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

How well-intentioned public health efforts can be unwitting but powerful drivers of stigma.

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.