushers, stereotype them as cold, paternalistic, or arrogant, and treat these clinicians differently in accordance with the conclusions they have drawn about them. However, the authors argue that although the patients may engage in all the components of stigma described above, they simply do not possess the social, cultural, economic, and political power to imbue their cognitions about staff with serious discriminatory consequences (Link and Phelan 2001:376). Link and Phelans stigma concept is therefore understood as a process that
57 only occurs (or is only meaningful) for those who occupy a subjugated economic, social or political class. In my study, I recognize the importance of power in the origination of stigma within a society. However, through evidence from the anthropological literature discussed below, I press Link and Phelans stigma concept to its next logical step one in which stigmatized groups, through the nature and extent of their responses to stigma, may demystify stereotypes and the basis for discrimination, normalize previously deviant identities, and ultimately transform the power relations through which stigma against them was originally expressed. Stigma is understood here as an historic, recursive process, allowing the possibility of practical solutions that focus not only on changing the attitudes and behaviors of those who practice stigma, but addressing concerns of identity and authenticity for those face it. Cultural Models of Stigma The Contribution of Anthropology and Ethnography Use of the stigma concept in anthropology has been less extensive than in the sociological and psychological work discussed above. Joan Ablon (1981; 2002) is widely recognized for contributing to the anthropology of impairment disability through her research with stigmatized populations such as dwar fs and people with genetic conditions (Shuttleworth and Kasnitz 2004). In addition to the traditional focus in medical anthropology on illness meanings and narratives of hope and cure, Ablons ethnographic work explores the role of social exclusion in the lives of those with bodily differences (Shuttleworth and Kasnitz 2004:142). Ablon takes a personal, actor based approach, studying individuals and groups as culture bearers and behavior creators, rather than focusing on the institutional contextual struct ures with which individuals and groups must deal (1981:6). It is through this distinctly anthropological approach to
58 stigma that her work diverges from that of sociologists, accounting for the specific cultural, social, and personal variations made explic it through ethnography. Ablon outlined five dimensions of stigma that are important for understanding the stigmatization of health conditions (1981; 2002). First is the nature of the illness which includes such aspects as its history, its attributed characteristics, and the basis for its stigmatization by society. Stigmas endured by those with visible bodily deviations, such as the physically maimed or disabled, involve negative social stimulus values that are generated by the cosmetic prescriptions of s ociety (Ablon 1981:7). Stereotypes about character, sexual and emotional proclivity, personality, and morals have historically been attributed to people with tuberculosis, and arguably to those diagnosed with sexually transmitted infections, particularly H IV/AIDS. In some cases, a social or healthrelated condition may take on the role of a master stigma that is seemingly used to define a person, discounting his or her other morerelevant to the context characteristics (Ablon 2002: S4). Examples of mast er stigmas in American society include homosexuality, mental illness, and cancer. A second dimension of stigma to be considered by anthropologists involves the sources that create and perpetuate the stigma (Ablon 2002: S4). For those with stigmatized healt h conditions, the experience of stigma may begin with negative attitudes and statements expressed in family, school, neighborhood, and health care contexts. Ablon notes that, for a child who is visibly affected by a stigmatizing condition, the taunts of ot her children may function as a primary source for the creation of stigma (2002:S4). In the United States, it is also important to stress the influence of the mass media in shaping the strict and far reaching American cosmetic values that define
59 normative standards of physical appearance (Ablon 2002:S5). Furthermore, some of the most salient experiences of stigma come from instances of rejection that occur in dating and sexual relationships, which Ablon has found to engender attitudes of low self worth (2 002:S5). Thirdly, it is important for anthropologists to explore the nature of stigmatized populations specifically, the demographic characteristics and other markers of social identity that may be over represented among those who are stigmatized. Ablon (1981; 2002) argues that poor populations, often of minority ethnicity, experience poorer health than wealthier members of society suggesting that they are therefore subject more frequently to stigmatizing health conditions. Through this dimension, Ablon touches briefly on stigmas of poverty (although she does not use this term), noting that the social and economic deprivation of these groups stigmatizes them from their point of entry into the medical system (2002:S5). In the articulation of stigmas of di sability impairment and stigmas of poverty, individuals who are affected by both may exhibit diverse cultural beliefs and compliance patterns, which serve to alienate them from care providers early on (Ablon 2002:S5). A fourth dimension of stigma deals with the kinds of treatments sought by stigmatized individuals which may include alternative, ethnic, or culturally identified types of practitioners. While medical pluralism is evident in the United States and other Western industrial societies, this does not mean that all modalities of treatment are considered to have equal legitimacy by normative standards. Rather, the hegemony of biomedicine ensures that alternative modalities, such as faithhealing, homeopathy, and traditional Chinese medicine, are r egarded as technically incompetent by larger society.
60 Thus, people with stigmatized health conditions may be reluctant to pursue these forms of therapy, cognizant that the general public may regard such careseeking as superstitious, useless, fraudulent, or illegal (Ablon 2002:S5). This dimension serves as an important, ethnographically informed complement to patterns of normative careseeking (or the lack thereof) found by social psychologists to affect those with mental disorders. Lastly, Ablon emphasiz es the anthropological study of coping with stigma the importance of exploring how stigmatized individuals cope with the daily insults that endanger their personal identity, social life, and economic opportunities (2002:S5). In her ethnographic work, A blon identified a number of common biographical features and ideologies among people who successfully cope with stigmatized health conditions (2002). Most important is the presence of unconditional family support and clear communication among family member s, which functions to instill confidence and security in the individual early in life (Ablon 2002). Positive parental communication is especially important for individuals whose parents have the same stigmatized condition, allowing them to address their fe ars and concerns. A second feature of successful coping involves having a philosophy that imbues individuals with the knowledge that having a special health condition does not detract from their innate abilities, does not make them lesser persons, and sho uld not in any way automatically disenfranchise them from the benefits enjoyed by mainstream society (Ablon 2002: S6). In many cases, it is through participation in support groups and organizations promoting equal rights that stigmatized individuals come to accept this philosophy. Through finding a community of people who share their same physical features and social experiences
61 stigmatized individuals may be instilled with a sense of empowerment that frees them from seeing their condition as shameful ( Ablon 2002:S7). While Ablons work focuses on stigmas of disability impairment, the dimensions of stigma she describes may be applied more generally to the stigmas explored in my study. In assessing the nature of these stigmas, it becomes immediately appar ent that some (such as homelessness, being on welfare, and begging) are exclusive to those living in poverty, while others (such as minority ethnicity, alcohol and substance abuse) are stigmas that disproportionately affect people living in poverty, but which can reasonably affect more affluent members of society. I refer to this distinction as specific and nonspecific stigmas of poverty, respectively. One hypothesis to be explored in future research is whether the specific stigmas of poverty (especially, the stigma of homelessness) function as master stigmas that discount an individuals other identity traits (Ablon 2002:S4). Evidence in support of this hypothesis would suggest that stigma can and does play a role in the low levels of self worth and the higher prevalence of depression shown to affect the homeless in epidemiologic studies (which are presented in more detail in Chapter 8). Ethnographic study of stigma in recent years has focused primarily on two sets of conditions HIV/AIDS and other sexually transmitted diseases (Cullinane 2007; Bhana 2008; Owen 2008; Chan et al. 2009) and mental disorders (Bergstresser 2006; Kohrt and Harper 2008; Jenkins and Carpenter Song 2008). While no anthropological studies to date have explicitly addressed stigma a mong people in poverty, recent work in these domains can offer relevant insights regarding the culturally shaped meanings of stigmas considered to be character based, as well as responses to stigma among those
62 affected. In a study of Thai nurses who face occupational exposure to HIV, the social perception of women with HIV/AIDS as guilty was found to be linked to violation of gender norms an issue that was central to their self identities (Chan et al. 2009). Similarly, ethnographic study of women with H IV/AIDS in Japan has revealed connections between the stigma of HIV/AIDS and traditional associations of women with ritual pollution and impurity in the Shinto religion (Cullinane 2007). With regard to how people with schizophreniarelated illness respond to stigma, Jenkins and Carpenter Song (2008) show how creative strategies for deflecting and resisting stigma are used in an intersubjective milieu and can facilitate a sense of normalcy. My study may be further informed through two additional bodies o f work: (1) anthropological studies of deviance, which is an important concept for understanding social stigma against homelessness, unemployment, and other behavioral aspects of poverty; and (2) ethnographic work conducted with populations in poverty, and in particular, the homeless. The Anthropology of Deviance Recognizing deviance as a concept that has gained little attention among anthropologists, Frielich et al. (1991) cite two important values acquired from anthropological study. First, through its em phasis on both complex and simple nonwestern societies, anthropology provides a wealth of fieldwork data that offer novel, comparative understandings of deviance and show how deviance is affected by sociocultural scale (Freilich et al 1991:2). Second, while respecting the legacy of labeling theory and the influence of structure on deviance, new models generated through anthropological work may permit the individual to reappear as a viable actor who creates and recreates sociocultural systems (Frielich et al 1991:2). The holistic
63 approach and ethnographic methods of anthropology make it uniquely positioned to inform, complement, and challenge models of deviance and stigma developed in other fields. In a review of the ethnographic literature, Raybeck (1991) shows the effects of sociocultural scale on deviance with examples from societies of varying complexity and size including those classified as hunter and gatherer, swiddenbased/tribal, peasant, and industrial. Among the qualities of deviance that vary are the degree of difference from normative values that a deviant behavior holds and the severity with which it is treated by society distinctions that Raybeck (1991) address es with the concepts of soft and hard deviance. Soft deviance is defi ned as behavior that departs from social and cultural norms but does not actively threaten the social order (Raybeck 1991:54). In contrast, hard deviance not only deviates from normative behavior, but is considered to threaten the social order. Raybeck also observes cross cultural differences in the timing and frequency of labeling, as well as the prevalence of secondary deviance which occurs as individuals accept and are influenced by the deviant label that others have applied to them (1991:52). Smallscale social units are characterized by personalistic, threedimensional ties, which allow members to rely generally on informal sanctions to control deviance (Frielich et al. 1991). In hunter gatherer societies, such as the Pygmy BaMbuti of northeastern Zaire and the !Kung Bushmen of the Kalahari Desert, authority tends to be evenly distributed, and there is a high level of interdependence among band members (Raybeck 1991). Labeling is rare in these societies, reserved only for those who engage in hard deviance, such as murder. Group responses to deviance do not typically involve
64 prolonged exclusion of the individual from social participation; instead, it is advantageous that reactions to deviance emphasize the reconciliation and reintegration of the offender to the group (Raybeck 1991:58). Similar patterns are observed in swiddenbased and tribal societies, such as the Semai of the Malay peninsula. The Semai are noted for their nonviolence, are extremely sensitive to the opinions of others, and, for reasons of reconciliation, interdependence, and mutual aid, are very reluctant to label those who violate social rules. However, they are known to make a distinction between themselves and outsiders; characteristic of tribal societies, the Semai do practice o ut group labeling and more extreme responses to deviance when applied to those outside their society. Raybeck notes that during the Communist insurgency of the 1950s, the otherwise peaceful Semai proved quite capable of killing outsiders (1991:61). In p easant societies, deviant behaviors are frequently subject to both the formal controls of the state in which these societies are embedded and the informal controls of the rural villages where members reside (Raybeck 1991). Although the state may formally label a villager as criminal for violating certain laws, fellow villagers may be reluctant to do so, particularly when rule violations involve indigenous cultural behavior. Among the Kelantanese of Malaysia, activities such as smuggling, bullfighting, cockf ighting, and gambling are prohibited by the state but considered among villagers to be valued pursuits through which villagers may gain the respect of their fellows (Raybeck 1991:63). Greater concern is instead placed on behaviors that endanger the solid arity of the village and threats to village welfare, which are controlled initially through informal means, such as gossip and social pressure. Deviance that persists
6 5 despite village efforts to promote conformity is treated through increasing social exclus ion, and ultimately, expulsion from village society. In contrast, relationships among members of largescale social units are impersonal formalized, structured and commonly devoid of personal content (Frielich et al. 1991:4). Members of large, modern societies have low visibility, which affords them a certain degree of freedom from interpersonal social pressures and greater reliance on the formal mechanisms of state control (Frielich et al. 1991:4). In discussing deviance within industrial societies, Raybeck (1991) draws on ethnographic data from smallscale social units that exist within these societies In Rock Island, a small fishing community located off the Atlantic coast, conflict and deviance are often handled through informal means, including a cooling off period during which the matter is not subject to a public forum, but is discussed by concerned community members (Raybeck 1991:66). As in tribal and peasant societies, the islanders are reluctant to label their coresidents as deviant, but do make a distinction between insiders and outsiders. Another example from a small Norwegian mountain community shows how the historic shift toward industrialization and modernity within a state may lead to changes in ways deviance is handled. Prior to 1970, this community was well integrated; it maintained a strong consensus about behavioral norms, and locals were concerned with maintaining ingroup harmony, preserving the network of interpersonal cooperation, and retaining an offender as a functioning member of the community (Raybeck 1991:66). However, with increasing industrialization came a schism between the more traditional farmers (living at the periphery of the community) and the modernists (living
66 more centrally) who took on new occupations that failed to promote community interdependence. The modernists consequently relied more often on formal sanctions to control deviance and more readily practiced labeling. In summary, Raybeck (1991) shows through the ethnographic literature that smaller scale social units practice labeling of deviants infrequently and gradually, tend to tolerate soft deviance, and have few instances of secondary deviance. In largescale social units, members are more apt to practice labeling, have less tolerance of soft deviance and commonly observe secondary deviance among those who are labeled. The author attributes these differences, in part, to the varying social cost s that labeling and sanctions imply across societies of different scale. Small scale societies rely on the interdependence of their members, and labeling a member as deviant reduces their social participation and generates divisions and conflicts that are ultimately harmful to the community. The social contributions of individual members of largescale societies are comparatively less significant, thereby reducing the social cost of labeling a person as deviant. In Western industrial societies, deviant identities and labels are far more extensive, and social responses toward stigmatized individuals and groups (whether formal or informal) are more severe. The contemporary focus by many anthropologists on concepts of agency and practice provides an important complement to structure in understanding the origins and dynamics of deviance, including its place in the diachronic study of cultural change. Frielich et al. (1991:6) argue for a dialectical approach in which emerging cultural patterns represent a synthesis between the proper behaviors enacted through cultural norms and the discrepant smart behaviors of individuals and groups With attention to
67 the emergence and alteration of cultural traits and institutions over time, deviant behaviors first become smart (representing practical, localized, and specialized strategies for solving day to day problems) a nd then proper (representing traditional practices and those governed by overarching cultural rules). The authors state that deviance not only promotes sociocultural change, its existence is a necessary condition for the maintenance of culture and society (Frielich et al. 1991:6). Thus, through long term cultural changes, stigmatized groups may gain legitimacy, and their behaviors and practices may become normalized. Ethnographic Studies of the Poor In the endeavor to theoretically ground an emerging anthropological study of the stigmas of poverty, I turn lastly to the body of ethnographic work that has focused more generally on poor and homeless individuals and communities. Ironically, the early work of Oscar Lewis (1966) may be considered a false start toward a critical understanding of stigmatization of the poor. In his study of Puerto Rican families, Lewis (1966) asserted that a substantial proportion of families who are certified as poor exhibit traits of a distinctive culture traits that involve family structure, interpersonal relations, spending habits, value systems, and time orientation. Reflecting the work of political economic theorists who ultimately set themselves in opposition to his ideas, Lewis considered this culture of poverty to be both an adaptation and a reaction of the poor to their marginal position in a class stratified, highly individuated, capitalistic society (1966:21). However, the language of adapt ation and resistance is subsumed in his work by a discussion of personalit y traits that he considered to be inherent to the culture among them, feelings of fatalism and helplessness, and a strong present time orientation with relatively little disposition to defer gratification (Lewis 1966:23). He viewed these traits
68 as key factors in the disengagement of the poor from civic society and in the reproduction of the conditions of poverty placing the responsibility largely on the shoulders of the poor. Lewis (1966) work therefore resonates with the underclass concept discu ssed in the preceding chapter, which locates poverty in individual behaviors and personal choices. Rather than reveal the nature and dynamics of stigma against the poor, his work instead served to perpetuate (and more importantly, legitimize through the language of social science) many of the negative attitudes and stereotypes of the poor that persist in modern industrial societies. In the decades that followed, a large body of ethnographic work emerged on homeless people in the United States work that pl aced poverty more explicitly in politicaleconomic perspective, while still respecting the agency of homeless individuals in adapting to the stressors of marginalization. The number of these studies expanded significantly following the economic recessions of the early 1980s and the wave of urban homelessness that resulted. Here, I focus on three such studies that were particularly influential in the anthropology of poverty and homelessness: James Spradleys (1970) work with urban nomads in Seattle, Irene Glassers (1988) ethnography of a New England soup kitchen, and Cohen and Sokolovskys (1989) portrait of elderly homeless men in the Bowery district of New York City. Spradley (1970) took on the topic of urban homelessness notably early, when the ranks o f the homeless were still populated mostly by solitary men whose poverty was often confounded by alcoholism and mental disorders. Early in his portrayal of the homeless, alcoholic men of Seattles Skid Road, Spradley remarked on the social rejection thes e men faced because of their deviance from cultural norms, noting that
69 the average citizen is repulsed because of the way they violate American values of cleanliness, steady employment, material possessions, and a commitment to home and family (1970:6). In a letter sent to Spradley from the Seattle City Jail, his key informant, William R. Tanner, used strong, emotional language to describe the attitudes and practices of the average citizen, writing: It pains me to watch the illiterate, homeless derelict s shafted by an exploitative, monied, parasitical society (1970:30). Yet in the same letter, Tanner characterized the urban nomad as one who chooses to disown society, leave the time clock and be nomadic (Spradley 1970:30). While Spradley (1970) did not explicitly address labeling effects, his ethnographic data suggest that both elements of structure and agency play a role in the perpetuation of stigma against the homeless whether framed in psychological terms as secondary deviance or in anthropologi cal parlance as recursive or dialectic processes. Spradley (1970) outlined four models of identity used to understand and identify the men he studied each reflecting the stigmatization of the poor to varying degrees. The first model is that of popul ar identity in which homeless, alcoholic men are seen as people who fail abysmally, are dependent on society, lack self control, drink too much, are unpredictable, and often end up in jail for their criminal behaviors (Spradley 1970:65). The second model is that of medical identity in which these men are defined on the basis of a disease alcoholism and characterized as unable to maintain themselves, to plan, or to perceive the consequences of their actions. The third model, legal identity builds up on and formalizes the stereotypes of the first, labeling the men as criminals. In the fourth model, sociological identity the concept of the homeless man is identified in demographic and behavioral terms; while seemingly neutral,
70 Spradley notes that even in this model, the focus on drinking behavior and homelessness reflects the dominant values in American society: sobriety, self control, the home (1970:67). The popular identity of homeless men is arguably the most stigmatizing both for the extent to which it is socially expressed and the broad range of stereotypes and negative attitudes it espouses. However, certain stereotypes appear in all the models in particular, those of the homeless as alcoholics and lacking in self control. For this reason, in studies that explore the stigmas of poverty, researchers should strive to address such stereotypes, the ways they figure in the lives of the homeless, and the strategies homeless individuals adopt in response to them. Glassers (1988) et hnography of a soup kitchen in a small city in New England covers a much broader range of identities considered to be marginal to the dominant culture. While they included the homeless, guests of the soup kitchen also represented sheltered people with li ttle income, those with problems of long term unemployment, and those with debilitating physical conditions, serious mental illness, or separation from family relationships (Glasser 1988:23). This more inclusive approach to the study population, while les s focused, allows for the recognition that people living in poverty may be affected by multiple problems and take on multiple stigmatized identities with each stigma marked by its own level of severity and operating in its own dynamic. This approach allows stigmas of poverty to be addressed as a single research topic. In her description of the social functions of the soup kitchen, Glasser (1988) notes that the soup kitchen is a place where the poor may find acceptance of behavior that is otherwise considered deviant by normative society. Glasser (1988) did not observe instances of labeling or categorizing; instead, the soup kitchen had an atmosphere
71 where people with a variety of deviant behaviors and conditions could coexist peacefully. This finding sugg ests that protection from stigma can extend beyond the simple in group affiliations that may form among discrete social identities and, at least in the institutional setting of a soup kitchen, cut across the myriad social identities affected by poverty. In this way, the soup kitchen functions as an asylum for many people who deviate from public norms of behavior (Glasser 1988:86). Evidence of the positive effects of group mentality was also observed outside the soup kitchen, on a field trip taken by guest s to a mental health clinic (as part of a community counseling course organized by the author). Eighty two percent of the soup kitchen guests had symptoms of psychological disorder, and many had been treated previously at the mental health clinic, where t hey described negative experiences with treatment staff and the sense of being treated as passive clients (Glasser 1988:126). However, upon their return to the clinic as a group, the former patients became vocal advocates for themselves (Glasser 1988:126) an example of resistance against stigma that implies protection from the effects of internalization and low self esteem. However, Glasser did address the question of self stigma that emerged for some guests, stating: One might hypothesize that since the guests are part of the dominant North American culture, with its well known derogatory view of all forms of welfare and charity, they too would share that outlook (1988:150). Glasser observed that the shame of being a soup kitchen guest caused some t o conceal this aspect of their social identity (a form of stigma management) one consequence of which being reluctance to recognize other soup kitchen guests in public. Such a response, I would argue, may serve to reverse the positive effects of group af filiation observed within the soup kitchen
72 setting: When one guest, through self stigma, denies interaction with another guest in more public spaces, the second guest (even if he or she does not self stigmatize) experiences this rejection just as poignantl y as rejection events that may occur in interaction with members of normal society. One year following the publication of Glassers (1988) work, Cohen and Sokolovsky (1989) published an ethnography of older homeless men who lived along Bowery Street in N ew York City. While acknowledging the negative influence of low social status on the lives of these men, their work is unique in that it elicited instances of labeling, stereotyping, and discrimination within and between groups of homeless men who lived in the study area. In one example, an informant named Uncle Ed expressed a cynical view toward the homeless men who attended Alcoholics Anonymous meetings in the Bowery, believing that they only attended these meetings because it was a requirement for receiving their public assistance checks (Cohen and Sokolovsky 1989:79). Here, public stereotypes of the homeless as lazy and dependent on the state were being articulated by a person who was also homeless. A second example involved negative views against mis sion stiffs homeless men who sought shelter in religious missions. Mission stiffs were described as outcasts on skid row who were humiliated by others, presumably because of the self deprecation they were forced to endure (namely, being forced to attend sermons) in order to receive food and shelter. While Cohen and Sokolovsky (1989) did not focus on issues of stigma, their work elicited instances of what may be called in group stigma the tendency of stigmatized people who have weak or nonexistent group affiliations to conceive a hierarchy of social legitimacy among themselves. This hierarchy is perhaps best exemplified in the
73 self imposed pecking order observed at cafeteria tables where the men ate differentiating those of high status (regulars, who had more social interaction) from those of low status (the drunkest, dirtiest, and craziest men) (Cohen and Sokolovsky 1989:133). Cohen and Sokolovsky (1989) also described forms of institutional stigma against the homeless that were embodied in the built environment specifically, in the construction, layout, and rules of flophouses and municipal shelters where the men could sleep for a small fee. Older lodging houses, for example, had been built purposely with precipitous stairs t hat would exclude people too inebriated to negotiate them (Cohen and Sokolovsky 1989:23). Some of the flops were also reputed to discriminate between better bums (long term, paying clients) and ticketmen (who received free referrals from the city) by e stablishing special sections for those in the former group (Cohen and Sokolovsky 1989:23). I n studies that address stigmas of poverty, it is important to understand the influence of structural stigma that may not necessarily originate from social interacti on. Because my study took place in a Western European setting, some discussion is warranted of ethnographic work conducted in this part of the world. Within this body of work, Patrick Gaborieaus (1993) ethnography of a small group of homeless people in P aris is exemplary. Gaborieau (1993) followed five homeless people on the streets of Paris for a full year, permitting a rich understanding of their life experiences, their strategies for survival, and their relationships both with each other and with the citizens they encountered on a daily basis. These clochard s (bums), as they were known, regularly practiced begging in the streets and were consequently subject to a
74 high level of stigma. In his portrayal and interpretation of begging, Gaborieau (1993) documented a range of the aspects of stigma discussed in this chapter from lived experiences of discrimination, to perceived stigma, stigma management, and resistance. Gaborieau described five categories of the gaze of the normal person who passes a b egging clochard on the street (1993:68). First, is the indifferent eye the look of a passer by who acts as if having seen nothing of the sad condition of the clochard (Gaborieau 1993:68). These are the citizens who approach from a distance, who switc h sidewalks when seeing the homeless person to avoid interaction. Second, is the interrogative eye of individuals who question the clochards presence on the streets, their purpose and their intent. Third, is the worried eye from passers by who, clinging to the stereotype of the homeless person as dangerous, fear being attacked. These categories describe three common stigmatizing responses to homeless people who beg: disregard, doubt, and fear. The remaining two categories the pathetic eye and the political eye describe more accepting responses, which have garnered less attention in research on the homeless in the United States. A person with the pathetic eye files the misery without daring to scrutinize (Gaborieau 1993:68). These are the pass ers by who sympathize with the beggar, who have a desire to help but possess neither the means nor the knowledge to do so. Lastly, the political eye describes the look of a citizen who considers the deplorable condition of the homeless person to be a socially constructed problem, and one which should be addressed with government aid. Gaborieau (1993) also described several expressions of perceived stigma among his informants, as well as the adverse effects that such perceptions can engender. In
75 one example, an informant claimed that because he lived on the streets, he inspired fear in those he passed; it was for this reason that he avoided social interaction (Gaborieau 1993:19). The same informant was quoted as saying: We are viewed like irreparable soc ial cases, failures like social garbage (Gaborieau 1993:92). In another example, a beggar noted that people would tend to give more money in his hat than in his hand, suggesting that they were afraid of infecting themselves by touching a clochard (Gabo rieau 1993:91). To a certain extent, Gaborieau confirmed such perceptions through his own observations, noting that the homeless beggar was routinely feared and rejected ignored as if he were not there, even when saying hello (1993:137). In response to passers by who exhibited disregard, doubt, or fear, the beggars in Gaborieaus ethnography were seen to practice a spontaneous psychology of character making judgments of those who rejected them on the basis of appearance, pace, clothes, face, and head (1993:76). To passers by who gave nothing, the beggars would apply negative character labels, such as radin (stingy), nul (nothing), or blas (indifferent). Gaborieau considers begging as a type of reciprocity a basic agreement on the separati on of complementary roles between citizen and beggar (1993:76). Therefore, while such responses could be characterized as a type of reverse stigma or evidence of ingroup affiliation and resistance, they may also be motivated by the beggars sense of violated reciprocity rules. The concept of reciprocity, whether through material or symbolic exchange, may be a useful tool for understanding stigmatizing experiences of the poor more generally. Rules of exchange mark many of the typical encounters the poor hav e with others in their daily lives from receiving food from
76 volunteers in a soup kitchen, to receiving approval for public assistance by social workers, to receiving change from passers by on the street. By taking into account expectations of reciprocity researchers of stigmas that affect the poor may find a useful model for understanding not only the types of encounters most likely to leave a lasting impression on those who are excluded, rejected, or victimized, but the types of responses such encounter s provoke. Stigma in Multidisciplinary Synthesis In th is chapter I review the stigma concept from its theoretical inception in the sociology of deviance, to the application of labeling and stigma theory in the social psychology of the mentally ill, to the emerging consideration of stigma in anthropology and its increasing use for understanding all experiences of human difference. Each field brings its own contributions to this understanding, highlighting the value of a theoretical approach to stigma that is multidisciplinary. While my study i s grounded in the theory and practice of medical anthropology, failure to acknowledge the ideas and findings of scholars from other disciplines would leave an incomplete picture of stigma one that ignores its origins, its transformations over the past 50 years, and its transformations yet to come. Much work has been accomplished to further our understanding of how stigma affects the mentally ill, people of marginalized gender, ethnicity, or sexual orientation, and people suffering from (or living with) a variety of medical (or medicalized) conditions. My study introduces a novel conceptualization of the various stigmas of poverty both specific (such as the stigmas of homelessness and unemployment) and nonspecific (such as the stigmas of alcohol and drug abuse, or the stigmas of minority ethnicity and nationality). By synthesizing the work of scholars before me, I do not
77 approach this new topic empty handed. I have instead a variety of useful concepts at my disposal, concepts which, in theory, should hel p to catalyze the endeavor of understanding how the poor experience, and respond to, the exclusion and rejection they encounter in their daily lives. In the chapters that follow, I present my ethnographic work conducted among various categories of the poor in Geneva, Switzerland people who, collectively, have been labeled by authoritative sources (e.g., policy, medicine, and the media) as living en situation prcaire. In an effort to shed light on the stigmas that affect this culturally heterogeneous population, I refer to and make use of a number of the concepts presented in this chapter. The experience of stigma may be characterized through such concepts as discrediting (Goffman 1963), labeling (Becker 1963, Schef f 1966, Link and Phelan 2001), stereoty ping and discrimination (Link and Phelan 2001), while responses to stigma are captured along a continuu m ranging from internalization and self stigma to in group affiliation and resistance (Goffman 1963; Corrigan 2002). Lastly, operating from a distinctly anthropological standpoint, I consider stigma to be a recursive process of social interaction (Frielich et al. 1991) both affecting and affected by those who bear its burden. It is in this way that stigma may ultimately be overcome, through the diachroni c give and take of structure and agency, transforming what is now deviant to what may someday be normal.
78 CHAPTER 3 POVERTY IN GENEVA: THE BALANCE OF STIGMA AND SOCIAL ACCEPTANCE Among the cities of Western Europe, Geneva is perhaps best known as a center for international diplomacy and humanitarian aid, and, as Switzerlands secondmost populous city, for its high standard of living and prosperity. Yet despite its wealth, Geneva p ossesses a substantial population or more accurately, populations of people living in poverty. The profile of Genevas disadvantaged is representative of the cultural heterogeneity of Swiss society, including both immigrants and citizens, and encompass ing many of the same interconnected social problems among the poor in the United States. It is partly for this representative diversity that Geneva was chosen as the site for research intended to elucidate the broad scope of stigmas of poverty and their as sociations with mental health. This chapter begins by briefly describing the state of poverty and social support in Switzerland, citing statistics and reports from government, nonprofit, and academic sources. These statistics focus on the years 2005 and 2006, when my study was conducted. An etic typology of the poor in Geneva follows, outlining categories of people and groups that were subsequently used for framing the studys research questions and sampling approach, and describing the stigmas they face. Lastly, I provide a closer look at community responses to poverty in Geneva, with an emphasis on the institutions and locations chosen as research sites. A Visitors Snapshot of Geneva Upon first setting foot in the streets of the Cit district, at the edg e of Lake Geneva, visitors will find themselves at the center of Genevas bustling economy. Tourists, diplomats, and corporate executives mingle here, arriving and departing via the regular circulation of the citys tram system all before the backdrop of two
79 celebrated landmarks: the Jet dEau (one of the worlds largest fountains), and the Cathedral of St. Pierre. In their interactions one can hear the multitude of spoken languages expected in a country that represents a gateway between Eastern and Western Europe. While the most common is French (the official language of Western Switzerland) it is not unusual to overhear at any given moment two of Switzerlands other official languages German (a Swiss dialect spoken primarily in the eastern part of the country) and Italian as well as English, the many languages of Eastern Europe (mostly Albanian, Romanian, and SerboCroatian), Arabic, Portuguese, and Spanish. For visitors, Genevas first impression is of a city, above all, international and mul ticultural, both prosperous and culturally rich. Given the citys propensity for reinforcing such stereotypes, it is naturally difficult to imagine that within the shadows of Switzerlands iconic and secretive banks can be found an undercurrent of disadvantage. But like its wealth, Genevas poverty is equally evident, and equally international. Visitors crossing any bridge over the Rhne river will hear the sounds of guitars, accordions and violins and from them the vibrant music of Eastern European trad ition that has come to characterize the Cit district as much as its banks and shopping centers. Most of the men and women holding these instruments are Rom ani (in popular discourse, gypsies) poor, undocumented, and often homeless. They place tiny wick er baskets at their feet to collect the change of passersby. T hey perform o n the Pont de la Machine at the streetcorners of Rue du March (the commercial district), and on the trams and buses. For some tourists, their music completes their experience of the city, embodying in part the citys charm.
80 However, t he young and healthy are accompanied by the old and disabled. Crossing the Pont des Bergues visitors will encounter an elderly woman alone, blind with cataracts, and profoundly pigeontoed. She rattles a metal cup half full of coins as she slowly makes her circuit across the bridge and back again, repeating in a thick accent: Pour manger, sil vous plat [To eat, please.] She varies the intonation of her words with each repetition, such that her declaration of hunger becomes a kind of song in itself. Her song plays on regardless of whether anyone is within earshot. Meanwhile, Romani children beg for money at outdoor restaurant patios, while their parents await their bounty on the nearby bridges. I n some cases, customers leave their tables only to find that their purses, wallets and billfolds have gone missing. Thus, for other tourists, and many locals, the presence of Romani people comes to represent the uninvited wave of illegal transient migration that brought them to Geneva, expectations of harassment, and fear of being swindled or robbed. On the south side of the river lies the Jardin Anglais a pleasant, lakeside garden popular among both tourists and small time drug dealers. There, young me n slowly roam through the crowd on bicycles, offering in hushed tones their merchandise (in most cases, marijuana) to those they have profiled as potential buyers. Many, if not most, are immigrants from the North African countries o f Algeria, Tunisia and M orocco The young men are undocumented, unemployed and inherently unemployable, and frequently targeted by the police. Their recourse to crimes such as drug dealing and petty theft has earned them a negative reputation in the media, and by extension, a public stigma against all poor North Africans
81 It would be an error, however, to suggest from these observations that poverty in Geneva is confined strictly to immigrant populations. The Romani and North African youths simply represent the faces most visible to first time visitors. The Swiss themselves are also at risk of finding themselves in situations of social and economic disadvantage, with equally varied outcomes. Near the tram stops, homeless and mentally ill men dig through public trash cans for food and tobacco. Small groups of youths self identified punks who wear black, don mohawk hairstyles, and adopt stray dogs can be seen sleeping by the riverside in the middle of the afternoon. At other times, they mingle with older, unemployed men at the street corners, drinking cheap beer from tall aluminum cans. And upon entering one of the citys many soup kitchens, one will encounter the myriad faces of those actively seeking public assistance: elderly pensioners, recovering alcoholics and drug addicts and those receiving unemployment benefits In my study, it is toward all of these groups that I turn an ethnographic lens. Consequently, an inclusive variety of locales comprises the setting for my research. During my year in Switzerland, my studies to ok me to locations both institutional and public in the former category, soup kitchens, homeless shelters, social service agencies, hospitals, clinics, police stations and prisons; and in the latter category, parks, street corners, train stations, trams and buses. I should acknowledge that such a broad focus could have compromised my ability to objectively observe and interpret the problems of stigma among Genevas poor. However, as an initial query of the concept of stigmas of poverty, I considered the m ethodological limitations of inclusiveness a necessary risk. Furthermore, as discussed in prior chapters, the stigmas of poverty are
82 not mutually exclusive. In any one individual, a variety of such stigmas may operate simultaneously, interacting to affect identity in ways that have yet to be understood. To study stigmas of poverty, therefore, requires the inclusion of all who live in poverty, which in turn requires the ethnographer to seek out all the places where such people may be found. Poverty and Socia l Support in Switzerland With a population of over 7.6 million and occupying an area approximately twice the size of New Jersey (C entral Intelligence Agency 2009), Switzerland is considered one of Western Europes most prosperous countries. The nation boas ts low rates of unemployment and a per capita GDP that is greater than that of the larger Western European economies (C entral I ntelligence A gency 2009). Even within the developed world, the Swiss people arguably enjoy a high standard of living and wealth. However, according to a 2005 report by the charitable Catholic organization Caritas, approximately 1 million people in Switzerland or greater than 1/8 of the Swiss population may live at the margins of this economic prosperity (T ribune de G enve 2005). Historically, after the Second World War, increasing economic prosperity and the development of state social support gave the impression that Switzerland had resolved its problem of poverty (Labarthe 2005). But with structural economic changes of the 1970s came a resurgence in levels of domestic poverty, which produced a class of victims of social downgrading, the excluded rejected from the workforce and constrained to living at the margins of society (Labarthe 2005). Comparable to that of other Wes tern industrialized nations, poverty in Switzerland continued throughout the 1980s, and increased in scope in the 1990s due to economic recession.
83 Compiling data collected in 2003 and 2004 by the Swiss Federal Office of Statistics and the Swiss Associatio n for Child Protection, Caritas projected that in 2006, Switzerland would cross the symbol ic barrier of 1 million people living below the poverty line defined at 4,550 Swiss francs of monthly income for a couple with two children and at 2,450 Swiss francs for a single person (Monnet and Vos 2006). This threshold falls considerably below the average national monthly household income of 8,96 7 Swiss francs in 2005 (Office f dr al de la s tatistique 2009a). The Caritas estimate represents a diverse population, including approximately 250,000 children, 200,000 retirees, and up to 284,000 persons who find themselves below the poverty line despite working 40 hours or more per week (the workingpoor ). Among the estimated million, 450,000, or nearly half, do not r eceive the financial or complementary social support to which they are entitled. Social support in Switzerland falls under the rubric of protection sociale (social protection), which may be divided roughly into two categories: (1) Social insurance program s intended to protect persons from different categories of precisely defined risks, most of which entail the absence or insufficiency of professional income; and (2) Social welfare accorded in response to the individual needs of persons who are unable to a ssure their own subsistence (O ffice fdral de la s tatistique 2009b). The primary Swiss social insurance program is the A ssurance vieillesse et survivants ( AVS ) (old age and survivors insurance) which, along with the P rvoyance professionnelle (professional planning program ) ensures a certain level of material security for people in retirement. Other social insurance programs include: A ssuranceinvalidit ( AI ) a financial support program for people with disabilities of permanent or long duration;
84 Assu rancemaladie a compulsory health insurance program that ensures coverage of the costs of medical treatment through one of the countrys numerous private health insurers; Assuranceaccidents an accident insurance program that provides coverage of the economic costs of accidents and is compulsory for all workers; Assurancechmage an unemployment insurance program that offers replacement income to individuals who are without employment ( chmeurs ) and works to prevent or overcome unemployment through courses, temporary jobs, and funding of training programs; and Allocations familiales an allocations program that serves to partially compensate for the costs of raising a family, and is administered by the countrys individual cantons (administrative di visions). While some of the Swiss social insurance programs are universal, such as the AVS and Assurance maladie, others are of particular benefit to those in situations of socioeconomic disadvantage. The AI and Assurancechmage programs are intended to o ffset the costs of having no professional income due to disability and unemployment, respectively helping to ensure a reasonabl e standard of living for people who would otherwise find themselves in poverty. In 2006, approximately 470,000 people received aid from the AI program, representing nearly seven percent of the Swiss population (Buri et al. 2007). The principal reason for receiving AI was illness, followed by congenital problems and accidents. Elderly men were the group most affected by disabilit y, with one out of five men in retirement receiving AI assistance. During the same year, on average, 131,000 people per month were registered for unemployment benefits in Switzerland, representing a national unemployment rate of 3.3 % ( Secrtariat dEtat lconomie 2007). The majority of chmeurs were 25 to 49 years old and had received benefits for one to six months (Secrtariat dEtat lconomie 2007)
85 The second general category of social support in Switzerland is aide sociale (social welfare), which is granted by the cantons to individuals and families that are unable to cover their basic needs (Office fdral de la statistique 2009b). The a ide sociale program was established to: (1) guarantee minimum subsistence needs, (2) encourage individual responsibility and autonomy, and (3) promote social and professional integration. According to the Office fdral de la statistique (2008), approximately 245,000 people received social welfare in 2006, representing three percent of the Swiss population. Rates of receiving welfare benefits were higher among single parent families (18% ), divorced individuals (7% ), children and adolescents (5% ), and young adults 18 to 25 years old (5% ). Social welfare was more common among people living in urban centers and those who had received no formal professional training. Greater than one half of those on social support had received assistance for more than one year (Office fdral de la statistique 2008) As suggested by the opening vignette to this chapter, a substantial proportion of those living in poverty in Switzerland are immigrants. In 2006, among over 18,000 new beneficiaries of Swiss AI pensions, 4,500 were immigrants living in Switzerland (Buri et al. 2007). The primary reasons for receiving AI pensions among immigrants were mental illness (42 % ) and musculoskeletal disorders (26% ). Immigrants receiving new AI pensions in 2006 were primarily of Turkish or ex Yugoslavian nationality, followed by Spanish, Italian and Portuguese. High rates of disability among immigrants from Turkey and former Yugoslavia are likely due to employment in under qualified, and presumably, high risk occupations (Buri et al. 2007). Notably, Romanian and North African
86 immigrants, who figure so prominently in the public eye in Geneva, do not appear in significant numbers in the national AI statistics. Regarding unemployment insurance, nearly 55,000 immigrants received benefits in 2006, representing 42% of chmeurs in Switzerland ( Secrtariat dEtat lconomie 2007). Among immigrants, the ra te of unemployment was 6% compared with 2% among Swiss citizens. Comparably, among recipients of social welfare in 2006, 44% were immigrants ( Office fdral de la statistique 2008). Considering that immigrants represent roughly 21% of the resident population o f Switzerland ( Office fdral de la statistique 2009c), these statistics particularly those for unemployment and social welfare suggest that foreign residents disproportionately represent those living in poverty in Switzerland. The increased risk of depending on social welfare for those of foreign nationality has been explained by lower levels of professional qualifications, lower chances of success in the workplace, and differences in family structure ( Office fdral de la statistique 2008). Governmen t statistics provide a perspective on Swiss poverty that is arguably limited, given that a recognized proportion of those in need of social assistance do not receive it. Sociologist Stphane Rossini (2002:1 ) considers the oublis de la protection sociale (those forgotten by social protection) to be a diverse population referring not to one, but multiple hidden poverties that exist in Switzerland. Rossini outlined nine categories of vulnerable populations that together comprise the Swiss phenomenon of hidden poverty: (1) the workingpoor; (2) singleparent families; (3) immigrants; (4) independent professionals; (5) the physically ill; (6) alcoholics and addicts of prescription medications; (7) addicts of hard drugs; (8) the homeless; and (9) the
87 instit utionalized. Some groups such as the sans papiers (undocumented immigrants) are not eligible to receive benefits in Switzerland because of their lack of legal status. In 2005, the number of undocumented immigrants was estimated at 90,000 nationally, sugges ting that the actual proportion of immigrants living in poverty is considerably higher than reported by social protection statistics (O ffice fdral des migrations 2005). However, the majority of those populations cited by Rossini (2002) do have legal rights to social protection, yet fail to access the system because of dysfunctional relations with social workers, gaps in information regarding the availability of assistance, feelings of shame, and reluctance to become a dependent of the state. The stat istics above also offer a profile of poverty in Switzerland that is based primarily on measures of personal or household income, which poses problems for the interpretation of a social problem that is multidimensional. According to Rossini (2002:1), povert y is heterogeneous, plural, and does not confine itself to a single economic dimension measured uniquely from thresholds of income. Among the many contributing factors in the production of poverty, disparities in wealth and status may explain the Swiss s ituation better than any absolute measure. Despite its small area, Switzerland is characterized by gradations in average household wealth and cost of living across cantons and communes. In 2005, average monthly household income ranged from 7,330 Swiss francs in the Italian speaking canton of Ticino to 9,371 Swiss francs in the three Frenchspeaking cantons surrounding Lake Geneva ( Office fdral de la statistique 2009a). Conversely, for a family with two children and an annual base income of approximately 4,400 Swiss francs per month (just below the poverty line), free disposable income was highest in Ticino and lowest in Zurich, after taking into
88 consideration social protection benefits and costs of rent and insurance (Knupfer and Bieri 2007). The poverty t hreshold assessed by Caritas may not capture such regional variations, ignoring the aspects of inequality that persist in communities where few households fall beneath the established threshold, but where clear divisions in social hierarchy are still appar ent. Using data from the 2001 Swiss Household Panel (SHP) a population survey of demographic variables, housing and living conditions, and mental and physical health in Swiss households Ferro Luzzi et al. (2006) sought to construct a multidimensional model of poverty in Switzerland using cluster analysis methods. While the authors statistical modeling is beyond the scope of this chapter, background data collected from the SHP may serve to elucidate dimensions of Swiss poverty that extend beyond the r estraints of low household income. Those incomerelated variables with the highest population prevalence included having unpaid bills (8% ), inability to afford saving 100 Swiss francs (12 % ), having no private retirement scheme (10% ), having income below needs (10% ), and inability to afford vacations (6% ) or go to restaurants (13% ). Certain variables concerned housing and neighborhood factors, which included having small housing (12% ), bad heating (7 % ), noise in the vicinity (21% ), pollution in the vicinity (15 % ), and violence in vicinity (12% ). Notably, variables for neighborhoodlevel poverty presented higher prevalence rates than those related to individual income. While self reported health status was relatively good for the population, a high percent age (19 % ) reported having a long term health problem or disability of a physical or psychological nature. Lastly, social factors frequently neglected in measures of poverty included not having association membership (25%) and a low frequency of contact wit h friends
89 While the Swiss nation as a whole is known for its wealth, Swiss society like many other Western societies is marked by socioeconomic disparities that draw clear lines between rich and poor. However, I caution against a stringent interpretation of rich and poor to mean the abundance or poverty of material wealth. Poverty in a developed nation such as Switzerland likely has less to do with inadequacy of income which for much of the residing population is accommodated by a comprehensiv e system of social protection and more to do with social and professional disqualification, hardship, the absence of social ties, the weakening of citizenship, situations of dependence and the incapacity to realize future projects (Rossini 2002:1). Lik ewise, the stigmas of poverty I explore in this study may have little to do with how much money a person has. While having an empty pocketbook may present stress in a persons daily life, I argue that it is not the leading element that marks a poor person as deviant in the public eye. Rather, stigma is directed against those elements of social identity that, as shown above, are connected to poverty: being disabled, unemployed, or from another country. To these I would add being homeless, addicted to drugs and alcohol, or employed in any number of clandestine or socially unacceptable occupations, including sex work. These life conditions characterize the experience of poverty more fully than the simple condition of having insufficient income, in part because they are each subsumed within the labels and stereotypes that the larger society holds against them, and from which processes of discrimination and devalued identity unfold. The next section details three such life conditions homelessness, unemployment, and foreign nationality that
90 each pose their own challenges to social identity among the poor in Geneva and which serve as a basis for the research questions and sampling in my study. A Typology of Stigmatized Identities in Geneva As in other develope d nations, discussions of housing, employment, and immigration are among the most salient in the public discourse surrounding poverty in Switzerland. The three domains are arguably interconnected. Employment and housing operate in a dialectic relationship, with one being difficult to secure without the other: While having a physical address is frequently a prerequisite for obtaining employment, it is difficult to afford the costs of rent without first having a job. Immigrants face obstacles in obtaining bot h housing and employment, through lack of formal professional training, language barriers, and discrimination on national and ethnic grounds. These three life situations represent a starting point for constructing a typology of stigmatized identities among the poor in Switzerland, but should not be considered mutually exclusive. Indeed, it is possible for an individual to self identify with more than one of these identities. One relevant question that naturally follows whether self identification with mul tiple stigmas produces a greater cumulative effect on physical, mental and social well being for individuals in poverty is one I return to in later chapters. Homelessness and Begging In Switzerland, and perhaps all of Western Europe, the homeless represent one of the most marginalized groups of society simultaneously an object of compassion and aversion, both institutional and individual. While many citizens support social reforms for improving the lives of homeless persons (e.g., funding for shelters, social integration programs), others have no desire to interact personally with those whom such programs would benefit. They avoid eye contact on the sidewalk, ignore appeals for spare
91 change, or simply cross the street to avoid such interactions outright. A legacy of stereotypes and identifications precedes such patterns of rejection, including beliefs that the homeless are: (1) unclean, and by association, likely the carriers of contagious disease; (2) mentally ill, and by association, dangerous; and (3) lazy and unwilling to work for themselves, as evidenced by their frequent recourse to such strategies as begging for spare change. Laws against homelessness and begging have existed in Geneva since 1946 (R ecueil systmatique genevois 1946). Article 37 of t he citys original penal code specified that a person could be subject to arrest, fine or both for: (1) wandering without fixed habitation, without means of subsistence and regularly exercising neither trade nor profession, or (2) begging or sending min ors or persons placed under their authority to beg. Negative political sentiment against begging in Geneva has traditionally been high, mostly generated from conservative political parties such as the Union dmocratique du c entre ( UDC) (Michiels 2005). Citing an insupportable level of begging in Geneva, in November 2005 the UDC submitted a motion entitled Tas pas deux balles? [Dont you have two bucks?] (Michiels 2005). Largely symbolic in scope, the motion insisted that authoriti es act against the practice of begging, which engenders a growing feeling of insecurity and feelings of guilt (Michiels 2005:5). In response, the police reported having more important problems to tend to, and considered begging neither exceptional nor th reatening to the public order. Regardless, a total of 163,000 Swiss francs in fines were imposed against beggars that year, of which 13,900 francs were collected (Estoppey 2007).
92 At the liberal end of the political spectrum, a growing sentiment of sympathy toward beggars has emerged in recent years. In January 2007, Article 37 was repealed as part of a new version of the penal code, effectively decriminalizing homelessness and begging (Depommier 2007; Budry 2007). During this year, the population of beggar s was estimated at between 150 and 200 people, and authorities otherwise recognized no other criminal offenses associated with them (Estoppey 2007). However, the police and security personnel originally responsible for enforcing the law were slow to change their practices. By the summer of 2007, police had imposed an estimated 100,000 Swiss francs of fines for begging (Budry 2007) a figure that was later cited as 800 separate fines, totaling 86,000 Swiss francs (Lecomte 2007). While the conservative Proc urer General Daniel Zappelli supported the continued repression of begging, the legal precedent set by the laws modification could not be ignored. In June 2007, Zappelli signed a joint agreement with the socialist State Council member Laurent Moutinot, af firming that the simple fact of begging would no longer be subject to fine (Gani 2007). Furthermore, those who had been fined for begging during that year were entitled to reimbursement by the state a political move that roused the ire of Genevas Part i libral (a conservative party) (Gani 2007; Lecomte 2007). In response, conservative politicians submitted a new motion against begging to the Grand Conseil (parliament) of the canton of Geneva (Gani 2007). Despite objections by human rights advocates, who claimed the urgency of such a law could only be required in the case of danger to public order (Depommier 2007), by the end of November the law had been drafted and passed, again criminalizing the act of begging (R eceuil systmatique genevois 2008).
