Stigma and salience: Photo-elicitation and identity work among formerly homeless adults with serious mental illness and substance abuse histories.

Stigma theory has expanded in recent years to consider “what matters most” to those who are stigmatized (Yang et al., Social Science & Medicine, 2007, 64, p. 1524) as well as the existence of intersectional stigma arising from multiple “spoiled identities” (Goffman, Stigma: Notes on the management of spoiled identity, 1963, Prentice-Hall). In this report, we extend stigma theory into an intersectional realm where “what matters most” is evidenced by participants in discussing—via visual imagery and identity narratives—their various “spoiled identities” and relative salience among these. In this regard, the experience of stigma—and the salience of various identities—may vary depending upon current circumstances and life experiences over time. This study used photo-elicitation interviews to examine intersectional stigma and salience through the “identity talk” of 17 formerly homeless persons with serious mental illness and histories of substance abuse. Research questions were: How do participants’ photographs and narratives reflect “identity work” in addressing intersectional identities? How (if at all) are the constituent identities accorded differential salience, that is, what matters most? Thematic analysis of photo-embedded transcripts was conducted to identify emergent themes related to three focal identities (homeless, serious mental illness, and substance abuse). Four themes were found: (a) positivity over negativity; (b) distancing, balancing, and foregrounding; (c) enduring stigma of substance use; (d) emergent and reifying identities. The greater salience of the substance abuser identity echoes previous research showing external stigma as being most egregiously directed to such individuals. Implications include considering the importance of intersectional stigma and asking “what matters most” when addressing clients who have experienced multiple forms of adversity. (PsycInfo Database Record (c) 2021 APA, all rights reserved)