Lazy, Crazy, and Disgusting: Stigma and the Undoing of Global Health

by Alexandra Brewis, Amber Wutich

Stigma is a dehumanizing process, a method of shaming and blaming that is embedded in our beliefs about who does and does not have value within society. In Lazy, Crazy, and Disgusting, medical anthropologists Alexandra Brewis and Amber Wutich explore another side of the issue: the startling fact that well-intentioned public health campaigns can create new and sometimes damaging stigma, even when they are successful.

Brewis and Wutich present a novel, synthetic argument about how stigmas act as a massive driver of global disease and suffering, killing or sickening billions every year. They focus on three of the most complex, difficult-to-fix global health efforts: bringing sanitation to all, treating mental illness, and preventing obesity. They explain how and why humans so readily stigmatize, how this derails ongoing public health efforts, and why this process invariably hurts people who are already at risk. They also explore how new stigmas enter global health so easily and consider why destigmatization is so very difficult. Finally, the book offers potential solutions that may be able to prevent, challenge, and fix stigma. Stigma elimination, Brewis and Wutich conclude, must be recognized as a necessary and core component of all global health efforts.

Drawing on the authors' keen observations and decades of fieldwork, Lazy, Crazy, and Disgusting combines a wide array of ethnographic evidence from around the globe to demonstrate conclusively how stigma undermines global health's basic goals to create both health and justice.

Genres: Nonfiction, Health, Anthropology

273 pages, Kindle Edition

Published November 19, 2019

Reviews

[Sarah · Rating 5 out of 5]

Very informative book about the failures in public health initiatives by utilizing stigma.

The book outlines examples of healthcare programs that use shame causing unintended negative outcomes. Shame contributes to further health problems, leading to depression and isolation of the targeted group. It also affects marginalized groups even more, including women, racial minorities, LGBT+ people, and the poor.

"Recent research in the United States suggests that the emotional impacts of weight stigma most affect those with less social, economic, or political power. Lower-income women are now showing the greatest emotional and psychological toll."

On top of creating emotional distress, mental health problems, and social isolation the programs mentioned in the book didn't work.

The book concludes by encouraging the reader to evaluate their own judgments of others and to extend compassion and empathy to those who face stigma, such as individuals with mental illnesses, obesity, or drug addiction.

One aspect I think the book could have explored more is why shame is used in public health policy—due to cost. Truly addressing issues like obesity would require major infrastructure changes to improve walkability, along with making healthy food more accessible and affordable. This is hinted at and mentioned briefly however I think it would have been interesting to explore further.

Also, I made a YouTube video discussing this book:
https://www.youtube.com/watch?v=4LYYw... !

[Abby Wilson · Rating 4 out of 5]

Very engaging for an anthropological book. Some heavy and dense material that was hard to get through but ultimately I learned a lot and will be working on tackling my own stigma and making my community a better place moving forward 👍🏼

[Shelbycat · Rating 4 out of 5]

Really interesting. Something for all of us think more on, our initial judgement and stigmatisation of others.

[Carrie Doss · Rating 3 out of 5]

Stigma sucks and it’s mind-blowing how prevalent it is within most cultures. America is definitely not exempt from this and it’s truly sad. Humanity needs more empathy and that is that!

[Hillary Ayala · Rating 5 out of 5]

I stumbled upon this book while Amazon "window" shopping and bought it because why not? The thing is that I didn't expect to love it so much. The book is a great tool for those who are dipping their toes on global health issues or are just interested in medical anthropology. To be honest I've even read lines to someone in the IT industry, it's just that appealing.
It is structured to approach stigma and its role in health; it especially touches the ground on several REAL interventions regarding sanitation, chronic diseases, and mental health.

Here are some of my favorite quotes:
"Illnesses don’t stigmatize people; people and the institutions they create do."
"Our collective public health efforts to fight fat often feel like a campaign against fat people themselves."
"At times, being bipolar can be an all-consuming challenge, requiring a lot of stamina and even more courage, so if you’re living with this illness and functioning at all, it’s something to be proud of, not ashamed of.”

Will probably read it again as soon as I finish school for the year!

[Mackenzie · Rating 3 out of 5]

Two of my former professors wrote this book and gave me a copy!

It was a great read if you want to learn about stigma which I feel like is an invisible plague that affects societies worldwide. I honestly never considered just how devastating stigma can be.

For something that should feel textbook heavy, it was an enjoyable read. This took me a long time only because I read it solely in my office bit by bit and I’m not great at reading nonfiction in general. I’m working on it.

Three stars solely for the fact that nonfiction is just not my genre of choice.

PS I was their first global health grad at ASU and felt very emotional at the acknowledgments section.

[Hailey Hansen · Rating 4 out of 5]

3.75- read excerpts of this for class and wanted to finish the rest. this is a very accessible introduction to stigma’s role in perpetuating major global health issues (hygiene, obesity, mental illness). i wish the analysis/proposed solutions went a little bit deeper. would love to read a follow-up book detailing evidence from the research the authors have done since

[Lindsay Douglass · Rating 5 out of 5]

Such a good book! So insightful for those interested in global health and also for those who just like to understand how human culture shapes our thoughts and behaviors both positively and negatively. I read it for class, but am tempted to purchase for myself for leisure reading in the future.

[Cara Lynn · Rating 4 out of 5]

Read for school

[Lindsay · Rating 5 out of 5]

Read as part of a medical anthropology course.

As usual, I don't normally rate books I read for school but I have to say-this was great. Super educational and well-written; should be required reading for those entering health fields.