93 T his vehement political tug of war highlights the conflicting sentiments of the Swiss public toward beggars and homeless persons. While laws against homelessness were not revived, politicians were successful in reinstating laws against begging, likely due t o strong public opposition to the practice. Laurent Moutinot, who supported the repeal of begging laws, admitted the challenges he faced in light of the strongly emotional context surrounding begging: Rarely in my career have I received messages so violent, going sometimes as far as to threaten my family. Its probably because beggars convey an image of humanity that we dont want to see (Estoppey 2007). The local media also plays a role in both reflecting and fueling the negative public image of beggars and the homeless. Stories in newsprint frequently portray the varying tactics of beggars as unscrupulous and deceitful (Michiels 2005; Hatet 2006). In particular, the presence of children in the ranks of beggars draws resentment from the public, both for their degree of aggressiveness in begging and for their presumed connection to organized networks. During the summer, customers of terrace restaurants along the Rhne are reportedly solicited for money dozens of times per day by children, who at times go as far as to steal money directly from the tables (Hatet 2006). In addition to being considered a form of child exploitation, the practice is criticized precisely for the same reasons that it is successful: Children provoke more sympathy than adults, t hey are considered less at fault for their marginalized condition, and they consequently produce greater returns from begging. Readers of the Matin Bleu a popular local newspaper are also warned against beggars who adopt the traits of apprentice musi cians, children who produce documents stating that their parents were
94 murdered in their home country, old women who pretend to be crippled, and mothers who shake their infants to draw the attention and pity of passersby (Hatet 2006). Stigma against homel essness and begging also affects other members of Genevas population, who may be neither homeless nor beggars. Street musicians, for example, are frequently confused for (or assumed to be) beggars, and often belong to the same groups and families as those who beg (Estoppey 2007). During the holidays, when the number of beggars and musicians in the streets typically increases, street musicians are required to participate in auditions that distinguish the true artists from the others in order to receive authorizations to perform (Haeberli 2006). Such auditions function as a proof of social legitimacy, in which street musicians are identified by default as members of a stigmatized group (beggars) and then assigned a higher status if they can prove themselv es worthy. Unemployment As discussed above, unemployment and under employment in Switzerland is known to disproportionately affect immigrants, in particular the sans papiers To a certain extent, the stigma of unemployment in Geneva is connected with the s tigmas of marginalized ethnicity and nationality; many members of the public are likely to stereotype poor immigrants as unemployed and to use racist and anti immigrant rhetoric to explain their exclusion from the workplace. In the case of immigrants recei ving chmage or other social benefits, normative portrayals of them as dependent on the State may increase their burden of stigma. Their dependence may be considered the result of weakness (physical, intellectual, or moral) or of calculated manipulation of the Swiss, cantonal and local social support systems. However, unemployed Swiss citizens are equally prone to these conceptualizations of unemployment suggesting that the
95 stigma of unemployment involves stereotypes and negative attitudes that are independent of ethnicity or nationality. As immigrants in Geneva are discussed in more detail below, this section briefly describes unemployment among Swiss citizens. In 2006, the unemployment rate was higher in Geneva than in any other Swiss canton at 7.3% o f the population in January of that year (compared with 3.9% of the Swiss population) (Bretton and Budry 2006). Over 16,000 chmeurs received unemployment benefits and nearly 23,000 pe ople were actively in search of work. The Cantonal Office of Employment explained this disparity as the result of a mechanical effect rather than real problems in the economy, with changes in Confederation regulations in July 2005 resulting in many chmeurs in Geneva losing their right to benefits (20 Minutes 2006a). These s ame people began to recuperate their benefits during the following year, adding to the existing baseline unemployment rate. While many of the able bodied unemployed Swiss in Geneva (whether receiving chmage or not) are men, recent media stories have focused on unemployment among single mothers and the particular challenges they face (Bzaguet 2006). In one case, Marjorie a 28year old single mother reported facing economic and relationship difficulties, constrained quality of life, perceived stigma and feelings of low self worth. Three months pregnant, Marjorie lived with her 11month old son and boyfriend in an old apartment in the Paquis district. She hoped to find a day care that could free her to find employment of her own, which proved difficult g iven her 3,400 Swiss francs of household income per month (provided by her sporadically employed companion). She reported conflicts with her boyfriend over her financial dependency on him. Although she met monthly with her social assistant, it did little t o restore her morale: I feel shame
96 and a sense of inferiority, especially with regard to my boyfriend. And then I have the impression that people think that I do nothing (Bzaguet 2006). Another case of a single unemployed mother Coralie, 21 years old highlights challenges sometimes faced in the very system established to assist those in need, and as in Marjories case, a resulting sense of low self worth (Bzaguet 2006). Because Coralie lived with her mother, the social services offered her a reduced benefit of 1,300 Swiss francs per month all of which she spent on her 15month old son. Coralie reported bad relations with her social assistant: Shes never there. She doesnt remember me. She doesnt help me fill out the paperwork. She failed her fi rst year of studies at the School of General Culture and dropped out, then worked for one year as a cashier a job she was forced to quit for health reasons. Consequently, Coralie blamed herself for not having worked harder at her studies: I dont feel v ery much pride. Besides, I would prefer to say that Im on unemployment than at the Hospice Gnral [welfare benefits provider] (Bzaguet 2006). Like the homeless and those who beg, the unemployed in Geneva face the stereotype that they are lazy and unwilling to work. Furthermore, those who receive unemployment benefits are frequently under suspicion of fraud labeled by the public as profiteur s ( people who take advantage of the system). This stigma is pervasive in Frenchspeaking European society in general and affects not only interactions between chmeurs and the public, but statelevel responses to the problem of unemployment. In 2005, for exam ple, political changes in France allowed agents of the French Ministry of Employment to freely exchange the personal information of applicants of unemployment benefits who were suspected of fraud (Radio France 2005). In response, associations,
97 left wing parties and syndicates denounced the motion as a form of harassment and a violation of privacy rights. Being an Immigrant As with homelessness and begging, the Swiss have been found to harbor ambivalent attitudes toward immigrants. According to a survey by Slection (a French language version of Readers Digest ), nearly 60% of Swiss respondents considered immigrants to be a benefit to Switzerland (T ribune de G enve 2006a). At the same time, federal laws regulating immigration and asylum have become more stri ngent. On September 24, 2006, 68% of Swiss voters supported revision of the immigration law (known in French as the Loi fdrale sur les trangers or LEtr ), restricting certain categories of immigrants from accessing the labor market, reinforcing measures for the social integration of legal immigrants, and making sanctions against criminality and abuses of immigration laws more severe (O ffice fdral des migrations 2007). Greater restrictions were set in place on the admission of immigrants from nonmember countries of the European Union, who must possess particular professional qualifications to be granted work permits a modification that explicitly aimed to reduce rates of unemployment and social assistance. Among the different nationalities and ethnic identities that characterize Genevas population, Roms (Romani) are among the most visible both in the public eye and in public discourse. The presence of nomadic Rom groups in Geneva may be explained by the same processes of discrimination, persecution and dislocation that govern the migration of refugees from other countries. Most originate from Romania, where, following a five century history of slavery, they face discrimination, few job opportunities, and impoverished living conditions (T lvision suisse romande 20 07a). In Switzerland,
98 they are able to obtain tourist visas, which are valid for up to three months, and earn an income potential that is reasonably greater than in their home country (Lecomte 2007). These earnings, however, do not come from legitimate employment, but rather from begging and petty crimes (T lvision suisse romande 2007a). As in their home country, the Roms are largely excluded from the workforce in Geneva. For these reasons, Roms bear a disproportionate burden of public resentment. According to members of the UDC, the gitans (gypsies) who beg so aggressively on the streets of Geneva are poor devils who arrive in bands from neighboring France and turn up in groups of 20 or 30: They arrive at seven in the morning, disperse, harass you, sometimes in an aggressive manner, and leave again at night. Some of them make up to 400 or 500 francs per day (Michiels 2005:5). Many are blamed for faking handicaps in order to arouse public sympathy a pervasive suspicion that circulates among legitimate street musicians, politicians, and social service professionals alike (Lecomte 2007). In an interview with Le Temps a director of the Salvation Army shelter claimed to have a test to determine whether a guest is faking disability: I sit him in the dining hall, I place his crutches in a corner, then, on the pretext that theyre blocking the passage, I move them farther away. At the end of the interview, the guy goes to get them without limping (Lecomte 2007). In addition to dishonesty and unscrupulous activity, Roms have been blamed for more explicit and severe acts of criminality. Local politicians have characterized Rom social structure as a mafia and their begging activity as an industry and have accused them in the trafficking of children (Mino 2006:11).
99 During the polemic surrounding begging in 2007, Roms were cited as the group most frequently fined during a time when begging was no longer illegal (Budry 2007). Reports also circulated of Roms being illegally searched and handcuffed by the police during routine checks, and being fined without receiving a receipt (the sole means with which they could feasibly obtain a reimbursement) (Depommier 2007). Complicating their situation, Roms generally speak little French, and possibil ities for appeal even if explained are likely left misunderstood (T lvision suisse romande 2007b). Among those homeless seeking shelter during winter, they are the group most frequently refused access to the Abri PC the citys largest winter homeless shelter (T lvision suisse romande 2007a). According to one report, many Roms leave the shelter after Christmas, being told by personnel that it would be impossible to accommodate them throughout the winter (Papaux 200 6). Women with children and minors who leave the Abri PC are lodged provisionally at the Salvation Army shelter. The political and public sentiment against Rom (and by association, Romanian) immigrants in Geneva reflects a rather explicit climate of xenop hobia. With the passing of the new law criminalizing begging (R eceuil systmatique genevois 2008), conservative lawmakers hoped to create the discomfort necessary to make beggars understand that their future is not in Geneva (Estoppey 2007). Immediately after the law was passed, those responsible envisioned a systematic census taking in which cantonal and municipal agents would directly confront Roms in the streets, check them regularly, and prevent them from taking root in the same places. Furthermore, agents would apply immigration laws whenever possible, relying in particular on a clause that permits immediate expulsion of persons unable to prove they have sufficient means of
100 subsistence to stay in Switzerland (Estoppey 2007). While such practices are technically legal, they amount to a targeted application of the law that unjustly persecutes a profiled segment of the population. Young maghrbins (Maghrebi) represent another highly stigmatized group within Genevas immigrant population. In 2006, members of the citys Social and Youth Commission cited, in particular, thirty young men who pose a problem to the public order (Mino 2006). These men, who are not clandestine, are known to consume and sell marijuana in the area of the Bateau Genve a soup kitchen and social service located at the southern edge of Lake Geneva (see below). The men were recognized to be violent, but only among themselves. The Bateau Genve has made efforts to force them off their premises, and directors at the Abri PC have had to maintain order by hiring a security guard for the night (Mino 2006; Papaux 2006). Personnel at the Abri PC admitted having been forced to exclude young maghrbins from the shelter after experiencing major problems with them (Papaux 2006). As with the Roms young NorthAfricans are occasionally the victims of police abuses in Geneva a likely consequence of profiling and stereotypes of criminality and violence. In one example, three police officers were accused in February 2006 of abruptly tackling and handcuffing a 40year old Algerian man who was leaving a store (20 Minutes 2006b). The following July, the officers were investigated for abuses of authority, and for resorting to disproportionate means of arresting a man suspected of pick pocketing. Among their indiscretions failing to identify themselves or demand the mans identification, placing a blindfold over his eyes, and dragging him into an alley to
101 search his person. Once at the station, the suspect was quickly found innocent after securi ty camera images showed he was not the man who had committed the crime. Immigrants who have arrived in Switzerland illegally, or who have otherwise overstayed their duration of legal residence, do not have official documentation to reside in the country and face additional forms of discrimination and exclusion. Statistics on the presence of sans papiers are understandably difficult to collect, as few undocumented immigrants will admit to their status for fear of being arrested or deported. However, two so urces of statistics may serve to provide a demographic profile of sans papiers i n Geneva reports from the cantonal services on sanctions and deportation of immigrants, and an indepth study conducted by the External Commission for the Evaluation of Publi c Politics (S yndicat interprofessionnel de travailleuses et travailleurs 2004). This profile differs from that reported in federal immigration statistics, with over two thirds of sans papiers originating from Latin America 20% from Brazil, 17% from Colom bia, 15% from Bolivia, 14 % from Ecuador, and 5 % from Peru (S yndicat interprofessionnel de travailleuses et travailleurs 2004:30). Immigrants from former Yugoslavia chiefly Kosovo, Macedonia, and Serbia represent 6 % of the sans papiers in Geneva, while those from other countries in Eastern Europe (Romania, Poland, and the Ukraine) are growing in number. Practically all undocumented immigrants in Geneva left their countries of origin for economic reasons, with situations of escalating poverty and conflict forcing them from their homes (S yndicat interprofessionnel de travailleuses et travailleurs 2004). In most cases, they are motivated by the prospect of making enough money to send home to their families, or to finance bringing their fami lies into the country. Switzerland is viewed
102 favorably as a destination because it is considered to have a strong local labor market, high quality of life, and high purchasing power. However, upon arriving in Switzerland, most immigrants are disillusioned by the low salaries they are able to secure. In Geneva, the average monthly salary among undocumented immigrants is l ess than 2,000 Swiss francs (Syndicat interprofessionnel de travailleuses et travailleurs 2004:35). The sans papiers in Geneva are largely a young population, with a mean age of 32 years old, the majority of whom are single. Among women, greater than twothirds are single mothers. For families illegally immigrating to the canton, only onethird of their children arrive in Geneva with them (S yndicat interprofessionnel de travailleuses et travailleurs 2004). The remaining twothirds remain behind in their country of origin, to be cared for by grandparents or other family members, attending school using money sent to them by their families in G eneva. Single mothers endure social and economic situations considerably more difficult than those of undocumented men. Among these difficulties is the reluctance of fathers to officially recognize their children; many of these fathers are married men, Swi ss citizens or established immigrants (holding a residence permit). In some cases, fathers have denounced the undocumented mothers of their children, threatening to report them to authorities. Given such situations, single undocumented mothers find themse lves in a state of total precariousness and live in a sta te of permanent insecurity (Syndicat interprofessionnel de travailleuses et travailleurs 2004:32). Over 75% of sans papiers in Geneva are employed in domestic work a situation that for many women also involves prostitution (S yndicat interprofessionnel de travailleuses et travailleurs 2004). The majority of these women originate from Latin
103 America, the Philippines, and the Middle East, while those involved in sex work arrive primarily from Africa. V ery few men are employed in these activities, working instead in hotels and restaurants (10% ) and construction (3% ). To account for low salaries, nearly one half of undocumented immigrants in Geneva work multiple jobs. Social Support in Geneva Geneva is the largest city in the Frenchspeaking region of Switzerland (known as Romandie). In January 2006, Genevas population was nearly 185,000, while the population of the canton of Geneva was nearly 441,000 (O ffice cantonal de la statistique 2006a). During the same year, approximately 26% of taxations in the canton of Geneva were imposed on people whose gross annual income was 30,000 Swiss francs or less (O ffice cantonal de la statistique 2006b) roughly equivalent to the Caritas poverty line estimate of 2,450 Swiss francs per month for a single person (Monnet and Vos 2006). While this should not be considered an official estimate of the percentage of people living in poverty in Geneva, it does indicate that poverty as measured by income alone affects a size able minority of its residents. A comprehensive system of social support is offered to Genevas poor through both public and private institutions. In 2006, the city counted 26 distinct establishments (known as lieux daccueil ) that offer reception, shelter, food, medical care, employment assistance, and services for persons with special needs (including women and children, adolescents, and people dependent on alcohol or drugs) (Table 3 1). Among these are 12 emergency shelters for the homeless or those in transitional or precarious housing situations, five day centers offering reception and free meals, and three locations offering inexpensive meals. In addition, free hygienic services (showers, haircuts, laundry) are available at three locations, and one mobile, university run clinic provides
104 healthcare for people without health insurance. While not all inclusive, the following section details the more established and networked of these social services, those with the highest impact on the populations serv ed, and those that were subsequently chosen as research sites for my study. They have been divided into three categories: social assistance organizations, day centers/soup kitchens, and homeless shelters. Social Assistance Organizations In Geneva, the majority of social assistance for the poor is handled by two organizations the Hospice Gnral the citys primary public social service, and Carrefour Rue a long standing private institution that operates a large network of day centers, shelters and other points o f service. A third institution is UMSCO a unit of the University Hospitals of Geneva that delivers health and social services to the poor and people lacking health insurance. The Hospice Gnral collaborates directly with federal, cantonal and mu nicipal authorities, as well as private institutions, to realize its mission of providing social assistance to the most impoverished residents of Geneva (Hospice Gnral 2009). More than 20,000 people receive assistance from the agency, including approxi mately 4,000 immigrants seeking asylum. The agency addresses its mission through six principal activities: (1) Social and financial assistance to individuals and families without sufficient resources; (2) Reception and social intervention (including financ ial assistance) for asylum seekers; (3) Assistance and accommodation to young adults in difficulty; (4) Management of three homes for the elderly; (5) Management of an establishment for people dependent on alcohol; and (6) Prevention and communication in f avor of all categories of the population. The agency is also in charge of the Service
105 du revenu minimum cantonal daide sociale ( RMCAS ), which offers welfare assistance for unemployed residents who have exhausted their options for unemployment benefits. The demographic profile of Hospice Gnral clients reflects the national Swiss statistics on social assistance The majority of cases handled by the Hospice Gnral are women, most of them single mothers with children, who frequently suffer from insufficie nt food pensions and lack of income from employment (Bzaguet 2006). In such cases, the role of the Hospice Gnral is to help singleparent families receive food advances and to help mothers find a professional activity or training program and day care options for their children (Bzaguet 2006). Youths and young adults have increasingly turned to the Hospice Gnral for assistance; between 1999 and 2004 the number of case files for young adult clients increased by 88% (Budry 2006). In 2005, 20% of cases ha ndled were young adults between the ages of 18 and 25. The main difficulties faced by young adults are employment and lack of education or training. On a positive note, the average duration of assistance for clients between 18 and 25 years old is considera bly shorter than that for other clients (by approximately onethird) (Budry 2006) The most well established private association for the poor in Geneva is Carrefour Rue which operates a number of distinct establishments and programs for the homeless and impoverished (Carrefour Rue 2009). Carrefour Rue w as founded in 1995, after 20 years operating under the name Carrefour an organization for prevention and social action that worked in the prisons and streets (Carrefour Rue 2006:6). Its shelter, the C oulou was opened in 1986 to house up to 30 homeless people for an unlimited duration of stay (although 90% of guests stay for six months or
106 less). By the end of 2006, the association also coordinated two transitional housing projects, three locations for the distribution of free food, three secondhand stores, two locations offering hygienic services, and one vacation facility, as detailed below: The Villas : A set of eight community homes for former residents of the Coulou of three to ten places each. Individual rooms are offered at low rental prices for an unlimited duration of stay. T he Studios : Twenty nine studio homes for individuals or couples who are ready for more autonomous living, each with furnishings and a kitchenette. T he Jardin de Montbrill ant : A soup kitchen located near the central train station, offering 150 free lunch meals per day year round. Car Touche : A stationary doubledecker bus, also located near the train station, which has been converted to a food service location that offers 50 free breakfast meals per day year round. RestoScout : A trailer operated by the scouts of Carrefour Rue that offers free dinner meals every Sunday, directly adjacent to Car Touche Aboudaby : A second hand clothing and linen store. The Cavernes dAli Baba: A second hand store selling furniture, books, kitchen appliances, and other items. The Jouetterie: A second hand store selling toys, books, games, and stuffed toys for children. The Points dEau : Two locations offering hygienic services, including showers, baths, laundry, haircuts, and health care. There is one location on each side of the Rhne ( Rive Droite and Rive Gauche). The Hameau des Chemineaux : A green space offering leisure and rest for up to a dozen people, dubbed by the association as a Club Med for the homeless (CarrefourRue 2009). Opened in late 2006, the Hameau consists of five stationary train cars (refurbished as sleeping and recreation areas), a trailer and a central tent. Guests may stay for a week end or for longer vacations, under the supervision of onsite social workers. Carrefour Rue also organizes community activities that benefit Genev as disadvantaged populations by offering them opportunities for work experience and modest compensation. These include an independent newspaper ( La Feuille de Trfle),
107 an independent radio station ( Radio sans chane) creative workshops, and rickshaws tha t circulate throughout the city for tourism, weddings, festivals, and publicity. Through collaboration with other state, cantonal and local institutions, Carrefour Rue offers temporary employment for those who seek assistance. In 2005, the association arra nged 20 temporary positions (for up to one year each) paid by the Cantonal Employment Office, which included assisting in the secretarys office, editing or reporting for the newspaper, collection and sale of secondhand items, masonry, local renovations, c ooking, and cleaning (Carrefour Rue 2006). Furthermore, in collaboration with the RMCAS Service, the association offered temporary employment for six people on welfare for up to one year each. To support these diverse service locations and community activi ties, Carrefour Rue employed seven paid full time workers (two social workers, one student social worker, an administrator, a secretary, and two cooks), two student interns, and received assistance from approximately 50 volunteers. In its provision of multiple and comprehensive social services for the poor, Carrefour Rue takes an explicitly humanistic stance, addressing the problem of prcarit (precariousness) in Geneva as both a socially constructed phenomenon and one that is best solved through acknowledging and enabling the agency of those affected. First, the associations directors recognize the seemingly insurmountable challenges faced by the poor, considering prcarit not as a disease, but as a social process of exclusion: While the stigmatized person is potentially capable and competent, he/she no longer has the strength to fight. Depending on the circumstances, it could happen to anyone among us (Carrefour Rue 2006:4). At the same time, the directors propose a more global approach, consideri ng impoverished people as human
108 beings who possess genuine internal resources with which they may improve their life situation (Carrefour Rue 2006:4). In both its actions and discourse, the association Carrefour Rue exemplifies an important counterpoint t o the stigma faced by the poor of Geneva social acceptance, charity, and empowerment. The UMSCO clinic was launched in 1996 as a pilot project by the universitys Department of Community Medicine, with the mission of improving access to health care for Genevas uninsured and under insured (Wolff 2004:5). The timing of this effort coincided with changes to Swiss federal laws that made health insurance a requirement for obtaining a residence permit (R ecueil systmatique du droit fdral 1996). Insurance co mpanies interpreted these changes strictly, instituting practices to exclude all undocumented immigrants from access to health insurance. Although both cantonal and federal laws have since been passed (in 2001 and 2002, respectively) that require insurance companies to accept applications from undocumented immigrants, UMSCO estimates that 90 to 95 % remain uninsured because of difficulties paying insurance premiums (Wolff 2004:8). UMSCO has since become an important (in most cases, the only) source of health care for many of the estimated 8,000 to 12,000 undocumented immigrants in Geneva (Wolff et al. 2005). In 2003, 89% of the clinics patients were without residence papers, with the majority originating from Latin America (58% ), including Bolivia (20% ), Brazil (11 % ), Colombia (10% ), and Ecuador (9% ) (Wolff et al. 2005:36). Most of these patients are women, frequently in need of prenatal and postpartum care (Wolff 2006). The UMSCO clinic also serves a second distinct population, composed primarily of men (80 % ) between 20 and 60 years old who frequent the citys day centers and
109 homeless shelters (Wolff et al. 2005:2218). These patients, referred to as grands prcaires (in great precariousness) have little formal education or training, high levels of unemp loyment, and a high prevalence of psychiatric comorbidities, alcoholism and tobacco use. In 2003, the grands prcaires treated at UMSCO had an average age of 42 years old, and nearly 60% were of European origin, including 32 % of Swiss nationality (Wolff 2 004). However, despite having legal residence in the country, only 28% had valid health insurance (Wolff 2004). The estimated 300 to 400 grands prcaires who live in Geneva may be grouped into five categories: (1) the marginalized, whose condition of pover ty is linked to family rupture, job loss, and illness; (2) those with problems of addiction and substance abuse, who frequently receive disability benefits from the AI ; (3) young adults with psychological problems, including many who have cut ties with the ir parents and did not finish their education; (4) female victims of domestic violence, notably women of foreign origin married to Swiss men, who fear losing their legal status if they leave their homes; and (5) the working poor, who, due to their unstable employment situation, rarely have access to housing (Wolff 2004:1617). The clinics delivery structure is based on the concepts of interdisciplinary care (nursing, medicine, and social work) and gatekeeping with nurses initially consulting with social service clients and referring them to medical doctors if necessary. In turn, the clinics medical doctors will refer care to specialists and to hospital services when costly exams and treatments are necessary. Patients therefore have three levels of acces s to care: (1) nursing consultations in various social service locations in the community; (2) an outpatient community clinic, located one floor above the Club social rive gauche ( CSRG ) soup kitchen (see below); and (3) the Policlinique de m decine (medica l
110 outpatient clinic) within the cantonal hospital. In traversing these levels of access, the clinic integrates patients into a network of community care and works to improve communication among providers. To facilitate delivery of care, UMSCO also emphasiz es assessment of needs through epidemiologic research of the populations it serves. In 2005 and 2006, UMSCO nurses consulted with patients at approximately 10 social service locations throughout the city on a weekly basis, including the Coulou (shelter), the Coeur des Grottes (womens shelter), CSRG (day center), the CAR (day center), the Jardin de Montbrillant (soup kitchen), and th e Bateau Genve (s oup kitchen). The sites, particularly CSRG became important locations for my study, largely through my initial collaboration with UMSCO As the institutional sponsor for my research, UMSCO offered me a glimpse into the practices and processes of community health care in Geneva, a convenient and safe location to conduct interviews with informants, and most importantly, an opportunity to familiarize myself with Genevas social service locations as I accompanied the nurses on their rounds. It was through UMSCO that I gained access to many of the service locations discussed below and to the diverse populations liv ing in poverty in Geneva. Day Centers and Soup Kitchens Among those services most actively and regularly used by Genevas poor are the day centers private and public establishments that offer reception and free meals. The two social clubs run by the ci ty of Geneva CSRG ( south of the Rhne) and Club social rive d roite ( CSRD, north of the Rhne) are open throughout the year, most days of the week, and offer activities, contacts with social workers and healthcare professionals, social company and an open ear (Papaux 2006). Known formerly as
111 Square Hugo, CSRG serves approximately 250 free meals per day, in a dining hall that can accommodate from 100 to 120 places (Papaux 2006). Breakfast is offered five days per week (Monday through Friday), while a hot lunch is offered every day of the week except Sunday (Ville de Genve 2009). Throughout the day, guests may also obtain various hot and cold beverages, including coffee, espresso, herbal teas, and sirop (fruit syrup mixed with water). The role of the soci al workers at CSRG is to guide the homeless and other guests in the steps they must take to find shelter, as well as assist in the creation and maintenance of links between clients and their families (Papaux 2006). For people in situations of extreme prca rit CSRG also allocates and manages emergency housing for short periods of stay (Ville de Genve 2009). Lastly, the day center is a site for social activity both informal and formal. Guests are permitted to stay beyond food service hours to socialize, play cards or chess, rest, and consult with social workers. CSRG therefore serves multiple functions for Genevas poor as a soup kitchen, social service, and social club. Appropriately, the location is characterized by an atmosphere of conviviality, part icularly during the winter holidays; as one reporter noted: With its imposing Christmas tree, its orange linoleum, its photos hung on the wall, its rock music in the background, Square Hugos lounge could resemble any restaurant in the area (Le Courrier 2004). The CSRG day center is located in the same building as UMSCO with the former at ground level and the latter on the second floor. It is partly for its proximity to the mobile clinic that CSRG was selected as my primary study site. The day center serves a broad demographic including both undocumented immigrants and grands prcaires
112 potentially because it is a convenient location for many of the clinics patients to wait for their appointment s. During nearly one year of participant observation at CSRG I played the role of both volunteer and guest, collecting ethnographic data using methods that are described in more detail in the following chapter. The citys largest day center is a privately run, churchbased establishment known as the CAR an acronym for caritas, accueil, rencontres, changes [ charity, reception, meeting, and exchange] Established by Caritas Genve in 1977, the CAR accommodates a larger number of guests than either o f the city run social clubs, serving one daily afternoon meal to approximately 150 people (CAR 2004; Arsever 2006). In addition to functioning as a soup kitchen, food bank, and center for social assistance, the day center provides free afternoon workshops in activities such as carpentry, painting, bike repair, pottery, and music. Extramural athletic activities include swimming, ice skating, basketball, football, and badminton. The CAR is one of three locations in Geneva that offers free showers and haircuts. One of Genevas more unique points of service for the poor is the Bateau Genve a day center located on a large steamboat that is permanently moored on the south side of Lake Geneva. Established in 1974, the Bateau (as it is referred to by locals) opens at 7 a.m. six days a week to serve free breakfast, and remains open for a free evening meal twice a week (A ssociation pour le Bateau Genve 2009). The service accommodates between 80 and 150 people daily, who benefit from the presence of four part t ime social workers, weekly discussion groups, and a weekly computer workshop. The guests known as passagers (passengers) are also given the opportunity to work on the boat on a day to day basis, at the rate of approximately 16.5 Swiss francs
113 per hour ( Association pour le Bateau Genve 2009). Work is generally for the upkeep and renovation of the boat, which at over 100 years old is in periodic need of painting, treatment for rust, waterproofing, and general maintenance. Compared with Genevas other day centers and soup kitchens, guests of the Bateau are primarily men, the majority young maghrbins As described above, due to the boats proximity to the Jardin Anglais many of these men are known to engage in drug dealing and other petty crimes, giving th e Bateau a reputation of being one of the citys more dangerous points of service. At night, the Bateau transforms into a social venue for the general public, hosting film screenings, music events and private parties. As described above, the Carrefour Ru e association operates the Jardin de Montbrillant a soup kitchen located near Genevas central train station in a building made available by the city (Carrefour Rue 2006). The Jardin de Montbrillant is a smaller space than either CSRG or the CAR servin g approximately 150 lunch meals per day throughout the year. On the first Friday of each month, the soup kitchen also distributes free clothing to those in need (Carrefour Rue 2009). Homeless Shelters Homeless shelters in Geneva are understandably at their most active during the winter months. For example, the Abri Protection Civile ( Abri PC ), whose explicit mission is to offer shelter to those with no other reasonable options for housing and to protect them from the cold (Papaux 2006), is open only during winter (from November 18 to March 31). With approximately 100 beds, the Abri PC is Genevas largest homeless shelter, and will accept any adult person in need, provided they respect the rules of the shelter: no drugs, no alcohol, and no weapons (Papaux 2006). Dogs, who frequently accompany the homeless of Geneva, are permitted on the premises. Separate
114 dormitories exist for women, while unaccompanied minors are not authorized to stay there. Showers, hygienic products and clothing are offered to guests, as w ell as hot soup in the evening and bread, tea, and coffee in the morning. In addition, the shelter operates a nightly tour of the city, in which social workers travel in a small bus to different locales throughout Geneva where the homeless are known to f requent, and offer those they encounter a ride back to the shelter (Le Courrier 2004). Each year, the Abri PC has reported an increase in its number of guests per night, from 25 in 2001 (when the shelter first opened), to 40 in 2004 (Le Courrier 2004). In 2005, this number increased considerably, with 120 guests arriving for the first night of the shelters opening (Papaux 2006). This number being greater than the shelters capacity, staff members were required to place mattresses on the floors to accommodate the surplus of guests. During the winter of 20052006, more than 700 homeless people were estimated to have stayed at the shelter; among them, twothirds were undocumented immigrants, and a markedly greater number than in previous years were reported t o have health problems, both physical and psychological (Papaux 2006). Many of the shelters guests arrive from neighboring France, reporting that in the French metropolises of Paris and Lyon, the possibilities of finding shelter from the cold are consider ably fewer According to Isabelle Widmer, assistant director of the citys social services, the recent increase in homelessness in Geneva is likely linked to the hardening of laws on asylum and decisions by immigration officials to reject applications for asylum producing a new class of clandestine immigrants known as NEM s ( non entre en matire) (Papaux 2006).
115 Another important emergency shelter is the Arme du Salut (Salvation Army) Accueil de Nuit which can accommodate up to 40 homeless people for a limited stay at 15 Swiss francs per night (A u C oeur des Grottes 2009). The Salvation Army shelter takes in men, women, and children accompanied by adults, with one floor reserved for single women or women with children. Accommodations include soup in the evening a nd a breakfast meal in the morning. During winter, the shelter has extended hours (remaining open until 9 a.m, and 11 a.m. on the weekends) and offers a hot meal at noon. Guests are also offered showers and relatively private rooms, with two beds each. Thus, for those who can afford the out of pocket cost, the Salvation Army shelter presents a more hospitable setting than the larger, more institutional Abri PC The Salvation Army also operates a womens shelter known as the Coeur des Grottes which offers lodging and psychosocial accompaniment for single women (and their children) who find themselves momentarily confronted by a situation of prcarit : family problems, domestic violence, or return from abroad (A u C oeur des G rottes 2009). The Coeur des G rottes can accommodate about thirty women for 84 Swiss francs per night a cost that is adaptable to the individual residents income and life situation. Women are accepted into the shelter without regard to legal or social status, and stay for a variable amount of time, generally until they have secured stable employment or housing. Residents are offered morning, noon, and evening meals, which they frequently prepare themselves as part of a community living model. As described above, the Coulou the t ransitional shelter operated by Carrefour Rue has housed up to 30 homeless people at a time for over 20 years (Carrefour Rue 2006). Originally a clock making factory, the building was made available to Carrefour -
116 Rue by the city of Geneva and converted to a shelter with multiple sleeping rooms, a central dining and living area, and a kitchen. A separate sleeping area is offered to single women. As with the Coeur des Grottes the Coulou operates under a community living model, with residents taking responsi bility for their activities of daily life (with the assistance of social workers and volunteers). There is no cost to live at the Coulou although space is limited and housing offers are granted on a caseby case basis. While residents may stay for an unli mited duration, only 10% stay longer than six months. Social Support as a Response to Stigma The social assistance organizations, day centers, soup kitchens, and homeless shelters described above represent only a selection of the institutions for social support offered to Genevas poor. This selection was based on their relevance for and impact on the various populations living in poverty overall, as well as their accessibility for conducting research acknowledging that all functioned as research sites at some point during my time in Geneva. A more comprehensive listing of social support institutions is provided in Table 31. In a city center with a population of less than 200,000, the comprehensiveness of its social support system is striking, and speak s volumes about the level of effort that many citizens undertake to address issues of poverty. Without question, this effort originates from a humanitarian standpoint, which implicitly opposes the stigma originating from other sources in Swiss society. In many of these institutions (as with Carrefour Rue ), poverty and prcarit are viewed as socially constructed phenomena the product of larger socioeconomic processes that are beyond the control of the individual. In the case of UMSCO health is considered a human right that is frequently suppressed by political and economic enterprise; improving access to health care for the poor is, to a certain extent, a matter of finding
117 the legitimate pathways through which the poor may circumvent t hese opposing political and economic forces. At the same time, social support in Geneva also places emphasis on the agency of the individual in improving his/her life situation. Most of the institutions described above have some component of self sufficien cy in their mission statements or modes of operation. It is not enough to assist the poor by giving them lifes basic necessities; long term solutions require improving access to education and training, and helping people to develop the skills they need to thrive in the greater community. While my study focuses on the stigmas faced by those who live in poverty, it is nevertheless important to acknowledge the culture of acceptance that supports them. For many, having a comprehensive system of social support may function to relieve the overall burden of stigma they experience in daily life. However, as shown in the following chapters, stigma whether real or perceived can also occur within the context of these social service settings. Such instances are of particular concern because they may both dilute the protective effects of social support on identity and generate fears among those so affected, resulting in a decline in helpseeking and service utilization.
118 Table 31. Social service locations in Geneva, 2006 Service type Client base Cost Amenities / Conditions Arme du Salut Accueil de Nuit Emergency shelter Anyone 15 CHF / night Soup, breakfast, showers Limited duration of stay Abri Protection Civile Emergency shelter Anyone Free Soup, showers Limited duration of stay La Coulou Shelter (transitional housing) Anyone Free 15 30 places Breakfast, dinner Unlimited duration of stay La Virgule Shelter (transitional housing) Anyone Free Lodging in trailers Showers, kitchen, food Social worker consultations Le Racard Shelter (transitional housing) Anyone 100 CHF / night Meals, breakfast Psychosocial support for people with chemical dependencies psychiatric problems and victims of physical abuse Renewable 3month duration of stay Communaut dEmmas Shelter (transitional housing) Men Free Reception center Work stay program Medical consultations Administrative service Unlimited duration of stay Au Cur des Grottes Shelter (transitional housing) Women 84 CHF / night Three meals daily Duration of stay determined by interview Accompaniment for women with or without children
119 Table 31. Continued Service type Client base Cost Amenities / Conditions La Halte dEmmas Femmes Shelter (transitional housing) Women Free Reception center Work stay program Medical consultations Administrative service Unlimited duration of stay Infor Jeunes Appartement Gabrielle Sabet Shelter (short term) Young adults 10 CHF / night Renewable 1week stay Foyer lEtape Shelter (short term) Children and adolescents 18 CHF / night Educational assistance Psychological support Placement of minors without guardians Onemonth stay Foyer le Pertuis Shelter (short term) Young adults 18 CHF / night Educational assistance Psychological support Onemonth stay Foyer le Pont Shelter (short term) Adolescents 18 CHF / night Reception center Socio educational support Placement of minors without guardians Onemonth stay Car Touche Meal service Anyone Free Breakfast RestoScout Meal service Anyone Free Dinner Club social rive droite Meal service Anyone Free Reception center Breakfast, lunch Social company Club social rive gauche Meal service Anyone Free Reception center Breakfast, lunch Social company
120 Table 31. Continued Service type Client base Cost Amenities / Conditions Le CAR Meal service Anyone Free Late afternoon meal Events Workshops Showers and haircuts Medical consultations Le Jardin de Montbrillant Meal service Anyone Free Lunch Le Bateau Genve Meal service Anyone 2 5 CHF Breakfast and lunch Work compensation La Galerie Meal service Anyone 6 8 CHF Brunch on Sundays Trait dUnion Meal service Families 5 CHF Reception for parents (with or without drug or alcohol dependence) Workshops Nursery Meeting space Les Colis du Coeur Meal distribution Anyone Free Distribution of foodstuffs by recommendation of social services Point dEau Rive droite Hygiene services Anyone Free Toilets and showers Haircuts, pedicures Dental and eye care Laundry Point dEau Rive gauche Hygiene services Anyone Free Toilets and showers Laundry Unit Mobile de Soins Communautaires Medical and social services People without health insurance Free Healthcare center Mobile health care to social service locations
121 CHAPTER 4 RESEARCH APPROACH: QUESTIONS, INFORMANT S, PLACES, AND METHO DS This dissertation reports on a oneyear ethnographic study of poverty and stigma in Geneva, Switzerland. Research questions and approaches to data collection were based on Link and Phelans stigma concept, which defines stigma as the cooccurrence of labeling, stereotyping, separation, status loss, and discrimination (2001:363). I focused broadly on the concept of stigmas of poverty defined as the set of socially discrediting personal attributes whether physical, mental, or behavioral that are either directly or indirectly associated with a persons condition of poverty. The methodology comprised a concurrent threephase approach that involved participant observation, qualitative interviews with a significant narrative component, and cultural domain analysis of personal label s for people in poverty. Because this study was conducted in a Frenchspeaking culture, the French term prcarit (precariousness) was chosen as an appropriate substitute for poverty While a direct translation of the word povert y exists in French ( pauvrt), initial work in the field revealed that this term would not capture the local meaning and experience of living beneath the norms of material wealth and social participation. Furthermore, the French term pauvrt carries its own stigma, and its corresponding personal label, pauvre (a poor person), can be derogatory when used outside more intimate social contexts. The term prcarit, on the other hand and its corresponding personal label, prcaire have seen increasing use i n academic, medical, and popular discourse. The term captures the uncertainties that accompany individual and community experiences of poverty and the sense that a persons condition could become worse. While the working poor are at risk of becoming unempl oyed, the unemployed are at risk of becoming
122 homeless. In turn, the homeless are at risk of physical harm from exposure. In addition to inadequacy of material wealth, prcarit addresses more explicitly the influences of physical, mental and emotional disability, social isolation, and concepts of vulnerability to structural forces. I return to a more thorough analysis of the term prcarit in Chapter 5, which presents results of the cultural domain analysis. Research Questions The general aims of this s tudy were to qualitatively explore: (1) the cultural processes involved in stigma of the poor, and (2) the shared cultural understanding of prcarit, and its personal label prcaire both for the aim of informing applications for practice and future st udy. Five sets of research questions grounded this work: 1 Who are the poor of Geneva, and in what social contexts do they experience stigma in their daily lives? Where, when, against whom, and by whom does stigmatization occur? 2 How do the poor respond to af fronts to thei r identity, and to what degree do they express internalization of or resistance against their stigmas? 3 Among the poor, which groups experience a greater burden of stigma, and which are more susceptible to its detrimental effects? 4 To what extent does stigma occur in Genevas social service settings? 5 Through what personal and cultural pathways can poverty related stigma lead to mental disorder in vulnerable persons or groups? In choosing these research questions, I considered potential contribut ions to both theory and practice. The first set of questions ( Who are the poor? In what context do they experience stigma?) addresses my studys descriptive aims, allowing for the construction of a map of poverty and stigma in Geneva and a profile of the individuals and groups affected by it. These function not only as a necessary starting point for the
123 studys remaining obje ctives, but as a basis for comparison with vulnerable populations in other societies. Question 2 ( How do the poor respond to stigma?) incorporates actor oriented theory into the working concept of stigma, acknowledging that people or groups are not passiv e recipients of labeling, stereotyping, and discrimination, but can and do actively participate in shaping their experiences and, consequently, their identities. Question 3 ( What groups are more susceptible to stigma?) and Question 4 ( To what extent does stigma occur in the social services?) a ddress issues of local practice. Question 3 is formulated to allow policy, social service, and medical professionals to identify people with the greatest need for targeted interventions that c ounter stigma, while Quest ion 4 addresses practices within Genevas social services that may contribute to the burden of stigma faced by the people they assist (Question 4). In answering these questions, my aim is to provide those who work with vulnerable populations locally with r ecommendations on how their policies and practices may be changed to promote social inclusion, empowerment, and self worth among the poor. Lastly, Question 5 ( How might stigma lead to mental illness?) has been posed to provide testable hypotheses for fut ure analytic studies exploring the associations between stigma and mental health. While statistical associations between discrimination and mental distress, for example, have been established in epidemiologic studies (Krieger 1999), less is known of the mechanisms or processes that link them. In this paper, I contend that these mechanisms are based on the demographic and cultural profile of the person affected and the nature of the stigma whether, using Goffmans typology, it is visible or hidden, physic al or character based, and tribal or acquired.
124 Informants The intent of my study was to capture the diversity of cultural and social experiences shared by people in prcarit I sought a broad range of possible stigma experiences and identities, which mi nimized the limits on eligibility for the study population. I chose to include in my observations any person who would be informally qualified as a client or guest of the social service institutions I would frequent, with no restrictions on age, gender ethnicity, or nationality. Taking microethnographic approaches to observation, I began with the assumption that stigma processes are necessarily based on interactions between two or more actors (or in some cases, between actors and their environment). B road standards of inclusion were therefore necessary to capture the full range of day to day interactions that could be qualified as stigmatizing. To improve the representativeness of the sample, I also extended my work beyond the doors of the social ser vices, and into the streets, parks, public venues and festivals, and public transportation. Efforts to involve street based observation and outreach were based on the likelihood that many of Genevas poor who spend their time in the streets may not frequen t the social service institutions. Theoretically, stigma may play a role in why a street person chooses to avoid the citys shelters and day centers; street based observations were therefore crucial to avoid this selection bias. This subgroup was more diff icult to define and restrict, because fundamentally it is impossible to determine with certainty a persons situation of prcarit. I based my selection of individuals and groups on two characteristics: 1 Outward appearance: including people who did not meet the cultures conventions of dress and hygiene and/or whose dress identified them with a cultural group associated with prcarit (e.g., punks Roms );
125 2 Behaviors: including people who engaged in begging or performing for money, hoarding possessions in publ ic (for example, in niches or grocery carts), searching through garbage bins or otherwise scavenging for discarded resources, erratic or bizarre behaviors that may indicate a psychological disorder (including talking to ones self), openly selling or using drugs, or drinking alcohol at a time or place that deviated from cultural norms. While my intent was to promote representativeness, I recognize that in settings such as soup kitchens, homeless shelters, and streets, access is limited to individuals who ar e approachable for an anthropologist (Glasser 1988). Among the limitations of this study is that certain groups remain unrepresented, including the violent, the severely mentally ill, and sex workers. Difficulties in gaining access to marginalized and dest itute populations have been recognized by a number of anthropologists who have worked with the homeless (Spradley 1970; Cohen & Sokolovsky 1989; Gaboriau 1993). Because those who are least approachable may face the greatest burden of stigma, the scope of m y study for understanding stigma among the poor should be considered broad, but not complete. The citys social and health service workers were also considered as informants, given their important role as actors in the daily lives of their clients and t he distinct possibility of their participation in instances of discrimination. In observations, the words and actions of social service workers were considered to be as important as those of clients and guests, especially during moments of interaction between the two groups. Furthermore, their regular, long term contact with Genevas poor allowed social service workers to provide a more comprehensive perspective of the different stigmas of poverty evident in Swiss culture, as well as details on the structure a nd functioning of the citys social service institutions. Social service workers included institution directors, nurses, social workers, other social service staff (e.g., receptionists), and volunteers.
126 Informant Demographics During the course of my fieldwork, I observed and participated in interactions involving hundreds of individuals. Among them, more detailed information was collected on 55 informants whose contributions I considered most relevant. These included informants whom I knew by first name and with whom I had frequent contact, informants who participated in an ethnographic interview or cultural domain activity, or informants whose stories otherwise addressed issues of stigma in exemplary ways. For each I assigned a pseudonym and collected basic demographic and background information, including gender, age, nationality, language, and occupation. Forty one informants (75% ) were identified as living in a situation of prcarit either in social service or public settings. They represented a broad spectrum of occupations and identities associated with poverty from students, laborers and service workers to the unemployed and sporadically employed, the homeless, the mentally ill, undocumented workers, medical tourists, s ocial assistance beneficiaries (e.g., those on disability or unemployment insurance), retirees beggars, drug users and drug dealers. Eight of these informants also received social assistance in the form of contre prestation (forbenefit), which guarantees housing arrangements through the city of Geneva in exchange for volunteer service at a city run social service location, such as CSRG In some analyses, these informants were considered apart from others in the prcaire gro up because of their dual role as both recipients of social assistance (who are potentially subject to stigmatization) and workers at a social service (who are potentially a source of stigmatization to others in prcarit). The remaining 14 informants (25% ) were social and health service workers established or intraining. Social workers represented the three types of social
127 professionals who graduate from the Swiss cole sociale (social school) educators, social assistants, and animateurs (social worke rs who organize group activities and work in community centers). The demographic distributions for both prcaire and social service informants are shown on Table 4 1. Eighty percent of prcaire informants were men, and greater than half were between the ag es of 40 and 59 years old. The proportion of informants age 60 years or older was low (5%), which may partly be explained by the fact that the Swiss become eligible for retirement insurance (AVS) at age 65 for men and 64 for women (Assurancevieillesse et survivants / Assurance invalidit 2010). Forty four percent were of Swiss nationality, which included persons whose only nationality was Swiss and those who were dual citizens (e.g., FrenchSwiss, Colombian Swiss, and MexicanSwiss). Among informants of foreign nationality, seven were from Western Europe (Belgium, France, Germany, Spain, and Sweden), six were from North Africa (Algeria, Morocco, and Tunisia), and five were from Eastern Europe (Albania, Romania, and Serbia). In contrast, all 14 social servic e informants were of Swiss nationality. Among prcaire informants, the most common nonEuropean ethnicities included Arabs, Latinos, and Roms All six North African informants were Arab, as was one informant from Australia. Latinos originated from Spain, M exico, and South America. The Latino category included those who were dual citizens with Switzerland and either Colombia or Mexico. Analysis of findings from these dual citizens focused on both categories Swiss and Latino because their encounters with stigma may vary depending on whether their nationality or ethnicity is most relevant. While Latinos with Swiss nationality (and consequently, a Swiss passport) are protected from the system -
128 level exclusion that affects most immigrants in Switzerland, such as reduced access to housing and employment, they may still experience interpersonal discrimination based on their ethnicity. Two informants who self identified as Rom were from Romania. In referring to the nomadic Romani families and musicians of Eastern Europe, residents of Geneva frequently use t he French term for Romanian ( roumain) interchangeably with Rom ani (Rom ) or gypsy (gitan ). All 14 social service workers were of European ethnicity. One third of prcaire informants were Englishspeakers a likely over representation of the Swiss population that resulted from selection bias. As an Englishspeaker, I found interactions more comfortable with informants who also spoke English, and was more likely to develop a rapport with them. I was also more often approached by these informants, many of whom sought an opportunity to practice their English. Notably, fewer social service workers (14% ) had English proficiency. Selection biases may also have occurred in other demographic categories, as I was more comfortable approaching men, younger persons, and those of European and American origin. Informant Profiles My level of association and frequency of contact with informants varied, from those who appear only once in recorded observations, to key informants with whom I had regular, familiar contact most for the duration of the stu dy. Here I provide details of 10 prcaire informants and one social service informant who contributed significantly to this study. They are identified by their assigned pseudonyms, which correspond with those used in subsequent chapters. Many participated in interviews (most of them taperecorded) and detail s of their life histories are notably more complete than those presented for informants who were not interviewed. These profiles describe the
129 informants situation at the time of study, the types of social assistance they used, and whether they had a history of homelessness, unemployment, alcoholism or drug abuse, or depression. When the information was available, the profiles also include details of the informants family and educational history.1Four individuals living in prcarit (Dorin, Lucas, Nadim, and Tania) and one social service worker (Laurent) were identified as key informants. All except Tania participated in an interview. I had regular contact with these five individuals (multiple times per week) for at least four months during the study duration. Other factors they shared as key informants included: (1) directed (informant led) interaction with me in both the social services and public locations; (2) introducing me to other people, groups, and places; and/or (3) competent knowledge of the Swi ss social support system, either as care seekers (e.g., Lucas) or as providers (e.g., Laurent). Three key informants Dorin, Nadim, and Tania are presented as case studies in Chapter 7, showing the potential connections between stigma and mental health. Prcaire informants Catherine. A Swiss German woman and retired speech therapist in her 60s, Catherine frequented CSRG almost daily for breakfast, lunch, and tea in the afternoon. While she sought social company at the day center, Catherine was often alone. She spoke of no family in Geneva. Her discourse was often hard to follow, and her behavior was perceived as eccentric. She consequently faced more stigma for her mental state 1 In Switzerland, primary education is compulsory and lasts for nine years, followed by a post obligatory secondary level that includes vocational training and general education. Options after primary and secondary education include apprenticeships (that can last up to four years), higher education institutions and universities.
