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Society for Medical Anthropology
Oral Presentation Session
Carl Denig
University of Edinburgh
Stigma management is often regarded as something done by marginalised or discredited individuals in response to a power structure which has (or could) thrust them into this unenviable position. But this is only half the equation: how are individuals defined as either clinically or socially other? What ethics guide interactions between those with spoiled identities and those unsullied in this setting? Drawing on a year of fieldwork with practitioners treating narcissistic personality disorder, I propose that some clinicians act as sympathetic others, being “wise” in Goffman’s sense (1963:28). Diagnosis can be strategic (e.g., Whooley 2010), but my informants suggest that this is done because supposedly universal DSM diagnoses carry different cultural and ethical connotations in different contexts. Contemporary advice books offer insight into both how lay diagnosis of narcissism is done, and what moral meanings it has. Both advice books and my informants offer insight into how stigma is instantiated in interaction. Ultimately, examination of these sources suggest that stigma management is a two-way process, having both supportive and reactive components. These elements serve either to maintain, mitigate or resist a culturally and situationally-specific spoiled identity. Clinical responses to narcissistic personality disorder can be either reactive or supportive, whereas lay reactions tend to be supportive. In this talk, I will examine these and other intersections of ethics and interaction, and the individual and society.