130 than for her state of poverty, which was likely mitigated by a pension and social assistance. Chatura. A unemployed Sri Lankan man in his late 50s, Chatura occasionally took meals at CSRG and the CAR and participated in CAR activity workshops. He had multiple health problems, including a cataract in his right eye and a hear t condition. He had few friends in Geneva, and he was sensitive to potential conflicts with other day center guests and prone to spells of weakness. David A 39 year old Swiss man who regularly frequented the CAR and CSRG David was receiving chmage a nd assistance from the Hospice Gnral at the time of his interview. He had completed his compulsory and secondary education, failed after one year in a railway apprenticeship, and had informal training in watchmaking. David had a brief history of depress ion and homelessness, which he overcame by working in contreprestation to obtain housing assistance. Dorin A 46 year old RomanianSwede who was homeless and unemployed, Dorin had been in Geneva for six weeks at the time of his interview. Dorin had compl eted only elementary school education in Romania, and had trained formally as an electrician but never received his certification. He had no friends in the city and was often depressed. He frequented CSRG for lunch and slept mostly in public parks. Isaa c A 45 year old Swiss man with a history of heroin abuse, Isaac was receiving state disability benefits ( AI ) and working contreprestation at CSRG at the time of his interview. He had completed his primary and secondary education, as well as an apprenticeship in carpentry. Isaac also had a history of homelessness, which coincided
131 with multiple changes in his support network and the beginnings of alcoholism and drug abuse. Lucas A 38 year old Algerian man who had come to Geneva to find professional work, Lucas was unemployed and ate meals regularly at CSRG at the time of his interview. He held a university diploma in food process engineering from an Algerian university, but its equivalence to Swiss standards was not recognized by potential employers. Findi ng himself excluded from the legitimate job market, he survived by working small jobs under the table. Nadim. A 25 year old FrenchAlgerian man who frequented CSRG and the Bateau, Nadim was homeless and sporadically employed at the time of his interview. He had obtained his primary education in Algeria, followed by architecture studies in France that he was unable to finish due to lack of finances. Nadim was an occasional panhandl er and had been periodically homeless in Geneva since his arrival in 1998 a situation that likely contributed to acute episodes of anxiety and depression. Paul A 47 year old German man who had lived in Geneva for over 25 years, Paul was unemployed and frequented the CAR at the time of his interview. He had completed schooling in Germany but took up no other trade, instead living as a squatter and street musician for much of his life. He had lived in Geneva undocumented for ten years before marrying a S wiss woman, which gave him residence papers and the right to Hospice Gnral aid. Paul had a history of depression, unemployment, and alcohol abuse. Rafik A 40 year old Algerian man, Rafik was homeless and unemployed at the time of his interview. He had c ompleted his obligatory education in Algeria and earned a
132 diploma as an assistant accountant. He had a history of receiving unemployment insurance both in Algeria and in Scandinavia. In Geneva, his situation was compounded by not having residence papers, m aking him ineligible for benefits. However, he used the citys day centers and shelters regularly and frequently had lunch at CSRG Tania. A 32 year old Serbian woman, former student and unemployed journalist, Tania visited CSRG often for meals. She had f ailed out of a university program she was taking in Geneva, and had also received complaints from former professors and employers that affected her ability to find work. Tania was later taken into preventive detention for making threats against others, and remained in prison for one year before being transferred to a psychiatric facility with a diagnosis of delusional disorder. Social service informant Laurent A 40 year old social animateur Laurent was codirector of the CSRG day center at the time of his interview. Laurent was an experienced and compassionate social service worker; he encouraged politeness and fairness among both the volunteers and guests of the soupkitchen, and was skilled at deescalating potentially violent situations. He was present, at times as an active participant, during a number of the stigmatizing encounters I observed at CSRG Study Sites My initial point of access to Genevas prcaire population was through the Unit mobile de soins communautaires ( UMSCO ) the mobile unit f or community health operated through the Department of Community Medicine (DCM) at the University Hospitals of Geneva. Details on the mission and operation of UMSCO have been previously described in Chapter 3. Under the guidance of the units director and chief medical doctor, I developed an early strategy of first encounters by shadowing
133 UMSCO nurses as they made their rounds to the citys shelters and day centers. I also occasionally attended the clinics weekly meetings to gain perspective on the types of problems commonly faced by their patients and their treatment approaches. Through UMSCO and the DCM I obtained the title of Scientific Collaborator at the University Hospitals of Geneva, which allowed me to apply for the ethical approvals necessary for conducting research with human subjects. Submission and approval of the research protocol through the hospitals Commission of Research Ethics was complete by the end of January 2006. My affiliation with UMSCO provided access to six social service sites: (1) CSRG; (2) the Bateau; (3) the CAR; (4) the Jardin de M ontbrillant; (5) the Coulou; and (6) the C oeur des G rottes Details on the structure and operation of these institutions are provided in Chapter 3. Of the six, CSRG, the Bateau, and the CAR became consistent sites of observation and recruitment of informants for interviews. The Jardin de Montbrillant and the Coulou both operated by the nonprofit organization Carrefour Rue were visited once each. Both UMSCO and the CSRG day center were located in the same building as my personal residence. For reasons of proximity and acces sibility to the prcaire population, CSRG functioned as my primary research site. In December 2005, I was introduced to the day centers directors and offered a position as a volunteer. During my first three months, I arrived three times per week on averag e to work behind the counter washing dishes, preparing and serving beverages to the guests, serving morning and afternoon meals, and helping to clean the facility near closing time. As I became more competent in French and established rapport with some o f the day centers more familiar faces, I spent more time in the dining room conversing and sharing meals with
134 the guests. By June 2006, I discontinued my regular volunteer duties and frequented the center as a guest standing in line with the other guests, obtaining a meal ticket and meal, and spending the afternoons in the dining room either unobtrusively observing or talking with other guests, informants, and social service workers. In December 2005, soon after I began working as a volunteer at CSRG I was introduced to the Abri PC by one of the day centers social workers. The Abri PC became the site of one single, but significant, observational session, during which I was invited by the shelters director to join him and his colleagues on their ron de (rounds) a latenight trip through the streets of Geneva in a large van to locate homeless persons and invite them to stay in the shelter. A second singleinstance observation took place in July 2006 at the site of the Hameau des Chemineaux an outdoor leisure and recreational space for the homeless operated by Carrefour Rue at the time still under construction. I was invited to visit the site by the director of Carrefour Rue and there interacted with a social worker and residents of t he Coulou as t hey worked to refurbish the facilitys train car sleeping units. Lastly, my work took me to other public and private locations that were not formally part of Genevas social service institutions. Early in the project, I observed locations at street cor ners, sidewalks, storefronts and building entrances, bridges and other spots at Lake Geneva and the Rhne and Arve rivers, shopping centers, parks, buses, and trams. In most cases, my presence at these locations was solitary and self directed. Later in the study, as I established a closer rapport with people I had met at CSRG, the Bateau, and the CAR, I wa s invited by informants to join them on excursions to various locations throughout the city. Through my connection with
135 informants such as Tania, Nadim and Dorin (whose stories are described in Chapter 7), my research took me to locations as wideranging as the cantons vineyards, a public concert, a film festival, a public swimming pool, and various cafs and private residences. Following the incarceration of a Serbian informant, Tania, I also made multiple visits to the Prison of Champ Dollon (10 kilometers from the city center) and the offices of the Hospice Gnral Figure 41 provides a map of Genevas city center showing the social service loca tions m ost relevant to my study, as well as important landmarks such as the Cantonal Hospital and the Jardin Anglais. Of the six social service locations, three the Bateau, CSRG, and the CAR were sites where I initially met the informants profiled above. P articipant Observation To gain a comprehensive understanding of the types of stigma faced by those living in prcarit, a methodology was necessary that would allow long term and wideranging access to study locations, and the capacity to gain the confidence of individuals and groups who characteristically have low levels of trust. These objectives were addressed through us e of participant observation, the central and most basic method of cultural anthropology. Dewalt and Dewalt define participant observation as a method in which a researcher takes part in the daily activities, rituals, interactions, and events of a group of people as one of the means of learning the explicit and tacit aspects of their life routines and their culture (2002:1). Thus, for a study focusing on the stigmas of populations living in poverty, my primary means of data collection involved regularly frequenting locations where such processes were likely to take place (social service
136 institutions, streets, public transportation, etc.), observing and interacting with the people there, participating in their activities, and taking notes on my experiences. Participant observation was conducted throughout the full duration of my time in the field, from December 2005 through October 2006. The focus of my observations bridged two levels: (1) that of multiple social institutions within a single community; and (2) the level of social situations encompassing respectively the macroand microethnographic approaches described by Spradley (1980:30). This division addressed both the practical and theoretical considerations of my research questions; general observ ations served to document the functioning and social dynamics of Genevas social service institutions, while more focused observations detailed the different types of stigmatizing encounters faced by those living in prcarit. Following Patrick Gaboriaus (1993) ethnography of the clochard s of Paris, taking nearly a full year of fieldwork permitted an understanding of the major and minor events that punctuate the lives of those I studied the ordinary moments, the daily and weekly activities, and in the lo nger term, the annual rhythm of life on the streets and in the social services. Fieldwork of this duration was necessary not only for establishing rapport with my informants, but for understanding prcarit in a city where the social service calendar cha nges according to the season. My level of participation ranged from passive (such as taking the role of bystander on a tram or park bench) to active (such as taking the role of day center volunteer or guest). In many cases my underlying role as a student researcher was known, which may have affected my ability to gain acceptance from certain individuals or groups either promoting or hindering my inclusion. Because most communication
137 took place in French, which is not my native language, my foreign origin was also apparent. Many individuals were informed, or correctly guessed, that I was of American nationality. These elements of my identity likely contributed to an observer effect, limiting the range of potential events to which I could bear witness. The more complete my integration into the social setting, the greater the impact my identity would have on the actions and words of others in my presence. I interacted extensively with individuals at social service sites and public locations, following three levels of interaction that naturally unfolded as part of my own integration into Swiss culture and the culture of Genevas social services. The first level of interaction was responsive, in which I listened to the conversations of others, responded t o questions (directed toward me or others), and participated in scripted encounters such as serving food or giving spare change. During times when I volunteered in the kitchen, interaction with other volunteers and social service workers was casual and spontaneous, while interaction with guests which involved primarily taking and filling their orders for coffee or tea was more prescribed. However, being a volunteer improved my ability to observe interactions among guests in the dining room, as the role allowed me to stand and watch without being obtrusive. Casual interaction with CSRG guests was more frequent when I joined them for meals and during the afternoon, when socializing comprised the primary activity. I interacted with strangers in public locat ions less frequently, usually in response to being asked for change. Such encounters occurred on sidewalks, street corners, parks, buses, trams and tram stops. The second level of interaction was directed, in which I approached others and initiated convers ations. This phase occurred concurrently with responsive encounters,
138 and became the predominant form of interaction as I improved my French language ability and familiarized myself with the city. In directed interactions, I would introduce myself, ask ques tions about the social services in Geneva, or make small talk. I would approach individuals in public locations who met one or more of my selection criteria based on appearance, behaviors, and group dynamics. Typically, as I came to recognize many of the r egular faces at CSRG and the CAR my questions became more personal. When circumstances made such questions acceptable, I would ask acquaintances to describe their lives in Geneva and the kinds of daily challenges they faced. Through both direct contact and using social service workers as intermediaries, I recruited informants for taperecorded interviews. Beginning in my third month in the field, I began participating in familiar encounters with people I had come to know and interact with on a regular basis. I developed friendships with certain informants individuals who frequently engaged or included me in conversation, invited me to share meals, and interacted with me at locations outside of the social service institutions. In sharing personal inform ation about myself, I was able to establish a more intimate level of trust with these informants and gain a more candid picture of their lives and their responses to the challenges of being poor. In some cases, I joined them in their daily movements, usual ly by foot, to different social service centers, cafs, parks, and stores. Familiar interactions were characterized by an increased level of involvement in the lives of informants. I became familiar with their daily routines, the places they frequented, and their social workers. With those who were not homeless, I visited their places of residence. With Tania, who during the course of my time in the field was
139 placed in preventive detention, my involvement extended to tangible assistance and mediation with her social service workers and lawyer. At the request of social workers at the Hospice Gnral I helped to coordinate payment of her rent, and eventually to find someone to sublease her room while she was in prison. I visited Tania in prison and maintai ned contact with her after my return to the United States via mail and email. This level of involvement may be criticized for affecting the outcome of my object of scientific study, making Tanias experiences impossible to interpret without also consid ering my own role. In terms of offering tangible assistance to informants, extended contact and escalating requests for support can put the fieldworker in a dilemma (Wolcott 2001). While aiding informants raises questions of validity, it is also increasing ly being considered an ethical obligation for fieldworkers who are closely tied with the communities they study. Following Carl Cohen and Jay Sokolvskys (1989) work with elderly homeless men in New Yorks Bowery neighborhood, my motives for conducting t his study and my responses to the findings should not be considered neutral. Furthermore, a certain emotional involvement in the lives of close informants is expected especially when dealing with vulnerable or disadvantaged populations. While emotional i nvolvement may threaten the validity of observations through selection biases (affecting the selection of events to observe or document) and distorted perception (exaggerating or understating the impact of events), it may also be considered an acceptable r isk associated with the process of building trust and rapport with informants. Harry Wolcott wrote that emotion has come to be regarded as a potential ally in our work rather than a sign of weakness in the worker (2001:59). In
140 decisions regarding my level of involvement in informants lives, I took both methodological and ethical concerns into consideration. To understand the different labels, stereotypes and instances of discrimination faced by those living in prcarit, I relied on both observed and narrated events. I considered for inclusion any observed events that were examples of direct or implied labeling and discrimination. While these involved primarily interpersonal encounters, I also made note of potentially stigmatizing situations involving the interaction of individuals with objects (e.g., signs) and systems (e.g., day center rules). Encounters where no real intent to discriminate was likely present, but where individuals may have perceived stigma due to miscommunication, cultural or linguisti c differences, or errors in perception or judgment were also noted. Narrated events were both volunteered and invited, usually by asking informants to describe an event in which they felt discriminated against. Throughout my time in the field I kept de tailed field notes of my experiences, describing my observations, my personal reaction to events, and thoughts on the societal implications of what I had observed. Field notes were written immediately after I returned from the location of participant obser vation, typically at my place of residence or the nearby university library. This strategy allowed me to avoid bringing my journal into the field and therefore reduce my obtrusiveness. However, without my journal I was unable to record conversations verbat im; as such, narrated events were condensed and their details limited to what I remembered to be most relevant after returning from the field.
141 In the case of Tania, in addition to field notes, I obtained documentation of her experiences in the form of l etters she sent to me following my return to the United States. Through this continued contact, Tania became a key informant not unlike William R. Tanner, with whom James Spradley (1970) had exchanged multiple letters during the course of his study of al coholics on Seattles skid row. Just as Spradley had received from Tanner a constant flow of insider observations of the Seattle City Jail, through my correspondence with Tania I was kept informed of events happening within the walls of Genevas Prison of Champ Dollon and, later, a psychiatric residential facility. Qualitative Interviews I conducted two phases of qualitative interviews: (1) short, semi structured interviews with six social service workers; and (2) longer, ethnographic interviews with 12 pr caire informants. Early in the study a preliminary question set was developed and used in interviews with four organization directors ( t he Coeur de Grottes the CAR Carrefour Rue CSRG ), one social worker ( the Bateau), and one assistant educator ( Abri PC ). I conducted most of these interviews during visits at the social service locations where these informants worked, and directed much of my inquiry toward their organizations structure and functioning. I also asked them to describe their clients and the types of stigmas they faced. Specific questions in these interviews included: Are there any people or groups that are not permitted to enter/use this service? In your opinion, what are the qualities of prcarit that draw the most criticism from the publi c? Why does the public stigmatize these groups? To what extent are these prejudices communicated in the media or public discourse?
142 What kinds of stigmatization of your clients or other people in prcarit have you witnessed? Can you think of a specific event? Information on stigmatized groups collected in these interviews functioned as counterpoint to the same information collected from prcaire informants, providing a more balanced view of stigma processes. A phase of taperecorded ethnographic interviews with prcaire informants began in the sixth month of the study. These permitted collecting narratives of an informants experiences living in poverty, perceptions of stigma against the poor in Swiss society, and testimonies of exclusion and discrimination. Situational context for these narratives was provided through discussions of the informants life history, current situation, and relationship with Genevas social services. Initially, a target sample of 30 informants was chosen for interviews, to be div ided into five quotas of six informants each. Sampling quotas were based on relevant subgroups of people living in prcarit including: (1) the homeless; (2) the unemployed; (3) people of marginalized ethnicity or nationality; (4) people with alcohol or drug problems; and (5) undocumented immigrants. People of marginalized ethnicity or nationality were defined as those coming from countries and regions against which institutional and informal discrimination were evident in the European community primarily the countries Eastern Europe (including Rom ania and those of former Yugoslavia), North Africa, and subSaharan Africa. After some time in the field, the third and fifth quotas were combined, as the majority of informants from these countries were also residing in Switzerland without documentation. The types of stigma affecting individuals based on their skin color, nationality, or legal status were connected to the extent that requiring separate quotas for these categories was unnecessary.
143 An interview guide was developed to cover four topic areas : (1) demographic information; (2) life history; (3) current situation; and (4) stigma. Appendix A provides the full interview guide, including the specific points of discussion and short responses elicited within each topic area. A Frenchlanguage version of the guide was developed and used as a checklist during interviews. The initial demographic section included the informants age, gender, nationality, ethnicity, and accordance with one or more of the four selection quotas. I also recorded the name of t he social service where the informant was first encountered. The remaining three sections of the interview were semi structured, and included the use of both descriptive and structural ethnographic questions (Spradley 1979). Points for discussion were int roduced by asking informants to talk about or describe their experiences and their situation, or to relate a story. While following the order of the general topic areas, within each area the specific questions and points of discussion were not restri cted to a particular sequence. In discussions of the informants life histories, I collected information on birthplace, parents occupations, education and professional training, as well as their more proximal histories of arriving in Geneva and experiences living in prcarit. I elicited the stories behind their situations of being homeless, unemployed, addicted to alcohol or drugs, or depressed. For each story, I asked informants to describe how they came into their situation, the types of assistance they received, and whether these events changed the character of their relationships with others. I began the third topic current situation by asking informants to describe a typical day in their life in Geneva. I obtained information on informants s ocial networks,
144 focusing on the individuals they interact with regularly, frequency of contact, and the character and quality of social support. To estimate the size of informants social networks, I asked them to indicate the number of people they could count on as true friends. This section also collected information about the informants experiences with the social services in Geneva, which services they used, how often, and how these services compared with those they may have used outside of Geneva. I asked informants to indicate which services they preferred and which they avoided, and their reasons for preferring or avoiding these services. Lastly, I asked informants whether they had any recommendations on how the social services in Geneva could be i mproved. The fourth and final topic stigma focused primarily on specific instances of stigma informants had experienced or witnessed. I began by asking informants to recall an instance in their lives when they were insulted, mistreated, or discriminat ed against In cases where the informant had numerous stories, I collected all instances, then asked the informant to elaborate on the event that was the most severe or unfair In cases where the informant had no personal experience to relate, I asked w hether he or she had ever been witness to an event where someone else was discriminated against I also asked informants to describe any instances of discrimination in the social services, assessing whether there were particular services or staff members who were unfriendly or nonaccepting, and whether there were any social service practices that excluded certain persons or groups and privileged others Finally, I asked informants to indicate which groups in Geneva they believed were the most stigmatiz ed and their perceptions of stereotypes in Swiss society.
145 Participants for interviews were recruited largely from the social service centers in particular, CSRG, the CAR, and the Bateau initially with the assistance of social service directors and wor kers who acted as liaisons. Most interview participants were informants I had interacted with regularly and who trusted me enough to allow their stories to be recorded. Prior familiarity with their stories in the course of my fieldwork helped facilitate the interview process. As Glasser (1988) wrote in her ethnography of a soup kitchen, long periods of repeated contact allow a persons story to come out, which also helps in learning about life cycles for example, periods of being housed and homeless, or periods of drinking and sobriety. I chose for inclusion any Frenchspeaking, Geneva resident who met at least one of the following criteria: 1 defined themselves as being in a marginal or precarious economic situation; 2 reported a period of homelessness of a t least one month in the past year; 3 reported a period of unemployment of at least one month in the past year; 4 considered themselves to have problems with alcohol or street drugs; and/or 5 reported using the citys social services for at least one month in the past year. Ethnographic interviews were conducted between April and October 2006 with 12 informants less than half of the targeted sample. Both language barriers and issues of trust made acquiring a larger sample for interviews difficult. One key in formant, Dorin, agreed to the ethnographic interview, but did not consent to being taperecorded. Interviews with two informants Lidia and Daniela were conducted by a trained student research assistant from the University of Geneva, Department of Sociology. Cultural Domain Analysis This study also sought to explore emic community understandings of the different types of personnes en situation prcaire (people in a precarious [life] situation) and the labels affixed to them in Swiss society. This domain may also be qualified as people in prcarit (as an acceptable English translation), and analyzing it using
146 cognitive methods is a useful strategy for understanding who comprises the poor of Geneva (Research q uestion 1) and which groups among them experience a greater stigma burden ( Research q uestion 3). Cultural domain analysis involves a sequence of data collection efforts, with the results of one process informing the design of the next. I used three techniques that are described briefly in this chapter, all conducted using Anthropac software (Lexington, KY: Analytic Technologies). Because of the iterative nature of this methodology, a full description of how the cultural domain was measured in the field is detailed in Chapter 5. Cultural domain analysis is the study of how members of a particular group think about lists of things that somehow go together (Bernard 2002). It is a way of describing and understanding culture at the linguistic level by objectively measuring the amount and distribution of cultural knowledge in a group of informants (Romney et al. 1986). The methodology focuses on a single domain of cultural knowledge that can be broken down into components types or variations of things within the domain with the goal of understanding how people structure the relationships among those things. Through cultural domain analysis, researchers elicit a folk taxonomy of items within a dom ain and determine the extent of cultural consensus or disagreement among informants regarding that taxonomy (Bernard 2002:282). I began the process by asking a small sample of informants (N = 44) stratified to represent people in prcarit (n = 26) and the members of the general public (n = 18) to list all the labels they could think of for people in prcarit (the domain in question). This free listing technique is a standard, objective way to obtain a meaningful sample of items in the domain that is nearly free of investigator bias (Romney 1999: S112). It
147 has been used by James Spradley (1970), who elicited lists of the different kinds of tramps from homeless persons living in Seattles Skid Row. Because prcarit was not defined for informants prior to the activity, replacing kinds of with labels for allowed me to explore both the social identities of those in prcarit (whether ethnic, national, medical, or cultural) and the acceptability of terms used to identify them (from formal, accepted terms to informal, stigmatizing ones). By combining the responses of all informants, I obtained a master list of labels from which other techniques could be used to elicit their structure within the domain. For the next step, the 34 most frequently lis ted labels were selected for pile sort activities, in which I showed informants a deck of index cards, each with a different label printed on it. Twenty seven informants stratified to represent people in prcarit (n =13) and members of the general publi c (n = 14) were asked to make piles of cards to indicate which labels were most similar. This technique produces item by item similarity matrices, which provide correlation statistics for every combination of two terms, for both individual informants and the aggregate sample. The aggregate matrix functions as a kind of answer key to the taxonomic structuring of items in the domain. Differences in domain structuring can be compared between groups of informants, for example, between men and women, and between young and old. Overall consensus scores determine the homogeneity or degree of agreement among informants, answering the question of whether the domain being studied is culturally valid. A third step involved label comparison tests using a smaller number of items in the domain with twenty five informants stratified to represent people in prcarit (n = 13) and members of the general public (n = 12). Paired comparisons explore how
148 informants perceive items according to a particular dimension or quality, and can be used to develop a ranking of the items on that dimension both for individual informants and the aggregate sample. Based on insights gained during the prior two activities, 11 of the most salient labels were chosen for comparison accordi ng to two dimensions: (1) severity (Which term is more insulting?); and (2) frequency (Which term is heard or used more often?). I obtained two ranked lists from analysis of the paired comparisons one ranking the 11 labels according to severity, and the other ranking them according to frequency. These rankings could help assess the stigma burden carried by the different labels and reveal differences in how people perceive the domain. In application, rankings could be used to help social and health ser vice workers improve their communication with people in prcarit and minimize the risk of unintentional stigma. Methods of Analysis The qualitative data produced by participant observation and interviews were accessed for analysis through field notes and transcripts, respectively. Both formats had a combination of French and Englishlanguage text, which necessitated manual coding without the assistance of qualitative/text analysis software. Grounded theory was used to explore these texts for the categories and themes associated with labels, stereotypes, and stigmatizing encounters relevant for people in prcarit. Labels and stereotypes were analyzed and presented in reference to findings from the cultural domain analysis in Chapter 5, while stigmatizing encounters were enumerated and profiled categorically for statistical analysis using SPSS software (Chicago, IL: SPSS, Inc.) in Chapter 6.
149 Field N otes All field notes originated in a single word processing file and were separated by date of observation into discrete units for analysis referred to here as observations Each observation was coded initially for location, whether occurring in social servic es, public or private settings. In cases where multiple discrete locations were observed on a single date, the observations were divided further to ensure that each had a single location code. Of 79 observations collected, 63% took place in a social or he alth service setting, including: o CSRG (33) o the Bateau (4) o the CAR (3) o Carrefour Rue institutions (3) 26% took place in a public setting, including: o streets/sidewalks (15) o trams (3) 4 % took place in a private setting (3), 3 % took place at the Prison of ChampDollon (2), and 5 % were recorded from telephone conversations (4). Observations were also coded according to their estimated duration (range: 5 minutes 6 hours; mean = 1.6 hours) and the number of informants present (r ange: 1 75; mean: 8). I indicated the involvement of known informants by listing them by pseudonym, which allowed me to calculate the frequency of observations in which each appeared. The four most frequently observed informants were Tania (13), Nadim (11), Catherine (8), and Lucas (6) each of whom is described briefly above. Next, I classified observations according to the most relevant informant subgroups they involved, shown alongside the same distribution for interviewed prcaire informants on Tabl e 42. An observation was considered relevant for a particular group if: (1) I observed interactions or instances involving members of the group that were useful for
150 understanding their experiences of poverty, exclusion, and stigma; or (2) I overheard rele vant conversations regarding members of the group even in their physical absence. About onethird of observations were relevant both for people of Eastern European nationality (particularly Serbs) and for people of Arab ethnicity (particularly Algerians). Greater than onethird of observations were relevant for Western Europeans (particularly the Swiss). The low number of observations that involved Roms (n = 5) understates the representation of this group in the media portrayals of prcarit discussed in Ch apter 3. It is possible that Roms face fewer instances of interpersonal stigma than popular discourse would suggest. However, this discrepancy is probably the effect of selection bias, as I was less likely to interact and establish rapport with Roms due to language barriers. With regard to conditions of physical/mental health or prcarit, observations were most relevant for informants who engaged in begging (19% ), and those who were homeless (15% ), unemployed (15% ), or mentally ill (13 % ). Ten percent of o bservations involved punk youths, which likely over represents their presence among the poor in Geneva. This discrepancy may be explained by my familiar association with a group of punk youths who regularly frequented CSRG particularly when the cultural d omain analysis was being conducted.2 2 Consequently, punk youths also had high representation in the freelist activities (15%). The group I associated with included a young Rom who self identified as Tzigane. Some observations were relevant for understanding how social and health service workers spoke about and interacted with people in prcarit, including nurses from UMSCO (6% ) and volunteers from th e citys day centers (1 3% ).
151 Lastly, observations were reviewed and coded for material relevant for understanding stigma processes against the poor. Cases where informants spoke of people in prcarit in categorical ways, specifically using personal labels that emerged from the cultural domain analysis, were coded as direct labels. Cases where informants spoke in ways that associated any of the various prcaire subgroups with negative qualities and behaviors were coded as direct stereotypes. I coded as indirect any material on labels or stereotypes that was revealed when informants discussed their perceptions of how a third party (particularly, the public) views people in prcarit. This information emerged when observing conversations between and among informants, as well as in my own conversations with them. Stigmatizing encounters were identified and coded as either observed (encounters that I directly observed) or narrated (encounters described to me by informants). Apart from this differentiation, I profiled stigmat izing encounters in the field notes using the same methods as for interview transcripts, which are described below. Interview Transcripts Transcripts of ethnographic interviews with 12 prcaire informants were produced from interviews that were taperecorded (n = 10), recorded in short hand (n = 1), or recorded using both methods (n = 1). I first coded transcripts by the pseudonym assigned to the interviewed informant, followed by a code that indicated the informants nationality, gender, and age. The distribution of interviewed prcaire informants according to nationality/ethnicity and selected conditions of physical/mental health and prcarit is shown alongside that for observed informants on T able 4 2. Interviews represented a less expansive range of nationalities than did observations. While the representation of Algerians, Arabs, and Latinos was approximately equal between the
152 two data sources, Eastern Europeans were under represented, and We stern Europeans were over represented in interviews. Fifty percent of interviewed informants were Swiss, including those with dual citizenship. Unlike the observations, which were cross sectional and typically assessed an informants state at a certain point in time, transcripts revealed the informants life conditions both at the time of interview and in their past. Furthermore, in observations it was often difficult to assign categories that were not always visible, such as alcohol/drug abuse, mental ill ness, domestic violence, drug dealing, single parenthood, or undocumented immigration. For these reasons, the various conditions of physical/mental health and prcarit generally had greater representation among interviewed informants. Unemployment and men tal illness were the most prevalent conditions, at 83% and 67 % respectively. Half of interviewed informants had a history of homelessness, and half had a history of undocumented immigration in Switzerland. Two thirds had a history of alcohol/drug abuse. Transcripts were coded following t he interview guide in Appendix A marking material related to the informants life history, current situation, and views and experiences of stigma. Labels and stereotypes that emerged or were discussed in interviews were coded as direct and indirect, following the same coding methodology as that used for observations. Indirect instances were far more common in interviews, most likely because I specifically asked these informants to describe their perception of public s tereotypes and usually elicited labels through a freelist activity. One exception is my interview with Hector, which took place at a caf on Rue Hugo de Senger directly across from CSRG Throughout the interview, Hector repeatedly called out to passersby
153 (most of them other Latinos who frequented UMSCO and CSRG ) in many cases harassing them and revealing direct instances of labeling and stereotyping. By definition, the stigmatizing encounters collected from transcripts were coded as narrated. I further distinguished narrated encounters that emerged spontaneously in the interview from those that were elicited by asking informants to describe an event in which they experienced or witnessed stigma against people in prcarit. Some informants provided more t han one elicited narrated encounter consecutively. The number of these encounters ranged from zero to four across interviewed informants. Encounters were otherwise profiled using the same methods as for observations, described below. Stigmatizing Encounter s A stigmatizing encounter was defined as any event, instance, or situation (either observed or narrated) in which a person in prcarit experienced, perceived, or could have conceivably perceived discrimination, status loss, mistreatment, or insult based on identity traits that are associated with prcarit. It was assumed that an instance of negative treatment could be directed at one or more such traits, given that multiple stigmas can affect a single person. Encounters were separated into discrete units enumerated, and coded to include the following minimum elements: (1) Encounter participants, including both the source of the stigma (the individual, institution, or system that stigmatizes) and its subject (the person being stigmatized); (2) Location of the encounter, from general entries such as Geneva or Switzerland to specific entries such as CSRG ; and (3) The action qualified as stigmatizing. In some cases, interviewed informants described a sequence of stigmatizing events as a single story tha t involved multiple sources, locations, and actions. For analysis, these sequences
154 were broken into discrete encounters and cross referenced with the others in the sequence; in this way the encounters could be analyzed both quantitatively as individual uni ts and qualitatively as a series. When the information was available, I also collected the subjects response to the stigmatizing action and any context relevant for understanding the encounter. I then coded encounters according to the method by which they were collected observed, narrated (in the field), narrated recording (in interviews), or elicited narrated recording (in interviews). Analyses of encounters were stratified by these four methods, as each method has different implications for both the validity of data and the salience of particular types of encounters for people in prcarit. E ncounters from taperecorded narratives have a greater level of detail, offering the specificity and precision of verbatim accounts. Next, all three types of narr ated encounters were coded according to proximity whether the subject of the encounter was the informant (primary) or another person being described by the informant (secondary). I also coded the subjects demographic characteristics (gender, nationali ty, and ethnicity) and their most relevant condition or marker of prcarit, which included: addiction, begging, drug dealing, homelessness, institutionalization, mental illness, physical illness, being punk Rom or a runaway, sex work, social service use squatting, undocumented immigration, and unemployment. Subjects who were social service clients were further classified according to the location for which the encounter was relevant (e.g., chmage, CSRG the CAR Hospice Gnral ). Analysis of field not es and transcripts using grounded theory revealed various categories of both encounter types and subject responses, which were subsequently
155 coded into the individual encounters. Following these recodes, I explored the possible associations between encounter components/types and response types using Pearsons chi square test for independence. Given the combination of methods used to collect encounters, assumptions of normality in the distribution of encounters could not be made. I therefore interpreted stati stical findings cautiously, considering them useful for exploratory rather than predictive purposes. Interpretation This study was designed to address a single problem using a combination of methods participant observation, qualitative interviewing, and the formal elicitation of a cultural domain. Findings from these field methods were combined with perspectives on poverty and stigma from the media and other archival sources, including popular, government, and academic publications. Given this multiplicit y of methods, an analytic approach was required that could make sense of the disparate sets of data produced. Social scientists use the term triangulation to describe how the use of several methods together will complement their respective strengths, minimize their respective limitations, and permit the cross validation of findings (DeWalt & DeWalt 2002). Combining methods also adds to the depth of research findings, as different types of data produce a complementary understanding of the problem at hand. For every type of data collected from statistics such as informants age or nationality, field notes, taperecorded narratives, freelists and pile sorts of terms used for people living in prcarit a new layer of detail was added toward understanding the life conditions of the poor in Geneva and their experiences of stigma. Triangulation allowed specific findings to be verified by assessing the concurrence or conflict of findings across methods. For example, on more than one occasion during
156 qualitative interviews, informants expressed the statement that former Yugoslavs are among the most stigmatized groups in Switzerland. This finding could be verified in a subjective sense through the study of individual cases, such as that of Tania, a Serbian woman. Likewise, the equally common interview statement that Romanians (or Roms ) are among the most stigmatized groups in Switzerland could be verified throug h study of the many articles written on them in local newspapers, the more popular of which tending to describe them in divisive and stigmatizing ways. The pervasiveness or severity of the stigmas against Romanians and Roms could be further verified through the cultural domain analysis, in which the term gitan (gypsy) appeared frequently on free lists and was also used in the pile sort activities. Cross validation was also observed for certain entries on the list of stigmatizing encounters such as a n encounter in which a soup kitchen volunteer knowingly serves pork to Muslims. I observed one possible instance of this encounter while at CSRG during a meal service, and was later narrated a more detailed instance during a taperecorded interview with Lucas, an Algerian informant. The observed and narrated encounters did not describe the same instance, so cross validation of their individual details was not possible. However, in assessing the usefulness of the encounter for understanding how soup kitchen guests experience stigma, having independent and concurring perspectives on the same type of event contributes to its likelihood of being a salient or indicative example. The two methodologies employed to collect encounters observation and narrative eli citation also increased the validity of findings by complementing their individual strengths and limitations. Observed encounters are more direct, objective,
157 and usually more detailed, but should not be considered representative of the potentially stigma tizing encounters experienced by the poor in Geneva. Because the majority of observations took place in social or health service settings (63% ), encounters occurring in locations such as soup kitchens, homeless shelters, and social assistance offices are o ver represented on the list. Narrated encounters relied on the testimony of others, making them subject to the biases and threats to validity incurred through retrospective interviewing. However, they tended to represent those encounters that were more sal ient to the informants and included a greater level of context Relying on multiple methodologies and long term immersion in the study setting helped in determining the verity of statements made by informants about themselves or about others. Repeated concurrence of statements with observed behavior and the statements of others was considered evidence that the informant making them was a trustworthy source of information. Conversely, if an informants statements had on more than one occasion been found to conflict with findings from other sources, that informants reliability was considered to be in question. Lastly, triangulation of methods allowed stigma against the poor in Switzerland to be documented and interpreted across all the conceptual components of stigma outlined by Link and Phelan (2001): labeling, stereotyping, separation, and status loss / discrimination. Participant observation permitted access to the study population in everyday settings and objective documentation of encounters characterized by status loss and/or discrimination. Qualitative interviews were necessary to understand how such encounters were framed subjectively by those experiencing them, and to place problems of stigma within a lifehistory context. Both methods also created opportunities
158 for conversations on the stereotypes and types of separation affecting the poor in Swiss society. Analysis of the cultural domain of the label prcaire allowed for a more focused and formal assessment of shared classifications of people living in prcarit, the stereotypes and labels associated with them, and the relative severity or acceptability of certain labels. Triangulation attenuates how findings as a whole are interpreted, and which findings are deemed more relevant, meaningful or useful. Those findings for which concurrence was observed across methods are emphasized because of their greater validity. Conversely, when narrated attitudes or testimonies were in conflict with observed events, related findings are interpreted cautiously. In such cases, rather than focus on the attitudes or events themselves (the verity of which are in question), interpretation shifts to the disparity of the findings, whether they are the result of an informants dishonesty, miscommunication, or misperception by the observer.
159 Table 41. Informant demographics Prcaire Social s ervice N = 41 Percent N = 14 Percent Gender Male 33 80% 8 57% Female 8 20% 6 43% Age 20 29 yrs 10 24% 2 14% 30 39 yrs 8 20% 2 14% 40 49 yrs 13 32% 5 36% 50 59 yrs 8 20% 4 29% 60+ yrs 2 5% 1 7% Nationality a Swiss 17 44% 14 100% Western European 7 18% 0 0% North African 6 15% 0 0% Eastern European 5 13% 0 0% North American 4 10% 0 0% South American 2 5% 0 0% Other 4 10% 0 0% Ethnicity b European 23 58% 14 100% Arab 7 18% 0 0% Latino 4 10% 0 0% Rom 3 8% 0 0% Sub Saharan 2 5% 0 0% South Asian 1 3% 0 0% Language c French speaking 2 8 68 % 12 100% English speaking 3 7 % 0 0 % French and English speaking 10 24% 2 14% a Percentages may exceed 100% because some informants had more than one nationality. Nationality was unknown for two prcaire informants; b Ethnicity was unknown for one prcaire informant; c English proficiency was unknown for two prcaire informants.
160 Table 42. Representation of informants in observations and transcripts Informant subgroup Observations a Transcripts b N Percent N Percent African 26 33% 3 25% North African 22 28% 3 25% Algerian 16 20% 3 25% Sub Saharan 4 5% Arab 25 32% 3 25% Asian 9 11% Eastern European 24 30% 1 8% Rom 5 6% Romanian 5 6% 1 8% Serb 14 18% Latino 13 16% 2 17% Latin American 6 8% 2 17% North American 6 8 % American 4 5 % Western European 30 38% 10 83% French 2 3% 2 17% German 1 8% Portuguese 4 5% Swiss 22 28% 6 50% Alcohol/drug abuse 5 6% 4 33% Alcohol 3 4% 2 17% Drugs 3 4 % 3 25% Disability 3 4% 2 17% Mental illness 10 13% 8 67% Begging 15 19% 2 17% Drug dealing 2 3% Homelessness 12 15% 6 50% Incarceration 6 8% 1 8% Punk youth 8 10 % Single parenthood 2 3% 3 25% Squatting 1 1% 1 8% Unemployment 12 15 % 10 83% Undocumented immigration 2 3% 6 50% UMSCO 5 6% Volunteers 10 13% a The number and percentage of observations that involved or were relevant for the indicated subgroup. Total percentages exceed 100% because observations could have relevance for multiple subgroups; b The number and percentage of interviewed informants who b elonged to the indicated subgroup. Total percentages exceed 100% because individual informants could belong to multiple subgroups.
161 Figure 41. Geneva social service locations
1 62 CHAPTER 5 LABELS AND STEREOTYPES OF PRCARIT In French, the word prcarit refers to a state of being most commonly translated into English as precariousness or uncertainty Its corresponding adjective, prcaire (precarious), can be applied generally to refer to a tenuous situation or position, an effort of questionable outcome, an unstable or irregular supply of job openings or resources, or even a dubious piece of information (Centre National de Ressources Textuelles et Lexicales 2009). In popular discourse, including language in the media, governments, and universities, prcarit frequently takes a distinctly social meaning Through this concept, the adjective prcaire may refer to both a situation of poverty and a person who lives in it. In some cases, the word may serve as a noun, as in the expression grands prcair e s (people in great prcarit) (Wolff et al. 2005) which functions as a label of social identity. However, during the course of my fieldwork in Switzerland, it became clear that prcarit encompassed more than simply a lack of financial resources, more than the experience of living in a ghetto, of being chronically unemployed or homeless. In popular discourse, prcarit also connotes the idea of exclusion from meaningful participation in social, political and economic life. A person en situation prcaire is by virtue of the term lacking in both material and social resources. For those in the lower classes of Swiss society, precariousness characterizes all aspects of life, whether it is security of food, housing, or person, physical or mental heal th status and access to healthcare, the ability to find and maintain employment at fair wages, or the size and quality of friendship and social support networks. To be in prcarit means having little control over ones own life, and having few opportuniti es to lead it
163 meaningfully Lucas, a 38year old Algerian guest of CSRG connected this concept with social injustice and the role of social services : La prcarit veut dire ceux qui ont pas le droit de construire une vie, un avenir Les services sociaux permettent quelquun de survivre, pas de vivre. [ Prcarit refers to those without the right to build a life, a future The social services allow us to survive, not to live.] Unlike poverty in English, which describes a situation of lacking, of being w ithout something that is necessary to live meaningfully (whether it be money, food, or family), prcarit describes a situation of uncertainty, of being in perpetual risk of losing the ability to live meaningfully. Thus, while both terms describe populations with very similar demographic characteristics, they allude to different challenges faced by these populations. The term grands prcaires has been used in medical and social service contexts to refer to those members of society who are extremely margi nalized those without the means to support themselves and who live solitary lives, without the support of family or friends (Wolff et al. 2005). The term is used by UMSCO as a valueneutral, acceptable label for persons who are otherwise subjected to mor e stigmatizing labels in their daily lives. As part of my study, I sought to understand the meaning of prcarit and of being en situation prcaire from the point of view of those most affected by it. What kinds of people fall under the label prcaire? What other labels are used to describe these people, and to what extent are these labels stigmatizing or acceptable? Is there consensus regarding how this domain is structured, the categories of people in prcarit, and the impact of the labels used to describe them? Furthermore, what are the most salient attitudes and stereotypes associated with these categories and labels,
164 and how do people in prcarit respond to them? With the intent of answering these questions, this chapter describes: (1) the field methods and results of a cultural domain analysis of labels for personnes en situation prcaire (hereafter referred to as people in prcarit) a domain that addresses the various social identities affected by socioeconomic marginalization and the sti gmas that correspond to them; and (2) the emic understanding of stereotypes associated with these identities, elicited through participant observation and qualitative interviews. Exploring Personal Labels as a Cultural Domain The cultural domain analysis c omprised three activities free listing, pile sorts, and paired comparisons each conducted with a sample of prcaire informants and a sample of informants from the general population to allow for comparisons in domain structuring. Prcaire i nformants we re selected for these activities using the same criteria outlined in Chapter 4, and most were recruited in social service settings (primarily CSRG ). General population informants were defined as those who did not meet the criteria for living in prcarit a nd selected by convenience sampling which introduced some selection biases, as described below By the nature of this methodology, informants in both groups also had to be fluent in French although immigrants in the prcaire group had varying degrees of proficiency, which could be indicated by assessing free list length and quality or individual competence scores generated from the pile sorting data. A total of 64 informants participated in the cultural domain analysis, although only seven (five prcaire and two general population) took part in all three activities. Onequarter of prcaire informants had also participated in ethnographic interviews However, the majority of cultural domain analysis informants (including all from the
165 general population sam ple) were excluded from additional study and in some cases, minimal information was collected on their background. This occurred partly because cultural domain analysis activities were conducted during the last month of my study, and there was little opportunity to collect additional data from informants participating in the study for the first time. At the very least, efforts were made to collect and record informants gender, age, nationality, and present occupation. Table 51 lists these in formants, pr oviding their demographic characteristics and indicating which of the three activities they completed. Within each group, informants are listed in the order in which they participated in the activities. For prcaire informants, defining occupation involved a certain degree of flexibility, as many indicated that they were unemployed, disabled, or receiving state benefits for their conditions. Activities were conducted in two waves one for collecting free lists and the second for collecting pile sorts and paired comparisons data in the same session which explains the general trend in activity grouping among informants. Collecting activities data from different samples (provided the samples are defined and recruited in the same way) is preferred, as it func tions as a crosscheck for the validity of conclusions regarding cultural consensus. Among the 34 prcaire informants, onequarter were men (76% ) and less than half (44 % ) were of Swiss nationality although two informants classified as Swiss had dual cit izenship with another country (Germany or Colombia). Their average age was 37 years old (range: 17 65 years old). The spread of nonSwiss nationalities was broad including three Algerians, one Rom, one Romanian, other informants from Eastern Europe (Poland and Czechoslovakia), and one Peruvian. However, it should be noted
166 that these nationalities (particularly Latin American nationalities) represent the majority of guests who use CSRG and other social services in Geneva, while they represented only onequarter of the sample. This discrepancy occurred largely due to language barriers. Many prcaire immigrants were not adequately proficient in French to participate in the cultural domain activities. It should therefore be understood that the terms collected represent those shared by the Swiss and French cultures and subsequently acquired by those French speakers from other cultures. Seventy percent of the prcaire informants were unemployed, including three young adults who self identified as punk, two who were receiving aid from the AI two chmeurs, one political refugee and one student. Compared with prcaire informants a smaller proportion of general population informants were men (53% ) and a greater proportion were of Swiss nationality (71% ). The average age of 34 years old (range: 20 61 years old) was comparable to that of the prcaire sample. Notably, many of those of nonSwiss nationality were French and four informants had dual citizenship with Switzerland and a Spanish speaking country (e.g., Colombia, Spain, or Mexico). Exactly half of the general population informants were in academia, whether as students, teachers, or professors. This was largely the result of the convenience sampling approach, with the dispro portionate number of university students and professors coming from within the social networks of the research assistants who helped in the activities There were notable differences between academic and nonacademic general population informants in age ( 3 1 vs. 38 years old), gender (41% vs 69% male), and nationality (80% vs. 62% Swiss). As such,
167 domain structuring in this sample is likely skewed toward that prevalent in Swiss academic discourse. Free List s Free list activities were conducted with a purposi ve sample of 26 informants considered to be in a situation of prcarit and 18 informants from the general population. Using a standardized form with 66 blank lines (three columns of 22 lines), informants were asked to list all the words or labels used for people in prcarit within a time limit of approximately ten minutes. Participants were encouraged to list terms they considered to be stigmatizing or insulting as well as those they considered to be acceptable. These instructions allowed for the collec tion of a single free list that could be used to analyze both the classification of groups within the domain (the different types of people living in prcarit) and the valuation of terms used to address them Prcaire informants listed an average of 10 labels (range: 2 67 terms), although the lower median of six labels may be more indicative of the typical response. The average was inflated by four informants who responded with greater than twice the average number of labels: an unemployed Swiss man ( 22 terms), a Swiss student (35 terms), and two punk youths from Qubec, Canada (22 terms and 67 terms). The Canadian youths had recently arrived in Geneva, and their lists were expected to contain a large proportion of local terms from their own culture. H owever, because there were only two Canadian informants, these terms were below the scree of the distribution (a threshold of low frequency) and were therefore excluded from the subsequent cultural domain activities. At the lower end of the range, eight i nformants (31 % ) provided four or fewer terms for varying reasons from boredom and indifference to the activity, to possible misunderstanding of its purpose.
168 General population informants listed an average of 23 labels (range: 9 62 terms) and a medi an of 19, considerably more than in the prcaire sample. This difference likely resulted due to discrepancies in education, with the excess terms listed in the sample representing those shared largely in academic circles. Supporting this interpretation, th e informant with the highest level of academic education in the free list activity (an economist) listed the maximum number of 62 labels. Free list data were entered into a single text file formatted for analysis using Anthropac software (Lexington, KY: Analytic Technologies). To facilitate analysis, terms were recoded using the following conventions: 1 Categorical nouns were made singular and masculine, unless accompanied by femme (woman), and all artic les were removed. For example, les rfugis (refugees) was recoded as rfugi (refugee). However, the femi nine spelling of terms such as femme battue (battered woman) was retained because these terms represent exclusively female identities. 2 Misspelled terms were recoded to be properly spelled accor ding to a standard French dictionary. For terms with more than one acceptable spelling, one spelling convention was chosen. For example, feignant and fainant are two acceptable spelling conventions for the same term (idler); for the purposes of analysis, all listings of feignant w ere recoded to fainant 3 Sentences or words that could not be used as personal labels were deleted. For example, pauperisation (pauperization) represents a social process rather than a personal qualifier and was therefore inapprop riate for the domain. 4 Abbreviations were r etained and capitalized. While SDF and sans domicile fixe represent the same identity (a person without fixed housing), qualitative interviews suggested that the abbreviated terms, when used in conversation, could be perceived as more stigmatizing than the equivalent fully spelled versions. 5 The words personne (person) and gens (people), when written before a qualifier, were considered redundant to the activity and deleted. The corresponding qualifiers were retained. 6 Phrases containing a personal label were reduced to only the relevant personal label. For example, dchet de la socit (trash of society) was reduced to dchet (trash).
169 7 Qualifying secondary terms relevant to the domain were separated from the primary ter m and listed separately. For example travailleur au noir (worker being paid under the table) was separated into two terms travailleur and au noir with au noir being a type of travailleur The decision to recode using this convention was made because some informants listed travailleur and au noir as separate terms. From the combined sample of 44 informants, a total of 387 French labels for people in prcarit were collected. A listing of the 102 labels mentioned at least twice is presented in Appendi x B showing the French term, its English translation, the frequency with which the term was listed, and its average rank or position on the informants lists. General population informants listed more labels than prcaire informants (262 vs. 202) and had a slightly greater proportion of labels that were mentioned at least twice (25% vs. 18 % ). On the pooled aggregate list, the six most frequently mentioned terms were listed more than ten times each: 1 sans papiers (undocumented immigrant ) frequency: 18 2 SDF (homeless) frequency: 17 3 profiteur (profiteer) frequency: 15 4 chmeur (unemployment recipient) frequency: 13 5 fainant (idler) frequency: 11 6 clochard (bum) frequency: 11 Among the 44 informants, there is an informal consensus that the dom ain includes immigrants, the homeless, and the unemployed. Notably, terms describing alcoholics or drug addicts were listed infrequently, with the most common alcoolique (alcoholic) and drogu (drug addict) occurring only four times each. Thus, while alcoholics and drug addicts are likely classified within the domain, they are less salient than the other three categories. There was a low frequency of terms for sex workers such as prostit u (prostitute) and pute (whore) which were listed only twice and once, respectively. It should be noted that the term SDF is an abbreviation for sans domicile fixe (without fixed domicile) which was listed by three informants. The listing frequency becomes 20
170 when both labels are combined, making SDF/ sans domicile f ixe the most frequently mentioned term. The six most common labels also represent those at varying levels of social acceptability, suggesting that the free list activity adequately captured both stigmatizing and acceptable personal labels. From participant observation and qualitative interviews, it was evident that terms such as sans papier s, SDF and chmeur were generally considered as acceptable or valueneutral ways of referring to people. On the other hand, terms such as profiteur and fainant are considered insulting, as they implicate negative traits for the people they label. In the case of profiteur the labeled person is considered to be unscrupulous and selfish someone who takes advantage of other people or the social support systems which have been established for deserving recipients. In the case of fainant the labeled person is considered to be lazy and unproductive, contributing nothing to society and likewise undeserving of the social benefits they may receive from the system. A preliminary analysis of these two terms profiteur and fainant was done to compare free list responses between the prcaire and general population samples. The term profiteur was mentioned considerably more often among informants from the general po pulation, appearing on six (23% ) of the lists within the prcaire sample and on nine (50% ) of the lists within the general population sample. The term fainant appeared on seven (27% ) of the lists within the prcaire sample and on four (22% ) of the lists w ithin the general population sample. However, a more sensitive indicator of salience may be the position of a term within each informants list, assuming that the closer to the beginning of a list a term occurs, the more salient the term is for that
171 part ic ular informant (Bernard 2002: 284). For each informant who mentioned one or both terms, the position of each term was recorded and normalized (position divided by total terms listed), producing a number between 0 and 1. Thus, the closer to zero an informant s normalized position score was for a particular term, the higher on the list that term appeared. Analysis of term position revealed that, while the term profiteur appeared less frequently on lists within the prcaire sample, its average normalized positi on (0.29) was higher than that among lists within the general population sample (0.43). Those prcaire i nformants who did list profiteur tended to list it earlier than the general population informants who listed it. The average normalized position for the term fainant was similar between the prcaire informants (0.54) and the general population informants (0.58). Sixtyeight labels (18% of total) were listed by both groups of informants. (These are listed in bold in Appendix B .) The shared labels included all the terms listed in the pooled sample four or more times, with the exception of three labels that emerged only in the general population group: immigr ( immigrant) listed six times, clodo (bum) and travailleur (worker) both listed four times. Whil e the lack of a term on the prcaire lists suggests that there may be a disparity in how the domain is constructed categorically by the different groups, review of related terms allowed for other explanations. Although they did not list immigr prcaire i nformants did list the label sans papiers (undocumented immigrant) seven times, along wit h other related labels such as rfugi (refugee) and requrant (asylum seeker), both listed twice. These informants had a clearly recognized category for immigrants in the domain, but spoke of them using more specific terms related to the immigrants condition. Furthermore, a search of
172 immigr in the LexisNexis Academic database (French Language News) returned 142 headlines, compared with 401 headlines for sans papiers and 233 headlines for rfugi.1 While prcaire informants did not list clodo the second most frequent item in their aggregate list was clochard (listed seven times) the m ore common variant from which clodo stems. Again, this would suggest that these informants did recognize a category for bums in the domain of prcarit, but had a selective w ay of talking about them. Both clochard and clodo may be considered pejorative or insulting the shorter version more so because it is a diminutive ter m used in more familiar exchanges. Review of aggregate lists revealed that prcaire informants did not consider diminutive variants of existing labels, with the exception of musico (musi cian). However, in addition to clodo general population informants al so listed: It is likely t hat the frequent appearance of immigr on the general population lists has more to do with its greater us age in academic than popular discourse. tox and toxico both familiar variants of toxicomane (drug addict), alcoolo a familiar variant of alcoolique (alcoholic), and junkie a familiar term for a drug addict borrowed from English. It is unlikely that prcaire informants were unaware of these more familiar variants, but rather that they chose not to list them. This choice may have been reflexive for prcaire informants who self identified with the homeless, drug addicts, or alcoholics, preferring not to associat e their own identities with diminutive terms. Conversely, general population informants may have been more likely to use these terms because they are external to prcarit (e.g., they have never lived homeless) ; despite their 1 The LexisNexis Academic database indexes 178 Frenchlanguage news sources. http://academic.lexisnexis.com/ accessed December 2009.
173 pejorative nature, these terms may have frequent use in the general population when speaking of people in prcarit outside their presence. The absence of travailleur on the lists of prcaire informants may reflect a real difference in the way the domain was conceptualized between the groups. With the exception of i llegal occupations such as drug dealing and prostitution, which involve a measure of risk and their own intrinsic prcarit, and one mention of au noir work related labels were largely absent from the prcaire informants l ists. However, general population informants listed travailleur four times, mostly in reference to immigrants working without legal status. It is possible that the proximity of the public to undocumented domestic labor makes this listing more likely. This pattern may also speak to the meaning of prcarit among those whose lives are touched by it. For people who are chronically unemployed, having a job even one that is under the table or unsanctioned is an improvement in life conditions, a step out of p rcarit The association of prcarit with work may therefore not have occurred naturally for these informants. Pile Sorts 34 Labels for People in Prcarit To explore how informants structured the domain of people in prcarit and determine the lev el of cultural consensus regarding its taxonomic structure, a method was required that could establish the similarity of items within the domain and their potential groupings. The 35 pooled free list terms that had been mentioned at least four times with the exception of two terms, clodo and travailleur were initially chosen for pile sorts. The research team chose to exclude clodo because it was a variant of clochard, with both terms having a high expected correspondence. Travailleur was excluded because it was a broad term that could also be used as a qualifier for persons
174 not living in prcarit. One final term toxico (drug addict) was added as a variant of both to x and toxicomane, which together were mentioned five times in the free list activity. The resulting 34 terms are shown below, in alphabetical order: 1 Alcoolique (alcoholic) 2 Chmeur (unemployment recipient ) 3 Clandestin (clandestine person) 4 Clochard (bum) 5 Dchet (trash) 6 Drogu (drug addict) 7 En difficult (person in difficul ty) 8 Etranger (foreigner) 9 Exclu (excluded person) 10. Fainant (idler) 11. Gitan (gypsy) 12. Glandeur (do nothing) 13. Handicap (handicapped person) 14. Immigr (immigrant) 15. Malade (sick person) 16. Marginal (dropout) 17. Mendiant (beggar) 18. Parasite (parasite) 19. Paum (dropout) 20. Pauvre (poor person) 21. Perdu (lost person) 22. Pouilleux (lice ridden person) 23. Prcaire (precarious person) 24. Profiteur (profiteer) 25. Punk (punk) 26. Racaille (rabble) 27. Refugi (refugee) 28. Requrant (asylum seeker) 29. Sans abri (homeless person) 30. Sans emploi (unemployed person) 31. Sans papiers (undocumented immigrant) 32. SDF (homeless person) 33. Toxico (drug addict) 34. Voleur (thief) Each of the terms was printed on a 4 x 3 index card, and the cards were numbered to permit collection of pile sorting data. Pile sorts were conducted with a sampl e of people considered to be in a situation of prcarit (n = 13) and a sample of
175 people from the gen eral population (n = 14), with demographic differences similar to those observed in the free list activity. Each informant was presented with the 34 cards (shuffled to ensure a random order) by distributing them faceup across a table, such that every card and its label could be seen. A standardized Frenchlanguage script was used to introduce the activity to th e informants and provide basic instructions. Informants were asked to organize the cards into piles by grouping cards with labels that go together Informants could make a ny number of piles provided that they did not put all the cards into the same pile (only one pile) or place each card in its own pile (34 piles). After each informant completed the activity, data were collected by recording the numbers printed on the back of the cards, with each line of data representing a different pile. Informants wer e also given the opportunity to explain the rationale behind their groupings. Data were entered into a single t ext file and analyzed using Anthropac software. Output from the analysis included: (1) an aggregate item by item proximity matrix showing the cor respondence of each term with every other term (the frequency with which two terms were placed in the same pile); and (2) a consensus analysis showing the pseudoreliability and eigenvalues of the domain and the estimated knowledge or competence of eac h informant, representing the degree to which an informants piles corresponded to the average distribution of cards. Label groupings The aggregate proximity matrix is provided in Appendix C showing frequencies of item by item correspondence ranging betw een 0.00 (terms never appearing in the same pile) to 1.00 (terms always appearing in the same pile). The correspondence of each item with itself is by definition 1.00, which may be seen as a diagonal series that bisects
176 the matrix into two identical corres pondence sets. By convention, only one correspondence set is shown. It should be noted that due to errors in data collection, seven of the 34 terms each have a listed self correspondence of 0.96. The highest correspondence values ( > 0.70) occurred among cl usters of terms representing major types of persons living in prcarit, designated by discrete social roles: 1 Immigrants: clandestin, tranger, immigr, rfugi, requrant, sans papiers 2 Unemployed persons : chmeur, sans emploi 3 Alcohol and drug abusers : alcoolique, drogu, toxico 4 Sick and disabled persons: handicap, malade 5 Homeless persons: sans abri, SDF High correspondence values within each of these clusters were expected, as terms within each cluster were roughly synonymous, suggesting that informants were using social roles as primary criteria for assessing similarities. Formal/generalizing labels : Of particular interest were more general terms for persons living in prcarit many of which have ambiguous valuations of acceptability. The lab el en difficult (in difficulty ) had high correspondence with chmeur (unemployment recipient) (0.63) and pauvre (poor person) (0.67), while chmeur and pauvre were grouped together among over half the informants (0.52). This suggested that many informants conceptually linked concepts of difficulty, pover ty and unemployment. The label exclu (excluded person) had relatively low correspondence with other labels, with the highest correspondences occurring with marginal (dropout) (0.44) and prcaire (0.44). Ini tially this would suggest that, despite a broad range of social roles considered within the domain of prcarit most informants considered such persons to be integrated members of Swiss society. The low correspondence of exclu
177 with the various labels for immigrants, which ranged from 4 to 11 % of informants was surprising, given the increasing climate of xenophobia in Switzerland and the exclusion that immigrant populations (both legal and clandestine) experience in Swiss society. Two factors could explain this finding: (1) the comprehensive system of social support for immigrants that remains despite new laws limiting their ability to enter and remain within Swiss borders; and (2) the importance of cheap, clandestine labor in Swiss society, particularly in domestic settings. H owever, it is more likely that exclu was considered a more general term that applied to all types of persons living in prcarit. Because this pile sorting activity did not allow single terms to be placed in multiple piles, informants who conceived all categories of people in prcarit to be generally excluded from Swiss society would have placed exclu in its own pile. The higher correspondence with the term prcaire another general term that applies to all categories supports thi s interpretation. It is also possible that in academic circles exclu is considered along with prcaire and marginal to be a neutral label, included in discourse through its connection to the concept of social exclusion. Indeed, in the general population the most educated informants placed these three terms in the same pile. In the case of a 43year old professor (G25), they were included with en difficult and perdu as noninsulting labels that describe precise situations, negative or not In the case o f a 26 year old professor (G26), they were included with en difficult, paum, pauvre, and perdu as labels defining a state or a situation The term prcaire itself was redundant with the activity, which was introduced as a set of labels for people in prcarit. Consequently, correspondences with this term are particularly salient for understanding the domain. Relatively high correspondences
178 ( > 0.20) with prcaire were observed for labels dealing with unemployment (chmeur, sans emploi), the homeless ( clochard sans abri, SDF), begging (mendiant), and other generalizing labels (en difficult, exclu, marginal, paum, pauvre, perdu). The point in common among these terms is that they all may be applied to Swiss citizens. Prcarit describes, above all, l ocal social and economic problems, which comprise much of what Rossini (2002) has referred to as the hidden poverties of Swiss society. Unemployment and homelessness em e rged as more salient categories of people living in prcarit than alcohol/drug abusers or immigrants. The highest correspondence betw een alcoolique and a general term was with the term paum (0.26) translated as dropout but generally defined as someone who has lost his or her way while the highest correspondence between rfugi and a general term was with the term pauvre (0.11) Informal/stigmatizing labels: Relatively high correspondence values ( > 0.20) were also observed among labels that are generally perceived as stigmatizing or insult ing, including dchet (trash), fainant (idler), glandeur (donothing), parasite (parasite), pouilleux (liceridden), profiteur (profiteer), racaille (rabble), and voleur (thief). It is probable that many informants organized cards using acceptability as a sorting criterion, although this dimension m ay not have been as salient as social roles and identities. Of special interest are correspondence values between these terms and more specific social roles and cultural terms, which can offer insight regarding the degree to which different categories of people in prcarit are stigmatized. In particular, the terms clochard (bum) and punk (punk) had relatively high correspondence with dchet
179 (grouped among twothirds and onequarter of informants, respectively) and racaille (grouped among onequarter of i nformants) suggesting that stigma may be higher against the homeless and street youths. The high correspondence between clochard and pouilleux (0.41) may have resulted from informants taking the term pouilleux literally, speaking to the popular stereotype of homeless persons as unclean. The term gitan (gypsy) had relatively high correspondence with voleur (0.26) and parasite (parasite) (0.15), alluding to stereotypes that Roms are thiev e s and, more abstractly, a harmful drain to social resources. This a nalysis allows for a more critical interpretation of public and political discourse on prcarit in the Frenchspeaking world. In November 2005, w hen Nicolas Sarkozy referred to rioters in the poor suburbs of Paris as racailles (Bacqu and Jakubyszyn 2005) in the minds of many he was implicitly labeling them as thieves and parasites bot h labels associated with racaille by greater than half of the pile sort informants. Sarkozys rhetoric also alluded to pressurecleaning the suburbs, which was by challenged as divisive by Frances liberal politicians. It implied that the suburban youths were refuse to be swept away usage that is consistent wi th the finding that the labels racaille and dchet also had high correspondence (0.44). Given the association of the suburbs and the riots with poor residents of Algerian origin, Sarkozys comments were also considered to have nationalistic and racist overtones. Aggregate grouping the answer key and its visualization Data from the pile sorts also produced an item by item consensus proximity matrix, which functions as a key representing the average distribution of cards across all informants. Based on the 27 sets of piles analyzed, the key may be interpreted as the most correct, ideal, or culturally appropriate organization of the 34 terms. Each
180 individual informants responses could be compared against this key to determine their similarity (a correlation statistic) that represents the correspondence of their piles with the ideal and may be interpreted as that informants knowledge of the domain. (A more formal approach to determining informant knowledge is part of the consensus analysis described below.) The following twelve clusters of terms represent the key to the domain of labels f or people in prcarit: Pile 1: alcoolique, drogu, toxico Pile 2: chmeur, en difficult, pauvre, prcaire sans abri, sans emploi, SDF Pile 3 : clandestin, tranger, immigr, rfugi, requrant, sans papiers Pile 4 : dchet, fainant, glandeur, parasite, profiteur pouilleux, racaille, voleur Pile 5 : handicap, malade Pile 6 : paum, perdu Pile 7 : clochard Pile 8 : exclu Pile 9 : gitan Pile 10 : marginal Pile 11 : mendiant Pile 12 : punk This analysis produced coordinates for mapping the proximities of the 34 items on a two dimensional plane, allowing a visualization of item similarities using a multi dimensional scaling (MDS) plot (Figure 51). This method provides insight into not only the label groupings, but also their relative similarities, represented by distance on the plot. Labels closer together on the plot are more similar than those farther apart. Thus, while the key places en difficult, pauvre, and SDF in the same group, from the plot it is
181 cl ear that informant s considered en difficult to be more similar to pauvre than it is to SDF. Labels with the greatest distance, for example profiteur and sans emploi, were not placed together in any of the 27 informants piles, suggesting there is a qualitative difference that keeps them separate. By revealing the spread of labels in this way, the MDS plot can also help elucidate the dimensions by which the domain is organized. In this case, it is reasonable to consider the x axis to represent the level of acceptability of the label, from most insulting to most acceptable. The cluster of labels in the lower left corner of the plot corresponds precisely with Pile 4 in the key above. Over the course of my fieldwork, I found that each of these seven words is universally considered insulting or stigmatizing some for more obvious reasons than others (e.g., trash, lice ridden, and parasite). It remained less clear how those in prcarit perceived the acceptability of labels at the right of the plot; the upper cluster represents formal and generalizing labels for the poor, including the homeless and unemployed, while the lower cluster represents various labels for immigrants. In one ethnographic interview, t he informant (Paul) considered SDF to be a strongly offensive label for a homeless person. It is possible that the x axis displays categorization by formality, rather than acceptability, of the labels as those to the far left are familiar and pejorative terms, rarely seen in print, while those to the far right are popular and academic terms written and seen in newspapers, spoken and heard in schools and clinics. Assessing the distribution of labels along the y axis, it is po ssible that informants also organized the domain according to a cultural personal dimension. Those at the bottom of the plot immigr tranger clandestin and gitan represent people of
182 foreign origin, with labels that express social or cultural identi ties. The labels at the top of the plot represent those in prcarit with addictions, impairment, or illness and more likely express personal identities, or potentially medical identities. Alternately, this dimension may represent the informants perceptio n of in group affiliation, with labels at the bottom describing people who have greater affiliation with others in their group (e.g., those sorted by implied ethnicity or nationality) than the alcoholics, drug users, and disabled people described in labels at the top. Information on medical conditions was not systematically collected from informants who participated in the pile sorts, making it difficult to determine whether this conception that the addicts and the disabled have low in group affiliation was valid. For this reason, I retain the more abstract cultural person dimension as the most appropriate interpretation. Cultural consensus and competence ratings Lastly, the pile sorting activity produced individual proximity matrices (one for each inf ormant) that could be used for consensus analysis, which assesses the validity of the cultural domain and rates informants according to their knowledge or competence within the domain. Eigenvalue statistics measure the influence of one or more factors on the construction of the domain. A domain is considered to be culturally valid (i.e., representing a bounded, single culture) if the ratio of influence between the strongest factor and the second strongest factor is greater than 3to 1. Table 52 presents the eigenvalue of the first factor, the percentage of variation it explained, and its ratio to the second factor for prcaire informants, general population informants, and the pooled sample. For all informants combined, the eigenvalue for the first factor was 16, it explained 89% of the variation in pile sorting, and its ratio to the second factor was 15to 1 well
183 above the 3to 1 standard for establishing validity. From these results it is evident that labels for people in prcarit is a valid cultural domain, both for people living in prcarit and people in the general population. However, this assumption is stronger for the general population (ratio: 21to 1) than for the prcaire population (ratio: 8to 1). In other words, there was greater agreement regarding the structuring of the domain among general population informants than prcaire informants. This difference may be explained by the greater variation in nationality in the prcaire group. Varying cultural origins likely affect the ways in whic h some labels are interpreted, and consequently lead to more differences in how they are grouped. The relative level of knowledge (or competence) of individual informants within the domain was assessed from the pooled pile sorting data. Competence scores represent the proportion of agreement an individual informant had with every other informant in the activity. Table 53 presents the competence scores for the 27 informants who participated, along with their relevant demographic characteristics. They are listed by the ID codes assigned on Table 51, in the order of most competent to least competent. Codes for prcaire informants begin with P and those for general population informants begin with G The average competence score across all 27 informants was 0.76 a fairly high level of knowledge shared by slightly more than half the sample. Among informants with competence scores greater than 0.80, nearly twothirds were from the general population. Four prcaire informants who had also participated in ethnographic interviews had a range of competence scores. Daniela (P33), Patrice (P21), and David (P04) all had competence scores of 0.75 or greater. Lidia (P31) had the lowest
184 competence score in the sample (0.33), which may partly be explained by the fac t that she had lived in Colombia a good part of her life. Correspondingly, when asked what prcarit meant to her, she responded that she thought it was a vague term. At the same time, despite her low cultural competence, she expressed her views of pr carit in ways that would likely resonate with others in her situation: Its a term that includes a lot of things... people who dont have resources, especially material ones. But they could also be relational or psychological. I think its a very vague term. And when I use it I have the impression of being locked in a prison. You put everything inside it. Its a very fixed word, a point of no return. Paired Comparisons A final phase of cultural domain activities was conducted to assess informants perceptions of labels according to the dimensions of severity and frequency Conducted concurrently with the pile sorts, the paired comparisons allowed me to explore the potential associations between selected labels and stigma both in determining how sev ere or insulting informants judged each term to be and how often they thought each term was used in Swiss society. Collecting both severity and frequency data on these labels offered a more precise estimate of the potential stigma burden these labels carry for people in prcarit. While a label may be considered extremely insulting or stigmatizing, a low frequency of social usage would mitigate its effects on the identity of those solabeled. Therefore, I considered it essential to combine these two dimensi ons for determining a labels salience with regard to stigma. Paired comparison activities were conducted with 13 people in prcarit and 12 people in the general population. The research team selected 11 labels to assess, eight of which were labels included in the pile sorts. These labels are listed below, with unique labels (those not assessed in the pile sorts) identified by an asterisk (*).
185 1 ) Dchet (trash) 2 ) Exclu (excluded) 3 ) Fainant (idler) 4 ) Inadapt* (misfit) 5 ) Incapable* (incompetent) 6 ) Marginal (dropout) 7 ) P aum (dropout) 8 ) Pauvre (poor) 9 ) Prcaire (in prcarit) 10) Profiteur (profiteer) 11) Victime* (victim) Data from the paired comparisons could potentially have allowed a property fitting (PROFIT) analysis to measure the acceptability of labels on the MDS plot in Figure 51. However, PROFIT analysis was not possible because the three labels used in the paired comparison activities that wer e not included in pile sorts inadapt, incapable, and victime had no proximity values. The research team chose to add these new terms because they are labels that challenge the concept of self efficacy. It was hypothesized that both groups of i nformants would find the terms inadapt and incapable more insulting than not, because these labels describe an individual whose situati on is linked to personal flaws and are therefore m ore accusatory. With regard to victime it was hypothesized that those in prcarit would find these labels more insulting, because the concept of victimization also denies them their agency, while those in the general population would find these labels less insulting because they acknowledge the structural nature of prcarit taking the blame away from the individual. While addressing these questions was considered more important than conducting a PROFIT analysis, the inclusion of unsorted terms should be considered a limitation of this study.
186 Worksheets were developed that listed every possible pair among the 11 labels (55 pairs in total). I first gave informants a red pen and asked them to review each pair of labels and circle the label they considered to be more insulting Then, I gave them a blue pen and asked them to circle the term in each pair that they considered was used (spoken or written) more frequently in Swiss society. Using this color coding technique, data on both dimensions could be collected on the same worksheet. Analysis involved coding each pair of labels according to the position of the label that was circled (1 or 2). This data was entered into two text files (one for severity and the other for frequency) and analyzed using the Anthropac program. For each dimension, the output included: (1) aggregate item by item dominance matrices (simple and scaled), showing the frequency with which labels in rows were dominant over labels in columns, and (2) aggregate scale values for the 11 labels across all informants, from which I obtained a single vector ranking of the items along the dimension being measured. For each dimension, labels were sorted according to their scale values, from most dominant to least dominant. Table 54 shows these rankings for severity and frequency in the pooled sample. Acros s the 25 informants, the label dchet was considered the most insulting, and substantially more so than the second most insulting label, incapable. Howev er, in the frequency rankings, dchet was the label informants considered was used the least often, suggesting that the act of calling or referring to a person as trash may be so insulting that it is usage is universally disapproved. On the o ther hand, the thirdmost insulting label, profiteur was also the third most frequent label. Although labeling a person as someone who takes advantage of others and
187 society is understood as insulting, it nevertheless occurs in Swiss society at a recognizably high f requency. The label considered to be most frequent marginal may be less pejorative than its English translation (dropout), as it emerged as one of the less ins ulting labels in the activity. Prcaire was ranked as the least insulti ng label, which helps to affirm its current usage in academic and popular discourse. However, it should be noted that the terms in this activity were introduced as labels for people in prcarit. This may have produced a form of interviewer bias in which informants assumed the researcher s preference for the prcaire label and responded accordingly. Paired comparisons data were also analyzed separately for prcaire informants and general population informants, with rankings shown on Table 55 and Table 56, respectively. For both groups, dchet emerged as both the most insulting and the least frequently used label. Also for both groups, the next three most insulting labels were fainant, incapable, and profiteur although not in the same order. Prcaire i nformants considered profiteur to be the secondmost insulting label, while general population informants considered it to be the fourthmost insulting label Both groups also agreed that marginal was the most frequently used label, while being among the l ess insulting. More differences between prcaire and general population rankings were observed for the frequency dimension, suggesting a disparity in usage for some terms between the groups. The gr eatest difference occurred for fainant, which prcaire in formants considered to be the thirdmost common label and general population informants considered to be the eighthmost common. It is possible that this word is used frequently among people in prcarit in their interactions with each other, but
188 rarely am ong members of the general population. Conversely, the term prcaire was considered by general population informants to be the thirdmost common term and by prcaire informants to be the seventhmost common term. This would suggest that prcaire is a word used more often among members of the public than among those it describes. These fi ndings suggest that the labels fainant and prcaire are less frequently used in mixed interactions those occurring between people in prcarit and members of the general population. The hypotheses regarding the three introduced terms ( those not in the pile sorts) inadapt, incapable, and marginal show mixed conclusions from comparison of the two ranked lists. While incapable was generally seen as stigmatizing by both prcaire informants (Rank 3) and general population informants (Rank 2), inadapt was located near the middle of the range, having a scale value less than zero for both groups (Rank 7 and 6, respectively). Both of these labels link prcarit to different types of personal flaws, which the informants may judge in different ways. In the case of incapable, the label describes a person who is incompetent naturally, in ways that generally cannot be changed; when used against a person it would deli ver an existential insult one of dismiss al and invalidation. The label inadapt describes a person who is a social misfit and whose flaws are the consequence of personal choices. When used against someone it delivers instead a moral insult one of admonishment and blame. From the ranking data it is clear that both people in prcarit and those in the general population consider the insult of invalidation to be more stigmatizing than that of morality. With regard to victime, I observed that the prcaire i nformants did in fact judge the label as more insulting (Rank 9) than did informants from the general population (Rank
189 11, the least insulting term). While the difference in ranking was only two, the difference in scale values was notable at 0.51 for th e prcaire group and 1.11 for the general population group. The distance from the neutral scale value of 0.00 (theoretically, a label that is neither insulting nor acceptable) was more than twice in the general population group than in the prcaire group. It should be noted that this difference was not one of directionality, but of magnitude. B oth groups of informants found victime to be more acceptable than it was insulting (with both having negative scale values for the term), but between the groups, those in the general population found it to be more acceptable. A label that denies a person his/her agency through acknowledging structural forces (and therefore absolves them of blame for their poverty), still assumes that the person is in a fixe d situation and unable to act. Victime suggests that a person does not have the physical, mental, or moral constitution to fight against the forces that generate disadvantage and poverty. Those who live in poverty are likely more sensitive to this denial of agency. W hile certainly less insulting than the terms inadapt and incapable, for people in prcarit the term victime may still evoke a sense that ones personal identity is being challenged. It is reasonable to suspect that some cases of perceived stigma in Swiss society may be the result of the use of labels like victime by members of the public in mixed interactions. Stereotypes of Prcarit in Geneva In qualitative interviews, 12 people defined as living in prcarit and six social service workers were asked who they believed were t he most discriminated groups in Geneva. Their responses had varying levels of specificity, and I encouraged informants to expand upon them for the purpose of exploring the stereotypes associated with these
190 identities. Table 57 pres ents the resulting list of identities, ordered by how often they were mentioned among the 13 informants who responded. A broad range of discriminated groups emerged from this query, mirroring and expanding the typology of stigmatized identities outlined in the Chapter 3. The most frequently cited were people of foreign origin and those involved with drugs or alcohol. Among the foreign nationalities cited, more than one informant mentioned Eastern Europeans (in particular, Romanians) and the maghrbins of No rth Africa. Three informants cited people on public or social assistance, such as unemployment or disability insurance, and two informants cited the homeless. Fourteen identity categories were mentioned by only one informant each. These are of interest bec ause many reflect the special interests or personal histories of the informants who cited them (identified in the table footnotes). Many of those in prcarit cited identities that corresponded with their own experiences. Both Isaac, a 45year old Swiss m an, and Lucas, a 40year old Algerian man, stated that people receiving social or public assistance were the most discriminated; both of these men had significant experience as beneficiaries of Genevas social service programs. The stigmatizing encounter s they cited, which are discussed in the following chapter, also reflect their emphasis on the social/public assistance beneficiary as an object of discrimination. A Swiss man named Frdric offered the most categories of stigmatized groups some of which were clearly connected with his personal life (e.g., people with foreign last names and people who marry foreigners). One informant a homeless Romanian man named Dorin expressed feelings of low self worth when describing the public mistreatment he often
191 endured. When asked to define Genevas most discriminated groups, his response was : It must be me. Im the smallest minority here. On the other hand, informants who cited immigrants or drug users tended to self identify with neither group although some were of Western European nationalities (e.g., German, French) which do not share the same burden of stigma as immigrants from Eastern Europe or Africa. In these cases, informants based their responses not on their own experiences as objects of disc rimination, but on what they have observed in public places and the social services, and on what they have seen and read in the Swiss media. Social service informants often cited identities that corresponded with the populations they assisted. The director of the Coeur des Grottes womens shelter (Suzanne) was the only informant to list women victims of violence, immigrants without training, and immigrants who dont speak French all relevant challenges faced by the women who live at the shelter. Likewise, a social worker at the Bateau (Rafael) cited North Africans and drug users as the most stigmatized groups. Located at the lake near the Jardin Anglais the Bateau serves a high number of young undocumented North Africans men who are frequently targeted by the police for their association with petty theft and drug dealing. During the course of my fieldwork, I elicited these and other common stereotypes of people in prcarit, focusing on how these stereotypes are expressed in society and translated by those they stigmatize. The following sections describe the most relevant stereotypes those that affect the most frequently cited identities above and their connections with each other and with the labels they involve, both stigmatizing and acceptable.
192 Ste reotypes of Poor Immigrants In my interview with Jules, director of the Carrefour Rue organization, he acknowledged that foreigners and immigrants bear a considerable burden of the prejudice against the poor in Swiss society. However, he qualified this statement with the observation that this pattern has not always existed, and that attitudes toward the poor change every five years or so. Indeed, many informants who had lived in Geneva for greater than 20 years attested to a change in attitudes toward imm igrants that corresponded with a perceived secular trend of increased national immigration. With rising immigration came an increase in the number of Roms and beggars on the streets of Geneva, explaining the prevalent labeling of people of certain nat ionalities (e.g.,Romanians) as mendiants (beggars). Jonas, an assistant educator at the Abri PC described this trend as a function of the preservation of Swiss identity: The Swiss are fixated on Romanians as people who beg, because they stand in front of t he banks, on the bus, they go to restaurant tables and all that. All this is really something the Swiss are used to when theyre traveling... These are things youre used to seeing in Naples, Rome, and Barcelona. Now when these things arrive here, its a s lap in the face. Because for a long time I think the Swiss were on a cloud looking down on people from above... So, when someone takes into account that their country isnt better than the others, its unnerving. And then, it s these people who are sudde nly stigmatized. Because begging itself carries some particularly severe stereotypes, the association of immigrants with begging can compound their stigma. In some cases, informants who expressed stigmatizing attitudes toward the poor conceptually grouped people of different prcarit categories, such as immigrants, beggars, and drug users. According to a young volunteer at CSRG who chose to volunteer in the social services as an alternative to his obligatory Swiss military service:
193 They use being hungry as an excuse to ask for change, which they use to buy alcohol and drugs. Once I gave a sandwich to a beggar and a few seconds later saw him throw it in the garbage. Nobody in Geneva goes hungry. Implied in the volunteers statement is the attitude that the poor should accept different standards of living because of who they are. While it would not be unreasonable for a more affluent stranger to reject unsolicited food, when someone in prcarit does so it is seen as an insult to the wouldbe donor and an adm ission that he/she intends to use the change collected from begging for inappropriate purchases. Most informants described or expressed stereotypes against people of specific nationalities. Complementary patterns of preference and rejection emerged for people from Spanish or Portuguesespeaking countries and people from the countries of North Africa and Eastern Europe. Social service workers and people in prcarit both considered Latino immigrants to be preferred by employers over poor immigrants of other nationalities, particularly when employment is au noir (under the table). However, this pattern was explained differently between the two groups. One the one hand, social workers tended to emphasize the industriousness and adaptability of Latinos. On the other hand, some immigrant prcaire informants expressed stereotypes of Latinos as under educat ed and over appreciated (Tania) or complacent (Rafik) reflecting a form of in group stigma that crosses nationality. Because Tania and Rafik belong to the very nationalities adversely affected by Genevas au noir employment patterns, their stereotyping of Latinos may be motivated by the perception of stolen resources with one group taking from the other a vital resource (employment) that seems to be in short supply. Regarding the Portuguese, some of the most divisive ingroup stereotyping was expressed by Chatura, a Sri Lankan man who ate regularly at Genevas soupkitchens:
194 They take all the jobs. They come to Geneva in droves, theyll take any job. And they live crowded together in tiny apartments. The Portuguese are more likely to be employed tha n the Swiss themselves. Its not that theyre hard workers, its because theyre willing to work for less money... The Portuguese are profiteur s. They come expecting everything. Chaturas choice of the label profiteur shown in the cultural domain analysi s to be stigmatizing classifies the Portuguese with any number of other prcaire identities considered to represent the self serving and selfish, people who take advantage ( profiter ) of the charity of others. This concept of taking advantage is a per vasive stereotype that cross cuts all categories of people in prcarit It is especially relevant to stigmas of unemployment and being on social assistance, such as chmage or the AI Stereotypes of dangerousness emerged for both Eastern Europeans and North Africans, particularly for people from former Yugoslavia. Serbs and Bosnians are described by some as easily bull necked ( cou detaureau) and violent, which social service workers stated was a reason they had trouble finding work. Paul, an unemployed Swiss man who criticized this stereotype, framed stigma against former Yugoslavs within the context of war and its adverse psychological consequences: When this conflict started in ex Yugoslavia, tens of thousands of people came to Switzerland, which came out of a situation of war. Family killed. The women raped. Their homes burned down. And obviously those people they come to a rich place like that [Geneva], theyre gonna freak out, theyre gonna be completely helpless, you know. [People say] All these people from the eastern countries or from Yugoslavia, theyre all criminals, they all steal, theyre all violent, they all have knives. But people dont realize, we dont know what happened to these people. Regarding North Africans, the assistant educator Jonas noted that they were regarded as hot blooded and had a reputation for being explosive in the Abri PC shelter. However, the primary stereotypes affecting North Africans were that they were
195 terrorists or drug dealers. Their association with drug d ealing was the more salient stereotype in Geneva. As Rafael, a social worker at the Bateau remarked: You really have the impression here that these people are broken down... You see people who sell drugs, who have practically no rights. They wander all day, have nothing to do, they give up looking for work. It happens like this Maghrbin equals problems. The maghrbin isnt trustworthy. Theyre a problem to hire. Generally, maghrbins create insecurity and fear. Ive heard people say, To cross a maghr bin in the street alone at night inspires fear. Some Algerian informants cited this stereotype as a reason they were rejected in various situations. For Nadim, this recognition translated to resentment of his fellow Algerians; he blamed the young undocum ented maghrbins who sold soft drugs along the lakeside for perpetuating the stereotype, affecting his reputation and his ability to find work. Finally, Romanians and Roms drew criticism from the public for their associations with scamming, theft, social indiscretions (e.g., cutting in front of people in lines), and profiting off of others. Much of the stereotyping of these groups originated from others in prcarit. Paul, who earlier offered a defense for former Yugoslavs, described the Roms who ate meals at CSRG as generally disrespectful: They give the impression that they just want to profit. Resonating with Nadims story, a Romanian woman named Danica remarked that it was because of the tziganes [ Roms ] who live by conning and stealing, and who train their children to steal that she had trouble finding work. Perhaps the most distanced stereotypes against Romanians were offered by Hector, an unemployed MexicanSwiss man wh ose interview was held at an outdoor caf and marked by a number of stigmatizing encounters that he instigated: Voil les manouches [motioning toward a group of Roms across the street]. They profit. They work the trams, earn 100 Swiss francs per day. They re not going to go eat cakes with that money. Theyre going to drink. They
196 come to eat here [ CSRG ] for free, then go on the trams to make more money. They dont want any more than that. Stereotypes of Alcoholics, Addicts, and Drug Dealers In many cases, i t was difficult to separate the stereotypes of drug users and drug dealers from those of maghrbins who have a very strong connection with drugs in Swiss public opinion. With regard to drug dealing maghrbins Lucas himself an Algerian offered a struc tural perspective on petty drug dealing, lack of documentation, behavioral health and stigma: Nine times out of ten those who sell drugs use them These guys, generally, if theyve spent two, three, four, five, six years here... Theres even some who have been in Geneva for ten years, always in an irregular situation [undocumented]. They cant get a job. If they find one, its a job that exploits them. Money from drugs is easier, more risky, but easier. From Swiss informants, it was clear that stereotypes affecting alcoholics and drug users of Swiss nationality took a different character. Their stigma was uncomplicated by stigmas of ethnicity or nationality, and instead focused on stereotypes of uncleanliness, culpability, laziness, and taking advantage of social programs. Isaac, himself a methadone addict and recovering alcoholic, reported hearing people speak of drug users as dirty and paid by the State. To a certain extent, his response to these stereotypes was one of resignation at times internali zing the stigma and expressing feelings of low self worth, and at other times ignoring it, largely through a process of desensitization. While most stereotypes of drug users and alcoholics mirror those of other groups in prcarit, this group is unique in that its characteristics render it amenable to medicalization by the medical and social service communities, and to a lesser extent, by Swiss society. According to Laurent, codirector of CSRG : People who abuse drugs are
197 viewed as if they were sick. Ther es been a transition in the view of those with addictions from one where they are criminal, to one where they are sick. Results from the pile sorting activities help to confirm this statement; on the MDS plot (Figure 51), the cluster of labels describin g alcoholics and drug users ( alcoolique, drogu, toxico) is located between the c luster of stigmatizing labels ( profiteur fainant, etc.) and the cluster of medical labels (handicap, malade). However, among these clusters, the labels for alcoholics and drug users are considerably closer in proximity to those for the sick and disabled. Medicalization takes away the basis for stereotypes of drug users and alcoholics that blame them for their conditions associating them instead with impersonal biological processes. However, in doing so it also takes away their agency, which, as analysis of the term victime has revealed, may have a greater impact on judgments of stigma among those in prcarit. Thus, while a shift toward medicalized identities for alcoholics and drug users represents a reduction in stigma burden, it does not eliminate stigma completely. It may be argued that this form of agency denial produces a different type of stigma one that is less obvious but nevertheless would have a measurable effec t on personal and social identity. Stereotypes of Unemployed/Underemployed State Beneficiaries It is in stereotypes of chmeurs disabled people receiving benefits from the AI and the working poor receiving welfare benefits (through Hospice Gnral and the RMCAS ) that one finds the concept of t aking advantage and the label profiteur at their most salient. These groups also face challenges similar to those faced by alcoholic and drug users, in that they are stereotyped as lazy and to blame for thei r condition. Collectively, these stereotypes are expressed most frequently in the context of state benefits and taxes, as shown from comments by multiple informants:
198 Isaac: Theres people in every district who do it [stereotype]... Its nearly racism, because they tell themselves yeah I dont want any trash in the city, some guy who cant pay his taxes. Lucas: The moment you become dependent on the social services, others regard you... I mean the Swiss, they regard you simply as a profiteur or a racail le Paul: People think, anybody who loses his employment, its his own fault. Jacques: Chmeurs are blamed for wanting it. And I know this is true. I know some people who are like that. Theyre on chmage because they want to be, because they want to do nothing. Laurent: For a long time, theres been this image of someone who takes advantage of society, who doesnt want to work. Even at the Office of Chmage, people are considered responsible for their situation. Tho se who receive less formal types of assistance through Genevas soup kitchens, day centers, and shelters are sometimes perceived as taking advantage in a more local context usually in reference to services rendered at the location. In one observation at CSRG Catherine an older Swi ss woman known for her eccentric behavior was criticized from a distance by the volunteers who served drinks behind the counter: She is always taking more than one drink at the same time a tea or a coffee. By the end of the day she is surrounded by fi ve empty cups. Implying that Catherines behavior was evidence that she was self serving or greedy, the volunteer who made this remark later that day made a point of enforcing a rule against serving two drinks to a single guest. As there was no such formal rule in the day center, the codirectors reversed her decision. Among other things, it prevented some guests from getting drinks for their disabled and elderly friends in the dining room. Stereotypes of the Homeless Despite their high perceived level of stigma in Swiss society, the homeless were the object of fewer explicit stereotypes than other groups in prcarit As in American
199 society, the Swiss homeless are stereotyped as unclean and unkempt characteristics that are embodied in the label clochard. However, the more salient stereotypes were those of the homeless as lazy and to blame for their situation resonating with stereotypes against drug users, alcoholics, and social assistance beneficiaries. Unlike these other groups, the visibly homeless are less likely to be associated with the concept of t aking advantage and the label profiteur potentially because they do not receive social assistance. Even if receiving benefits from formal programs such as the Hospice Gnral and the AI the most marg inalized of Genevas homeless often do not seek assistance from the citys day centers or soup kitchens. Isaac who had some experience living homeless in Geneva associated the condition with the failure or deficiency of a persons social support: In Geneva, someone who all of a sudden nobody employs, without family... the guy immediately becomes a clochard. The paucity of stereotypes for the homeless may reflect the silent acceptance of homelessness by Swiss society. For many, homelessness is an unavoidable byproduct of fluctuations in the market economy, while for others, it is a situation linked to personal choices and moral weakness. This stigma of homelessness is likely reflected less in the political or public diatribes that perpetuate misunders tanding and stereotypes, and more in direct acts of mistreatment and discrimination stigmatizing encounters of the kind described in the next chapter.
200 Table 51. Cultural domain analysis informants ID Name a Age Gender Nationality Occupation b Activities c FL PS PC Prcaire informants P01 Isaac 45 M Swiss Disabled/ AI P02 Lucas 38 M Algerian Unemployed P03 Nadim 25 M French Algerian Unemployed P04 David 39 M Swiss Contre prestation P05 Paul 47 M German Swiss Unemployed P06 Jacques 51 M French Unemployed P07 35 M Swiss Unemployed P08 31 M Polish Day laborer P09 20 M Canadian Punk P10 2 3 M Rom Unemployed P11 65 M Congolese Political refugee P12 51 M Malagasy Mover P13 61 M Algerian Unemployed P14 40 M Italian Hairdresser P15 17 M Swiss Punk P16 55 F Swiss Restaurant worker P17 30 M Swiss Chmeur P18 21 F Canadian Punk P19 25 M Czech Unemployed P20 33 M Peruvian Unemployed P21 Frdric 47 M Swiss Chauffeur P22 34 M Romanian Unemployed P23 20 M French Unemployed P24 21 F Swiss Student P25 25 F Swiss Unemployed P26 27 M Swiss Unemployed P27 50 F Swiss Chmeur P28 45 M Spanish Unemployed P29 36 M French Unemployed P30 25 M Portuguese Building p ainter P31 Lidia 28 F Swiss Colomb. Contre prestation P32 59 M Spanish Industrial p ainter P33 Daniela 44 F Swiss Video store worker P34 47 F Swiss Disabled/ AI
201 Table 51. Continued ID Name a Age Gender Nationality Occupation b Activities c FL PS PC General population informants G01 24 F Swiss Student G02 52 M Swiss Teacher G03 49 F Swiss Midwife G04 24 M Swiss French Intern G05 23 M Swiss Student G06 24 F Swiss Speech therapist G07 23 F Swiss Student G08 50 F Swiss Economist G09 27 M French Fitter G10 28 M French Unemployed G11 20 F French Student G12 24 M French Cook G13 20 M French Student G14 38 M Swiss Plastic surgeon G15 25 F French Midwife G16 71 M French Retired technician G17 39 F Swiss Educator G18 61 F Swiss Homemaker G19 48 F Colomb. Swiss Anthropologist G20 23 F Swiss Mexican Student G21 24 M Swiss Intern G22 32 M Malagasy Student G23 25 M Swiss Student G24 58 M Swiss Mechanic G25 43 F Spanish Swiss Professor G26 26 F Spanish Swiss Professor G27 40 M Swiss Engineer G28 27 F Student G29 24 M Student G30 25 M French Swiss Student a Pseudonyms of informants who participated in an ethnographic interview ; b Among prcaire informants, many listed having a profession, although they were unemployed at the time. These included carpentry, electroplating, management, and in Lucas case, agroindustrial engineering; c Cultural domain analysis activities: FL= Free li sts; PS = pile sort s ; PC = paired comparison s.
202 Table 52. Cultural consensus statistics, by informant group Eigenvalue Percentage of variation explained Ratio to second factor Prcaire 7.029 82% 8.2 : 1 General population 8.992 93% 21.4 : 1 Total 16.027 89% 15.2 : 1 Table 53. Informant competence scores in pile sorts ID Age Gender Nationality Occupation Competence score G02 52 M Swiss Teacher 0.91 G24 58 M Swiss Mechanic 0.89 P29 36 M French Unemployed 0.87 P27 50 F Swiss Chmeur 0.86 G21 24 M Swiss Intern 0.86 G22 32 M Malagasy Student 0.86 G25 43 F Spanish Swiss Professor 0.86 G27 40 M Swiss Engineer 0.85 P33 44 F Swiss Video store worker 0.83 P30 25 M Portuguese Painter 0.82 G19 48 F Colomb. Swiss Anthropologist 0.82 P34 47 F Swiss Unemployed teacher 0.80 G29 24 M Student 0.80 P21 47 M Swiss Chauffeur 0.78 G03 49 F Swiss Midwife 0.77 P24 21 F Swiss Student 0.76 P04 39 M Swiss Contre prestation 0.75 G26 26 F Spanish Swiss Professor 0.75 P10 23 M Rom Unemployed carpenter 0.74 P26 27 M Swiss Punk 0.72 G20 23 F Mexican Swiss Student 0.72 G23 25 M Swiss Student 0.72 G28 27 F Student 0.71 G07 23 F Student 0.66 P32 59 M Spanish Painter 0.63 P28 45 M Spanish Unemployed manager 0.44 P31 28 F Swiss Colomb. Contre prestation 0.32
203 Table 54. Paired comparisons: label ranking b y severity and frequency (total) Most to least insulting Most to least frequent Rank Label Scale value Rank Label Scale value 1 Dchet 1.58 1 Marginal 0.45 2 Incapable 0.60 2 Pauvre 0.28 3 Profiteur 0.56 3 Profiteur 0.23 4 Fainant 0.41 4 Exclu 0.22 5 Paum 0.16 5 Prcaire 0.21 6 Inadapt 0.20 6 Paum 0.14 7 Exclu 0.23 7 Fainant 0.07 8 Marginal 0.64 8 Incapable 0.20 9 Pauvre 0.70 9 Victime 0.21 10 Victime 0.72 10 Inadapt 0.41 11 Prcaire 0.82 11 Dchet 0.77 Table 55. Paired comparisons: label ranking by severity and frequency ( prcaire) Most to least insulting Most to least frequent Rank Label Scale value Rank Label Scale value 1 Dchet 1.39 1 Marginal 0.44 2 Profiteur 0.59 2 Paum 0.41 3 Incapable 0.57 3 Fainant 0.36 4 Fainant 0.24 4 Profiteur 0.23 5 Paum 0.13 5 Pauvre 0.11 6 Exclu 0.28 6 Exclu 0.08 7 Inadapt 0.33 7 Prcaire 0.03 8 Marginal 0.45 8 Incapable 0.18 9 Victime 0.51 9 Victime 0.25 10 Pauvre 0.65 10 Inadapt 0.49 11 Prcaire 0.69 11 Dchet 0.75 Table 56. Paired comparisons: label ranking by severity and frequency (population) Most to least insulting Most to least frequent Rank Label Scale value Rank Label Scale value 1 Dchet 1.94 1 Marginal 0.52 2 Incapable 0.70 2 Pauvre 0.49 3 Fainant 0.70 3 Prcaire 0.47 4 Profiteur 0.58 4 Exclu 0.38 5 Paum 0.28 5 Profiteur 0.25 6 Inadapt 0.08 6 Paum 0.14 7 Exclu 0.19 7 Victime 0.18 8 Pauvre 0.80 8 Fainant 0.23 9 Marginal 0.98 9 Incapable 0.25 10 Prcaire 1.04 10 Inadapt 0.44 11 Victime 1.11 11 Dchet 0.87
204 Table 57. Interview responses: the most discriminated identities The m ost discrim inated group in Geneva I nformants citing N % Immigrants 9 69% Eastern Europeans 4 31% Romanians 3 23% Former Yugoslavs 1 8% Chechens 1 8% Africans 3 23% North Africans 2 15% Sub Saharan Africans 1 8% Arabs 1 8% Immigrants without training 1 8% Immigrants w ho dont speak French 1 8 % Immigrants on social assistance 1 8% Alcohol/d rug related 5 38% Drug users /addicts 5 38% Drug dealers 2 15% Alcoholics 1 8% People on public/social assistance 3 23% Immigrants on social assistance 1 8% Homeless people 2 15% Clochard s 1 8% Women victims of violence 1 8% People with foreign last names 1 8% People who have less than others 1 8% People who marry foreigners 1 8% Me [informant indicated himself] 1 8 %
205 medical / personal insulting / familiar acceptable / formal cultural Figure 51. MDS plot: 34 labels for people in prcarit Alcoolique Clochard Dechet Drogue Exclu Gitan Glandeur Marginal Mendiant Parasite Profiteur Punk Racaille Voleur Chomeur Clandestin En difficulte Etranger Faineant Handicape Immigre Malade Paume Pauvre Perdu Pouilleux Precaire Refugie Requerant Sans abri Sans emploi Sans papiers SDF Toxico
206 CHAPTER 6 ENCOUNTERS: OBSERVATIONS AND NAR RATIVES OF STATUS LO SS AND DISCRIMINATION Its well after 10 pm on a cold night in January. Im riding in a large white van through the streets of Geneva with Julio, the director of the Abri PC his young colleague Ren (an assistant educator), and a man and woman who appear to be TV journalists the former a cameraman and the latter a reporter. It seems an unlikely crew, the journalists being unexpected company for my first visit to the homeless shelter. Yet, their interest in what the social workers called la ronde (the rounds) a nightly tour through Geneva to find the homeless and offer them shelter is as legitimate as my own. Every winter brings reports of the deaths of homeless people from the cold, and any organized effort to address this problem is one worth observing and documenting. Our first stop the Bateau. Ren briefly scours the area with a flashlight, under boats that are housed on trailers along the lakeside. The reporter a sks Julio how many people they picked up during their five months of operation last year. His response: about thirty. Our second stop a park west of the Rhne river. Last week they found someone trying to sleep in the public bathroom here. We make about four or five more stops at various parks and boat landings, tracing the beams of our flashlights down rows of skiffs and looking under tarps. Later, we make a uturn to a spot we already visited, where Julio notices a solitary Asian woman on the side of t he highway, pushing a shopping cart filled with plastic bags. Julio stops the van and in a matter of seconds we are all outside in the cold, walking toward the woman. The cameraman quickly sets up his gear, which includes a powerful field light that he trains on the woman and our group as we approach her. Naturally, the woman flees. She abandons her shopping cart, taking her bags with her, and Julio recommends that the camera crew stay behind. He and Ren question her gently, but with little success. The w oman departs up the roadside, shaking her head and repeating in simple French, a va! a va! [Its okay, or Im fine.] She continues despite the social workers assurance that they will not harm her. It is likely that she understands neither their words nor their intentions; she may be without residence papers, fearful of strangers especially those in positions of authority or, in the case of the journalists, those who would expose her. Julio speaks in hushed tones to Ren as they slowly follow her. Suddenly, the woman drops one of her bags, and it shatters loudly on the ground. What was once a large glass bowl now juts through the thin plastic bag in shards. The woman looks back at us with a scowl, packs up her
207 broken goods, and proceeds toward a foot tunnel that leads under the highway to the other side. After the woman disappears into the tunnel, Julio asks me if I would try speaking English with her. I descend with him into the tunnel for one last attempt and we catch up to her a short way in. She moves slowly, struggling with her bags. On our approach, her body language conveys anger and fear. She takes the broken bowl from her bag and shouts at Julio in French: Prenez Prenez! Je veux pas! Jetez telling him to take it and throw it away. Julio takes the bowl readily, carrying a worried, apologetic smile. Of course, he says. Were sorry. Julio continues speaking to her something he has already said to her, and which I repeat to her in English: Maam. Were from the civil protection of Geneva. We can help you. Are you alone? The woman pauses, looks away from us and waves her palm in our faces, shooing us away. Non! a va a va Then she collects her parcels and continues under the highway. Julio remains a moment to watch after her wearing a defeated expression. He seemed unwilling to believe what had occurred. I leave the ronde feeling as if we had tormented a foreign woman who, while seemingly in a precarious situation, may not have needed the help the social workers offered. Judging by her purchases, maybe she wasnt alone. Maybe she did have a place to stay. I took her words a va at face value. But in a global sense, things are not necessarily okay. As an immigrant with language barriers, she might have had some anxiety about her legal status and about strangers in general. She may have run because she mistakenly perceived we had targeted her for being of foreign origin. Furthermore, even if she understood (and believed) we were from the Abri PC the presence of the camer as made the risk too high that the authorities she feared (e.g., Swiss immigration officials) could identify her. Fieldnotes. January 26, 2006. A primary goal of this study was to take an inventory of the different instances of stigmatizing encounters wh ether specific or general, individual or structural that emerged in ethnographic study of the poor. I begin this chapter with an example that is unique on many counts one where my role as participant was as relevant as that of observer, and one involv ing a person of uncommon nationality, with people of Asian origin representing only 3% of profiled prcaire informants in my study. Of special interest was the unanticipated presence of journalists in the encounter, and the
208 compounding effect they had on t he Asian womans experience of stigma. This was one of few instances in this study characterized by both direct stigma (the harassment and invasion of being filmed without ones consent) and implied stigma (the mistaken perception of danger imparted by the persistence of the social workers). On the womans part, the presumed underlying stigma was likely that of foreign nationality, and potentially of undocumented legal status. Yet for the social workers, it was her overall situation that attracted their at tention being alone on the roadside late at night, in below freezing temperatures, and pushing a shopping cart filled with bags some distance from the nearest store. While Julios decision to stop for this woman followed a cognitive act of discrimination (based on what he saw and the social meanings it conveyed), it was not the discrimination that accompanies the ideas of separateness, negative labels, and stereotypes of interest in this study. Instead, the social workers were motivated by humanitarian values, and their acts of outreach conveyed benevolent concern rather than prejudice and resentment. Any stigma the woman may have felt in her interaction with them would have been perceived in error but perceived nonetheless. As for the journalists, the m otivation was to get the story of Abri PC in winter, one in which the woman had unwittingly played a part. While the cameraman and reporter may have shared the humanitarian values of Julio and Ren, it was not a factor necessary for their participation. Th eir actions were less sensitive and more obtrusive, and through their exposing nature, likely contributed to the womans fear and anxiety. Thus, even if their intentions were good, the journalists risked generating further disadvantage for a woman whose si tuation would already be qualified as precarious
209 In fieldwork that focuses on the perspective of people who are mistreated and discriminated against, it is often difficult to gauge the perspective and intentions of those individuals and institutions co nsidered to be the source of stigma. Little doubt is cast in cases of direct discrimination that involve acts of targeted violence or the denial of employment, services, or residence permits based on ethnicity or social status. However, many encounters inv olve stigma that is indirect, concealed, or implied to varying degrees. Implied discrimination involves an encounter in which there is some doubt that the persons intent is to discriminate. In many cases, what is perceived to be an insult may instead have been a misunderstanding engendered by language barriers. In others, what is perceived to be an unfair denial of services may instead have been the application of social service rules. People may also correctly perceive acts of discrimination that would ot herwise go unnoticed. The defining quality of implied discrimination is not that it is necessarily invalid or imagined, but that it does introduce some measure of doubt as to the authenticity of the stigmatizing act. Likewise, a direct act need not be moti vated by prejudice; but at the very least, its contribution to the subjects experience of stigma and its negative consequences is significant enough to be considered negligent. For this study, I assessed each of the encounters I collected with regard to its potential authenticity coding them as either direct or implied. Direct encounters were those shown to be the explicit product of stigma, or which could easily have been considered the product of stigma by an unconnected third party observer. Imp lied encounters were those that could potentially have offended someone and led them to suspect discrimination, but that would not have been seen as discriminatory by an
210 unconnected thirdparty observer. Interpretations from a thirdparty perspective are n ecessarily subjective, and for some encounters that had both elements to varying degrees there is a wide margin of error. T he inability to distinguish between direct and implied discrimination in some cases was a limitation of this study. I also classifie d encounters as either individual (involving interpersonal exchanges between people in prcarit and other people) or structural (involving the interaction of people in prcarit with rules, laws, systems, objects, and the built environment). The resulting sample of encounters covered a broad range of specific and general situations, demonstrating the extent to which stigma may be experienced at all levels of social distance, and pointing toward ways that social service workers can minimize perceived stigma regardless of its authenticity. The Anatomy of a Stigmatizing Encounter A total of 237 encounters were collected from both direct observation and informants narratives, with narratives falling into three collection strategies recall from the field, tap e recording of ethnographic interviews, and taperecording of elicited responses in interviews. In elicited recorded narratives, I asked the informant to relate an event in which he/she (or someone he/she witnessed) was insulted, mistreated, or discrimina ted against for being in a situation of prcarit. These encounters were enumerated and coded for three basic components: participants (sources and subjects), location, and action, with frequencies of the first two guiding analysis and interpretation of t he third. As described in Chapter 4, each of the four collection methods presented different standards of validity, salience, and specificity, which necessitated the separation of encounter analyses. Encounters collected from recorded elicited narratives were
211 considered the most salient because they represent the informants personal experience, excluding stigma that is understood through hearsay. Furthermore, these encounters are analogous to free list items that appear at the top of an informants list; they are the first examples that come to mind when the question is raised, and are likely those that have the greatest impact and meaning for the informants. Table 6 1 provides the distribution of encounters by participant characteristics among all 237 enc ounters, separately for each of the four data collection methods. For simplicity in reporting, I also provide the distribution among all methods combined. However, I caution against making interpretations from the total frequencies; the analysis that follows relies upon the encounter frequencies as they are seen in each method discretely Table 62 provides the distribution by location, in a subsample (n = 126) that excludes encounters too general to classify beyond the regional or national levels. Notably most encounters collected from field narratives were too general to classify, with only seven having a specified location. There was some correspondence between encounters with general locations and those representing acts of structural discrimination, a s evidenced by the high proportion of systemic sources of stigma from field narratives (56% ). With many of these encounters excluded, the locations presented in Table 62 are therefore more indicative of acts of individual discrimination. Overall, the most common sources of stigma were social service workers, other people in prcarit, local and regional police, and employers or potential employers, while the most common subjects were social service users and homeless people. Correspondingl y, stigmatizing encounters occurred most often in social service settings and public spaces. Given that I regularly frequented and recruited interview participants
212 from Genevas soupkitchens, day centers, and streets, these associations are expected. The distribution of encounter participants and locations should not be considered representative of stigmas of poverty in the population, but instead indicative of which locations were assessed more comprehensively and about which more detailed, informed inter pretations can be made. Fourteen percent of observed encounters involved potentially stigmatizing instances that originated from me in my interaction with others. While it was never my intent to discriminate against others during the course of my work, a number of misunderstandings occurred (largely from language barriers during my first few months in the field) that could have reasonably led the person I was interacting with to feel insulted. Examples include my reference to street people as pauvres in an interaction with two Swiss men asking for change at a grocery storefront, and my failed attempt at conversation with a young Tunisian man, in which the man felt I had accused him of stealing a portable DVD player he was using. In the Tunisians case, ex pectations of a specific stereotype (NorthAfrican men as thieves) led him to perceive stigma that was not authentic. Such misunderstandings were likely common in a number of the encounters I assessed, and failure to account for them would result in an inc omplete understanding of how stigma is perceived and experienced. Generally, men were more frequently the subject of stigma than women, representing up to threefourths of encounters. Up to twothirds of encounters involved subjects of Swiss nationality, while onethird of encounters involved subjects from Eastern Europe, and another onethird from North Africa. The most common situations of prcarit identified among stigma subjects were homelessness (about onequarter of
213 narrated encounters), mental illness, undocumented residence status, and unemployment (each representing up to onefifth of encounters). The majority of encounters directed against people in institutions (e.g,. prisons, mental health facilities) involved either Tania or Frdric. Stigma i n the Social Services Greater than onethird of encounters collected through observations and recorded elicited narratives involved social service workers as sources of stigma, and up to 60% of individual encounters occurred in social service settings. Th e majority of these encounters were characterized by insensitive communication on the part of social service workers direct or implied insults that were expressed in three distinct ways: Through provision of services in an unfriendly manner such as when the social service worker was perceived as blunt, cold, demanding, dismissive, inattentive, or patronizing, or when, as some informants stated, the social worker seemed annoyed or said something with extreme coldness; Through the use of inappropriate words (implied insults) such as referring to people who receive social assistance as clients or addressing them with the familiar pronoun tu which in formal settings is normally reserved for addressing children and animals; and Through direct insults or harmful actions which included telling informants to go back to their country of origin, telling them that they did not deserve the social assistance being offered, or that they were crazy or had problems. In rare cases, direct insults were expressed t hrough actions, which were generally directed toward the subjects ethnic and cultural origins. Lucas provided a particularly salient example in a recorded elicited narrative one in which t he narrators proximity to the encounter was secondary (i.e., the subject of the encounter was not Lucas, but someone he had observed): Id prefer not to name places...but... Lets say its a place where, well... a place I usually go to eat. This one day they made pork. Muslims dont eat pork. But thats not the problem its not that... Normally they put a sign on
214 the door that says theyre serving pork. So, they warn those who dont eat pork that theyve got pork. Even so, they put up a notice. One day, one of the volunteers said to himself: Im not going to put up the sign. Im going to let them eat pork. Whats the point of that? Absolutely nothing. We found out that in fact they were serving pork. Someone said to the volunteer that if theres pork, I wont eat. Oh l l! the volunteer said. Thats crazy. In any case, it was like he was saying to the guys: Fuck off! Youll eat some pork!. Its a way of telling the people, whatever their denomination, that he doesnt care. But him... hes supposed to, you could say, respect the other In fact hes not oblig ated to. He could do his job well and put up the sign and then the people are free to decide, whether they eat or they dont eat, whether theyre denomination X or Y, or allergic, or... It really doesnt matter. But out of respect for the people, you warn them. Hes not obligated to react with this attitude: Go fuck yourself. Its pork. Eat it our clear out! Anyhow, its like there was hate somewhere... The volunteer was full of hate. Its practically... Its an event anyhow where I felt that this guy had some sort of malice... some malice to say to someone else that hes racaille This narrated encounter helped support the validity of a similar encounter I had observed earlier during my time working behind the counter at CSRG In the observed instance, t he Menu au Jour sign (featuring a cartoon pig) was posted to inform guests pork was being served on that day, pork filled tortellini: Theo, an older Swiss man with a reputation for his crude humor and insensitivity, is dishing the tortellini to guests as they move down the line, when suddenly a young Muslim man who had just received his food begins shouting at him. A newcomer to the soupkitchen, the man was not aware he had been served pork until some other guests informed him. In response, he throws his plate facedown on the serving compote and is ushered out by the other staff. From the observation alone, Theos exact intentions are unclear. He may have been hoping to dupe Muslims into eating pork (relying on the Menu au Jour sign to protect him from liability), or he may have simply been dishing the food inattentively. Yet, the encounter cited by Lucas which shows that this kind of stigma against Muslims can
215 and does occur in the soupkitchens lends support to the theory that Theos act of di rect discrimination may have been authentic. Other common encounters involving social service workers were characterized by the denial of services. In most cases, social service workers denied services based on the exigencies of some rule or regulation; provided that the rule itself was not discriminating (or the social service worker was not bending the rule to unfairly deny services to particular groups), the discrimination in these encounters was implied. Examples included: Abri PC staff requiring undoc umented foreign guests to leave the shelter during the last month it is open; Au Coeur des Grottes staff denying admission for women with substance abuse problems or mental illness because they are too marginalized and wouldnt manage; CAR staff denyi ng a homeless Romanian mans request for a shower, saying it was too late for showers (Dorin); CAR staff denying a sick Italian mans request for orange juice, saying it wasnt his turn, and later giving the guest lemon seltzer water when his turn came; CAR staff denying undocumented immigrants remuneration (10 CHF) for participating in afternoon activities workshops. CSRG staff denying guests requests for an extra slice of bread or extra packets of sugar, citing rules that established per person lim its for these services (one slice of bread, and two packets of sugar); CSRG staff denying requests for coffee during the lunch hour, when serving hot beverages was against the rules; and CSRG staff denying requests for extra food before the second service was officially declared. One observed encounter involving denial of services at CSRG is worth noting because it was more direct. In this encounter, which occurred on my first day volunteering at the day center, counter staff had begun handing out two sli ces of bread
216 to guests who asked for it a practice that technically was against the day centers rules: In response, the volunteer doing the tickets (handing meal vouchers to guests at the door) approaches two men who were given extra bread, takes the bread from their plates and puts it back in the serving bin. While the volunteer was enforcing a rule that, in theory, was to the benefit of all guests collectively (ensuring that each would have at least one slice of bread), his decision to take food away from the guests could easily have been interpreted as unfair and unnecessarily hostile. In some cases the sources of stigma in the social services were the institutional structures, rules and practices themselves, rather than the social service workers using (or misusing) them. One example cited by both Lucas and David involved the perceived stigma of being judged by others while standing in line outside a soup kitchen. In both cases, the location considered most problematic was the Jardin de Montbrillant which is near a busy central part of the city and is smaller in space than Genevas other soup kitchens. As a rule, the soup kitchens doors open five minutes before the meal service starts, meaning that the guests who arrive must line up outside, someti mes thirty minutes or an hour in advance. According to David: As far as the Montbrillant is concerned, the problem is that its also small. Whats always bothered me about is that youre confined outside the doors waiting for it to open. Thats pretty heavy, you know. Especially since youre on a major road, just behind the train station... The fear of being seen there, the fear of saying why [youre there], that somebody would know that I use this kind of place. Davids narrative reveals the potential that social service structure has in making stigmas of poverty more visible. The act of standing in a soup kitchen line functions as a marker of poverty for many guests who could otherwise pass as normal (Goffman
217 1963). For David, the soup kitchen line m akes it more likely that others would know of his poverty and subsequently stigmatize him for it. These examples suggest that, in social service settings, careful attention should be paid to rules regarding the distribution of services and their consist ent application. When some social service workers apply the rules and others do not, guests/beneficiaries who are denied services are likely to sense unfair treatment. In many cases, people respond to this perceived stigma with hostility, contributing to a n atmosph ere of conflict in Genevas day centers that leads many who would otherwise use these services to avoid them. Furthermore, structural aspects of social service operations can exacerbate a persons experience of stigma in the absence of interpersonal encounters. These rules and practices are generally enacted without real intent to discriminate or generate disadvantage for social service clients; knowing the extent and consequences of their adverse affects is a necessary step in making the delivery of services more equitable and sensitive for the people who use them. Stigma in the Streets Encounters with police and strangers in public places were common in informants narratives. Among elicited recorded narratives, police officers and officials were the source of stigma in 20 % of encounters, and members of the general public were the source of stigma in 10 % of encounters. Public places, which included streets, parks, and publicly accessible buildings such as the train station and a local iceskat ing rink, were the location of 25% of encounters. The subjects were most often homeless (25 % ) and/or North African (25% ), many of whom were cross classified as alcoholics or drug addicts, drug dealers, and beggars. Roms were also subject to stigma in publi c,
218 usually in their role as street musicians; because I interacted with very few Roms during my time in the field, most of these encounters were collected through observation. Many encounters cited by the homeless involved harassment by others while they w ere sleeping (or trying to sleep) in parks, building cellars, and parking lots. This type of encounter was instigated by police officers, passers by, and property owners indicating the pervasiveness of public opinion against a homeless persons act of sl eeping or loitering in public. Nadim, who had a fiveyear history of intermittent homelessness in Geneva, cited numerous instances in which he was forced to leave places where he was sleeping: Sure, theres people who bother me. Ive had people call the police. Theres people who bring the Protectas people who bring the Securitas [private security guards]. Theres always these complications... Obviously, someone who lives in a building he... he wants peace and quiet and everything. But by the police, by the State, yeah. For someone who doesnt have a place, if it starts raining or snowing its better to sleep inside an apartment building than to sleep outside. Nadim considered harassment to be more stigmatizing by the police than by the building residents. While residents had a right to expect their homes to be free of intruders or uninvited guests, he saw eviction by the police as unreasonable, and during winter, inhumane. Homeless undocumented immigrants were at particular risk of stigma, largely enacted through structural encounters that originated in regional and national immigration and housing laws. Lucas cited two problems that undocumented immigrants face when seeking housing: (1) Proprietors either refuse to house undocumented immigrants (in accordance with the law), or they overcrowd them into small housing units until legal tenants become available, at which point the undocumented immigrants are forced out; and (2) Social services do not offer
219 undocumented immigrants adequate housing; with the exception of Abri PC in winter, shelters turn away those without residence papers. Furthermore, as shown in the section above, it is standard practice at Abri PC to limit shelter to only those who are legally in the country and have the documents to prove i t. These encounters occur at the structural level, and as such, solutions to overcome them require addressing not the interpersonal resources and skills of shelter staff and housing proprietors, but the rules they are constrained by law or professional obl igation to follow. As a social worker at the Bateau, Rafael had a first hand perspective of the daily conflicts between police and young maghrbins who spent time on the south bank of Lake Geneva, many of whom were often arrested for drug dealing and petty theft. Referring not to a specific event, but to a general pattern he had seen, Rafael described a series of three related encounters that occur in the public spaces around the Bateau in the Jardin Anglais and along the lakeside: a This is a zone where a lot of cannabis is sold... just up to the Bateau [laughs]... and around the Bateau. So the police have a large presence in the immediate surroundings. The dealers here are maghrbins Theyre the ones who have the market in this district. Here, when someone leaves the Bateau, the police are there waiting in front to check their papers. Nobody has ever asked me, even though they dont necessarily know me... Nobody has ever asked me for my papers. And a lot of people of Western nationality like that dont have them. A maghrbin is stopped nine times out of ten. b In zones like this, its true that there are cannabis dealers. When someone gets stopped, theyre searched, every time... I dont know how they justify it. Because a lot of them dont have much, just a little bag, little things like that. Theyre never arrested for it, but theyre searched anyway. You get the impression that, these searches...theyre searched for the money they have on them. And its often taken from them... They dont have the means to defend themselves. c. Sometimes theyre taken to the police station because they dont have their papers. Then one hour later theyre back here, until the next time theyre arrested. Some of the guys here have been arrested 10, 20, 30 times. The
220 problem is when people dont have their papers, there are conventions. They cant be sent back to their country. So theyre searched, arrested... Here in Geneva theres been a measure for the past few years to expel them from the territory, or part of the territory. There is a territory of the city center that comes from the Jet dEau and runs along the lakeside to the Usine [a community space that was once a factory building], then goes up to the train station. The city center is... when youre talking about people without papers or asylum seekers, Im not sure, but especially for people without papers... if theyre tricked so to speak, theyre expelled from this zone. And next, the problem for them is if theyre arrested in this zone, even without illici t activity, its cause for imprisonment. They could go up to six months in jail. Not the first time, but the second arrest in the zone like that can give them six months in jail. Thats a long time... When theyre drug dealers, theyre tricked while theyr e dealing. Theyre subject to the measure of expulsion from the city center and next, if theyre found in the area again, even if they havent done anything wrong, theyll be arrested. This is a measure that began a few years ago. It was the last chief of the police department who did it. I dont know. Now theres a new police chief. I dont know if this will change. In the lives of these young North African men, the experiences of being questioned, searched, victimized, and arrested by the police each hav e their own implications and effects. The targeted questioning of men for their papers (encounter a) represents an act of stereotyping one that assumes, based on the color of their skin, their dress, and their language, they are in the country illegall y or involved in illicit activities. Subsequent searches by the police (encounter b) imply that the men are lying about their residence status, while the act of taking their money more explicitly victimizes them. Although I did not confirm this type of encounter through other means in the field, it is a reasonable expectation that some authority figures would take advantage of young maghrbins knowing that many of them do have money acquired through illicit activities. Lastly, the repeated arresting of undocumented men, their placement outside of the designated zone, and their continual return to this zone (encounter c) represents a revolving door of the kind described by Spradley (1970). This is an encounter that may be designated as both individual (being arrested by the
221 police) and structural (being targeted by local regulations), and which emerges through the conflict between Swiss law and the maghrbins need for a means for livelihood. While superficially the practice functions as a means of r educing or discouraging crime in the area, it also has a cosmetic purpose the removal of undesired individuals and groups from a known tourist area. The idea that a zone may be made cleaner by the removal of young maghrbins implicitly labels these men as dchets (trash) or racaille (rabble). These implications are likely far more stigmatizing than the more physical acts of being questioned, searched, and illegally dispossessed of money. These three types of public encounters against maghrbins may oc cur discretely or in succession, depending on the persons situation; furthermore, as Rafael notes, a single individual may be subject to these practices and measures multiple times. Understanding the experience of stigma for young maghrbins in Geneva therefore requires acknowledging all three types of encounters and their cumulative impact. While in theory, these encounters could discourage men from using the services offered by the Bateau, it should be noted that this consequence was not observed in the field. It is likely that the benefits the men receive from being in the area group affiliation and a means of livelihood (albeit through illegal activities) outweigh the consequences. Although Roms were found to be a highly stigmatized group from anal ysis of labels and stereotypes in both media sources and ethnographic findings, the range of encounters collected for this group was limited. Most of the encounters I observed between Rom street musicians and the general public revealed a certain underlying resentment, but few explicit instances of discrimination. On the citys trams and buses, people often ignored or glared at Rom musicians as they made their rounds among
222 passeng ers to collect change acts that could be interpreted as stigmatizing, but which produced little reaction from the Roms In their long history of performing and begging for change, not only in Geneva, but in cities across Europe, it is possible that Roms have come to accept this subtle level of animosity, or that they have become d esensitized to it. As for those who would stigmatize the Roms the object of their resentment may have less to do with their ethnic or national origins, and more to do with the persistence and cunning of their strategies for livelihood: Riding the tram on my demi tarif I purchase the all Genve one hour ticket to Gare Cornavin [the train station] and back. On my way to the train station, I watch the performance of a young musician a Rom teenager with an accordion, wearing a sports jersey and baggy pants, frayed at the fringes. His fingers dash skillfully around the keyboard as he walks among the passengers at a moderate pace. As he reaches my row of seats, he approaches a young woman sitting next to me, asking her: Are you Arabian? She shakes her head no. Algerian? he tries again. No. Sorry, she responds. A young man who accompanied the woman onto the tram watches them intently from where he stands, holding a rail to steady himself. The Rom asks her a few other nationalities, which are also wrong. A fter he walks on, finding a spot closer to the front of the tram to play, the womans companion shakes his head and rolls his eyes. I wonder whether the musician was trying to find a song to play for the girl based on her nationality. This would of course have obliged her boyfriend to pay for the song. As the tram stops and exchanges passengers, the musician ambles further along, and the boyfriend glares after him menacingly. I wonder whether the boyfriend would have reacted as strongly had the musician b een of Western European descent. After I run my errands at the station, I return just in time to get on the #15 tram back to Uni Mail [a university building]. To my surprise, the same young Rom musician is on this one. He had gotten off the northbound tra m and onto the southbound tram, making the same trip past the train station both times. There could be a reason why he chooses the #15 tram maybe that its full of foreigners, travelers, wealthy people, and those new to Geneva. I decide to observe from t he back of the tram where I can count how many people give the teenager money. When he reaches my car, where some twenty passengers are seated, he plays for only a moment, and doesnt get more than two or three donations. He gets off the tram just after the bridge
223 over the Rhne, likely to begin his circuit again. Unlike some of the street musicians I have seen in the U.S., he does not linger. Instead, he is transient, like his ideal audience. Some might say he works the crowd at the expense of the corner. W hile the young Rom could admittedly have collected hundreds of Swiss francs per week from his music, as suggested by articles in the local media (Michiels 2005), he engaged in the practice at the expense of increased risk of harassment from authorities and increased self subjection to stigma. From a formalist standpoint, I interpreted his decisions as a balance between total francs gained on the one hand and perceived risk of arrest, fines, and stigmatization on the other. From a substantivist standpoint, the Roms decisions are based on his cultural and ethnic heritage an adaptation or innovation of strategies for livelihood passed down for generations, which is not necessarily motivated by the goal of maximizing assets. In public opinion, it is likely t hat the former standpoint predominates. Passengers on the trams are not naive to the strategies of street musicians, and at times, their reactions betray the belief that such strategies are manipulative and self serving. Although my observations of Roms revealed certain insights regarding their relations with the general public, I was not able to elicit an emic perspective of stigma for this group. Given that Roms were considered one of the most stigmatized groups in Geneva, much remains to be unders tood about how they experience and respond to stigma in their everyday lives. In group Stigma Other people in prcarit were an unexpected, but relatively common source of stigma in this study representing nearly one quarter of observed encounters and 15 % of elicited narrated encounters. These encounters occurred in part due to the
224 heterogeneity of social identities associated with prcarit. To a certain extent, people in prcarit of Swiss nationality practiced stigma against those of Eastern European, North African, and Latino nationalities based on the same labels and stereotypes discussed in Chapter 5. Generally, these types of encounters were also characterized by a sense that foreign people in prc arit were taking advantage of social and economic benefits and resources to which those of Swiss origin had entitlement. For example, some Swiss soupkitchen guests would insult and mistreat guests of foreign nationality, who they feel have unfairly gained access to social assistance, which is perceived as a limited resource that the foreign guests do not deserve. Laurent, codirector of CSRG spoke of a group of regular Swiss guests who were politically conservative: They dont accept the foreign people who come here. And theyll tell them things like: Get out of here! Go back to your own country! Referring to the same group of guests, David, an unemployed Swiss man who worked at CSRG in a contreprestation arrangement, explained that these men were f ar more often a source of discrimination against foreign guests than any of the day center workers: Well, its important to know that there are 200 people, 240, 250 people according to the day. And I find there are very few accidents. And knowing that ther e could be up to 50, 55 nationalities maybe... honestly, I find that there really is [an atmosphere of] respect here. Nobody has anything. The need for a hot meal. I find there are very few fights. Even with people who dont support themselves, its very, very, very rare that I would see any racist gestures or... simply intolerant. There could be words and such... Theres a table of old Swiss men, that I call the old fascists... They arent necessarily [fascist] but theyre really intolerant in their wor ds. Youre in our country now. Were the ones with rights here, not you. So, theres that, bluntly racist words so to speak... they dont even realize what theyre saying. Such instances of verbal abuse generate an atmosphere of tension and conflict in settings where Swiss and foreign people come together and have the potential to
225 discourage those of foreign origin from using local social services. Rafik, a homeless Algerian man, cited encounters with other social service guests as a reason he decided to find alternatives to Abri PC for shelter in winter: I found another place to stay because [at Abri PC ] I feel... Well, Ive always been an optimist. Id rather wake up to see the sun, and see people with smiles on their faces. But down at the PC the peopl e there are discriminated, sad, isolated. You say hello to them and they dont answer you, or they want to start a fight with you, take vengeance against you. You know what I mean. Thats why I told you downstairs that I dont like the Bateau, because th e people there are really demoralized, hateful, and theyre just looking to create problems. As a point of comparison for the tension he felt at Abri PC (which shelters many homeless Swiss people), Rafik referred to the Bateau, where a greater proportion o f guests share his North African origins. While in both social services the action of the ingroup encounter is the same (starting fights, creating problems), the ethnic and national profile of the source only differs from Rafiks in the first location. Being of foreign origin is therefore not the sole or necessary reason a person in prcarit experiences ingroup stigma and avoids certain social service locations. A more significant form of ingroup stigma was found in encounters between individuals and groups living at different levels of prcarit, in which people whose conditions were less severe practiced stigma against those who were more marginalized. People in situations of homelessness or drug/alcohol dependence emerged at the bottom of a hier archy of social identities, potentially experiencing stigma from encounters with other people in prcarit such as the unemployed or the working poor. Perhaps the most stigmatized identity was that of the clochard (bum) a designation reserved for the handful of mostly solitary homeless men and women who fished through garbage bins on Genevas streets, wore secondhand clothes that were
226 in poor repair, and owned only that which could be kept on their person or safely in some public niche. For this more des titute group, encounters originating from other people in prcarit were likely a stronger predictor of their avoidance from social services than those that originated from social service workers or the general public. Such encounters were observed occasionally at CSRG with one notable example from my second month in the field: It is a cold, January afternoon at Square Hugo, just after the first meal service. The kitchen is bustling with volunteers, and the dining room is filled to capacity. With some pa tience, one can make out the sounds of five or six distinct languages beneath the din of clinking plates and scraping forks French, Spanish, Romanian, Arabic, Portuguese, perhaps Russian. Among the hundred who have come for a hot meal, drink, and slice o f bread is a homeless couple, who despite their Swiss identity stand out from the other guests in the way they look, the way they behave, the way they are received. His look is that of a ragged lumberjack thick plaid jacket, ripped pants, torn work shoes, unkempt beard, graying hair hidden beneath a tweed cap. His nose and cheeks are blotched red. On good days he is lucid, mildtempered. Upon entering the soupkitchen he will smile at the volunteers and other guests he passes, but says very little. Her look is one of function and opportunity, evident in the wrinkled, loose fitting dress she wears beneath a coat given to her by the social services. The pattern of her dress is old, reminiscent of the 70s. Her long black hair is tangled and coarse. On good days she takes her place in the meal line with a cheerful smile, chats with the people standing near her, uses tu when addressing volunteers she recognizes. On this day they sit together at one of the small tables close to the entrance. Only moments into their meal, his voice cuts the air with a loud string of insults and other French words slurred and swallowed beyond comprehending. His sudden anger is directed first at his partner, then at the world around him whose attention he has now drawn, albei t fleetingly. Hes leaving, he says. He springs from his chair and storms out of the day center. At once, the mans partner begins crying. She gets up from her table to one where about six other guests are seated and seeks comfort from her peers there. Another woman tries reassuring her to calm her down. Like the homeless couple, this woman is Swiss, redfaced, bundled in a hooded coat
227 donated through charity. She is unable to pacify the homeless woman with soothing words, and after a few minutes she changes her tactic and begins hitting the woman on the head with a rolledup newspaper. A West African man rolling a cigarette at the adjacent table begins mimicking the sucking sounds of the homeless woman, glaring at her and grinning mischievously. The woman c ontinues to cry throughout the second meal service, for the next forty minutes. Her mascara runs. She returns her plate of food in the navette window [dishwashing station] practically untouched. Pre sumably, the less destitute day center guests treated the homeless woman in this way not because she would be identified as a clochard, but because of her behavior; her crying was disruptive and drew unwanted attention to their table. However, her lower status within the domain of prcaire identities made her mor e vulnerable to mistreatment; effectively disenfranchised and with little recourse for defending herself, she was an easier target for those seeking to vent their frustrations. Although it did not emerge unsolicited in this study, it is possible that thos e in more regular or stable situations of prcarit harbor resentment for the clochard s for reasons similar to Nadims resentment of the more marginalized North African youths who frequent the lakeside (discussed in Chapter 5). In both cases, people in the more marginalized group behave in ways that perpetuate stereotypes affecting both groups. In the case of the homeless couple described above, their unpredictable, emotionally charged outbursts (especially the mans) could be interpreted by onlookers as ev idence of mental illness or aggressiveness stereotypes that many homeless and street people confront in their daily lives. The finding of stigma that originates within the community in prcarit (or the interpretation of these encounters as stigmatizing) runs counter to Link and Phelans (2001) assertion that stigma is dependent on situations marked by differential access to social, economic, and political power. While differences according to nationality or
228 degree of prcarit may incur some advantages f or the Swiss and those in less marginalized situations, in reference to the wider society all people living in prcarit have the lower share of power. Link and Phelans (2001) criterion of differences in power is useful for limiting the definition of stigma, as it excludes encounters that originate from people with less power against people with more power. I would argue th at power differentials are necessary for the production of stigma at the cultural and historical levels, but that once a stigma is established in a society, it may be expressed and perpetuated by people of any social, economic, or political status. In this study, the stigma originating from other people in prcarit was just as significant as that originating from people in more affluent positions, and in some cases more relevant for questions of access to social assistance. Stigma Against the Unempl oyed Sans P apiers and State Beneficiaries Encounters against the unemployed were enacted in onefifth of recorded narratives and 15% of elicited recorded narratives. This study did not reveal a distinct stigma of unemployment that was not also connected to a persons residence status or receipt of state benefits. In correspondence with findings on stereotypes of the unemployed, the majority of encounters involving unemployed people targeted their situation of being without papers, or of receiving benefits from chmage the AI or the Hospice Gnral For many undocumented immigrants seeking work, the absence of residence papers creates a significant structural barrier that effectively denies them access to the job market. As with the barriers to shelter discussed above, Swiss immigration laws generate obstacles to both legitimate employment and the state social support that would otherwise be offered to compensate for unemployment. For the simple state of
229 being without papers, the undocumented are therefor e marginalized by barriers to three basic resources housing, employment, and formal social assistance.1While lack of education and training can also impede undocumented immigrants in their search for employment, those with experience and credentials in their country of origin are equally affected. Lucas, who had a degree in food processing engineering from a university in Algeria, cited Swiss immigration laws as the source in a series of encounters that led him to abandon his search for legal employment and turn to working au noir (under the table): Furthermore, as one informant remarked, the high level of bureaucracy involved in obtaining residence papers evident in the number and complexity of different forms that must be filled out is enough to discourage or prevent many immigrants from applying. People who cannot speak French, cannot read, or who are not made for dealing with this type of system are consequently excluded. Lucas: Practically the first moment I was in Geneva, I started looki ng for a job. CV. Everything that was necessary. I found three possibilities for work. One here at the university restaurant in Uni Mail. A second at the engineering department. And I applied for a design engineer post. And then, there was no problem. I had an interview... They give you an interview, they look at your CV. At the end of the interview they ask you, Do you have your residence permit? No. What nationality are you? Algerian. You dont have a European nationality? No. They cant hire you... Ryan: It was at the end of the interview that they asked you this question? L: Well yeah. Because I did manage to present my CV. Its certainly reprehensible. Unfortunately, there it is. R: And this happened for all three jobs? 1 Formal social assistance is to be d istinguished from informal types that do not discriminate according to residence status, such as day centers and soup kitchens.
230 L: All three jobs. Especially at the engineering department. I was really interested in that application. I already had good experience in the industry. I had already done some substitute teaching. I had a certain experience in education, so to speak. But unfortunately, there it is In fact, in the three cases they told me that they couldnt hire someone who didnt have a valid residence permit. Otherwise, the person needed to be of European nationality. One of the European nationalities... R : And how did you react to all this, after the first or the second interview? L : Quite simply, I stopped looking for legal work. I told myself, Well, now I cant work anymore in my professional field. I looked for work under the table. That was it. I started looking a little at the farms, t he exploitations on the periphery of Geneva. I was able to work one day out of three maximum. Although the more relevant source of stigma in these encounters was structural, the role of the individual in Lucas experience of stigma was not lost in his narr ative. In encounters like these, the individual is generally acknowledged as a mediator in the production of stigma that originates from laws and rules. However, the manner in which employers, police, social service workers, and others apply these laws and rules to real situations can mitigate or exacerbate the stigma that follows. For Lucas, it is reprehensible that certain laws prevent him from obtaining employment for which he is qualified. Yet the employers decision to ask questions about residence s tatus and nationality at the end of the interview is also brought into question. In retrospect, the interview is perceived as a waste of time for the jobseeker; it is therefore significant for Lucas that his potential employers continued with the interviews without knowing whether they could legally hire him. Lucas later went on to describe the challenges of working au noir (under the table) and the types of stigma he faced as a worker with no legal rights: To be a worker under the table is to be exploited... Simply put, youre not paid like a Swiss, or a European. A Swiss or European in any case, in general... Lets say that they would have an average salary of 18 francs an hour. In restaurant work, for a South American or an African theyre going to
231 get 1 2 francs maximum. If you work eight hours a day, an African isnt going to tell his boss: I cant work more than eight hours. If theres work to do, he has to do it if it takes ten hours or eleven hours a day. From this point, there is absolutely no guar antee of social coverage, of health insurance, absolutely nothing. While the encounters faced by undocumented immigrants are primarily structural in origin, once they are employed under the table, stigma takes an individual quality. Employers of undocument ed workers are not obligated by law to offer low pay, long hours, and no benefits. It is rather their decision to take advantage of the irregular situation of their workers, admittedly at the risk of being discovered and sanctioned by the authorities. Swis s citizens in prcarit do not face the same structural barriers to employment as undocumented immigrants. Those who remain unemployed are frequently assisted through a state benefits program such as chmage (unemployment insurance), the AI (disability ins urance), or welfare benefits administered by the Hospice Gnral Consequently, it is for their status as beneficiaries of the state that the Swiss unemployed are stigmatized, almost exclusively in encounters that would characterized as individual. Isaac, who had a history of receiving unemployment and disability assistance, cited interpersonal encounters with strangers that were directed against him (primary) as well as against others (secondary): One time, I had a buddy who... who was also on AI He had some bad times, because he eventually wanted to start working again at a certain percentage. So he would have maybe 50% [of his time], maybe more... One time, he was talking about this with someone at a bistro and there was another guy who said, If you dont stop working Im going to call the assuranceinvalidit to tell them youre working hours. The guy got involved in his business, and that really made him uneasy, because he wanted to give it a try. Anyhow, it didnt have anything to do with the other guy.
232 Its like for me, once there was a guy who was talking about me, saying, Yeah, he is paid by the State. Druggie whats his name. Ive often... Its often bothered me, what this guy said. Well, now I dont pay much attention. But there are people who... I know people who are really bothered by this kind of thing. W ell in that case, I had the right because I wasnt being paid [working illegally] so I did what I could... Even so there are people who come here [ CSRG ]. Another time there was a guy who sai d to me: Right, youre on vacation to drug yourself and now its because of that youre on AI And they dont know. Theyre jerks. They get involved in other peoples business that they dont understand. In Isaacs individual encounters with strangers, t he stigma of drug use also emerges as relevant. Encounters targeting his status as a state beneficiary cannot be interpreted without also taking into account his history of drug dependence. Furthermore, while Isaac did not cite the label profiteur as an el ement in these encounters, the idea that he was taking advantage of the system is a necessary component. What is most stigmatizing is the sources assertion that the state beneficiary chooses to be on drugs and disability insurance, that he is willfully manipulating the system for his own benefit. Isaacs response to these encounters resonates with Davids description of encounters instigated by the Swiss fascists at CSRG the source does n ot, or cannot understand the reality of the subjects situation, and therefore has no right to make such judgments. The Continuum of Responses to Stigma When asked how he responded to the combination of being insulted and witnessing others in his situatio n being insulted, Isaac said: In my life, sometimes I defended myself... But I also know that sometimes I would tell myself, Its just like that. Its like now, well I dont know. Normally I shouldnt, but in cases like that I feel kind of targeted. I ask them, Why cant I have some peace? But thats kind of exaggerated and paranoid... Because I am a little bit, I have this problem a bit. Im kind of worrisome... And its also for that reason that I... that I sank into drugs and all that.
233 Isaacs respo nses to instances of the same type of encounter varied over the course of his life in prcarit from resistance, to resignation, and back again. It remains unclear what life circumstances or undisclosed details of Isaacs encounters may explain these dif ferences in response. Yet, as an endpoint, Isaac attributes his subsequent anxiety and drug use to the cumulative impact of these experiences. His changes in social identity may themselves be considered a response to stigma whether characterized as invol untary and internalizing, as a strategy of adaptation, or both. Isaacs narrative offers a concise example of the range of responses to stigma revealed in this study. Categories of subject responses were conceived along a scale, ranging from internaliz ing responses on one end to resisting responses on the other, as shown in Table 63. From review of the literature, I expected some informants to internalize their stigmas (self stigma), expressing low self esteem in reference to the encounter and defen ding the actions of the source. I also expected other informants to resist by rejecting the labels, stereotypes, and encounters that stigmatized them. From review of field notes and transcripts, four other response categories emerged avoiding, ignoring, adapting, and legitimizing. I coded encounters according to their response when the information was available. In many cases a single encounter could have multiple responses, and some more detailed, complex encounters revealed the dynamics of response types shifting over time. Table 64 shows the distribution of encounters by response type in a subsample of encounters for which responses could be obtained (n = 173), separately for each of the four collection methods. Internalizing responses were suited for collection using all
234 methods. Although by definition, internalizing responses should be invisible to the observer, their more adverse effects on mental well being anxiety, low self esteem, and depression can manifest in episodes of crying, panic and other behaviors. Consequently, one in five observed encounter responses were coded as internalizing. Avoiding was sometimes indicative of an internalizing response, and other times as an adaptive response. In observations, it was often difficult to tell whi ch type of avoidance was occurring. Responses where the subject ignored the source of stigma were also difficult to gauge in observations, where they were most common, as they may occur as a form of avoidance, an adaptation, or the outcome of language barr iers and cultural misunderstanding in cases where encounters were verbal. They may also be an indication that the subject considered the encounter to be inconsequential, of low severity or significance as a stigmatizing act. Adapting responses often involv ed multiple actions and time points, and were therefore more adequately collected from narratives. Likewise, legitimizing responses were slightly more frequent in narratives because the verbal expression of legitimacy often occurs in retrospect, as the inf ormant reflects upon the encounter. Responses of resistance are by nature external and occurred in greater than onethird of observed responses. This section presents findings relevant for four of the response types internalizing, adapting, legitimiz ing, and resisting which could more reliably be collected in ethnographic study. For each response type, I present exploratory statistics of their possible associations with locations, participants, and five encounter types: (1) reciprocal encounters, characterized by an exchange of goods or services (commonly between the source and the subject); (2) encounters involving social/health service
235 rules or practices; (3) encounters between the subject and the legal system, at any point in the legal process (fr om interpersonal encounters with police and judges to systemic encounters involving federal or cantonal laws); (4) encounters in which the subject is labeled or insulted; and (5) encounters in which the subject is the victim of a violent act. I conducted s tatistical tests on a subsample of narrated, individual encounters (n = 85) with the intent of improving the normality of the encounter distribution. However, given the qualitative nature of data collection, it should be noted that these findings are cons idered exploratory rather than predictive. Internalizing Examples of internalizing responses may be found in a three of this chapters excerpts: (1) Davids description of the fear of being seen while standing in line at the Jardin de Montbrillant ; (2) N adims statement that building residents who bother him while he sleeps on their property simply want peace and quiet; and (3) the homeless woman crying and unable to eat at CSRG after an altercation with her partner and subsequent mistreatment by other guests. The first reveals an element of shame in the soupkitchen guests reflection on his own prcarit, suggesting that he has internalized popular conceptions of what it means to use such services. The second is qualified as internalizing because it may be seen as an apology for the sources behavior, an implicit acceptance of their right to act in stigmatizing ways toward the subject. (It should be noted that Nadims response to the same type of encounter instigated by the police was qualified as legit imizing.) The third example is suggestive of internalization through associated behaviors, although the experiences that the homeless woman internalizes are not exclusively those of being mistreated by the other guests. In the homeless womans case, her al tercation with her partner, which is not considered a stigmatizing
236 encounter, is the trigger to her emotional breakdown. The subsequent mistreatment by others likely exacerbated this episode and is assumed to have also been internalized. Lidia, who recei ved housing assistance in a contreprestation arrangement at CSRG suggested that the devalued ( devalorisante) self image of people in prcarit may in some cases be the product of roles people are expected to play (or believe they must play) in their interaction with the social services: Say that you want to get something from the social services. You really have to get in the skin of someone who suffers, to enter into a logic of misery, show that you dont have what you need if you want to have assi stance immediately, in an emergency. So in that sense, yes, I think you have to belittle yourself in order to get access to help. And once you give them the chance, they use this [on you] and give you an image that is devalued. From Lidias narrative, the performances enacted by people in prcarit are stigmatizing experiences, in the sense that the realities of formal social support force them to behave and speak of themselves in self deprecating ways. For those seeking social assistance, the internalizati on of stigma may feasibly originate from this type of performance, with or without the other stigmatizing encounters they face in their daily lives. However, Lidias example includes only a portion of people living in prcarit Furthermore, among other i nformants who participated in pile sort activities, her competence score was the lowest suggesting she did not share the groups conceptions of prcarit, or that her structuring of the domain was from a specialized perspective (as evidenced by her prior education in sociology). Overall, this studys findings suggest that internalizing responses can and do result from single or cumulative stigmatizing experiences. The contribution of a persons role as a social
237 service beneficiary akin to the sick role as defined in medical anthropology remains a question of academic interest, but one that was not addressed in this study. Associations were found between internalizing responses and the subjects 2 = 13.411, p < 0.001), a social service client 2 2Adapting = 5.864, p = 0.015). All three individual narrated encounters affecting drug addicts were provided by Isaac, whose internalizing responses corresponded with depression and hi s own history of alcohol and drug abuse. Internalizing was found in 41% of individual narrated encounters involving social service clients and 45 % of those involving the unemployed. The hypothesis that the homeless would more likely internalize experiences of stigma was not supported statistically, although internalizing responses were observed in a slightly higher proportion of homeless subjects (24% ) than subjects who were not homeless (17% ). No associations were observed between internalizing and source, location, or encounter type. Adaptive responses were common in encounters where the subject was denied certain social or economic resources (and in response found an alternative strategy for obtaining them) and in situations where the subject experienced multiple or repeated encounter s at the same location (and in response found an alternative location). In this chapter, an example of the former can be seen in Lucas narrative of being denied legal employment opportunities because of his undocumented residence status. His response of l ooking for employment au noir is an adaptive strategy utilized by most sans papiers in Geneva, who are otherwise excluded from the job market. An example of the latter type of adapting may be found in Rafiks narrative of ingroup stigma at Abri
238 PC In res ponse to his encounters, Rafik sought shelter in places where he would not be in the presence of the discriminated, sad, and isolated homeless who were the source of his direct and perceived stigma. Both cases show that adapting is a common response in encounters where the subjects basic needs are at stake here, employment and shelter, respectively. Lying about ones personal history emerged as an adaptive strategy for people who were rejected jobs based on their nationality or situation of prcarit. In a narrative collected from the field, Nadim spoke of a job he held briefly as a painter, in which he was told by his employer that she did not trust him after he had only worked for three days. Perceiving his employers rejection to be based on the fact that he was from Algeria, Nadim said he would have better chances if he lied about his nationality when applying for jobs in the future. Narratives collected from other informants suggested that such challenges were faced by a variety of people in pr carit including not only North Africans, but subSaharan Africans, the homeless, sex workers, and others. In some cases, using a local social service may be considered an adaptive response to stigma. Suzanne, director of the Coeur des Grottes told the story of a woman she had sheltered who was rejected by potential employers for being visibly homeless: There was a lady who came here from North America or England... I dont remember anymore, but I believe North America. She had some problems with her credit cards... not the most resourceful when it comes to real life. She came to Geneva to look for work... I asked her, What kind of work are you looking for? What kind of diploma do you have? She shows me an interpreters diploma that said she could speak Russian perfectly. She could speak English perfectly... French good enough but not very current... Then she told me, I came here because I would like to work with international organizations. I wanted to bring my money but wasnt able to. So, Ive had a lot of trouble because of this, because I havent been able to find housing,
239 et cetera. This lady had been in the streets for three days, and she smelled bad... Here, we gave her clothes, we let her take a shower, et cetera... to wear clean and proper clothes. We took care of her for ten days, for her meals, et cetera... to help her. And then, she found work in an international organization. She didnt need anyones help after that. But at that moment when I met her, she was in a total state of prcarit. While internalizing responses can have detrimental effects on the subjects overall quality of life and make no contribution toward stopping the reproduction of stigma, the effects of adaptive responses are mixed. In the short term, adaptation reduces the subjects exposure to stigmatizing encounters, which theoretically can have a positive impact on the subjects quality of life. Through restructuring their environment toward one that is more accepting, people in prcarit can remove a significant number of the many stressors they face in their daily lives. In the case of the North American woman in Suzannes narrative, the strategy of seeking assistance from the womens shelter served to remove her stigma permanently. With the help she received, she was able to find employment and housing. However, adaptive responses do not change the fact that stigma still occurs in society. These responses benefit the individual subjects who practice them, but have little impact on the attitudes and practices of those who would stigmatize. In statistical analyses, adaptive strategies were more common among subjects 2 2 = 5.908, p = 0.015), 2 = 7.040, p = 2 = 6.684, p = 0.010). Notably, none of the 14 individual narrated encounters involving Eastern Europeans as subjects were followed by an adaptive response. This contrasts with half of the 18 encounters involving North Afr icans. As discussed above, the homeless are more likely to use adaptive strategies
240 because their domains of exclusion are expansive. Lacking access to basic needs such as employment and housing, formal and informal social support, the homeless face multiple difficulties to which they must adapt for their survival. The association of adapting with North African subjects may be confounded by homelessness, as most of these individual narratives were collected from Nadim and Rafik, both of whom were from Algeri a and homeless. Likewise, the Eastern Europeans who contributed to narrated encounters were limited to Tania (from Serbia) and Dorin (from Romania). The absence of adapting responses among Eastern Europeans may be explained by the fact that each of these t wo informants had patterns of responses that did not include adaptation; for Dorin, most responses alternated between internalizing and legitimizing, while for Tania, all responses were legitimizing or resisting. Among the five encounter types, those characterized by insults and labels were less likely to engender an 2Legitimizing = 5.099, p = 0.024). Associations were not observed between adapting and encounter sources or locations. Legitimizing responses were seen as indicativ e of positive self image and group affiliation, creating the conditions in which real change in public attitudes toward people in prcarit may be effected. In this chapter, a response of self legitimacy may be found in Isaacs narrative of being verbally insulted by strangers for his drug use and disability insurance, and of witnessing others insulted in this way. In the secondary encounter, Isaac referred to the source as a guy who got involved in [the subjects] business and who didnt have anything to do with the source. He later repeated these sentiments in response to his own encounter. While Isaac believed that his alcohol and drug use was a problem, and he was receiving methadone and psychiatric treatment, he would not
241 accept the stereotype that his drug use was a motivation for getting disability insurance. Isaac initially began to receive AI benefits following a serious motorcycle accident in which he had broken both his legs, and a series of life traumas that led to his prcarit and drug use. His accusation that the source knew nothing about him was made with his life story in mind. In this way, Isaacs response can be seen as legitimizing for not only his social identities as a recovering addict and beneficiary of the AI but also for his personal identity. One type of legitimizing response with the potential for reducing the occurrence of stigmatizing practices in society is that of education, in which the subject responds to the source by making arguments for the authenticity of his/her social and personal identity, and/or arguments to invalidate the stigma in question. Education is typically practiced in order to discredit a stereotype, but may also take the form of appeals for sensitivity, tolerance, or acceptance in general. In this s tudy, which focused on interpersonal encounters, such responses were simple, discrete, and strongly dependent on context. For example, in an encounter with a young Japanese woman who expressed fear when learning of his nationality, Nadim responded by saying, Dont be afraid. Not all Algerians are thieves and drug dealers. While this single contradiction of stereotypes may likely have had no effect on the womans attitudes and beliefs about Nadim or Algerians in general, the consistent expression of statem ents like this could have a positive, cumulative impact. At higher levels of social organization, self legitimacy through education of the public is an important function of advocacy groups that work to address stigmas against people with impairment disabi lity (Ablon 2002) and stigmas based on ethnicity, gender, or sexual orientation. It is reasonable that advocacy
242 groups for the homeless would function to educate and sensitize the public about problems of homelessness. However, I would contend that such gr oups are most effective when they are self organized, or at the very least include people with the stigma in question. The challenge of low group affiliation is therefore one that must first be overcome before largescale efforts can work to legitimize hom eless identities and reduce the burden of stigma. The only statistical associations observed for legitimizing responses were with 2 = 7.470, p = 0.006) and social service clients 2Resisting = 4.983, p = 0.026) both groups h aving a higher proportion of legitimizing responses in their encounters, at 57 % and 41 % respectively. As described above, individual narrated encounters involving Eastern European subjects were collected from two informants (Dorin and Tania), who both had a pattern of legitimizing responses. No associations were observed between legitimizing responses and encounter sources, locations, or types. Resistance is the most externalizing of the response types, and in theory can have both positi ve and negative effects on the quality of life of people in prcarit and the reproduction of stigma. Along with legitimacy, resistance has historically been an important component of social change; when conducted without violence and within the extent of the law, it can potentially contribute toward changing negative attitudes and stereotypes. However, many acts of resistance are damaging to both parties in an encounter and convey a sense of randomness or uncontrollability that does little to improve the s ubjects relations with others.
243 One excerpt presented in this chapter has elements of a resisting response: My observation of Theo, a CSRG volunteer who served pork to a Muslim guest I n response to being served pork, the Muslim guest became angry and ini tiated a verbal altercation with Theo, which ended by the guests defiant gesture of throwing his plate of food onto the serving compote. While understandable, the guests outburst did not produce immediate benefits for him or the other guests, nor did it necessarily help to reduce the occurrence of future encounters of this type. However, it did contribute to an atmosphere of conflict in the soup kitchen, and potentially to the reproduction of stereotypes of soup kitchen guests as violent or unstable. In social service locations such as day centers, soup kitchens, and homeless shelters, it is of critical importance to address sources of stigma that are liable to lead to responses of resistance. In one example from my fieldnotes, Ray a regular CSRG guest of American origin violently resisted a situation in which he was denied services: May 24, 2006 CSRG Ray, the American guy, comes in wearing his thick framed glasses and widebrimmed white hat. His hand is bandaged from some kind of injury. I join him a t the counter after exchanging a few words in English. He orders hot tea, and is given two sugars to go with it. A few minutes later, after chatting in French with another guest, Ray asks the volunteer, Mara, for two more sugars. Mara promptly refuses his request. Ive already given you two sugars, she says matter of factly. But Ive always asked for four, Ray replies, explaining that it was his customary serving, one that had always been given to him before. The volunteer then holds up a blue wooden serving box that contains the sugar and turns it to show Ray the note that had been pasted on the front: Max. 2 sugars per person. I notice that the box has been mostly covered by a sheet of aluminum foil, with a small opening from which the volunteers can distribute the sugar packets. This is a new strategy employed to prevent guests from reaching over and taking the sugar packets for themselves, as I have seen them do in the past.
244 At this point, Ray loses it. He begins cursing at the women behind the cou nter: Putains! [Whores!] Salopes! [Bitches!] His voice raised, his sudden outburst jars the tranquility of the social club. The volunteers ignore him, continuing their work, even smiling and laughing at his insults. Because of their reaction, I at first wonder whether the whole episode is a sort of charade, whether Ray was just playing and the volunteers were in on the joke. But after a few more gros mots [bad words] the authenticity of Rays anger is clear. Laurent calmly walks up to him and urges him to leave, but Ray is already on his way out the door. They both disappear into the entrance stairwell for a few minutes. I notice that Ray has left his tea on the counter, untouched. Laurent returns and I explain to him that I have never seen Ray so angry before. His name is Ray? Laurent asks me. What happened here exactly? I describe to Laurent what I had observed. We talk about the rules of the day center. According to Laurent, these kinds of things happen because the volunteers do not apply the rules consistently. Some respect the rules, while others dont. At this point, Ray returns to shout more obscenities, unsatisfied with the results of his previous rant. This is racism! he shouts. Laurent again escorts the angry American out of the day center, this time using his name. This example highlights the relevance of social service rules and practices in the guests experience of stigma components of the encounter that can potentially be modified through proper training of volunteers and review of the centers structure and norms of operation. Furthermore, Rays experience and his consequent act of resistance were likely exacerbated by the changes made to the sugar box itself an environmental source of stigma that implied guests were being ov erindulgent in their sugar consumption and needed to be controlled. Stigma marked by the denial of services reflects a sense of unmet reciprocity. Encounters between social service workers and clients often involve an exchange of goods or services from t he social service to the person in prcarit. The clients expectations of what and how much is exchanged may follow a pattern of regular
245 interaction and familiarity, the clients knowledge of legal rights as a recipient of assistance, or for many foreign people, assumptions that social services would act in goodwill through the charity concept. Changes to social service rules or practices and their inconsistent delivery can affect this pattern of exchange, leading clients to sense the violation of establis hed rules of reciprocity. The feeling that ones rights and privileges have been violated is a reasonable precursor to responses of resistance, especially when connected with the denial of basic needs. However, while resisting responses occurred in 29% of reciprocal encounter types and 36% of subjects who were social service clients, neither factor was significantly associated with resistance in statistical tests. With regard to subject nationality, acts of resistance were considerably more common among Sw iss citizens (61 % ) than among subjects from Eastern Europe (29% ) or North Africa (6 % 2 = 18.534, p = 0.005). As discussed above, the likelihood of resistance may increase as perceived risks of enacting the response are removed, or decrease as risks are compounded. Foreign people in prcarit are more frequently the target of police than the Swiss, largely because of immigration laws, but also for their associations with petty crime (particularly young maghrbins ). These groups may avoid responses of resistance because of the attention such responses attract. Conversely, Swiss citizens do not concern themselves with immigration authorities and may find encouragement to resist in their own sense of national, cantonal, and personal rights. 2 = 14.292, p < 0.001) 2 = 4.573, p = 0.032), at 4% and 0% of individual narrated encounters, respectively. Conversely, resistance was far more likely among
246 2 = 19.447, p < 0.001), at 75% of individual narrated encounters. In many of these cases, the subjects act of resistance came in the form of rejection of mental illness labeling or treatment. Tania, who maintained that she was not crazy after her arrest and imprisonment, said of a new psychiatrist she had been assigned: He thinks Im paranoid and should be on sedatives. At my last meeting with him, when he mentioned it, I just stood up and walked out. Understandably, among the five encounter types, those characterized by insults and labels more frequently engendered 2A Recursive Model of Stigma = 4.574, p = 0.032). Findings from this chapter provide an initial glimpse of how stigmas of poverty are enacted, through encounters that are both individual and structural in nature. From a small sample of informants I collected personal narratives of stigma, which, considered alongside encounters I witnessed through participant observation, revealed how people in prcarit experience stigma in the social services, in the streets, from other people in prcarit, and against their identit ies as sans papiers and state beneficiaries. While my methodologies would not allow for objective measurement of which groups in prcarit in the population were most affected by stigma, they did reveal the wide range of encounter types experienced by the various groups I studied. By assessing the response of the subject as integral to the encounter, I shift from the popular conception that stigma is expressed as a oneway dynamic, and from the portrayal of people who experience stigma as passive victims It is through an individual response whether mental, physical, or both that the subjects experience of stigma is completed, for better or worse. Findings suggest that repeated responses of internalization may indicate impairment of the subjects sel f efficacy and possibly mental
247 illness. Adapting responses are potentially more positive, as they remove the source of stigma for the individual. However, adaptation does little to promote social change for the group. Legitimizing and resisting responses do have the potential for ultimately removing stigmas and normalizing previously stigmatized identities at the historic level. Group affiliation is an important component for the transformation of individual cases of self legitimacy into larger scale advocacy efforts. More extreme responses of resistance, for their part, have the potential of generating deeper rifts between the stigmatized and society, in some cases serving to perpetuate the very stereotypes being resisted. The majority of encounters with a response dynamic (multiple response types occuring in succession) involved a stage of resistance, almost always before the manifestation of other responses. Resistance is a riskier type of response, as it can instigate an escalation of hostility, putting the subject in danger of physical harm, removal, or arrest by authorities. In this chapter I present a recursive model that can identify ways of addressing and eliminating stigma that focus on not only the source (i.e., through modification of laws, rule s, or practices) but on the subject (i.e., through encouragement of self legitimacy and group affiliation). Many of the encounters cited here are suggestive of links between stigma and mental illness, and can point toward strategies for reducing vulnerabil ity and symptoms that include the stigmatized person as an actor. Chapter 7 presents in more detail the cases of Dorin, Nadim, and Tania, which provide rich context surrounding the connection of stigmatizing events and situations with stress, emotional bre akdowns, and diagnosed mental disorder.
248 Table 6 1. Stigmatizing encounters: participant characteristics Observed (n = 52) Field narrative (n = 34) Recorded narrative (n = 131) Recorded elicited narrative (n = 20) All methods (N = 237) N % N % N % N % N % Source a Employer 0 0% 3 9% 13 10% 1 5% 17 7% Family 0 0% 0 0% 3 2% 1 5% 4 2% Me 7 14% 0 0% 0 0% 0 0% 7 3% Media 1 2% 0 0% 1 1% 0 0% 2 1% Police 0 0% 4 12% 16 12% 4 20% 24 10% Prcaire 12 23% 1 3% 15 12% 3 15% 31 13% Professor 0 0% 1 3% 0 0% 0 0% 1 0.5% Property owner 0 0% 0 0% 6 5% 1 5% 7 3% Public 8 15% 2 6% 12 9% 2 10% 24 10% Public official 0 0% 0 0% 2 2% 0 0% 2 1% Religious figure 0 0% 0 0% 1 1% 0 0% 1 0.5% Social service 19 37% 4 12% 24 18% 7 35% 54 23% Structural 5 10% 19 56% 38 29% 1 5% 63 27% Subject gender Men 36 77% 15 54% 64 83% 11 79% 126 76% Women 11 23% 13 46% 13 17% 3 21% 40 24% Subject nationality b Eastern European 6 18% 11 38% 14 15% 1 6% 32 18% Latino 4 12% 4 14% 8 8% 0 0% 16 9% North African 1 3% 9 31% 20 21% 6 35% 36 21% Swiss 10 30% 3 10% 37 39% 5 29% 55 31% Subject situation c Alcoholic/addict 2 4% 0 0% 4 3% 0 0% 6 3% Homeless 2 4% 10 29% 30 23% 5 25% 47 20% Institutionalized 0 0% 6 18% 3 3% 0 0% 9 4% Mentally ill 7 14% 7 21% 22 17% 0 0% 36 15% S ervice user 30 58% 2 6% 39 30% 9 45% 80 34% Undocumented 1 2% 7 21% 22 17% 2 10% 32 14% Unemployed 3 6% 2 6% 26 20% 3 15% 34 14% a Each encounter was coded as having one source. Instances where two types of sources were involved were split for the purpose of analysis; b Totals do not equal 100 % because only the top four nationality groups are shown. Subject nationalities of the remaining encounters were coded as other or unknown; c Situations represent those most relevant to the encounter, not necessarily every situation the subject experiences. Encounter subjects could have more than one coded situation of prcarit
249 Table 6 2. Stigmatizing encounters: locations Observation (n = 52) Narrative (n = 7) Recorded narrative (n = 52) Recorded elicited narrative (n = 15) N % N % N % N % Businesses 8 15% 0 0% 6 12% 1 7% Hospitals/clinics 3 6% 0 0% 0 0% 0 0% Institutions Academic 0 0% 1 14% 0 0% 0 0% Legal/penal 0 0% 0 0% 2 4% 0 0% Religious 0 0% 0 0% 1 2% 0 0% National border 0 0% 0 0% 1 2% 2 13% Private residences 0 0% 1 14% 3 6% 0 0% Public places 6 12% 1 14% 7 13% 4 27% Public transport 4 8% 1 14% 1 2% 1 7% Social services Shelters 2 4% 1 14% 12 23% 2 13% Soup kitchens 28 54% 2 29% 16 31% 4 27% Other 1 2% 0 0% 3 6% 1 7%
250 Table 63. Continuum of responses to stigmatizing encounters Response type Characteristics Internalizing Subject expresses some degree of self stigma, holding the same stigmatizing beliefs about his/her identity as the source. Subject expresses low self esteem, anxiety, or sadness in reference to the encounter. Subject defends the actions of the source, considering him/herself culpable or deserving of the stigma. Avoiding Subject makes efforts to avoid the source of stigma and situations where similar encounters are likely. Subject expresses a sense of denial or impaired self efficacy regarding the encounter, but does not explicitly express self stigma. Ignoring Subject ignores the source of stigma, neither interacting with nor responding to the source. Adapting Subject devises a strategy to minimize the likelihood of future stigmatizing encounters or mitigate their consequences. In many cas es, any of the other five response types may also be qualified as adapting. Subject is ambivalent toward the encounter, accepting the stigma as natural, or the way things are Legitimizing Subject expresses the authenticity of his/her identity in reference to the encounter, either directly to the source at the time of the encounter, or afterward in reflection. Subject provides reasons why he/she does not deserve the stigma in question, either by defining him/herself as an exception or by criticizing (and delegitimizing) the source. Subject works to educate the source regarding the authenticity of his/her identity or the invalidity of the stigma in question. Resisting Subject responds defensively toward the source, potentially instigating a verbal or physical altercation. Subject responds in a passive aggressive manner toward the source, for example, by intentionally denying the sources requests. Subject expresses strong resentment of the source and denounces the source upon reflection of the encounter.
251 Table 64. Distribution of encounter response types, by collection method Observation (n = 46) Field narrative (n = 29) Recorded narrative (n = 87) Recorded elicited narrative (n = 11) N % N % N % N % Internalizing 9 20% 6 21% 17 20% 2 18% Avoiding 7 15% 3 10% 4 5% 3 27% Ignoring 18 39% 0 0% 3 3% 3 27% Adapting 2 4% 11 38% 34 39% 4 36% Legitimizing 5 11% 7 24% 17 20% 2 18% Resisting 17 37% 5 17% 27 31% 3 27%
252 CHAPTER 7 PATH WAYS TO PSYCHOSOCIAL DISTRESS: THREE CASE STUDIES O F POVERTY AND STIGMA Among the informants I encountered and came to know in the field, Dorin, Nadim, and Tania were exemplary in showing the dynamics of stigmas of poverty. In their stories I gained a rich understanding of the various attributes that are stigmatized, the various ways stigma is pract iced or produced, and the various ways that one can respond to it. From my intensive, long term association with each of these key informants, I obtain ed a perspective on stigma that emphasizes social context, personal history, and the complementary trajec tories of experience and identity. Each of the three struggled with multiple stigmas in their daily lives, including stigmas of nationality (whether Romanian, Algerian, or Serbian), homelessness, unemployment, and mental illness. Some stigmas had predominance over others, which sometimes elicited responses from the informants that differed in intensity or type. More importantly, my time with Dorin, Nadim, and Tania revealed how stigma interacts with, overshadows, or underlies other stressors of living in pr carit to produce a singular experience. These case studies also offer insight into the influence such an experience has on personal and social identity, and in times of increased adversity, on mental health. Each of their experiences is unique, showing different pathways to psychosocial distress that involve different actors and places, different types of encounters and responses. A homeless Romanian man struggles with his low sense of self worth. An Algerian man, arrested for vagrancy one too many times, suffers acute episodes of anxiety. A Serb stigmatized for her nationality becomes paranoid, hostile and violent. Their stories not only elucidate the potential connections between stigma and mental health, but also point toward practical strategies for addressing both.
253 Dorin (In)visible in a New City I recall one particularly hectic day in July working at CSRG when a palpable tension could be felt among both volunteers and guests. The volunteer who had arrived before me had accidentally switched the coffee and hot chocolate urns causing me to serve guests the wrong drink on numerous occasions. Meanwhile, another volunteer, a middle aged Swiss woman of Hungarian descent, was being teased by a new guest a young man who found amusement in snatchi ng away his meal ticket every time she reached out to take it. He did this five or six times before moving on a behavior that incurred practically no reaction from the veteran volunteers working behind the counter. Shortly after this, an older Latino ma n arrived one who was also new to the soup kitchen. The man seemed angry, and was at first antagonistic with me and the other volunteers. When he began shouting interjections and wandering aimlessly through the soup kitchen, a Swiss man in a baseball cap called to me through the navette window (dishwashers window). Somebody should do something about this jerk, he said. Theres something wrong with him. Near the end of my shift, a third newcomer arrived a solitary man in his forties, long haired a nd unshaven. He approached me, speaking English, which was welcome respite for a frazzled American volunteer lost in complicated drink orders and his own bad French. The man wanted to help out, to work behind the counter as a volunteer, but he didnt know who to talk to. I couldnt quite place his accent, aside from knowing that English was not his native tongue. He introduced himself as Dorin, and said he was originally from Romania.
254 I sat with Dorin briefly and we chatted over a cup of espresso. He had r ecently arrived in Geneva and was homeless and looking for paid work, ideally in a job that would suit his interest in ecology and affinity for nature and animals. Dorin had spent many years living in the Romanian capital Bucharest and wanted to get away f rom larger cities. At one time he had dreams of being a shepherd. Knowing only this, I suggested that he try to find work on a trailblazing crew, given that such work would be plentiful during the summer in a mountainous country such as Switzerland. Secret ly, however, I suspected that his own language barriers (he spoke little to no French) would make his efforts at finding work in the canton of Geneva more difficult than he imagined. Dorin and I soon became friends, and during the next few months I saw him on a nearly daily basis. Dorin normally spent his nights in one of Genevas many parks often constructing makeshift shelters for himself with sheets and blankets, mostly for the sake of privacy. Largely due to their association with gitans (gypsies), st reet musicians and thieves, Romanians in Geneva often have difficulty being accepted by Swiss locals and finding employment. However, Dorin had two additional life circumstances working against him: his low competence in French, and, being new to town, a n onexistent social support network. He was, for all intensive purposes, completely alone. From Romania to Sweden, to Switzerland Dorin was born in Romania, where he lived the first 25 years of his life one of six children in a working class family. Hav ing received no more than an elementary school education, some music courses as a child, and some courses in a trade school, he worked in Romania as an electrician. From the very beginning of his story, the unfairness of life in a competitive world became a clear and salient theme:
255 As a child I was pretty good in school. Every year they give awards for the best marks, just like in sports 1st place, 2nd place, 3rd place. One year me and another guy, we were waiting to be called. According to the notes, we were 3rd place. But they put someone else in front of us, a nephew of somebody. Even in his own family, Dorin perceived himself a victim to individualism, where everybody wanted to be bigger than the next person. Despite having five siblings, very little sharing or mutual aid occurred in his home. At 25 years old, Dorin moved to Sweden, where he spent the next twenty years of his life. He was granted political asylum and a Swedish passport, and after nine years, married a Swedish woman. During the course of his marriage, Dorin was wrought with periods of self doubt and feelings of inadequacy. He knew people were talking shit about him and complaining to his wife that she could find a good Swedish guy He attributes the dissolution of his marriage to hi s own status as a poor foreigner: She said I was just an immigrant. I didnt have much money... Because of that, she left me to find a real man with money. Its the same story: The female tries to get a bigger, richer man. After twenty years, Dorin never lost the sense of being a foreigner in Sweden, and of being devalued for it. While he claims that people have the right to legally camp in the woods, the few times he tried it, he was harassed by property owners and passersby. His experiences of mistreat ment by the Swedish police were severe: In Sweden theyll arrest you just for walking, especially if you dont bow down before them, especially if you think you might be a human being. Try to keep your head up, and they arrest you Then, the day you final ly put your head down, they wont let you. Now, at age 46, Dorin had come to Geneva to find a new life. He admitted finding it difficult. He had never lived like a vagabond, and he treated his visible
256 homelessness as a social liability. Ironically, t he fact that the public tended to avoid him for the way he looked left Dorin feeling invisible. He found it hard to blame the Swiss: Theyve got a hard life themselves, with taxes and things. You cant give to everybody. More significant were instances in the past six weeks, when people did not avoid him. People with dogs have approached him while he was sitting on a bench in the park, harassed him, and called the police on him. One instance involved a seemingly arbitrary interaction with foreign youths while he was trying to sleep on a park bench: Once, some young guys started throwing pieces of bread at me. But these guys were children of foreigners. I dont know what they said, whether they were talking shit about me... So I threw the bread back at them and said, What the fuck are you doing? You crazy or something? They tried to provoke me. After that I didnt look at them. I looked in the other direction, tried to keep it cool. And then they left. A Date Gone Awry Late one afternoon in September I had an unplanned meeting with Dorin. I was working on my computer in the kitchen of my residence when he walked in. After I had noticed him sleeping under the stairwell of the basement, he had been letting himself into my residence more often. Sil ently negotiating the apprehension of my roommates, I welcomed Dorin and invited him to join me for a cup of espresso. He mentioned that he had met some young women in the park who wanted to meet me, and that we could meet them at Plainpalais at 5 pm. The prospect immediately seemed dubious to me. He claimed the women were LatinAmerican. While they spoke no English, they did speak French, and Dorin claimed to speak some Spanish as well. But why would these women want to meet me? Giving Dorin the benefit of the doubt, I assumed that he had been playing the role of key informant finding other foreigners living in prcarit in Geneva who might be interested in helping
257 me with my work. Earlier, he had offered to help find Romanian informants, who, like Latin os, were not well represented in my study. I agreed to meet Dorin near the skate park at Plainpalais I rode my bicycle, arriving at the skate park a few minutes late. But he wasnt there. The fairgrounds were characteristically busy, and heavy traffic li ned the boulevards on both sides as the working Genevans made their way home. Not knowing where I might end up, I stayed on my bike, riding around the area in slow, leisurely circles for ten minutes or so. I began to feel self conscious, because this kind of activity mobile loitering was a practice of drug dealers at the nearby Jardin Anglais I imagined that someone would come up to me a police officer asking me for my papers, a user asking for drugs, or a drug dealer accusing me of being in his terr itory. I settled behind a billboard between a free bike rental place and the Boulevard Georges Favon. Five minutes later, I heard Dorins voice call my name from behind. He was carrying two or three bags of possessions mostly clothes and wearing his baseball cap. His hands and arms were covered with white paint, as he had just finished working a shift painting at the Bateau. Standing next to him was a young Latina woman with big hoop earrings, wearing an anxious expression on her face. I greeted Dorin in English as I dismounted from my bike. Then, suddenly, the woman murmured something, turned around and walked away. Whats going on? I asked him. Who was that? It was the girl he had met in the park.
258 Maybe she is going to get her half sister, Dorin said, speaking of the other woman he had met the night prior. In the meantime, I tried to get some clarification from him. The women were not interested in doing an interview with me. He claimed to have told them that he had an American friend, and that t hey wanted to meet me end of story. I got the sense that he was using me as a kind of legitimacy chip: Given his own condition as a lone, homeless foreigner, bringing me along on his date would prove to these girls that he was telling the truth, and al so that he was trustworthy enough to have a friend. We waited about ten minutes, but the Latina woman never returned. From the timing of events, it seemed reasonable that my arrival is what caused her to leave. It is possible that I made myself suspect by loitering the grounds on my bicycle, and the woman l eft in apprehension. Or I may simply have not been the person she was expecting. Yet, Dorin insisted that it was probably him. He searched for some explanation for why the woman would reject him now Maybe it was the paint covering his hands and arms. Maybe it was the fact that when he first met the women, it was dark and she didnt get a good look at him. Now in the daylight, maybe his appearance turned her off. Maybe it was all my bags, he suggested as a last possibility. I asked him why his bags would turn her off, and he said simply: Its weird. You dont show up for a date with your luggage. Nothing E lse M atters In mid October, I saw Dorin for the last time before leaving the field. As with many of our encounters, it was not planned. It was an u nseasonably warm day for early autumn in Geneva. I was taking the day off with some friends from my residence,
259 playing ping pong at the Parc des Bastions Dorin approached me, unshaven, his long black hair tucked beneath a baseball cap, but notably without his backpack. Over an espresso at the caf, he explained that his backpack had been stolen from him as he slept at the edge of Lake Geneva. With it, he lost his identification and MP3 player. Without the first he would have even more difficulty finding w ork and assistance. And without the second, he jested, he would have trouble maintaining his sanity. Dorin sat at the caf piano to demonstrate some of the skills he had learned in his childhood music lessons, and perhaps to ward off the impending madness that would arrive now that he was without his music. He played a few bars of Mozart and other classics, and then transitioned to more contemporary material. As he played a keyboard version of Metallicas Nothing Else Matters the other patrons in the ca f nodded and smiled. Here was a sight nobody expected to see, accompanied by sounds nobody expected to hear: A homeless Romanian man playing Metallica on a caf piano. At the edge of the piano was a sign in French, in plain view: Do Not Play But nobody stopped him from playing. This was perhaps one of few moments during Dorins time in Geneva where he could express himself without being rejected or excluded. Sitting behind the piano at the park caf, he had a role to fill, however short lived. Planetar y Escape During the brief time that I knew him, I often found Dorin in a depressed state. His low sense of self worth could be seen in how he described his own poverty in his interview at times, considering his disadvantaged state as a curse, and at ot her times framing it as punishment for being an asshole in a previous life. In jest, he suggested that he may have been Adolph Hitler reborn a sentiment that, upon
260 reflection, led him to make the far more serious statement that he was resigning his wi ll to live. At other times, Dorin recognized that he once held a certain compassion for others in his state. While he claimed that it hurt to see other people suffering, he now felt that in observing the suffering of others, he was going to lose it H is new strategy was to stay cool ignore, and look away. Those who suffer, he suggested did not deserve compassion any more than he did. On another occasion, Dorin suggested that being someone with nothing, being a nobody was like being stuck between life and death His discourse conjured images of the homeless man as a ghost wandering the streets one who, despite the reality of his visibility, is treated by others as if he cannot be seen. In so many words and actions, Dorin portrayed himself as t he walking undead. Perhaps it was no accident that, among the makeshift shelters he had devised for himself in the park, one was a coffin made from wood and cardboard boxes. While the explicit function of such a structure was to keep him from view and inclement weather, the form Dorin had chosen for it spoke to something far more profound a symbolic connection with death borne from his seeming invisibility. Regardless of how Dorin tried to make sense of being homeless and poor in Geneva, the end resul t was a blow to his self esteem. Dorin was depressed, and often concealed his suicidal thoughts in euphemisms. At the end of his interview with me, he remarked: The other day when I tried to buy a pack of cigarettes, the Arabian guy tried to cheat me one franc... I hate everybody, including myself. Its true. Do I want to go home? I want to go to Mars, Jupiter, Pluto. I want to go into nature.
261 Dorins depression seemed connected to two negative outcomes of being homeless the stigma and discrimination he experienced and perceived, and his solitude. Finding himself alone in a foreign country, without the ability to communicate in any of the countrys four national languages, Dorin was sensitive to perceived discrimination. He accused the social services of practicing favoritism evident in things as simple as the small quantity o f food being served in the soup kitchen, the reluctance of certain volunteers to hand out extra dessert when it was available, or the experience of being thrown out near closing time, even if he was offering to help clean up. Dorin emphasized that such discrimination was more often practiced by the foreign volunteers, rather than the Swiss ones. He recalled one occasion when a foreign volunteer rejected his request for extra bread: He should have looked down at the bread, to see. But instead, he looked at me, like he was judging me or something. He did this just to hurt me. He decided he didnt like the way I looked and refused to give me bread. Dorin also sensed structural dis crimination in laws dealing with housing and immigration Although he did not know the laws in Switzerland, he i nsisted, I have no rights here. And they have no obligation to me. Yet it was through other people that Dorin encountered these laws, and he was more emphatic in his subsequent description of these interpersonal exchanges. The social services, he said, always told him to go back to Sweden a country he associated with persecution and insanity. I dont want to die in Sweden, he said. If I died here on the street I would be happier. Dorin believed that Swiss law made the social services patronizing He found it ironic that social workers were empowered to help people who were in a better situation
262 than he. Their problems were easier to fix, yet they could do nothing for people, like him, who had the most problems: If youre well dressed and you look healthy, theyre going to help you. But if you look like a bum, you get nothing. Speaking of others in his position, Dorin suggested th at poverty causes people to lose their personalities: They lose their own character because society makes them all rubbish. I couldnt help but suspect that his knowledge of this process one linking poverty, discrimination, and the dissolution of ident ity was the knowledge of an expert who had experienced the very process firsthand. Nadim Defending Nationality, Hiding Homelessness It is four o clock in the afternoon and Rue Hugo deSenger is quiet, the shadows of tightly packed buildings growing longer with the setting sun. Inside the CSRG soup kitchen, volunteers are wiping down tables and counters, sweeping floors, preparing to close for the day. Most of the guests have already left. The Roms have gone back to their spots in the Cit district and on the tram s to play music Many of the guests have gone to the CAR in time for the 4:30 meal a short, 10minute walk into Carouge The few stragglers remaining inside finish their drinks stamp out their cigarettes, and wrap up their chess games. On th e sidewalk I encounter Nadim coming out the front door. The thin, young FrenchA lgerian man is wearing a wrinkled red shirt, and his frown preemptively speak s of some recent misfortune. Nadim is normally outspoken upbeat. Today he is reticent and I hear little more than a weak salut [hey] as he approaches. Im completely desperate, he tells me. The Hospice Gnral didnt pay him the full amount he normally receives monthly because of an outstanding bill with Swissc om one of Switzerlands telephone and mobile communications companies. The bill amounts to 1000 CHF in fixedline services, dating to when he lived in the apartment of a friend. The social service agency deducted a sum from his benefits to pay half the debt, and Nadim is left short on his income. This problem compounds his already troubling lack of shelter. W ithout his expected revenues, he cannot pay to sleep in a shelter such as the Salvation Army His closest relative is his sister, who lives in Lausanne a 40minute train ride from Geneva. He avoids Lausanne anyway, he says, because of the racists there. Last night he worked at his new security job
263 until 2 am, then attempted to sleep in a parking lot. He was discovered by the Geneva police and taken to jail, where he managed to sleep two of the four hours he was there. For Nadim, the situation is a complete mess He admits to contemplating suicide. Next to come out of the soup kitchen is Catherine a n older Swiss German woman who approaches me with a newspaper published by t he Interpr ofessional Syndicate of Workers (SIT) in which she points out a story about women in the workplace. Nadim immediately dismisses the SIT paper as a load of bullshit Cathe rine seems slightly taken aback but does nt lose her composure. Practicing her English, she engages me in a brief discussion on womens rights Nadim (who understands no English) disengages and sits on the curb, his head in his hands. In an effort to include him, I try switching the convers ation back to French, but he expresses no interest in the subject Instead, he calls a friend on his cel l phone to ask for a loan. A s soon as Nadim asks for some money, its apparent that the other party hangs up. Lucas arrives next on his bicycle, stopping at the curb to greet us. He practices his English salutations then dismounts and quickly reverts t o French. The Algerian man smiles beneath his baseball cap. He produces some loose tobacco and rolls two cigarettes one for himself and one for Nadim. Th e younger Nadim accepts Puffing away at his cigarette, Nadim complains of headaches, stress, and depression. After a minute or so, Catherine leaves, and Lucas and I stay with Nadim. Can you pass me thirty francs? Nadim asks Lucas. He needs the money for two nights at the Salvation Army. After that, he explains, he will take the train to Lausanne to work and stay with his sister. Can you pass me thirty francs? he asks Lucas again. Lucas fumbles with his words. Being older and more educated than Nadim, he may be better off. But as a Maghreb immigrant, his troubles with ethnic discrimination are the same. Without steady employment or income, he comes to the soup kitchen daily. Lucas tilts of his head, reluctant to loan any money. You know, Nadim, he says carefully. You still owe me ten francs from a few months ago. After this the two friends switch to Arabic. Nadim confirms he still needs money. Lucas confirms Nadim still owes him money. Nadim is running out of people to ask. In the end, Lucas admit s that he doesnt have the money to give.
264 Nadim walks three storefronts down to the corner at Boulevard Pont dArve one of Genevas busiest and most polluted roadways. As we watch him asking a man on the sidewalk for money, Lucas offers his take on Nadim : He doesnt have a long term plan. He doesnt have the ambition to make something lasting, to get off the streets. Lucas has the equivalent of a Bachelors degree from an Algerian university, but because of his lack of residence papers, he cant find a job in his field. He gets by working au noir (under the table) and hopes that he can someday establish himself in Switzerland. Yet Nadim has no diploma to back up his efforts toward building a normal life. Nadim returns empty handed, his eyes anxious and fixed to the asphalt in front of him. Lucas suggests that he find a quiet place to sleep where nobody will disturb him, but Nadim shakes his head. His experience in the quiet places parks, gardens, apartment lobbies has been less than ideal. Than ks anyway for the advice, Nadim tells him. I offer to fetch Nadim my last ibuprofen which I keep in my dormitory room five floors above the soup kitchen. He takes the pill and the water I offer him, then throws the empty pill bottle on the sidewalk. The plastic bottle cracks against the ground, bounces a few times and rolls off the curb. Nadim mounts his bicycle and shakes my hand. He hardly says a thing to Lucas before riding off. Fieldnotes. June 21, 2006. I begin in the middle of Nadims story to illustrate a low point in the life cycle of a young FrenchAlgerian immigrant, struggling to make a life for himself in a city where prejudice against Algerians and the homeless is a daily reality, and in a country where bureaucratic roadblocks constrict acces s to two of lifes most important necessities: housing and work. Nadims problems were compounded by having few trustworthy and supportive personal connections. The manifestation of his fears and worries expressed above acts as counterpoint to his lifes plateaus, as he oscillated between galrer (slaving away) and se dbrouiller (managing) to make ends meet. At the positive end are the stories of motivation, diligence and the combination of serendipity and agency that would allow him success in finding stability, both physical and mental.
265 I met Nadim one month earlier at the Bateau, on a day when the soup kitchen was holding its weekly passengers meeting a kind of open forum for staff, volunteers and guests Nadim introduced himself to me as a 25year old FrenchAlgerian, standing out from the rest of the guests for his outspoken, alert demeanor. His blue jeans and orange knit mesh shirt were clean and in good repair, and they fit his small frame well. By hi s appearance, a rip at the elbow of his corduroy jacket was the only sign that he may have been in a situation of prcarit As I met and chatted with him more frequently, it became clear that his apparent stability was tenuous, and that his life while d irected toward reasonably singular goals (housing and work) was equally marked by periods of loss and distress. I followed Nadim in his daily travels throughout Geneva from May to September 2006 at the Bateau and CSRG in cafs, on the trams and buses, to summer festivals and public swimming pools Slaving Away for Money in Switzerland Upon his arrival in Geneva, Nadim was impressed by the natural surroundings, the security, and the social life of the city. It was immediately apparent to him that som eone with adequate financial means could live a good, quiet life in Geneva: No disturbances, lots of advantages. And the work is well paid. Nadim, however, was far from having such financial means himself. For his first year and a half in Geneva, he slept outdoors in a sleeping bag. After two years, Nadim found temporary work, having been granted a 90 day work permit. He secured a steady cleaning job, but after one and a half years was fired without cause: I was working on the 13th and fired the next morning. He told me You dont have the right to step foot in this workplace. I was never able to figure out why. It is possible that his dismissal dealt with a dispute over hours. Initially, Nadim was
266 working the graveyard shift from m idnight to 8 am. When his boss asked him to extend his regular work shift by working until 10 am, Nadim faced an untenable situation. For ten hours of work with no break, he was paid a meager salary somewhere between 2,300 and 2,600 Swiss francs (CHF) per month, or 11.5 CHF to 13.0 CHF per hour. These figures were considerably lower than the national minimum wage standards for unskilled workers, which range between 3,400 and 4,000 CHF per month. In terms of supplementing the income earned through work, Nadim claimed to have little in the way of external sources of support By the time he had arrived in Geneva, he had cut off ties with his family for undisclosed reasons a topic he preferred not to discuss. Nadim had a number of friends in Geneva, although he remarked that most of those friends with apartments never wanted to lend a hand. His a ctivities with such p eople were limited largely to simple rendez vous (meetings) and formalities: Really, theres no activity. Its go get some coffee and after that, thanks goodbye, see you. Theres no discussion. Theres nothing. At best, on any given day Nadim would find himself at the Bateau to work and socialize which helped to relieve the stress of life on the streets. When asked how many friends he had whom he could count on for support, Nadim replied: Ya pas a [ There arent any. ] He was reluctant to consider t h e people he met in social contexts as true friends. Nadim carried a strong sense of independence when speaking about more formal social support. While he valued the comprehensive nature of social services in Geneva and criticized the legal restrictions that prevent immigrants from accessing the system, he insisted that the ultimate goal was to become independent. When asked which of the
267 citys social service centers he preferred, his response was emphatic: Its not a question of preference. I prefer not to be there! I prefer to work, and to go home after my work is done. Getting off of social support requires obtainin g the very things the social support system is set in place to offer: housing and work. For Nadim, there was a certain order to the housing work dynamic. While Lucas and other informants suggested that the lack of housing and work was a self defeating cycl e recognizing that it is difficult to secure one without the other Nadim attested to a simple and practical solution: Il faut travailler dabord. [ Work comes first. ] One cannot obtain housing without the finances and security offered by steady employ ment. But with the existence of clandestine job opportunities (primarily in the food service and domestic labor sectors), it is possible to get a job without an address. The problem is that such job opportunities are sporadic, and often difficult to secure when the supply of clandestine labor exceeds the demand for workers. Nadims own pattern of working usually involved finding temporary employment for a few days at a time. Sometimes he would find a job in Lausanne and spend the 20 Swiss francs for the tr ain ride. Then, after returning to Geneva, he would spend the rest of the week asking people for money or selling his belongings. Nadims case raises the question of whether the paucity of paid work (in a conventional sense) is due to structural constrai nt such as the low availability of jobs or discrimination or to his own unwillingness to work. If the latter, I would argue that it is not out of laziness that Nadim would choose to remain unemployed. Work conditions and pay for undocumented immigrants are arguably less than ideal. The very language Nadim uses
268 in speaking of work for example, his tendency to refer to work as slaving away alludes to the injustices and severe working conditions faced by undocumented immigrants. Its not easy living in Geneva, in any case. Even today I still have a sleeping bag on my back. Here in Switzerland they dont have the social support [for undocumented immigrants]. People with papers they can have social support, they give them a hand But for people who dont have papers, its very tough. They sell drugs, or find themselves in prison, here and there. One quarter of the foreign populati on here is driven crazy. In three breaths, Nadim makes the conceptual leap from social marginality to psychological hardship with social support connecting them. He implies that living undocumented and in a state of prcarit, through processes of social causation, can contribute to the mental illness of his peers. Observations in the opening field notes of his case suggest that he shares these risks. Cellars, Shelters, and Jails At the time I met him, Nadim had not once found proper housing in Geneva since his ar rival in 1998. In his appeals to the citys social services for assistance, he had always been told that he would need Swiss papers to obtain housing. His French passport would not automatically qualify him for housing, and without proper Swiss residence documentation, he was classified as sans papiers (an undocumented immigrant). Nadim frequently slept in homeless shelters, such as the Salvation Arm y, or when the weather was reasonably pleasant, outdoors on the streets, in parking lots, and in gardens. As he began meeting people and making friends, some would offer to put him up, sometimes for a week, sometimes for a number of months. Being homeless in Geneva, as in any city, comes with a number of complications and hardships. During periods of bad weather, Nadim often chose to sleep in a bloc a
269 group of buildings, generally residential, where he could find a place to hide himself from view. Sometimes he slept beneath a stairwell, sometimes in a cellar generally in buildings that did not have a keypad code for entry. Staying hidden was a constant concern. To avoid being seen by the building concierge, Nadim would force himself to wake as early as 4 am and leave the building before the concierge would arrive. However, despite his efforts, Nadim was occasionally bothered by strangers, passersby, and property owners, who would call the police or a private security guard to remove him from the premises. Nadims search for stable housing did not follow a straight trajectory. Rather he experienced fluctuations in his ability to secure shelter, regulated on one hand by external factors that were beyond his control and on the other by his agency to pull himself out of homelessness largely by saving money through clandestine work However, when I first interviewed him, Nadim was experiencing a low in his cycle of relative comfort and extreme duress: Right now I dont have any money. I cant even move The best solution remaining for me to do is to find a sleeping bag at the C AR and every day look for a building that doesnt have an entry code, where I can get in and sleep Yesterday I slept in a parking lot. I t was tru ly horrible. During the coldest months of winter, Nadim would sleep out of necessity at the Abri PC Otherwise, he preferred to stay away from the shelters and find his own spots to sleep alone. Among all the shelters of Geneva, his experiences at the Salv ation Army were the worst. It costs 15 CHF per night to stay at the Salvation Army a requirement that Nadim considered unfair, since many of the shelters prospective guests could hardly afford it. Those staying for the night are awakened the next morning at 6 am and given only 15 minutes to eat breakfast. By 6:15 am, the directors begin insisting that
270 guests leave for the day. They insist, Nadim said. Whats more, they yell: Lets go! Get out! Out, out, out! Nadim also perceived a strong sentiment of racism at the shelter, and referred to those in charge as enfoirs (imbeciles) who treated the homeless with disrespect: Its the directors against the homeless who sleep there. They give you dishonest look s They talk to you like youre a dog. Pff Just drop it. Nadims responses to questions of discrimination at the shelter were emotionally charged, and his reluctance to talk about it spoke toward even stronger sentiments of anger or shame that he preferred to avoid altogether. After his experiences at the shelter, Nadim stated that he preferred to sleep outside than at the Salvation Army. However, two months later, he was still taking opportunities to sleep there. His social worker was helping him get a discounted rate of 15 days for 150 Swiss francs (while normally such a stay would cost him 225 Swiss francs). This would give him the physical protection of a shelter and daily breakfast while he waited for an apartment to be ready a long anticipated arrangement made with the help of the social services. Nadims decision to opt for either material discomfort (e.g., sleeping in a parking lot, hunger) or social discomfort (e.g., sleeping at the Salvation Army) may have been a difficult one, with the outcome depending strongly on other factor s such as the receipt of an economic windfall, the need for stability during life transitions, or his own state of mind. In the meantime, Nadim had sold his bicycle an old, weathered hybrid that was nevertheless of high quality. It was a light bike, with front suspension, a well oiled chain and some recently added parts, including a new seat and two cable locks. While sel ling
271 his bicycle left him with the money he needed for his twoweek stay at the Salvation Army, it also left him without his regular means of transportation. The next day, I received a phone call from Nadim, a familiar desperation in his voice. He had spe nt another night in jail, this time for getting caught riding the tram without a ticket. Normally, this would not be cause for arrest, although the 100 Swiss franc fine (or 80 Swiss francs for those who have the money on them) is hardly an affordable expense for someone like Nadim. But this was Nadims eighth consecutive unpaid fine, and he claimed that if he couldnt come up with 150 Swiss francs, he would be sent back to France. He had already given the money earned from selling his bike to the Salvation Army. I was unwilling to loan Nadim such a large sum, and secretly had my doubts regarding the veracity of his story. While his claim that he had been caught on the tram without a ticket seemed reasonable, I was uncertain whether this would actually be cause for deportation, even for an undocumented immigrant. I retained the possibility that Nadim was performing: Being experienced at borrowing money, expressing the fear that he could be deported (whether real or imagined) may have been a successful borrowing strategy for him in the past. Leaving Prcarite and Finding Home Two weeks passed before I saw Nadim again. He arrived at CSRG in good spirits, wearing a clean white shirt and white shorts. He told me that he had finally moved into his new apartment and invited me to see it. Nadims new place was in Lignon, a thirty minute bus ride from the city center. As we rode, I learned that since the time I last saw him, Nadim had obtained a job at the airport. By day, he worked with the airport security. By night, he trained to drive the aircraft tow tractor (the vehicle that pulls
272 planes to their gates). Having worked both shifts yesterday, he complained of fatigue and lack of sleep. Nadims apartment was surprisingly nice, located centrally (with a commercial cen ter nearby), in an enormous 15storey block style apartment building. The apartment was on the 10thGiven everything, one obvi ous question occurred to me: How does a man who was sleeping on the streets a month ago find himself in this sizeable apartment (~2500 Swiss francs per month) with all this stuff ? The answer was deceptively simple. Nadim revealed that the apartment belonged to his brother who lives in Paris. His brother has had the apartment for years, renting it out for supplementary income. During that time, Nadim had been ashamed to tell family members of his homelessness a situation exacerbated by his estrangement from them. But at the urging of his social worker, Nadim finally agreed to contact his brother. When his brother discovered he needed a place to live, he waited until the apartment was vacant and allowed Nadim to live there. All this stuff was in fact his brothers. floor, had a fair sized kitchen, living room, three bedrooms and a bathroom. Remarkably, the apartment was fully furnished: dining table and chairs, a large television, video game system, couch, lounge chairs, and computer. The walls were decorated with photos, medals, ornamental weapons swords, a medieval flail, and pistols. Books, paperwork and trash were strewn about the floor. Over lunch, Nadim mentioned a planned trip to Tunisia at the end of summer to visit his wife. He had never told me he was married, and after all his talk about flirting and sleeping with women, I assumed he wasnt. On the bus back to Geneva, I asked him how long it had been since he had seen his wife.
273 March, he replied curtly. Five months had passed since they were together. He offered no further details, falling back into a troubling silence. We got off the bus near the Cornavin train station. Before we parted ways, Nadim asked me: Is it obvious in my face that Im tired? I little, I replied honestly. But not much. In August I visited Nadim at his apartment for a second time. I arrived in Lignon at 4:30 in the afternoon on an unseasonabl y cloudy and cold day, and sat on a bench by the playground as I waited for him to get me. After thirty minutes, Nadim finally came out to greet me, wearing shorts and a tank top and complaining of the cold weather. He mentioned that his copine (girlfrie nd) and her sister were also visiting him. On the elevator, I asked him about his wife, to which he replied starkly: Lets not talk about my wife. The girls were both highschool students of Italian origin no older than 18 and 13 years old, respectivel y who lived with their parents on the floor above Nadims. Nadim and I descended to the commercial center to buy drinks and snacks. I used this opportunity alone with him to ask a question that had been nagging me for some time: Why was staying at the S alvation Army so important that he would sell his bicycle? Was it the discomfort of sleeping in the streets? The cold? The hardness of the ground? The discomfort was part of it, he admitted. But there was something else. Was it the image of being sans abri ? Thats exactly it, he said. Its the image. Its disgusting. We joined the girls back inside and watched television. Nadim occasionally went to the kitchen to make food hardboiled eggs and couscous with chicken. On one such trip, the girls challe nged me to guess their ages. In this way, it was revealed to me that
274 Nadims copine was in fact 15 years old which would make it illegal for him to engage in sexual relations with her, given that the age of consent in Switzerland is 16 years old. The y ounger girl also revealed that Nadim smoked marijuana from time to time. She has seen it herself another surprise, considering that months prior Nadim had expressed a strong dislike for drugs and drug users. In Nadims eyes, drug users and dealers were th e most stigmatized groups in prcarit in Geneva. S pecifically, he was referring to the young maghrbins who sold drugs at the shore of Lake Geneva. The stigma faced by Algerians in Geneva wa s a sore spot for Nadim, who directed his anger against the young North African drug dealers for helping to create negative stereotypes Considering these earlier conversations, I confronted Nadim with the young girls claims, to which he offered a half cocked smile and no real reply. This would be the last time I saw N adim before leaving Switzerland. Although I remained in the country for two months after visiting his apartment a second time, he stopped frequenting the soup kitchens and his cell phone soon became disconnected. I left the field with a sense of uncertaint y about Nadims story. Because of his regular presence at the Bateau and CSRG and my interactions with his social workers and mutual acquaintances, I did not question the fact that he lived in a situation of prcarit that he was a FrenchAlgerian immigr ant with problems finding housing and employment, and that he had considerable experience sleeping on the streets. But his story is marked with numerous inconsistencies, and in some cases, instances of outright dishonesty. Nadim was not only dishonest with me regarding his drug use, the age of his girlfriend, and possibly his reasons for being broke but with others as well. While he claimed to be married to a woman on the other side of the Mediterranean, he
275 had no qualms about flirting and sleeping wi th other women in Geneva. While he had family in France and Switzerland, he remained for a great deal of time on the streets because he refused to tell them of his situation. Any interpretation of Nadims story must therefore take into account its inconsi stencies. The truth of his story is produced from a combination of genuine disclosure and performance. While Nadim may have considered me a friend, I was not close enough to be a true confidant. He d escribed his situation as desperate at times, and I s ometimes found myself having to separate the exaggerated from the genuine acutely aware of my own role as a person both willing and able to help him. Despite these inconsistencies, there was no doubt that for Nadim, being poor and homeless were sources o f stigma and stress the first contributing to an ever present sense of social precariousness, mistrust and low self esteem, the second acting as a trigger to emotional breakdown (or possibly, the performance of emotional breakdown) Nadim internalized t he public stigmas against homelessness and was frequently adverse to others he encountered in the shelters. As such, during the low points in his life cycle when he was literally without shelter, his self worth suffered to the point where he was reluctan t to seek help from his family. In the opening account Nadim was also overwhelmed by the rigors of sleeping on the streets (discomfort, sleepdeprivation, harassment by police) and the dejection of an exhausted support network. He was in debt to many peopl e and continued to borrow money until people began turning him down, as there were few people whom he had not already asked. Through economic and political mechanics it was the larges t, most distant creditor (Swisscom) to be paid off first. The rest were f riends and family, many having greater need for the debt
276 settlement than a large telecommunications company. In their eyes Nadim felt shame by his situation a state of emotional prcarit that in such a time of duress paved the way toward acute episodes of anxiety and depression. Yet Nadim also legitimized his Algerian identity. In times of lucidity and direction, Nadim would work to demystify the image of Algerians as dealers and thieves. Sometimes he expressed his legitimacy by condemning the minority o f Algerian youths at the lakeside who he believed perpetuated these stereotypes. Other times he expressed it through his actions and aspirations, such as volunteering for Genve Solidarit (a youth center), participating in group meetings at the Bateau, an d planning to organize a group for Algerians in prcarit. My dream is to one day have the financial means to give my support to places like this [ CSRG ], he said. It is potentially Nadims legitimized ethnic and personal identity that helps to protect his self esteem, which otherwise would deteriorate in his internal ization of the stigma of homelessness He expressed mental illness symptoms only when his homelessness became an inescapable physical and social stressor, making him more aware of his state and catching him in a downward emotional spiral. Nadims story illustrates the dynamics of stigma for a person in prcarit, showing the interaction of in ternalized homelessness and legitimized nationality. Tania The Incarceration of a Serbian Journali st I first met Tania on a sunny, warm day in May, as we were both crossing the Boulevard Pont dArve from the direction of Uni Mail, one of the larger and more modern buildings of the scattered University of Geneva campus. We were only blocks away from CSRG where I had worked as a volunteer for five months. I immediately recognized her as a CSRG regular a dark haired woman in her early 30s, who
277 normally ate alone, guarding herself from others with looks of anger or apathy. Until then I had never spok en with her. On this day, as we waited for the tram to pass, she recognized me and took the initiative herself, speaking with me in French. She introduced herself as a student and a journalist, and invited me to walk with her to the soup kitchen and exchange stories. Her first words in this exchange were startling. I was visited by the Geneva police this morning, she said matter of factly. They wanted a statement from me because I threw a drink in my professors face. Tania felt it was ridiculous that the police in Geneva would not tolerate behavior she viewed as private and inconsequential. In my country it is normal if someone insults you, she said. And the police have better things to do than get involved. Tanias country is Serbia, making her a member of one of the more stigmatized groups in Geneva. I asked Tania what her professor had done to make her want to attack him, and her answer was simple: Hes a racist and he hates Serbs. He called me a liar. During the six months to follow, I woul d befriend Tania and follow her in her travels through the landscape of Geneva a journey that acquainted me with the life and mind of a foreign woman pushed to the edge of paranoia, and ultimately, the impersonal processes of the Swiss social support and justice systems. Tanias story offers an understanding of the ways in which stigma and discrimination can exacerbate symptoms of mental disorder, and when dealing with the tribal stigma of nationality (Goffman 1963), provoke externalizing responses of r esistance that, ironically, reinforce the very stereotypes perpetuated by a stigmatizing public body.
278 Living V iolence the L ine b etween V ictim and P erpetrator Tania was not born a poor Serb at least, not by Serbian standards. Born and raised in a middleclass family in Belgrade, she attended university and found employment as a journalist. With the gradual dissolution of former Yugoslavia, she was witness to the violence of war, and personally knew several women in Belgrade who were raped. She first arrived in Geneva to cover an international conference, funded by a scholarship a trip originally intended to take no more than a few weeks. By the end of the conference, she received news that Belgrade was being bombed by NATO. The bombing was part of NATOs initiative to force the Serbian government to end its civil war in Kosovo, and resulted in the deaths of at least 32 people over a threemonth period (Grad Beograd 1999). An attack against the Radio Television of Serbia building was especially troubling for Tania, who personally knew many of the journalists who worked there, one of whom was killed. She did not return to Serbia during the war, and she remained in Geneva, where she enrolled in the university. Tania attributed her troubles wit h the university to discrimination and mistreatment by certain professors. One professor, she claimed, had refused to pass her if she didnt accompany him on a date. Three other professors insulted her and were disturbed by her Serbian nationality. She w as told that her level of achievement was below that of her classmates, and for eight months she was left waiting for her grades. However, her exams consisted mostly of essays on topics that she was permitted to choose herself. Tania claimed that the professors consistently rejected the topics she had chosen in some cases topics dealing with Serbian issues. After she failed her exams, she complained to her professors and sought appeals. Ultimately, the director of the institute
279 banned her from studying at the university, and she was expelled without a refund on her tuition. Believing that her expulsion from the university was unjust, Tania again resisted. She began sending insulting emails to the former professors who had insulted her, and whose unfair practices she perceived to be the true cause of her academic failure. Tania believed that she was being stigmatized because Serbs were considered bad people and uniformly responsible for the war crimes committed by the regime of Slobodan Milosevic. In re sponse, the director of the institute filed an injunction against Tanias physical presence on university property. Tanias communications with her former professors soon became more persistent, bordering on harassment. Her sense of being a victim of discr imination expanded at this time, as she revisited her interactions with colleagues and former employers many of whom soon began receiving hostile emails, phone calls, and text messages from her. In some cases, simply flooding the email inboxes of those who had insulted her (and consequently blocking their email, as she put it) functioned as an accessible strategy of resistance for someone with scarce financial means. A wealthy Jewish family for whom she had worked as a babysitter became the recipient of an inordinate number of hostile messages because they had refused to help her find a lawyer during a time when she most needed legal assistance. In 2006, three years after her expulsion from the university, Tanias strategy of resistance shifted fro m verbal to physical. At a museum cocktail party she encountered one of her former professors, confronted him, and threw a glass of wine in his face. The professors glasses were broken in the altercation (although he was not otherwise
280 physically harmed) and he complained to the Geneva police. A wave of violence followed. Within the span of one month, Tania slapped a Hungarian woman working as an assistant at the university, struck the face of another former professor she encountered at a tram stop, and broke the glasses of a third professor all responses to ostensible insults against her nationality. Her disposition became increasingly paranoid, which was reinforced as former colleagues and employers began filing official complaints against her. Months af ter these incidents, Tania maintained that the attack at the cocktail party or at least, the physical damage resulting from it was an accident. During the first few weeks I knew her, Tania spoke frequently of the Geneva police, expressing disappoi ntment that they would not let her push or slap people. As with the altercation with her former professor, she considered this kind of violence to be simple and the active involvement of the police in such simple acts as a symptom of the over sensitivit y of the Swiss people. However, in processing this cultural difference, Tania did not blame the individual police officers who had approached her. The blame, rather, would go to the Swiss institutions, the laws, and the judges who enforced them. A Myster ious Disappearance During the first week of June, Tania and I had agreed to meet two traveling Americans at an open film festival near the univ ersity. Our purpose was twofold watch a few hours of short student films, and take advantage of the free food a nd drink being offered outside. This was one of a number of locations Tania included in her strategy for living on meager income. However, uncharacteristically, she never showed up. She responded neither to phone calls nor text messages. Her daily visits t o CSRG ceased, and the social workers there had not seen her.
281 Four days later, I went to her apartment in the Jonction district. The building was dilapidated and old, and foreign voices and accents emerged from every half open apartment door. I buzzed her doorbell twice and waited for a few minutes. Just as I was preparing to abandon the effort, the door opened. It was her roommate, a young Japanese woman named Kiho. She seemed unnerved, hurried. Im sorry, she said in French, stepping out and closing t he door behind her. Im on my way out. I followed her into the street and questioned her on Tanias whereabouts. She claimed to have not seen Tania for four days. Doesnt this concern you? I asked her. Shes probably in jail, Kiho replied curtly bef ore leaving for her class, walking quickly to avoid my questions. I recalled Tania telling me about her Japanese roommate a student of music at the university who normally kept to herself, yet for whom Tania (the official tenant of the apartment) had f ew positive words. Tanias reluctance to befriend her roommate likely stemmed from prejudice against the Japanese which she expressed in the context of a former Japanese employer she claimed had mistreated her. Given Tanias difficulty accepting people o f other cultures, it is likely that relations with her roommate were unfavorable, and understandable that her roommate would dismiss her. Suspecting that Kiho was correct, I stopped at the police station on Boulevard de Carl Vogt and asked if Tania had r ecently been arrested, but she was not on their list. Nor was there any record that she had been admitted to the hospital. I stopped in the office of Gauchebdo, a weekly communist newspaper that had published some of her stories wondering whether the reporters there had heard from her. The two young
282 men working there were not surprised upon hearing that Tania had disappeared. They considered her to be obsessive and were aware that she was having problems renewing her residence permit. The next Monday, I received an answer. At the end of my shift at CSRG I picked up the last remaining copy of the daily Tribune de Genve newspaper and found a story with the following headline: Five university professors threatened with death by a female student. Two pro fessors claim to have been attacked by a woman who failed her exams (TDG 2006b). Without mentioning her name, it was immediately apparent that this was Tanias story. A dozen plaintiffs had accused her of threats, assault, and causing minor bodily injury, and she had finally been taken in by the police. In the courtroom, Tania legitimized her actions: They prohibited me from studying and insulted me because Im Serbian, the defendant maintained. I have never supported Milosevic. I simply responded to the insults I received. She turned to address the team of lawyers representing the plaintiffs and added: I dont have the means to defend myself in this way [in a court of law]. In Switzerland, it is money that leads to justice. Yet the lawyers of those accusing her made a strong case. In addition to the incident at the cocktail party, they cited her attack of another professor near a bus stop, and the thousands of messages she sent to their clients and their clients relatives. In the interest of publ ic safety, Tania was taken into preventive detention for what would prove to be an extended stay. An Insiders Perspective on Swiss Justice and Social S upport One week following the T ribune de Genve publication, I received a call from Jol, a social worker from the Hospice Gnral Jol informed me that he had received my phone number from Tania through her lawyer and was taking care of her case while
283 she was in prison. Tania had been charged, but sh e had not yet been tried or convicted. For now, her status was in limbo, likely because the judges were reluctant to deem her competent for trial. Jol said she would likely be held for two or three months. Following the advice of a sociotherapist from th e prison at where Tania was being held, I arranged to meet her in person. On July 23, following two weeks of approval and scheduling, I was sitting across from her in a large room that connected the prison with the screening area, along with seven or eight other inmates and their visitors. Tania claimed she was being well treated. The guards were polite, and they regularly brought her newspapers. Tania claimed to have written me a few letters, which I never received. All mail moving in and out of the prison is censored, and the judges are authorized to prevent the delivery of letters that might compromise the justice process. Tania believed she may have written too much about her case or about other people she had met in prison. Letters to me, her parents, other friends, her cousin, and other journalists in her network throughout Europe all returned undelivered. She also admitted to being frustrated with her lawyer, who did not visit her or inform her as much as she would have liked. To occupy her time, Tania kept busy doing pottery. She felt a sense of comfort when she looked at the 12 figurines she had made, calling them people sitting in a park. Her first psychiatrist maintained that she was normal, but sensitive, and on the verge of mental illness. But the judge rejected this assessment and required a second statement from another psychiatrist. The second psychiatrist met with her four times and maintained that he could arrange her release, as long as she agreed to admit herself into a mental hospital. He believed that Tania was paranoid and should be on
284 sedatives. But Tania found it insulting that this would be a condition of her release and refused his advice. She maintained that she was not delusional in her belief that her professors had gravely mist reated her. The following month I received another call from the prisons social services. I was asked if I would be willing to place a classified ad with the universitys housing office to find a new roommate for Tanias apartment. Evidently, the Hospice Gnral was going to cease payments on Tanias share of her housing. Tania also wanted a jacket because the prison was getting cold as the Swiss winter approached, and the simplest solution was for me to retrieve one from her apartment and bring it on my next visit to the prison. The social worker explained that it was important for me to write to Tania so she wouldnt feel alone, that it was good for her to have some contact from the outside. I placed the classified ad, and in the weeks to follow I met a few prospective roommates at her apartment. Kiho had returned from Japan. Together we emptied Tanias bedroom and prepared it for a new tenant. The bedroom was tiny (~12 x 7 feet), musty and cluttered exactly as she left it the day of her arrest. Everyt hing was thrown into black garbage bags clothes, shoes, books, papers, makeup and hauled down two flights of stairs to the buildings primitive cellar, where Tania had been allocated a locking storage closet. Kiho and I vacuumed and dusted. I found cl ean sheets for the bed. Yet, despite our efforts, none of the prospective tenants agreed to take on the room. The apartment was simply too small and old. The bathroom floor was saturated and rotting from water that leaked out whenever the shower was run a problem Tania had requested to be fixed on countless occasions. Some buildings in the Jonction neighborhood were dilapidated compared to other parts of town. Although the
285 apartment was close to the university campus, too many factors deterred students fr om taking it. I met with Tania in prison three more times before leaving Geneva. Each visit blended into the next. We would speak about her case, and she would proclaim her innocence, contrasting her actions with the more serious crimes of her cellmates. Her complaints of the justice system became more frequent and nuanced on the one hand, she was frustrated with her lawyers incompetence, the judges lack of compassion, the psychiatrists complicity, and on the other hand, she insisted that she was treated well in prison and that actors of the justice system (in particular, the police) were not those who discriminated against her. At the end of each visit, Tania and I would say the same farewell: Next time we see each other, it wont be here. As her detainment had already gone longer than anyone expected, her release from prison seemed imminent. Yet by October, when I left Geneva, Tania was still in prison. Her preventive detainment of two to three months had gone on for five. The rest of Tanias st ory is told in letters written from prison, which often took longer than a month to reach the United States. In December she was moved to the Tuilire prison in Lausanne. Although she said she was treated well in the new prison, Tania became depressed, and admitted having to force herself to write letters. Part of the problem was eating too much and gaining weight. Another part was her sense of getting old, and her realization that she was turning 34 and in many ways had missed opportunities to enjoy her y outh. Tania complained of the lack of visitation, with me and her mother being the only people to visit her during six months of detainment.
286 In February 2007, the courts agreed to release Tania on the condition that she visit a doctor regularly as an outpatient. Yet until the administrative processes were complete, she would remain in prison. She was given medications for her depression, and found fulfillment in writing poems in English. Her mental health improved as she got more rest. At the Tu i lire the y allowed her more social time with other inmates, she could shower any time she wanted on the weekends, the food was good, and the work (making chocolate boxes, packing flowers) was easy. Trading Prison Cells for Hospital Beds Tania was released from prison the second week of July 2007 thirteen months after she had been taken in. She returned to her apartment in Geneva and was permitted to stay in Switzerland as long as she agreed to temporarily admit herself into a psychiatri c hospital. Over one year after her arrest, she had finally accepted the term of release that had been offered her the preceding summer a term she initially rejected this one with threats of deportation, rather than release from prison, as incentive. But after enough time, the prospect of freedom was worth the personal insult of accepting that she needed psychiatric treatment. At first, Tanias depression returned. She limited her activities to swimming in the river and staying in bed. Her phone was disconnected, and she made no effort to connect it, claiming that almost every conversation makes me more ill, because of prison. In September, Tania participated in ArtAir a large openair painting workshop, for which she produced an abstract oil paint ing of the Cit du Temps an historic building situated along the Rhone river. After several hours of painting in the sun and a sunburn to show for it Tania sold her painting to a Swiss doctor for 100 Swiss francs The doctor assumed she was a profess ional painter, and suggested that Tania
287 continue to paint. Art whether pottery, poetry, or painting functioned as a creative outlet for her emotions and a means of self affirmation. Through pottery and poetry she could show that she was not so crazy as people made her out to be: Perhaps someone will finally believe that I am intelligent, although they believe different due to my Serbian nationality. In October 2007, Tania was again detained this time in a psychiatric hospital in fulfillment of her prison release terms. The doctors claimed she was depressed and paranoid, although she was reluctant to accept their diagnoses. Feeling like she was in a hotel, Tania was told that her hospitalization would last a few weeks a claim she was quic k to doubt. After her experience with the justice system, it was reasonable that she would question the words of the physicians. One month later, her characterization of the hospital changed to that of a prison. Having only one hour per day to walk outsi de her cell, she became increasingly depressed. Her physicians diagnosed her with trouble dlirant (delusional disorder) a psychotic mental illness characterized by one or more nonbizarre delusions, which involve real life situations that could be true, but are not or are greatly exaggerated (A merican P sychiatric A ssociation 2000). After two months, Tania was beginning to accept the conditions of her detainment. She was permitted to paint as often as she liked, and received affirmation from the nurses r egarding her work. Tania was encouraged when one of the doctors pointed out that there was nothing violent about her paintings helping her to detach from the persistent stereotype of Serbs as violent. She was told that because of her mental state, Swis s law did not consider her responsible for the acts she was accused of committing. Although such a judgment was based on accepting a psychiatric diagnosis to which she
288 was initially resistant, it may have had an affirming function for Tania in that, finall y, she was officially being absolved of her actions. Put simply, her experiences of the past year were a struggle for affirmation of self one that placed her in the difficult position of choosing between being guilty and being mentally ill. Reframing what it means to be mentally ill a person in need of support, rather than a person prone to immorality, unreason, or violence allowed Tania to accept this new role. Experiencing Discrimination, Perceiving Persecution For Tania and other Serbs living in Geneva, the stigma of nationality is central, while poverty and prcarit are common experiences that follow. Otherwise mentally balanced people find themselves in a self perpetuating cycle of discrimination, deprivation, and resistance. Learning that they are former Yugoslavs, prospective employers and landlords dismiss them as dangerous and unstable. Unable to find work and earn the income necessary for life in an expensive city, they find themselves living in unacceptable housing, accepting free meals and clothes offered by the social services, and seeking out food in unlikely places. Unable to forge close friendships, they spend a great deal of time alone. Coming from a war torn country, having witnessed unspeakable atrocities in the shadow of s eemingly uncaring or ignorant Western powers, it becomes easy for the Serb to imagine that her poverty and failures in life are the direct result of the hostile sentiments of others. It is this sense of injustice that leads her to resistance, and without t he sufficient financial means, the only avenues of resistance that remain open are criminal. To quote Tanias courtroom speech: I dont have the means to defend myself in this way. In Switzerland, it is money that leads to justice. Through her desperate acts of resistance the Serb proves to the Swiss people their own suspicions that former
289 Yugoslavs are violent, unstable people and justifies their discrimination of her. The stigmatization of the Serb becomes acceptable because the stereotypes are true and so the cycle perpetuates. The escalation of Tanias exchanges with others in positions of authority represents a form of complementary schismogenesis, as described by Gregory Bateson (19 87). Encounters with her professors and former employers are ma rked by the progressive exaggeration of behaviors, beginning with her professors decision to fail her proceeding through a cycle of harassment (on Tanias part) and the official filing of complaints (on the part of her former professors and employers), a nd ending with her incarceration and diagnosis Somewhere in the midst of this process, Tanias mental health suffers becoming an element in the dialectic. A creative, intelligent, university educated woman with no history of prior psychiatric treatment but admittedly made vulnerable by years of exposure to armed conflict begins to lose her gr asp on reality. Her symptoms of paranoia, the stigma she perceives at every turn, whether real or imagined, increase in proportion to her experiences of adversity. When she fails her coursework and is dropped from her academic program, she blames her professors. In her eyes, t hey failed her because she is Serb, or because she refused to date them. When she is unable to renew her residence papers and her press card, she suspects her former employers and the complaints they must have filed. When she cannot get the babysitting job she needs, she has surely been rejected, or replaced by someone of a more acceptable nationality. She cannot prove that these things occurred, but with each new episode of economic and social hardship, she feels them and begins to bel ieve they are true.
290 Stigmas Place in Social Causation The theory of social causation that the adversity of living in poverty increases vulnerability to, and risk of mental illness includes within its model a range of contributing factors (Dohrenwend et al. 1992). In addition to the primary and immediate stressors of hunger and exposure, the poor face exclusion from many aspects of cultural, economic, and political life. Their poverty and exclusion are associated, as either cause or effect, with hav ing little social support. And, as I have documented in this study, the poor experience stigma a combination of being labeled, stereotyped, discriminated, insulted and mistreated that may reasonably contribute, along with other risk factors, to states of poor mental health. The methodology of my study did not include confirmation of an informants mental illness diagnosis (with the exception of Tania) ; any interpretations regarding the influence of st igma on mental health therefore do not address the etio logy of specific mental illnesses, but rather the informants general level of psychosocial distress. While both Dorin and Nadim were homel ess and internalized the stigma attached to homelessness, their responses manifested in different behaviors and emotional states. Nadim considered his lack of housing a source of shame; although he openly spoke of his own prcarit in the soup kitchens and day centers, he kept his condition secret from his family a response that served to perpetuate his life on the streets. Despite the discomfort of sleeping outside, he preferred cellars and parking lots to the Salvation Army shelter, which he referred to as a place of misery. It was in his interaction with others at the shelter that such misery was produced (both from staff and guests), forcing him to confront his own social identity as it aligned with the very people he found repugnant. Nadims consequent frustration and anger may be seen as a
291 defense against these unwelcome aspects of his social identity a defense that, when stressed, may have led to episodes of anxiety. Dorin also self stigmatized because of his homelessness, and like Nadim, spoke of other homeless and poor people with disdain. Yet his feelings of low self efficacy and self worth were less concealed, and his emotional responses were more indicative of depression. The most reasonable explanation for these differences would likely invoke the influence of social support. Neither Nadim nor Tania had many friends, yet their long term presence in Geneva nevertheless allowed them the comfort of some kind of social support, however unreliable and shifting. Dorin, on the other hand, had been in Geneva for six weeks, had no friends, and couldnt speak to most of the people he encountered. His social exclusion was more complete, and his symptoms more severe. For Nadim and Tania, the stigma of nationality was also salient. Both were of nationalities known to be regarded poorly in Geneva, and both legitimiz ed their national identity in encounters with others who challenged it. However, Nadims acts of self legitimacy manifested in steps toward positive change discrediting stereotypes, becoming active in the community, and finding work and housing. In contrast, Tanias responses shifted from legitimacy to resistance as her adversity increased, ultimately leading to delusions of persecution. Less is known about her life prior to her arrival in Geneva, but it is reasonable to assume she experienced some degree of trauma during the armed conflict in her hom e country. In Tanias case, stigmatizing experiences may have exacerbated a mental condition that had already taken root. Consequently, her responses led to negative outcomes, both for her (as a prisoner and psychiatric patient), and for other Serbs faced with the challenge of overcoming stereotypes.
292 CHAPTER 8 PRACTICALI TIES: STRATEGIES FOR REMOVING STIGMA, AFFIRMIN G IDENTITY, AND IMPROVING MENTAL HEALTH In this study, I sought to identify and elucidate the stigma process as it occurs in the lives of the poor an endeavor that to date has had little representation in anthropology and other social sciences. As a study setting, I chose a city in a developed, Western country with social problems that largely mirror those found in the U.S. In making th ese decisions, I acknowledge having both theoretical and applied aims. Descriptive, ethnographic study of the stigmas of poverty can make an important contribution to scientific models of identity, deviance, and social interaction, as well as models of pov erty and social exclusion. Qualitative work represents the initial and necessary inductive stage of the scientific process one where research questions are refined, descriptive inquiries are addressed, and hypotheses are developed. Yet even in this stag e, insights can be gained for informing the practices and policies that affect the lives of people studied. Indeed, with its emphasis on intensive, long term fieldwork and observation in natural settings (rather than experimental or clinical settings), e thnography can provide insights that other methods may miss. The final chapter of this paper presents these insights as they emerged over the course of nearly one year in Geneva, addressing strategies that social service workers, health care workers, and policy makers may implement for the aim of reducing the burden of stigma, affirming positive and healthy identities, and improving the mental health of people living in prcarit. Source and Subject Directed Intervention In Frenchspeaking Switzerland the concepts of prcarit and social exclusion are closely related. The poor are seen as blocked from participating in social and economic
293 life, and strategies for improving their conditions necessarily involve their r insertion into society (rehabilitation or reintegration). Findings from my ethnographic work show that stigma may function as both an inhibitor and a motivator of this reintegration. On the one hand, experiences of rejection, discrimination, and mistreatment can lead to reduced social support through responses of avoidance, which promotes the reproduction and exacerbation of the state of exclusion. In principle, the association of certain ethnicities and nationalities (e.g., Romanian, Algerian, or Serbian) with poverty may be explained by the excluding effects of their stigmas, which inhibit them from participating meaningfully in society. On the other hand, poverty and social exclusion lead many people to accept (willing or not) new identities such as that of a homeless person, a drug addict, or a beneficiary of state assistance which are connected to specific behaviors and practices and tend to be medicalized or problematized in popular discourse. Unlike ethnicity or nationality, these social identities are generally unwanted by those who f ind themselves so labeled. Homelessness is a difficult life condition, and it is reasonable to assume that most homeless people desire to find housing and stability, to pull themselves ( se tirer ) from their state of prcarit. The stigma associated with these identities, in combination with the other material and social stressors of living in poverty, is often enough to motivate people to improve their life situations. Returning briefly to Nadims story, we see his stigma of homelessness acting as an inhibitor of reintegration. The shame of being homeless caused him to disconnect from his family and hide his condition from others, which led to a period of reclusion and served to perpetuate his homelessness. Yet, we also see in Nadim a drive to improve
294 his situation his self stigma leading to efforts to get off the streets. The motivation to find housing is not simply the warmth and protection of having a shelter, but al so the security of having an accepted social and personal identity. Both living homeless and being homeless emerge as factors in Nadims decision to seek housing assistance with the help of his social worker, and eventually to reconnect with his family. T hese findings suggest that positive outcomes can be produced by interventions that focus on both the source and subject of stigma. Sourcedirected interventions are designed to promote change in the people and institutions that reproduce stigma through the expression of labels, stereotypes, and discrimination. Such interventions function to normalize stigmatized identities from the outside, and are particularly suitable in cases where stigma is tribal in nature (Goffman 1963). Examples include educational campaigns to fight racism or homophobia, with the aim of discounting stereotypes and changing how the public at large conceptually frames the coexistence and interaction of different social identities. The use of sourcedirected intervention is more real istic in institutional settings, such as prisons, hospitals or social services, where efforts can focus on changing the practices of the sources who play different roles in these settings. Recent efforts in public health, for example, have emphasized sensi tivity training and new guidelines for doctors when dealing with children affected by the stigma of overweight and obesity (Puhl and Bachman 2009). The recommendations to the city of Geneva presented in the next section take the form of sourcedirected int erventions, as they address ways the citys social and health care services can change their practices to minimize the burden of stigma on social service guests, state assistance beneficiaries, and uninsured patients.
295 In many cases, the source of stigma i s more pervasive than can be contained in a societys institutions even if the origins of the stigma are institutional. Pervasive stigma, such as that directed against the homeless or drug addicts, is a learned phenomenon contained in the day to day interaction of informal networks from the loud voices of the private media to the quiet voices heard on elementary school playgrounds and around family dinner tables. Acknowledging the difficulty of changing such stigmas from their source, another approach is to promote changes in the subject. Subject directed interventions function in two ways, by: (1) disconnecting stigmatized attributes and conditions from individuals thereby transforming their deviant identities into normative ones, or (2) helping individuals to build internal/psychological resources that can minimize the detrimental effects of stigmatizing encounters and encourage positive expressions of identity. It should be noted, however, that while sourcedirected interventions have the potential to remove stigma from society as a whole, subject directed interventions are focused on the individual, and do not address the potential for historic change. The first type of subject directed intervention is justifiable for stigmas that are medicalize d or problematized by society as described in Nadims story above. Such stigmas include those of physical or mental illness and many of the stigmas of poverty that incorporate a behavioral component, such as homelessness, unemployment, and drug addiction. Efforts to help people overcome their condition of poverty will in turn free them of its stigmas. Such interventions are practiced for their own sake in Western societies, whether they take the form of medical treatment, employment programs, or social assistance. Their value far exceeds that of reducing stigma, yet they are also
296 difficult to realize, given the chronicity of poverty and its connection with political and economic systems. This study was valuable in revealing ways that stigma can be address ed by reinforcing the internal resources of the subject. Interventions designed to build up and stabilize a persons social identity are based on the assumption that stigma is an inevitable aspect of life in poverty. Because stigma cannot be completely rem oved by promoting changes in the source, it becomes imperative that the stigmatized individual learn strategies for deflecting it. Whether through counseling or the promotion of group affiliation, such interventions can function to minimize the effects of stigmatizing encounters on self esteem and reduce instances of violence, arrest, or other negative life consequences that can result from such encounters. Among the response types assessed in Chapter 6, legitimizing was the response most frequently associ ated with positive self image and life outcomes. From this finding, an important step in improving the lives of the poor is the implementation of group sessions or workshops aimed toward developing a persons self legitimacy skills and promoting positive g roup affiliation. In the case of Tania whose stigma of Serbian nationality was salient to her perceived persecution and consequent incarceration there were few community resources for promoting group affiliation among poor ex Yugoslavs. In many ways, Tania was (to use the popular expression) a walking time bomb. Assuming she had a predisposition to paranoia and delusions, her stigmatizing encounters with her professors functioned as the trigger to mental disorder. While it is completely conjectural it is possible that Tania may have escaped her imprisonment and diagnosis
297 of delusional disorder if there had been a venue for young Serbs to associate and discuss their problems of prcarit. Support groups mediated by an ingroup counselor (i.e., a cou nselor of ex Yugoslavian origin) could function as an outlet for Serbs to express their anger and frustration over experiences of discrimination in more positive ways. Tanias problems in Geneva were also linked to popular stereotypes of Serbs as violent or criminal, and the related stigma of mental illness. Shortly after I met her, Tania expressed disbelief that the Geneva police would question her for the simple act of throwing a drink in her professors face. She explained her actions, and her resistance to the police response, by invoking Serbian culture: In my country it is normal if someone insults you. And the police have better things to do than get involved. This disconnect in cultural standards is a likely factor in the perception of discrimination for poor Serbs in Geneva. Practices that are considered normal in their home country are considered evidence of criminality or mental illness in their new country, and the consequence of continuing such practices is the burden of being labeled crimi nal or mentally ill. The perception that others thought she was crazy likely contributed to the escalation of Tanias hostility and violence, which ironically served to confirm the stereotype of Serbs as violent in the public eye. It is therefore important that support groups, as described above, make transparent the discrepancy between Serbian and Swiss standards of behavior affirming the authenticity of Serbian standards while at the same time educating participants on the limits of acceptable behavior in Switzerland.
298 Recommendations to the City of Geneva As part of my role as Scientific Collaborator at the University Hospitals of Geneva, I agreed to submit a report of formal recommendations to the city based on the findings of my study. I focused my recommendations on the improvement of social service practices at CSRG toward the aim of reducing the burden of stigma experienced by its guests. Recommendations were originally drafted in English, and translated to French with the help of research assi stants from the University of Geneva, Department of Sociology. I presented recommendations in three themes most characterized by source directed intervention: (1) harmony among guests; (2) the sensitivity of volunteers to cultural and personal difference; and (3) social service rules. Encourage Harmony among G uests While social services were often cited as a common setting for discrimination, many instances involved conflict between serviceusers, rather than between service workers and clients. The guest s of CSRG are a demographically heterogeneous population, representing a broad range of nationalities and ethnicities. Common situations involved Swiss clients practicing discrimination against foreign clients particularly Maghrebi, Romanians, and ex Yug oslavs. Mistreatment of persons who are self conscious about their marginalized ethnic status (perceived stigma) often leads to hostile verbal altercations between guests. These events create an unsettling atmosphere for other serviceusers and contribute to nonutilization of services by those who fear being exposed to such situations. In every observed case of hostility between guests, social service directors promptly and tactfully intervened generally by asking the disruptive guests to leave. The dir ectors always approached such guests calmly and in a nonaccusatory tone,
299 often explaining to them that their behavior was frightening other clients. In no case was it necessary to physically force a disruptive guest to leave. Notably, every such case of conflict resolution was performed by the director on duty. The question remains whether, in the absence of a director, the social service volunteers would be capable of addressing these situations themselves. I recommended that new volunteers receive traini ng to ensure that they can handle conflicts between guests in a way that recognizes the comfort and safety of all. Developing means to prevent the incidence of such conflicts is more difficult. Instances of discrimination between guests are often rooted in common prejudices and stereotypes that only largescale educational reform could change for example, the idea that all Algerians are drug dealers, that all Romanians are profiteur s, or that all ex Yugoslavs are violent. The pervasiveness of these ster eotypes is the main challenge of source directed interventions. One potential strategy could involve regular group forums, in which serviceusers are invited to discuss their concerns and complaints with the help of a trained facilitator. However, the effectiveness of such a strategy would be limited due to self selection: Voluntary participants are more likely to already have some sense of tolerance for other cultures. Another strategy would be to offer informal Frenchlanguage sessions to interested gues ts, acknowledging the fact that many altercations are rooted in language barriers and misunderstandings. Free, onsite language instruction would also offer clear advantages for immigrant serviceusers who are in search of employment and housing.
300 Require S ensitivity Training for V olunteers Instances of stigma and discrimination practiced by social service workers were rare. These generally involved mistreatment of ethnic minorities with regard to food services. Both observation and narrative elicitation rev ealed instances where volunteers intentionally served pork to Muslim clients. This kind of behavior from volunteers, while rare, should never occur, and could be prevented by appropriate screening of volunteers upon hiring. Directors should take care to ev aluate the intentions of each potential volunteer prior to hiring, and to determine whether the volunteer is sensitive to the broad demographic range of serviceusers and their needs. In another observed case, a Muslim guest was inadvertently served pork and became angered upon discovering he had been served pork. While this may not have been an instance of intentional discrimination, it could have been prevented if volunteers had taken care to announce verbally that pork was being served. This is a common practice for many of the volunteers who serve food, but it is not consistently applied. The Menu au Jour sign (which informs guests that pork is being served) should not be relied on as the sole warning, as one cannot expect that every guest will be abl e to read or interpret it. Volunteers were also observed reproaching guests for not eating their food. In one case, a Latina guest who was clearing her plate was scolded by a volunteer for throwing away bread. The guest was blamed for taking the bread of fered to her when she did not really intend to eat it. Volunteers who perform such actions are motivated by the idea of controlling waste and ensuring that there is enough food to meet the services demand. While this is of important value, volunteers should recognize that it must also be balanced with the value of ensuring the comfort of serviceusers and making them feel
301 welcome. Guests who fear being scolded by service workers may be reluctant to come at all, which defeats the mission of getting food to every person in need of a meal. One simple strategy for balancing both values would be to ask clients whether they would like bread before handing it to them. Apply Social Service Rules in a Just and Consistent M anner In many observed cases, altercations occurred between volunteers and guests who perceived they were being stigmatized due to inconsistent application of social service rules. CSRG has a number of rules regarding the distribution of food and drink that are intended to control cost or maintain e fficiency of service. These include: (1) No more than two sugar packets per person; (2) No more than one slice of bread during the first lunch service; (3) Temporary cessation of coffee and tea service during lunch; and (4) No more than one drink per person. However, not all volunteers apply these rules consistently, which leads some guests to perceive favoritism or stigmatization. During the lunch service, volunteers were observed giving extra bread to their friends and acquaintances, then giving only one p iece to other guests who they did not know. This creates a situation in which some guests sense they are being singled out when their requests are refused. More legitimate exceptions are made regarding the one drink rule, in cases where guests are gett ing drinks for their friends. This exception is frequently granted to friends of elderly guests who are not capable of getting drinks themselves. Problems occur when other serviceusers subsequently ask for multiple drinks and are denied the request. These guests frequently blame volunteers for applying a doublestandard, and sense that they are being mistreated. It is important for service workers to realize that many guests are sensitive and prone to perceiving mistreatment. To avoid such instances, rul es regarding food
302 distribution should either be applied consistently or discontinued. It is for the social service directors to decide whether a rule is an effective means of cost control, given the potential for alienation of serviceusers when it is not applied consistently. Rules may be interpreted by clients as arbitrary, and volunteers should be able to explain to clients why the rules are in place, and why certain exceptions are made. One solution is to offer guests a means of participating in the rule making process. Rules are decided upon by social service workers at meetings that take place outside of the services normal operating hours. While it may not be practical to include interested service users at these meetings, their voices may be heard by offering a suggestion box in which clients may write and submit comments to be addressed by serviceworkers. This recommendation may function as an example of both sourceand subject directed intervention. Final List of Recommendations While the occurrence of intentional discrimination at CSRG is very rare, certain practices lead clients to perceive they are being stigmatized or mistreated. The following recommendations were provided to the city of Geneva to help address these issues: Screen prospective volunteers to ensure they are sensitive to the needs of serviceusers. Volunteers who may be likely to intentionally mistreat guests should not be hired. Train new volunteers to ensure that: (1) they are capable of handling conflicts bet ween guests respectfully and efficiently; and (2) they are respectful of the broad demographic range of clients, particularly with respect to Muslims and the consumption of pork. Offer service users the opportunity to voice their comments and complaints, either through facilitated group forums or using a suggestion box. Re evaluate food distribution rules to determine whether they are worth the potential sense of alienation they impose upon guests. Ensure that existing rules are applied
303 consistently by al l volunteers, and that volunteers are capable of explaining the purpose of these rules. While these recommendations were specific to CSRG practices, they may reasonably be relevant for Genevas other day centers and soup kitchens, and in a general sense, f or such services as they operate in other developed, Western countries. Although the national profile of the poor and homeless in the United States is not as diverse as in Switzerland, sensitivity to cultural differences among American social service worke rs and volunteers would serve to reduce stigma against AfricanAmericans, Latinos, and other ethnic groups disproportionately affected by poverty. Likewise, it is reasonable to suspect that conflicts among social service clients also occur in the United St ates, and that the inconsistent application of social service rules can result in a clients suspicion of favoritism and the avoidance of social services in the future. Stigmas of Poverty in the Stress Model for Mental Illness: Future Directions Poverty has been considered throughout history as a root cause of illness and disease (McMichael 2001:27, ONeil 2006:24). In the developed world, where poverty is relative to the wealth of middle and upper classes, the lack of comparable economic and social capital generates disadvantages that can lead directly and indirectly to poor health. Referring to the pathogenic role of inequity, Paul Farmer (2003 :20) considers it a striking fact that wealthy nations riven by social inequality have poorer health indices th an societies in which comparable levels of wealth are more evenly distributed. The potential mechanisms by which poverty promotes disease include: (1) malnutrition and its damaging effect on disease immunity (Fitchen 2000); (2) increased exposure to dis ease agents and toxic contaminants in residential, occupational, and
304 neighborhood environments (Brown 1995); (3) inadequate medical care (both preventive and therapeutic), which encompasses lack of access, inability to pay, and under utilization; (4) a greater prevalence of high risk behaviors among the poor, which include those resulting from systemic deficits in health education and the promotion of individual risk by neighborhood and economic factors (Lynch et al. 1997); and (5) the pathogenic effects of stress in the social environment, affecting disease immunity, mental and physical health. The result is a broad range of diseases and outcomes that are more prevalent among persons of low socioeconomic status, including but not limited to heart disease, stroke, lung diseases, diseases of the digestive tract, kidney diseases, HIV related diseases, tuberculosis, suicide, and other accidental and violent deaths (Marmot 2004). This list also includes mental diseases and disorders that have higher reported rates among the poor in studies of low socioeconomic status, neighborhoodlevel poverty, and homelessness. Symptoms of mental illness were fairly common among informants in my study, and I sought to explore the potential reasons for this high prevalence focusing on the possibility that stigma may be a causative factor. This section provides the theoretical background for social causation and stress models of mental illness. From my findings, I contend that stigma is a likely factor within this model wi th effects varying depending on the severity of the stigma, the frequency of stigmatizing encounters, and the types of responses enacted by those who are stigmatized (as discussed in Chapter 6) Understanding stigma as a causative factor in mental illness has implications for the development of targeted interventions
305 improving the ability of social and health care workers to identify those most vulnerable to mental illness and to develop strategies for prevention. Mental Health among the P oor In modern classstratified societies, a long history tracks the association of those in the lower strata, the poor and destitute, with unreason and abnormal behavior. In his work Madness and Civilization Michel Foucault (1965) wrote of the founding of the Hpita l Gnral in Paris in 1656, which unified the citys existing hospitals and marked a movement toward increasing confinement throughout 17th In contemporary populations, observed associations between poverty and mental illness persist across varying measures of socioeconomic status, ranging from conventional indicators such as education, employment, or income (Dohrenwend et al. 1992, Lynch et al. 1997, Johnson et al. 1999, Miech et al. 1999, Kessler et al. 2003), to measures of restricted standard of living (Vetter et al. 2006), neighborhood poverty century Europe. Charged with housing the poor of Paris, these establishments were to accept, lodge, and feed those poor who presented themselves (or were sent by authority), regardless of their physical or mental condition. Madmen were also subject to confinement in the hospital wards, prisons and workhouses, resulting in a proximity that assigned the same homeland t o the poor, to the unemployed, to prisoners, and to the insane (Foucault 1965:39). Nearly two centuries later, the French psychiatrist Philippe Pinel remarked that the debauchery, dissentions, and shameful distress of the lower classes was the most fertile source of insanity treated in the French asylums (Foucault 1965:259). Pinels moralistic interpretation of the condition of the poor is notably similar to that practiced in the early industrial era, and which continues to qualify thinking and dis course on poverty and mental health today.
306 (Silver et al. 2002, Galea et al. 2007), and situati onal indicators such as being homeless or on welfare (Ritchey et al. 1990, Susser et al. 1993, Votta 2003, Lauber et al. 2005). A wide range of mental disorders is linked to poverty, including anxiety, depression, bipolar disorder, alcohol and drug disorders, schizophrenia, attention deficit disorder, and antisocial conduct disorder. Some studies report high rates of depression among the urb an homeless (La Gory et al. 1990; Ritchey et al. 1990; Votta and Manion 2003). In a study based on the Homeless Enumeration and Survey Project in Birmingham, Alabama, Ritchey et al. (1990) reported that 73 % of homeless people met the criteria for possible clinical caseness of depression, as determined by a score of 16 or more on the Center for Epidemiological Studies Depression Scale (CES D). Using the same CES D score threshold, other studies have reported possible depression in 9% to 20% of community wide samples, and in 30% to 40% of both the unemployed and those living in poverty (Ritchey et al. 1990). The authors considered the high rates of depressive symptoms among the homeless to be indicative of extreme distress on par with rates experienced by acute depressives, mental health clinic patients, psychiatric inpatients, and alcoholics. Other studies have reported mixed findings on the link between homelessness and depression (Susser et al. 1993; Lauber et al. 2005). In a review of studies that assessed risk f actors for homelessness in the United States, Susser et al. (1993) reported that lifetime prevalence of conditions such as schizophrenia and bipolar disorder were more than five times greater among the homeless than in the general population. However, diff erences in rates of depression were moderate, with lifetime prevalence among both
307 the homeless and nonhomeless varying widely (from 4% to 25% ) depending on the study location. A study of homelessness among psychiatric inpatients in Switzerland found that homeless inpatients were significantly less likely than other inpatients to be diagnosed with affective and mood disorders such as depression, and significantly more likely to be diagnosed with mental disorders due to drug use (Lauber et al. 2005). However the comparison group did not comprise a sample of the general population, but rather other psychiatric inpatients. It is also possible that the relative stability and care characteristic of the hospital setting may have alleviated depressive symptoms amo ng those homeless who would otherwise have been diagnosed as depressed on the streets. Social Causation and Social Selection To explain associations between poverty and mental health, studies in the social sciences, medicine and public health have frequent ly turned to one of two theories: (1) social causation whereby the stress and incremental adversity of living in disadvantage leads to the incidence of psychiatric problems; or (2) social selection whereby persons with prevalent psychiatric problems tend to drift into or fail to overcome poverty due to the disabling effects of their poor mental health (Dohrenwend et al. 1992). Addressing these theories, a number of cohort studies have sought to establish the temporal relationship between mental illness and acquired attributes of poverty such as low income and poor educational attainment (Lynch et al. 1997, Johnson et al. 1999, Miech et al 1999). In a community based longitudinal study of families in New York State, Johnson et al. (1999) reported that low parental education and occupational status, but not low parental income, were associated with increased risk of anxiety and depressive disorders in offspring. All three parental socioeconomic status variables
308 were associated with increased risk of disrupt ive and personality disorders in offspring, while none were associated with substance abuse disorders. With the exception of substance abuse, most of these findings are consistent with the theory of social causation. Regarding social selection, youths with anxiety and depression were not more likely to drop out of high school or to fail to continue education beyond high school. Conversely, social selection was strong in youths with disruptive or substance abuse disorders, who were more than twice as likely to drop out of high school and nearly four times as likely to discontinue education beyond high school than youths without these disorders. In psychiatry, the association between mental illness and homelessness has most often been explained by social sel ection theories (Cohen and Thompson 1992). Cohen and Thompson (1992:818) argue for an alternate interpretation toward understanding poor mental health among the poor, in which the homeless mentally ill are first seen as impoverished and disenfranchised, r ather than diseased, as excessively burdened by dislocations because of their symptoms, disabilities, lack of resources, dependence on others, and susceptibility to stigma, neglect and victimization. The material constraints of poverty, compounded by f eelings of disconnectedness, self blame, demoralization and powerlessness, may explain much of the association between homelessness and affective disorders, such as depression (Cohen and Thompson 1992:819). A number of studies have shown evidence for soci al causation of depression and depressive symptoms among the homeless (La Gory 1990; Littrell and Beck 2001; Calsyn and Winter 2002; Votta and Manion 2003). In a study of 150 homeless persons
309 in Birmingham, Alabama, La Gory et al. (1990) found that stressf ul life events and crises were significantly correlated with depressive symptoms. They also found social support to be protective against depression, although it did not mediate the effects of life circumstances. A crosssectional study of 90 AfricanAmeri can homeless men also tested the influence of daily stressors on the prevalence of depression (Littrell and Beck 2001). The authors assessed the influence of two types of coping strategies as mediators: (1) emotion focused strategies such as venting, behav ioral and mental disengagement, and reliance on alcohol and drugs, and (2) problem focused strategies such as active coping and planning, which were more common among homeless men with fewer symptoms. However, when the studys stress indicators were included in the analysis, uncontrollable stressors were found to increase depressive symptoms, even for active copers. The finding that structural and infrastructural factors have strong effects on the incidence of depression corresponds well with the set of known factors particularly childhood trauma reported in the epidemiological literature (Smit et al. 2004). Within populations of low socioeconomic status, therefore, one is expected to find cases of depression in which conditions of poverty preceded and l ed to depressive symptoms. However, beyond known family and childhood risk factors, further research is warranted to elucidate the material and social factors of poverty that increase the risk of mental disorders. The S tress Model Articulating Poverty, Stigma, and Mental H ealth The social causation model depends largely on ideas of stress in the environment. In describing the associations between poverty and disease, Edward ONeill (2006), emphasized three relevant findings from recent medical and epidemiologic research: (1)
310 Poverty causes illness more than illness causes poverty; (2) Illness is not due solely to destructive healthrelated behaviors, such as smoking and poor diet; and (3) Illness is not due solely to structural or material deficiencies. He concluded that the most significant causative factor explaining socioeconomic health disparities is stress, and the way stress causes the mind to affect the body. The early work of John Cassel (1976) provides a basis for c urrent models of the pathogenic role of stress as it occurs in the social environment. Cassel argued that psychosocial factors produce signals and symbols that alter neuroendocrine secretions in the body, changing a persons biochemical balance and predi sposing one to disease. In simpler terms, t he biochemical changes described by Cassel correspond with the fight or flight response, which is normal and adaptive in acute situations of immediate threat (Marmot 2004: 114). However, in humans this response can be stimulated by both physical and symbolic threats, such as missing the bus for a job interview or speaking in front of an audience. Furthermore, health problems become more likely when such stressors are continuous and maintained over time. From thi s foundation, social causation theory asserts that barriers to highly valued goals faced by disadvantaged groups produce stress and incremental adversity, which in turn lead to psychiatric problems (Dohrenwend et al. 1992). Furthermore, stress that occurs from low status within a system of hierarchical social positioning may also increase risk of illness (including mental illness) a phenomenon that Michael Marmot (2004) labels as status anxiety. Preventive factors in this model include social support, p sychological coping mechanisms, and self esteem (Calsyn and Winter 2002; Votta and Manion 2003). Articulating social causation with the recursive model of stigma
311 presented in Chapter 6, I contend that stigma defined as the cooccurrence of labeling, ster eotyping, separation, status loss and discrimination (Link and Phelan 2001) can also play a crucial role in the etiology of mental illness. Based on my findings of the different types of stigmas faced by people in poverty, the different ways people respond to stigma, and different outcomes both positive and negative of a persons cumulative experiences of stigma, I present a model that can function as the basis for future studies (Figure 81). T he three vertical sections of the model designate (from le ft to right) the stigma in question, the stigmatized persons primary mode of response, and the potential outcomes. The four most relevant stigmas of poverty that emerged in this study are listed according to their likelihood of group affiliation. People w ho are dependent on drugs or alcohol and the homeless are considerably less likely to have meaningful and positive associations with others who share their stigma, compared to people who are unemployed or of marginalized ethnicity/nationality. Internalizin g, avoi ding, and ignoring responses may be grouped in the same category. Although future research may help to elucidate their nuances, in this study they were frequently interchangeable. These responses to stigma were more likely among people with drug/alc ohol dependence and the homeless, and they frequently indicated a higher risk of affective disorders, such as depression. No single group had a preference for adapting responses; while many encounters involving the homeless were observed to involve adapting responses, adaptation was a strategy used by all informants. Legitimizing and resisting were more frequent among informants whose relevant stigmas were those of unemployment or ethnicity/nationality. Because a self -
312 affirming group culture was largely abs ent for drug addicts/alcoholics and the homeless, these informants were less likely to externalize. It is important to note that the outcomes are not necessarily the result of responses to stigma; while responses may change the outcome, it is the stigma i tself that initiates it. The outcomes should instead be considered the result of the confluence of stigmatizing experiences, responses, and other factors in the informants lives. Likewise, the responses should be considered indicators of potential outcom es, rather than etiologic factors. From the model, a person who consistently internalizes his/her stigma is more likely to suffer from an affective disorder, such as depression. Outcomes labeled as positive change include two types: (1) positive change i n the subject of stigma, which functions to mitigate its negative effects; and (2) positive change in the source of stigma, which functions to reduce stigma as it occurs in society. The former is the more likely outcome of adapting, while the latter is mor e likely the outcome of legitimizing. R esponses of resistance are the most likely to lead to externalizing disorders, and, as Tanias case shows, may reinforce the very stereotypes being resisted. Lastly, social support and group affiliation are included i n the model as mediators of positive mental health outcomes protecting those who internalize from affective disorders, and protecting those who adversely resist from externalizing disorders. Future Research The Cultural Epidemiology of Stigma A fina l application of my study concerns directions for future research on the interrelated problems of poverty, stigma, and mental health. Ethnographic work is vital to the inductive phase of the research process, which includes the development of models, hypot heses, and the instruments needed to test them. Appropriate to this initial
313 phase, my study was broad in scope and inclusive of the range of identities among the poor an approach that allowed the identification of patterns most relevant for a social problem that science has yet to fully scrutinize. The patterns I emphasize most are: (1) the links among social identity, group affiliation, and self esteem; (2) the articulation of structural and individual discrimination (the first acting through the second) ; (3) the role of in group stigma and the hierarchy of social identities; and (4) the continuum of responses to stigma and their associations with both identity and outcome with outcomes ranging from local and individual (e.g., removal of stigma from the person, social service avoidance, or mental illness) to historic and recursive (e.g., the reinforcement of stereotypes, organized self legitimacy, or removal of stigma from society). The next phase of the research process would endeavor to test hypotheses formulated around one or more of these patterns. Based on the interpretations and conclusions made from my findings, a number of hypotheses regarding the influence of stigma on mental health may be tested contributing to known models of the etiology of mental illness and new approaches to prevention. Of particular relevance is the general hypothesis that a persons life experience of stigma predicts the incidence of mental illness, independent of known risk factors. However, for future research to be successful in this effort, both the study population and the mental health outcome would need to be specified beyond the broad specifications required of ethnographic research. For this work, I would propose a focus on the homeless, who represent the most marginalized, isolated, and deprived groups living in poverty in Western societies. Selection of this focus is justified by two important observations: (1) The homeless emerge at the bottom of the hierarchy of in-
314 group stigma; encounters against them can o riginate from any source, no matter their social class, which suggests that the homeless may bear the greatest burden of stigma among the poor; and (2) The links between homelessness and depression are well documented, while the mechanisms that generate these links have yet to be fully understood. The observational study designs of epidemiology crosssectional, casecontrol, and cohort studies are well suited for testing hypotheses on the etiology of disease. Because of the transience of homeless populations and the high potential of attrition, cohort studies would be difficult to realize. Given the availability of epidemiologic field instruments (such as the CES D), a more viable design is the casecontrol study, which would compare the stigma burden of homeless people who screen positive for depression with that of homeless people who screen negative. Using this design, researchers can test the hypothesis that life experience of stigma among the homeless independently predicts the prevalence of depr ession. Multivariate models would include material and social stressors and other known risk factors for depression, as well as protective factors such as social support, group affiliation, and legitimizing attitudes. Of particular interest would be the protective effects of organizations that bring homeless people together to promote positive change. Group affiliation has traditionally been a challenge for the homeless because of their isolation and lack of trust in others who sleep on the streets and in shelters. One means of overcoming this challenge is the street newspaper a practice that began in the 1990s (presumably in New York City) and can now be found in cities across the United States and other parts of the world (Howell 2003). These newspapers primarily cover topics of poverty and homelessness
315 and often take an editorial stance of countering stereotypes and erroneous beliefs about the homeless. More importantly, the street newspaper involves the homeless in mutually beneficial interaction; in m ost cases homeless people are the vendors of these newspapers, and in many cases they are contributors. In a casecontrol study of stigma and depression among the homeless, membership in such organizations may be one of the stronger protective factors fu nctioning to mitigate the effects of stigma through the establishment of group identity and reinforcement of self esteem. One particular challenge for testing these hypotheses is the development of instruments needed to measure and quantify stigma. As wit h most epidemiological measures of exposure, a retrospective measure of stigma would need to assess the duration, frequency, and severity of exposure to its components labels, stereotypes, and acts of discrimination. A reasonable starting point would be the Experiences of Discrimination (EOD) instrument developed by Nancy Krieger and colleagues (2005) to measure self reported experiences of racial discrimination. Adapting this instrument for measuring experiences of discrimination among the homeless could be facilitated through cultural domain analysis of the kind described in detail in Chapter 5. My study analyzed the cultural domain of labels for people in prcarit Further research would benefit from an analysis of the cultural domain of stigmatizi ng encounters or experiences of discrimination. Freelists can be used to elicit the most salient types of encounters, while paired comparison activities can be used to assess their severity. Provided there is an acceptable level of cultural consensus on the severity of encounters, results from this analysis can be used to weight encounters as they are measured in structured interviews.
316 Concluding Remarks Taking a multidimensional approach to poverty, the evidence of stigma against the poor is pervasive. Poverty in Western societies is about exclusion from economic and social life, barriers to education and meaningful employment, political disenfranchisement and unsafe neighborhoods. While accounting for and acknowledging the influence of these structural factors on the lives of the poor, my study was designed to elucidate how stigma is experienced at ground level. Throughout this work, I have argued that it is largely through interpersonal encounters that structural forces produce and reproduce stigma. People living in poverty are not stigmatized for their simple lack of money. Rather, the focus of stigma against the poor is, more often than not, rooted in ideas of personal culpability, maladaptive behaviors, and immoral lifeways. The homeless man is not stigmatized for his lack of shelter, but for the idea that he is at fault for it. The Algerian, the Romanian, and the Serb are not stigmatized for their countries of origin, but for the idea that they are criminal or violent. Homelessness and ethnicity ar e instead visible markers by which people identify those who are different, and to which negative stereotypes and attitudes are attached. In this sens e, stereotypes help to define both the stigma itself, and the boundaries within which the stigma may be pr acticed. A stigma of poverty should therefore be understood as one experienced by the poor, rather one directed at the state of being poor. It is from this perspective that the gravity of stigmatizing experiences in these populations can be realized. For each major challenge a disadvantaged man faces, there is a person or group who will insult him for it. If the man is simply unemployed, he faces one stigma, along with all the labels and stereotypes associated with it. Others blame his unemployment on laziness or apathy,
317 and he is labeled a glandeur (do nothing). If the man is also a beneficiary of state assistance, he faces two stigmas. In addition to the labels and stereotypes of the unemployed, he is subject to the stereotype that he is trying to c heat the system. Others call him a profiteur (profiteer) a label even more insulting than the first. If the man is also a drug addict, he faces a third stigma, and so on. This concurrence of multiple stigmatized identities poses a considerable challeng e for both those living in poverty, and the social workers, clinicians, and other professionals who are committed to helping them. As a final remark, it is important to avoid framing the poor as passive victims of stigma. The experience of stigma is a necessary counterpoint to the practice of stigma emphasizing the behavioral and psychological responses of those who are stigmatized. Stigma process does not end with exclusion, status loss, or discrimination. The responses of those who ar e discriminated against may lead, depending on a variety of cultural and personal factors, to perpetuation of stereotypes and stigmatizing practices, protection against stigma through affiliation with group identities (where difference is embraced and legi timized), or the emergence of self stigma and its negative psychological sequelae when social and personal identity come into conflict. The outcome of stigma is therefore a recursive social and psychological dynamic between the practices of the normalizing social body and the experiences and responses of those labeled as different. It is a dynamic that can promote both social and personal change, and one that marks a potential point of intervention for improving the health and well being of those who need i t most.
318 Figure 81. A recursive model of stigma and mental illness
319 APPENDIX A INTERVIEW GUIDE Discussion Short response Interview date ...................................................................................... Informants name ................................................................................ Social service location ......................................................................... (1) Demographic information Gender ........................................................................................... Age ................................................................................................. Ethnicity / nationality ...................................................................... Quotas: Homeless .................................................................................. Unemployed .............................................................................. Marginalized ethnicity/nationality .............................................. Alcohol/drug dependent ............................................................ (2) Life history Childhood / family life ........................................... Birthplace; country of origin ...................................................... Parents professions ................................................................. Educational ..................................................... .................... Professional training ....................................... .................... First arrival in Geneva .......................................... Leaving country of origin ................................. Arriving in Geneva .......................................... Experiences with prcarit ................................... Circumstances of becoming: Homeless ................................................... Unemployed .............................................. Addicted to alcohol or drugs ...................... Depressed .................................................
320 Discu ssion Short response (3) Current situation ................................................ Typical day in informants life ............................... Family and friends ................................................ Frequency of interaction ........................................................... Shared activities ............................................. Support received ............................................. Support offered ............................................... Number of true friends ............................................................ First time using Geneva social services .............. Which services were used ........................................................ Frequency of use ...................................................................... Comparison with services outside Geneva .... Preferred services ..................................................................... Reasons they are preferred ....................... Good points / advantages of going ............ Least preferred services ........................................................... Reasons they are least pref erred .............. Informants recommendations ........................ (4) Stigma and discrimination Event where informant experience d stigma ......... If more than one, the most severe/unfair ..... If none, an event involving someone else ...... Discrimination in the social services .................... Unfriend ly / non accepting staff ...................... Discriminatory social service practices ........... Most stigmatized groups .................................... Reasons groups are stigmatized ....................
321 APPENDIX B FREE LISTED TERMS FOR PEOPLE IN PRCARIT The following table provides 102 labels for people in prcarit that were listed two or more times in the cultural domain analysis activities. Items shown in bold were listed by both prcaire and general population informants. Term French term English translation Frequency Avg. Rank 1 Sans papiers Undocumented immigrant 18 10.67 2 SDF a Homeless 17 9.41 3 Profiteur Profiteer 15 7.67 4 Chmeur Unemployment recipient 13 9.54 5 Clochard Bum 11 7. 18 6 Fainant Idler 11 8.09 7 Sans abri Homeless 9 13.56 8 tranger Foreigner 8 18.50 9 Pauvre Poor 8 9.13 10 Rfugi Refugee 8 16.88 11 Marginal Dropout 7 8.29 12 Requrant Asylum seeker 7 9.00 13 Clandestin Clandestine 6 10.17 14 Exclu Excluded 6 8.00 15 Immigr Immigrant 6 8.00 16 Paum Dropout 6 14.83 17 Punk Punk 6 7.17 18 Racaille Rabble 6 10.67 19 Dchet Trash 5 14.20 20 Gitan Gypsy 5 11.80 21 Glandeur Do nothing 5 8.80 22 Handicap Handicapped 5 24.20 23 Malade Sick 5 7.80 24 Mendiant Beggar 5 9.20 25 Perdu Lost 5 16.00 26 Sans emploi Unemployed 5 6.60 27 Voleur Thief 5 10.40 28 Alcoolique Alcoholic 4 8.00 29 Clodo Bum 4 4.25 30 Drogu Drug addict 4 11.50 31 En difficult In difficulty 4 4.50 32 Parasite Parasite 4 12.00 33 Pouilleux Lice ridden 4 7.50 34 Prcaire Precarious 4 14.00 35 Travailleur Worker 4 17.50 36 la rue On the street 3 5.00 37 Anarchiste Anarchist 3 11.00
322 38 Artiste Artist 3 10.00 39 Asocial Antisocial 3 16.00 40 Assist Assisted 3 21.00 41 Cas social Social case 3 15.00 42 Dmuni Impoverished 3 21.33 43 Frontalier Border crosser 3 12.33 44 Inadapt Misfit 3 23.00 45 Incapable Incompetent 3 40.00 46 Inutile Useless 3 14.00 47 Junkie Junkie 3 14.00 48 Nomade Nomad 3 12.67 49 Paresseux Loafer 3 11.67 50 Qui ne travaille pas Who does not work 3 11.67 51 Rebut Scum 3 13.00 52 Sans domicile fixe Homeless 3 3.33 53 Squatter Squatter 3 21.67 54 Tox Drug addict 3 13.67 55 Vagabond Tramp 3 7.33 56 Victime Victim 3 15.33 57 Working poor Working poor 3 9.67 58 l' AI b On disability insurance 2 11.50 59 Abuseur Abuser 2 12.50 60 g Elderly 2 16.50 61 Alin Lunatic 2 25.00 62 Antisocial Antisocial 2 10.50 63 Au noir Under the table (worker) 2 13.00 64 Beneficiaire Beneficiary 2 18.00 65 Bon rien Good for nothing 2 14.50 66 Bougnoule Colored 2 8.50 67 Dans la merde In the shit 2 2.50 68 Dealer Drug dealer 2 8.00 69 Dbauch Lecher 2 14.00 70 Dlinquant Delinquent 2 14.50 71 tudiant Student 2 7.00 72 Faible Weakling 2 14.50 73 Famille monoparentale Single parent family 2 20.00 74 Femme battue Battered woman 2 18.50 75 Femme seule Single woman 2 22.50 76 Fou Crazy 2 3.50 77 Galrien Galley slave 2 21.00 78 Garce Bitch 2 12.50 79 Idiot Idiot 2 4.00 80 Ignorant Unknowing 2 36.00 81 Illettr Illiterate 2 14.50 82 Jeune Youth 2 23.50 83 Journalier Day laborer 2 21.50 84 Malheureux Wretch 2 26.50 85 Manouche Romani 2 40.50 86 Menteur Liar 2 7.00
323 87 Migrant Migrant 2 16.00 88 Necessiteux Needy 2 33.50 89 NEM c Rejected asylum seeker 2 7.00 90 Nul Nothing 2 19.50 91 Oblig Forced 2 21.50 92 Pochtron Drunk 2 4.00 93 Prostitu Prostitute 2 16.50 94 RMI iste d Welfare recipient 2 3.00 95 Roumain Romanian 2 20.00 96 Sans ressources Without resources 2 5.00 97 Sud americain South American 2 7.00 98 Toxicomane Drug addict 2 16.50 99 Tricheur Cheat 2 7.00 100 Tzigane Romani 2 19.00 101 Vaurien Worthless person 2 10.50 102 Zonard Suburban delinquent 2 2.50 a SDF = S ans domicile fixe (term # 52) b AI = A ssurance invalidit c NEM = N onentre en matire d RMI = R evenu minimum dinsertion
324 APPENDIX C PILE SORTS OF LABELS FOR PEOPLE IN PRCARIT : AGGREGATE PROXIMITY MATRIX 1 Alcoolique to Fainant ALC CHO CLA CLO DEC DRO DIF ETR EXC FAI ALC 1.00 CHO 0.11 1.00 CLA 0.00 0.15 1.00 CLO 0.15 0.11 0.07 1.00 DEC 0.15 0.00 0.04 0.33 1.00 DRO 0.81 0.04 0.00 0.11 0.15 1.00 DIF 0.15 0.63 0.07 0.11 0.04 0.07 1.00 ETR 0.00 0.15 0.85 0.11 0.04 0.00 0.07 1.00 EXC 0.07 0.19 0.07 0.19 0.15 0.11 0.30 0.04 1.00 FAI 0.07 0.04 0.00 0.22 0.33 0.11 0.04 0.00 0.00 1.00 GIT 0.00 0.07 0.48 0.15 0.11 0.00 0.04 0.48 0.07 0.07 GLA 0.07 0.07 0.00 0.26 0.37 0.11 0.04 0.00 0.00 0.93 HAN 0.41 0.15 0.07 0.07 0.04 0.37 0.19 0.07 0.07 0.04 IMM 0.00 0.15 0.85 0.11 0.04 0.00 0.07 0.93 0.04 0.00 MAL 0.44 0.15 0.07 0.07 0.11 0.37 0.19 0.07 0.07 0.00 MAR 0.11 0.07 0.07 0.26 0.22 0.15 0.19 0.07 0.44 0.19 MEN 0.07 0.15 0.07 0.44 0.11 0.11 0.15 0.11 0.33 0.19 PAR 0.04 0.00 0.04 0.22 0.48 0.07 0.00 0.04 0.07 0.67 PAUM 0.26 0.19 0.07 0.30 0.19 0.22 0.30 0.07 0.26 0.22 PAUV 0.07 0.52 0.07 0.19 0.04 0.04 0.67 0.07 0.30 0.00 PER 0.19 0.19 0.04 0.22 0.19 0.15 0.37 0.07 0.26 0.30 POU 0.04 0.04 0.00 0.41 0.67 0.04 0.04 0.00 0.15 0.41 PRE 0.00 0.37 0.07 0.22 0.00 0.04 0.56 0.07 0.44 0.00 PRO 0.07 0.00 0.04 0.19 0.22 0.07 0.00 0.04 0.04 0.59 PUNK 0.22 0.15 0.15 0.22 0.26 0.22 0.15 0.19 0.04 0.15 RAC 0.00 0.00 0.00 0.26 0.44 0.04 0.00 0.00 0.04 0.41 REF 0.00 0.19 0.81 0.07 0.04 0.00 0.11 0.89 0.04 0.00 REQ 0.00 0.15 0.81 0.07 0.04 0.00 0.07 0.89 0.11 0.00 SABR 0.04 0.52 0.11 0.30 0.00 0.00 0.33 0.07 0.33 0.00 SEMP 0.11 0.85 0.11 0.11 0.00 0.04 0.52 0.11 0.26 0.00 SPAP 0.00 0.15 0.85 0.07 0.04 0.00 0.11 0.78 0.11 0.00 SDF 0.04 0.48 0.11 0.33 0.04 0.07 0.30 0.11 0.30 0.00 TOX 0.74 0.04 0.00 0.11 0.19 0.93 0.07 0.00 0.15 0.11 VOL 0.11 0.00 0.04 0.22 0.26 0.15 0.00 0.04 0.11 0.33 Legend : ALC = Alcoolique ; CHO = Chmeur ; CLA = Clandestin ; CLO = Clochard ; DEC = Dchet ; DRO = Drogu ; DIF = En difficult ; ETR = Etranger ; EXC = Exclu ; FAI = Fainant ; GIT = Gitan ; GLA = Glandeur ; HAN = Handicap ; IMM = Immigr ; MAL = Malade ; MAR = Marginal ; MEN = Mendiant ; PAR = Parasite ; PAUM = Paum ; PAUV = Pauvre ; PER = Perdu ; POU = Pouilleux ; PRE = Prcaire ; PRO = Profiteur ; PUNK = Punk ; RAC = Racaille ; REF = Rfugi ; REQ = Requrant ; SABR = Sans abri ; SEMP = Sans emploi ; SPAP = Sans papiers ; SDF = SDF ; TOX = Toxico ; VOL = Voleur English translations may be found in Appendix B and as a standalone list in Chapter 5.
325 2 Gitan to Pauvre GIT GLA HAN IMM MAL MAR MEN PAR PAUM PAUV GIT 1.00 GLA 0.11 1.00 HAN 0.11 0.04 1.00 IMM 0.48 0.00 0.07 1.00 MAL 0.07 0.00 0.78 0.07 1.00 MAR 0.11 0.15 0.04 0.07 0.11 1.00 MEN 0.26 0.19 0.00 0.11 0.00 0.37 0.96 PAR 0.15 0.63 0.07 0.04 0.04 0.15 0.19 1.00 PAUM 0.07 0.22 0.19 0.07 0.19 0.30 0.19 0.19 1.00 PAUV 0.04 0.00 0.11 0.07 0.15 0.15 0.19 0.00 0.26 1.00 PER 0.04 0.30 0.11 0.07 0.11 0.37 0.22 0.19 0.78 0.30 POU 0.11 0.44 0.04 0.00 0.07 0.15 0.15 0.59 0.19 0.07 PRE 0.04 0.00 0.07 0.07 0.07 0.22 0.26 0.00 0.26 0.67 PRO 0.15 0.56 0.00 0.04 0.00 0.11 0.26 0.59 0.15 0.00 PUNK 0.26 0.19 0.07 0.19 0.07 0.26 0.26 0.15 0.19 0.15 RAC 0.15 0.44 0.00 0.00 0.00 0.15 0.15 0.59 0.11 0.00 REF 0.44 0.00 0.11 0.93 0.11 0.04 0.07 0.04 0.07 0.11 REQ 0.48 0.00 0.07 0.89 0.07 0.07 0.11 0.04 0.07 0.07 SABR 0.11 0.04 0.07 0.07 0.07 0.15 0.30 0.00 0.19 0.37 SEMP 0.07 0.04 0.11 0.11 0.11 0.07 0.11 0.00 0.19 0.44 SPAP 0.37 0.00 0.07 0.78 0.07 0.04 0.07 0.04 0.11 0.11 SDF 0.11 0.04 0.11 0.11 0.07 0.19 0.30 0.00 0.22 0.37 TOX 0.00 0.11 0.33 0.00 0.41 0.22 0.15 0.04 0.22 0.04 VOL 0.26 0.37 0.00 0.04 0.04 0.19 0.37 0.44 0.07 0.00 3 Perdu to Sans emploi PER POU PRE PRO PUNK RAC REF REQ SABR SEMP PER 1.00 POU 0.19 0.96 PRE 0.30 0.07 1.00 PRO 0.11 0.30 0.00 0.96 PUNK 0.19 0.19 0.07 0.15 1.00 RAC 0.11 0.48 0.00 0.44 0.26 1.00 REF 0.07 0.00 0.07 0.04 0.15 0.00 1.00 REQ 0.07 0.00 0.11 0.04 0.15 0.00 0.89 1.00 SABR 0.19 0.07 0.33 0.04 0.11 0.00 0.07 0.11 0.96 SEMP 0.19 0.04 0.37 0.00 0.15 0.00 0.11 0.15 0.59 0.96 SPAP 0.07 0.00 0.15 0.04 0.15 0.00 0.78 0.81 0.19 0.22 SDF 0.15 0.07 0.33 0.00 0.15 0.00 0.11 0.11 0.81 0.52 TOX 0.15 0.07 0.04 0.07 0.26 0.04 0.00 0.00 0.00 0.04 VOL 0.07 0.30 0.00 0.56 0.26 0.56 0.04 0.04 0.04 0.00 4 Sans papiers to Voleur SPAP SDF TOX VOL SPAP 0.96 SDF 0.19 0.96 TOX 0.00 0.07 1.00 VOL 0.04 0.00 0.19 1.00
326 LIST OF REFERENCES 20 Minutes 2006a Chmage en hausse Genve. 20 Minutes (Lausanne, Switzerland), August 9. 2006b Genve: trois policiers inculps apr s une interpellation muscule. 20 Minutes (Lausanne, Switzerland), July 21. Ablon, Joan 1981 Stigmatized Health Conditions. Social Science and Medicine 15B(1): 5 9 2002 The Nature of Stigma and Medical Conditions. Epilepsy and Behavior 3(6 Suppl. 2): 2 9. Americ an Psychiatric Association 2000 Diagnostic and Statistical Manual of Mental Disorders. DSM IV TR. Washington, DC: American Psychiatric Association. Ana nd, Sunhir and Amartya Sen 1997 Concepts of Human Development and Poverty: A Multidimensional Perspective. In Human Development Papers 1997: Poverty and Human Development. Pp 1 19. New York: United Nations Development Programme. Arsever, Sylvie 2006 L homme pour qui cest toujours Nol. Le Temps (Geneva, Switzerland), January 9. Associa tion pour le Bateau Genve 2009 As sociation pour le Bateau Genve: Une le dans la ville. Electronic documen t, http://www.bateaugeneve.ch, accessed 11/09/09. Assurancevieillesse et survivants AVS / Assuranceinvalidit AI 2009 Rentes de vieillesse. Electronic document: http://www.avs ai.info/ahv/00161/00180/index.html?lang=fr accessed 02/13/10. Au Coeur des Grottes 2009 LArme du Salut Genve. Electronic document, http://www.acdg.info/coeur/158.html accessed 11/09/09. Bacqu, Ra phalle and Christophe Jakubyszyn 2005 Azouz Behag, principal opposant Nicolas Sarkozy; Matignon laisse libre de ses critiques son minister de lintgration. Le Monde (Paris, France), November 2. Baer, Hans A., Merrill Singer, and Ida Susser 1997 Medical Anthropology and the World System: A Critical Perspective. Westport, Connecticut: Bergin and Garvey. Becker, Howard 1963 Outsiders: Studies in the Sociology of Deviance. New York: The Free Press. Bernard, H. Russell 2002 Research Methods in Anthropology: Qualitative and Quantitative Methods. Walnut Creek, CA: AltaMira Press. Berger, Barbara E., Carol Estwing Ferrans, and Felissa R. Lashley 2001 Measuring Stigma in People With HIV: Psychometric Assessment of the HIV Stigma Scale Research in Nursing and Health 24: 518 529.
327 Bergstresser, Sara M. 2006 Work, Identity, and Stigma Management in an Italian Mental Health Community. Anthropology of Work Review 27(1): 12 20. Bzaguet, Laurence 2006 Les femmes, cibles privilgies de la prcarit. Tribune de Genve, April 5. Bhalla, A.S. and Frdric Lapeyre 1999 Poverty and Exclusion in a Global World. New York: St. Martins Press, Inc. Bhana, Deevia 2008 Beyond Stigma?: Young Childrens Responses to HIV and AIDS. Culture, Health and Sexuality 10(7): 725 738. Bourgois, Philippe 1989 Crack in Spanish Harlem: Culture and Economy in the Inner City. Anthropology Today 5(4): 6 11. Brandon, David, Richard Khoo, and Rea Maglajlic 2000 European snapshot homeless survey: Results of questions asked of passers by in 11 European cities International Journal of Nursing Practice 6: 39 45. Bretton, Marc and Eric Budry 2006 Chmage: Genve ne doit plus tre la lanterne rouge. Tribune de Genve, February 11. Brown, Peter J. 1997 Understanding and Applying Medical Anthropology. Mountain View, CA: Mayfield Publishing Co mpany Brown, Phil 1995 Race, Class, and Environmental Health: A Review and Systematization of the Literature. Environmental Research 69: 1 5 30. Budry, Eric 2006 De plus en plus de jeunes adultes frappent la porte de lassistance. Tribune de Genve, January 28. 2007 La m endicit nest p lus a mendable Genve. Tribune de Genve, June 8. Buri, Markus, with Andrea Hrter and Gabriel Sottas 2007 Statistiques de la Scurit Sociale: Statistique de lAI, 2007. Berne, Switzerland: Office Fdral des Assurances Sociales. Calsyn, Robert J. and Joel P. Winter 2002 Social Support, Psychiatric Symptoms, and Housing: A Causal Analysis. Journal of Community Psychology 30(3): 247 259. CAR 2004 Rapport dactivit. Caritas Genve: Geneva, Switzerland. Carrefour Rue 2006 Carrefour Rue : Organisme de prvention et daction sociale. Rapport dactivit 2005. AnneCath erine Nanjoud, ed. Geneva, Swit zerland: Carrefour Rue. 2009 Carrefour Rue: Association priv daction sociale auprs des personnes sans abri et dmunies. Electronic docu ment, http://www.carrefour rue.ch/ accessed 11/06/0 9.
328 Casciano, Rebecca and Douglas S. Massey 2008 Neighborhoods, unemployment, and welfare use: Assessing the influence of neighborhood socioeconomic composition. Social Science Research 37(2): 544 558. Cassel, John 1976 The Contribution of the Social Environment to Host Resistance American Journal of Epidemiology 104(2): 107 123. Cattacin, Sandro, Brigitta Gerber, Massimo Sardi, and Robert Wegener 2006 Monitoring misanthropy and rightwing extremist attitudes in Switzerland: An explorative study. Research report PNR 40+, So ciograph Sociological Research. Geneva, Switzerland: University of Geneva. Caughey, John L. 1980 Personal Identity and Social Organization. Ethos 8(3): 173 203. C entral Intelligence Agency 2009 The World Factbook. Electronic document, https://www.cia.gov/library/publications/theworld factbook/ accessed 11/01/0 9. Centre National de Ressources Textuelles et Lexicales 2009 Dfinition de PRCARIT Electronic document, http://www.cnrtl.fr/definition/precarite accessed 12/0 3 / 09. Chan, Kit Yee, Arattha Rungpueng, and Daniel D. Reidpath 2009 AIDS and the Stigma of Sexual Promiscuity: Thai Nurses Risk Perception of Occupational Exposure to HIV. Culture, Health and Sexuality 11(4): 353 368. Chapple, A., S. Zierbland, and A. McPherson 2004 Stigma, shame, and blame experienced by patients with lung cancer: qualitative study British Medical Journal 328(7454): 1470. Chen, Shaohua and Martin Ravallion 2008 The Developing World Is Poorer Than We Thought, But No Less Successful in the Fight against Poverty. Washington, D.C.: The World Bank, Development Research Group. Electronic document, http://www wds.worldbank.org accessed 05/ 24 / 09. Cohen, Carl I. and Jay Sokolovsky 1989 Old Men of the Bowery: Strategies for Survival Among the Homeless. New York: New York: The Guilford Press. Cohen, Carl I. and Kenneth S. Thompson 1992 Homeless Mentally Ill or Mentally Ill Homeless? American Journal of Psychiatry 149(6): 816 823. Corrigan, Patrick W. and Amy C. Watson 2002 The Paradox of Self Stigma and Mental Illness. Clinical Psychology: Science and Practice 9(1): 35 53. Cullinane, Joanne 2007 The Domestication of AIDS: Stigma, Gender, and the Body Politic in Japan. Medical Anthropology 26(3): 255 292. Daly, Gerald 1996 Migrants and gate keepers: The links between immigration and homelessness in Western Europe. Cities 13(1): 11 23.
329 DeNavas Walt Carmen, Bernadette D. Proctor, and Jessica C. Smith 2008 Income, Poverty, and Health Insurance Coverage in the United States: 2007. Current Population Reports, P60235. Washington, D.C.: U.S. Census Bureau. Electronic document, http://www.census.gov/prod/2008pubs/p60235.pdf accessed 05/ 25 / 09. Depommier, Jol 2007 Rom en Romandie, Pas une Sincure. Gauchebdo, No. 25, June 22. Dewalt, Kathleen M. and Billie R. Dewalt 2002 Participant Observation: A Guide for Fieldworkers. Walnut Creek, CA: AltaMira Press. Dohrenwend, Bruce P. 2000 The Role of Adversity and Stress in Psychopathology: Some Evidence and its Implications for Theory and Research. Journal of Health and Social Behavior 41(1): 1 19. Dohrenwend, Bruce P., Itzhak Levav, Patrick E. Shrout, Sharon Schwartz, Guedalia Naveh, Bruce G. Link, Andrew E. Skodol, and Ann Stueve 1992 Socioeconomic Status and Psychiatric Disorders: The CausationSelection Issue. Science 255: 946 952. Erikson, Erik H. 1959 Identity and the life cycle; selected papers. New York: International Universities Press. Estoppey, Didier 2007 Genve Cherche Calmer sa Population en Disciplinant ses Mendiants. Le Courrier, November 14. Falk, Ge rhard 2001 Stigma: How We Treat Outsiders. Amherst Mass. : Prometheus Books Farmer, Paul 2003 Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley, CA: University of California Press. Ferro Luzzi, Giovanni Yves Flckiger and Sylvain Weber 2006 A Cluster Analysis of Multidimensional Poverty in Switzerland. Cahier de recherche (HES SO/HEGGE/C 6/1/2CH). Geneva: Haute cole de G estion de Genve. Fitchen, Janet M. 2000 Hunger, Malnutrition, and Poverty in the Contemporary United States: Some Observations on Their Social and Cultural Context. In Nutritional Anthropology : Biocultural Perspectives on Food and Nutrition. Alan H. Goodman, Darna L. Dufour and Gretel H. Pelto, eds. Pp. 335 347. Mountain View, CA : Mayfield Publishing Company Foucault, Michel 1965 Madness and Civilization: A History of Insanity in the Age of Reason. New York : Pantheon Books. Frielich, Morris, Douglas Raybeck and Joel Savishinsky eds. 1991 Deviance: Anthropological Perspectives. New York: Bergin and Garvey. Gaboriau, Patrick 1993 Clochard: LUniverse dun Groupe de Sans Abri Parisiens. Paris : Julliard.
330 Galea, Sandro, Jennifer Ahern, Arijit Nandi, Melissa Tracy, John Beard, and David Vlahov 2007 Urban Neighborhood Poverty and the Incidence of Depression in a PopulationBased Cohort Study. Annals of Epidemiology 17: 171 179. Gani, Cynthia 2007 Rgions : A Genve, Laurent Moutinot Libralise la Mendicit. Le Temps (Geneva, Switzerland), June 28. Glasser, Irene 1988 More Than Bread: Ethnography of a Soup Kitchen. Tuscaloosa, Alabama: University of Alabama Press. Glaser, Irene and Rae Bridgman 1999 Braving the Street: The Anthropology of Homelessness. New York: Berhahn Books. Goffman, Erving 1963 Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, New Jersey: PrenticeHall, Inc. Gove, Walter R. 1980 Labeling and mental illness: A critique. In Labeling Deviant Behavior, Walter R. Gove, ed. Pp. 53 109. Beverly Hills, CA: Sage. Grad Beograd 1999 City of Belgrade NATO Aggression, 1999. Electronic document, http://www.beograd.rs/cms/view.php?id=201271, accessed 01/06/ 10. Grewal, Kiran 2007 The Threat from Within: Representations of the Banlieue in Fre nch Popular Discourse. In Europe: New Voices, New Perspectives Proceedings from the Contemporary Europe Research Centre Postgraduate Conference, 2005/2006. Matt Killingsworth, ed. Pp. 41 67. Victoria, Australia: University of Melbourne. Haeberli, David 2006 Mendiants: la Ville v a a gir pour les Ftes de Nol. 20 Minutes (Lausanne, Switzerland), October 11. Hatet, Olivier 2006 Les Restaurateurs E n Ont Marre des Enfants Qui Mendient sur les Terrasses. Le Matin Bleu (Geneva, Swit zerland), June 27. Hospice Gnral 2009 Institution genevoise daction sociale. Electronic document, http://www.hg ge.ch/ accessed 11/04/ 09. Howley, Kevin 2003 A poverty of voices: Street papers as communicative democracy. Journalism 4(3): 272 292. Jenkins, Janis H. and Elizabeth Carpenter Son g 2008 Stigma Despite Recovery: Strategies For Living in the Aftermath of Psychosis. Medical Anthropology Quarterly 22(4): 381 409. Johnson, Jeffrey G., Patricia Cohen, Bruce P. Dohrenwend, Bruce G. Link 1999 A Longitudinal Investigation of Social Causation and Social Selection Processes Involved in the Association Between Socioeconomic Status and Psychiatr i c Disorders Journal of Abnormal Psychology 108(3): 490 499.
331 Kamerman, Sheila B. and Alfred J. Kahn 1997 The Problem of Poverty in the Advanced Industrialized Countries and the Policy and Programme Response. In Human Development Papers 1997: Poverty and Human Development. Pp 81 124. New York: United Nations Development Programme. Kessler, Ronald C., Patricia Berglund, Olga Demler, Robert Jun, Doreen Koretz, Kathleen R. Marikangas, A. John Rush, Ellen E. Walter, and Philip S. Wang 2003 The Epidemiology of Major Depressive Disorder: Results From the National Comorbidity Survey Replication (NCS R) JAMA 298(23): 3095 3105. Keusch, Gerald T., Joan Wilentz, and Arthur Kleinman 2006 Stigma and global health: developing a research agenda. Lancet 367: 525 527. Khusro, Ali M. 1999 The Poverty of Nations. New York: St. Martins Press, Inc. Knupfer, Caroline and Oliver Bieri 2007 Impts, Transferts et Revenus en Suisse. Berne: Confrence Suisse des Institutions dAction Sociale. Kohrt, Brandon A. and Ian Harper 2008 Navigating Diagnoses: Understanding MindBody Relations, Mental Health, and Stigma in Nepal. Culture, Medicine and Psychiatry 32(4): 462 491 Krieger, Nancy 1999 Embodying Inequality: A Review of Concepts, Measures, and Methods For Studying Health Consequences of Discrimination. International Journal of Heal th Services 29(2): 295 352. Krieger, Nancy, Kevin Smith, Deepa Naishadham, Cathy Hartman, and Elizabeth M. Barbeau 2005 Experiences of discrimination: Validity and reliability of a self report measure for population health research on racism and health. Social Science and Medicine 61(7): 1576 1596. Labarthe, Gilles 2005 Statistiques sociales en Suisse: attention, zone de brouillard. Le Courrier, December 16. La Gory, Mark, Ferris J. Richey, and Jeff Mullis 1990 Depression among the Homeless. Journal of Health and Social Behavior 31: 87 101. Lauber, Christoph, Barbara Lay, and Wulf Rssler 2005 Homelessness among people with severe mental illness in Switzerland. Swiss Medical Weekly 135: 50 56. Lecomte, Christian 2007 Rgions: Genve, face face avec les mendiants. Le Temps (Geneva, Switzerland), September 22. Le Courrier 2004 Au Square Hugo la table est toujours mise. Le Courrier (Geneva, Switzerland), December 30. Lewis, Oscar 1966 The Culture of Poverty. Scientific American 215(4): 19 25.
332 Link, Bruce G., and Jo C. Phelan 1999 Labeling and Stigma. In Handbook of the Sociology of Mental Health. Carol S. Aneshensel and Jo C. Phelan, eds. Pp 481 494. New York: Kluwer Academic/Pl enum Publishers. 2001 Conceptualizing Stigma. Annual Review of Sociology 27: 363 385. Link, Bruce G., Elmer L. Struening, Sheree NeeseTodd, Sara Asmussen, and Jo C. Phelan 2001 The Consequences of Stigma for the Self Esteem of People With Mental Illnesse s. Psychiatric Services 52(12): 1621 2001. Littrell, Jill and Elizabeth Beck 2001 Predictors of Depression in a Sample of AfricanAmerican Homeless Men: Identifying Effective Coping Strategies Given Varying Levels of Daily Stressors Community Mental He alth Journal 37(1): 15 29. Lynch, John W., George A. Kaplan, and Sarah J. Shema 1997 Cumulative Impact of Sustained Economic Hardship on Physical, Cognitive, Psychological, and Social Functioning The New England Journal of Medicine 337(26): 1889 1895. Marmot, Michael 2004 The Status Syndrome: How Social Standing Affects Our Health and Longevity. New York: Times Books. McMichael, Tony 2001 Human Frontiers, Environments, and Disease: Past Patterns, Uncertain Futures. New York: Cambridge University Press. Mead, George Herbert 1934 Mind, Self and Society: From the Standpoint of a Social Behaviorist. Chicago: The University of Chicago Press. Michiels, Renaud 2005 LUDC Dit Stop aux Mendiants. Le Matin Suisse, December 19. Miech, Richard A., Avshalom Caspi, T errie E. Moffitt, Bradley R. Entner Wright, and Phil A. Silva 1999 Low Socioeconomic Status and Mental Disorders: A Longitudinal Study of Selection and Causation during Young Adulthood. American Journal of Sociology 104(4) : 1096 1131. Mino, M. Jacques 2006 Rapport de la commission sociale et de la jeunesse charge dexaminer la motion due 30 novembre 2005 de MM. Ren Grand, Sbastien Bertrand, Alain Dupraz, Mmes Frdrique Perler Isaaz et Alexandra Rys, renvoye en commission le 18 janvier 2006, intit ule : Prcarit et mendicit Genve May 21, 2006. Electronic document, http://www.humanrights.ch/home/upload/pdf/070706_Rapport_M 576163.pdf accessed 11/03/ 09. M onnet, Vincent and Anton Vos 2006 Dossier : La Suisse, Si Riche Si P auvre. Campus Magazine de lUniversit d e Genve, 80: 1 4 29.
333 National Coalition for the Homeless 2008a Hate, Violence, and Death on Main Street U.S.A.: A Report on Hate Crimes and Violence Against People Experiencing Homelessness, 2007. Electronic document, http://www.nationalhomeless.org/publications/hatecrimes/index.html accessed 06/15/ 09. 2008b NCH Fact Sheet #2: How Many People Experience Homelessness? Electronic document, http://www.nationalhomeless.org/factsheets/ accessed 06/08/ 09. Newburn, Tim and Paul Rock 2005 Living in Fear: V iolence and Victimisation in the Lives of Single Homeless People. London: Crisis. Electronic document, http://www.crisis.org.uk/data/files/publications/LivingInFear_full. pdf accessed 06/18/ 09. Office Can tonal de la Statistique 2009 Rsultats statistiques : Bilan et tat de la population du canton de Genve en 2008. Electronic document, http://www.ge.ch/statistique/tel/publications/2009/resultats/dg rs 200901.pdf accessed 06/09/ 09. 2006a Population rsidante du canton de Genve. Electronic docum ent, http://www.geneve.ch/statistique/population_residante/ accessed 11/04/ 09. 2006b Nombre et rpartition des contribuables personnes physiques imposs au barme ordinaire, selon la c lasse du revenu brut en 2006. Chiffres annuels, Canton de Genve. Electronic document, http://www.ge.ch/statistique/statistiques/domaines/20/20_02/tableaux.asp#1, accessed 11/07/ 09. Office fdral des m igrations 2005 Environ 90 000 r sident s illgaux (sans p apiers). Press release: April 26, 2005. Electronic document, http://www.bfm.admin.ch/bfm/fr/home/dokumentation.html accessed 11/01/ 09. 2007 Projets de l gislation termins : Nouvelle loi sur les trangers. Electronic document, http://www.bfm.admin.ch/bfm/fr/home/dokumentation.html accessed 07/11/ 09. Office fdral de la statistique 2008 La statistique de laide sociale Rsultats pour lanne 2006. Neuchtel: Office fdral de la s tatistique. 2009a Enqute sur les revenus et la consommation, 2005 : Revenu des m nages. Revenus et dpenses selon la grande r gion, 2003 2007. Electronic document, http://www.bfs.admin.ch/bfs/portal/fr/index/the men/20/02.html accessed 11/01/ 0 9 2009b Assurance sociales: Vue densemble. Electronic document, http://www.bfs.admin.ch/bfs/portal/fr/index/themen/13/02/01.html accessed 11/01/ 09. 2009c Population rsidante permanente s elon la nationalit et le s exe. Electronic document, http://www.bfs.admin.ch/bfs/portal/fr/index/themen/01/02.html accessed 11/01/ 09.
334 ONeil, Edward Jr. 2006 Awakening Hippocrates: A Primer on Health, Poverty, and Global Service. Chicago: American Medical Association. Owen, Gareth 2008 An Elephant in the Room?: Stigma and Hepatitis C Transmission Among HIV positive Serosorting Gay Men. Culture, Health and Sexuality 10(6): 601 610. Papaux, Yvan 2006 Genve: SANS ABRI Reportage. Le Courrier (Geneva, Switzerland), April 19. Perlick, Deborah A., Robert A. Rosenheck, John F. Clarkin, Jo Anne Strey, Jamelah Salahi, Elmer L. Struening, and Bruce G. Link 2001 Adverse Effects of Perceived Stigma on Social Adaptation of Persons Diagnosed With Bipolar Affective Disorder. Psychiatric Services 52(12): 1627 1632. Phelan, Jo, Bruce G. Link, Robert E. Moore, and Ann Stueve 1997 The Stigma of Homelessness: The Impact of the Label Homeless on Attitudes Toward Poor Persons. Social Psychology Quarterly 60(4): 323 337. Puhl, Rebecca and Keith Bachman 2009 Stigma, Prejudice and Childhood Obesity: Tools to Increase Sensitivity in Healthcare Delivery. Paper presented at the National Initiative for Childrens Healthcare Quality 8th Annual Forum for Improving Childrens Healthcare, Grapevine, Texas, March 12. Pyne, Jeffrey M., Eugene J. Kuc, Paul J. Schroeder, John C. Fortney, Mark Edlund, and Greer Sullivan 2004 Relationship Between Perceived Stigma and Depression Severity The Journal of Nervous and Mental Disease 192(4):278 283. Radio France 2005 Big Brother chez les chmeurs? Radio France, December 27. Raybeck, Douglas 1991 Hard V ersus Soft Deviance: Anthropology and Labeling Theory. In Deviance: Anthropological Perspectives, Morris Frielich, Douglas Raybeck, and Joel Savishinsky, eds. New York: Bergin and Garvey. Recueil Syst matique du Droit Fdral 1996 RS 832.10: Loi fdrale du 18 mars 1994 sur lassurancemaladie (LAMal). Electronic document, http://www.admin.ch/ch/f/rs/c832_10.html accessed 11/0 8 / 09. Recueil Systmatique Genevois 1946 F 3 25.04: Rglement sur le Vagabondage et la Mendicit. Electronic document, http://www.geneve.ch/legislation/welcome.html accessed 11/02 / 09. 2008 E 4 05: Loi Modifiant la Loi Pnale Genevoise ( Mendicit)(10106). Modifications Rcentes, May 1, 2008. Electronic document, http://www.geneve.ch/legislation/welcome.html accessed 11/02/ 09.
335 Ritchey, Ferris J., Mark La Gory, Kevin M. Fitzpatrick, and Jeffrey Mullis 1990 A Comparison of Homeless, Community wide, and Selected Distressed Samples on the CES Depression Scale. American Journal of Public Health 80(11): 1384 1386. Romney, A. Kimball, Susan C. Weller, and William H. Batchelder 1986 Culture as Consensus: A Theory of Culture and Informant Accuracy. American Anthropologist 88(2): 313 338. Roosevelt, Margot 2008 Homeless man lighted on fire identified as John Robert McGraham. Los Angeles Times. October 13: Electronic document, http://articles.latimes.com/2008/oct/13/local/mehomeless13, accessed 06/17/ 09. Rossini, Stphane 2002 Les pauvrets caches en Suisse. Analyse qualitative des processus de prcarisation et perspec tives daction sociales. Fonds national de le recherche scientifique, PNR 245 Problmes de lEtat Social. Neuch tel, Switzerland: University of Neuchtel. Rubin, Joel 2008 Arrest in slaying of homeless man set afire. Los Angeles Times L.A. Now. January 22: Electronic document, http://latimesblogs.latimes.com/lanow/2009/01/los angeles p 4.html accessed 06/15/ 09. Sahlins, Peter 2006 Riots in France: Civil Unrest in the French Suburbs, November 2005. Electronic document, http://riotsfrance.ssrc.org/, accessed 06/05/ 09. Scheff, Thomas J. 1966 Being Mentally Ill: A Sociological Theory. Chicago: Aldine. 1999 Being Mentally Ill : A Sociological Theory. New York: Aldine de Gruyter. Secrtariat dEtat l conomie 2007 La Situation sur le March du Travail en Janvier 2007. Berne, Switzerland: Secrtariat dEtat lconomie. Sen, Amartya Kumar 1992 Inequality Reexamined. Cambridge, Mass.: Harvard University Press. Shuttleworth, Russell P. and Devva Kasnitz 2004 Stigma, Community, Ethnography: Joan Ablons Contribution to the Anthropology of Impairment Disability. Medical Anthropology Quarterly 18(2): 139 161. Silver, Eric, Edward P. Mulvey, and Jeffrey W. Swanson 2002 Neighborhood structural characteristics and mental disorder: Faris and Dunham revisited. Social Science and Medicine 55: 1457 1470. Sirey, Jo Anne, Marha L. Bruce, George S. Alexopolous, Deborah A. Perlick, Patric k Raue, Steven J. Friedman, and Barnett S. Meyers 2001 Perceived Stigma as a Predictor of Treatment Discontinuation in Young and Older Outpatients With Depression. American Journal of Psychiatry 158(3): 479 481.
336 Smit, Filip, Aartjan Beekman, Pim Cuijpers, and Ron de Graaf 2004 Selecting key variables for depression prevention: results from a populationbased prospective epidemiological study Journal of Affective Disorders 81: 241 249. Spradley, James P. 1970 You Owe Yourself a Drunk: An Ethnography of Urban Nomads. Boston: Little, Brown and Company. 1979 The Ethnographic Interview. Dallas: Holt, Rinehart and Winston. 1980 Participant Observation. New York: Holt, Rinehart and Winston. Stateman, Alison 2008 Violence Against the Homeless: Is It a Hate Crime? Time. October 22: Electronic document, http://www.time.com/time/nation/article/0,8599,1852825,00.html accessed 06/15/ 09. Susser, Ezra, Robert Moore, and Bruce Link 1993 Risk Factors for Homelessness American Journal of Epidemiology 15(2): 546 556. Susser, Ida 1996 The Construction of Poverty and Homelessness in U.S. Cities Annual Review of Anthropology 25: 411 435. Syndicat Interprofessionel de Travailleuses et Travailleurs (SIT) 2004 Un secteur et des travailleurs euses dans lombre: Rgularisations les sans papiers et le secteur de lconomie domestique. Bull etin dinformation, No. 93. SIT : Geneva, Switzerland. Takahashi, Lois M. 1997 The SocioSpatial Stigmatization of Homelessness and HIV/AIDS: Toward An Explanation of the NIMBY Syndrome. Social Science and Medicine 45(6): 903 914. Tlvision suisse r omande 2007a Tziganes, la route de lEldorado Suisse. Tlvision Suisse Romande, June 14. Electronic document, http://www.tsr.ch/tsr/index.html?siteSect=300003&sid=7850223, accessed 11/03/ 09. 2007b Mendicit Genve: la polmique continue. Tlvision Suisse Romande, June 14. E lectronic document, http://www.tsr.ch/tsr/index.html?siteSect=200003&sid=7926637, accessed 11/03/ 09. Townsend, Peter 1993 The International Analysis of Poverty. New York: Harvester Wheatsheaf. Tribune de Genve 2005 Un m illion de p auvres en Suisse, selon une estimation de Caritas. Tribune de Genve, December 28. 2006a Une majorit des Suisses considrent les immigrs comme un gain. Tribune de Genve, January 4. 2006b Cinq enseignants universitaires menacs de mort par une tudiante.Tribune de Genve, June 19.
337 United Nations Development Programme 2007 Human Development Report 2007/2008, Fighting Climate Change: Human Solidarity in a Divided World. Electronic document, http://hdr.undp.org/en/media/HDR_20072008_EN_Complete.pdf accessed 05/24/ 09. U.S. Bureau of Labor Statistics 2009 The Empl oyment Situation: April 2009. Washington, D.C.: United States Department of Labor. Electronic document, http://www.bls.gov/news.release/pdf/empsit.pdf accessed 05/25/ 09. 2007 Charting the U.S Labor Market in 2006. Washington, D.C.: United States Department of Labor. Electronic document, http://www.bls.gov/cps/labor2006/chartbook.pdf accessed 05/25/ 09. U.S. Census Bureau 2008 How the Census Bureau Measures Poverty (Official Measure). Electronic document, http://www.census.gov/hhes/www/poverty/povdef.html accessed 05/24/ 09. Vetter, Stefan, Jerome Endrass, Ivo Schw eizer, HsunMei Teng, Wulf Rossler, and William T. Gallo 2006 The effects of economic deprivation on psychological well being among the working population of Switzerland. BMC Public Health 6: 223. Ville de Genve 2009 Club social rive g auche. Elect ronic document, http://www.geneva city.ch/dpt5/social/exclusion_csrg_f.php, accessed 11/09/ 09. Votta, Elizabeth and Ian G. Manion 2003 Factors in the Psychological Adjustment of Homeless Adolescent Males: The Role of Coping Style. Journal of the American Academy of Child and Adolescen t Psychiatry 42(7): 778 785. Waxman, Chaim I. 1977 The Stigma of Poverty: A Critique of Poverty Theories and Policies. New York: Pergamon Press. Wilkins on, Richard G. 1994 The Epidemiological T ransition: From Material Scarcity to Social Disadvantage? Daedalus 123(4): 61 77. Wolcott, Harry F. 2004 The Art of Fieldwork. Walnut Creek, CA: AltaMira Press. Wolff, Hans 2004 Unit mobile de soins communautaires (UMSCO): un modle daccs aux soins pour les plus dmunis Genve. M.P.H. thesis, Institute of Social and Preventive Medicine, University of Geneva. 2006 Prise en charge des jeunes femmes enceintes et sans papiers Genve. Paper presented for the Sant et Migrations Training Program Migration globale et enjeux locaux : Recherche en sciences mdicale et sociales, Lausanne, Switzerland, June 15. Wolff, Hans, Marius Besson, Marylise Holst, Eliana Induni, and Hans Stalder 2005 Ingalits social es et sant: lexprience de lUnit mobile de soins communautaires Genve. Revue Mdicale Suisse 1 : 2218 2222.
338 BIOGRAPHICAL SKETCH Ryan Theis was born in Chicago, Illinois and has lived most of his life between Florida and Ontario, Canada. He received a Bachelor of Science degree with honors from t he University of Florida, with a major in journalism and a minor in anthropology. In 2001 he entered an interdisciplinary program at the University of Florida, receiving a Master of Arts in anthropology in 2003 and a Master of Public Health in epidemiology in 2004. As a graduate student, he helped to conduct applied ethnographic research on adolescent tobacco use, farmworker housing, and substance abuse treatment for veterans, and epidemiologic research on kidney cancer, obesity and nutrition. He qualified for doctoral candidacy in 2005 and conducted his doctoral fieldwork in Switzerland from November 2005 to October 2006, funded by a grant from the U.S. Fulbrig ht Program and the Swiss Confederation.