Many assume that individuals with a hidden stigma escape the difficulties faced by individuals with a visible stigma. However, recent research has shown that individuals with a concealable stigma also face considerable stressors and psychological challenges. The ambiguity of social situations combined with the threat of potential discovery makes possessing a concealable stigma a difficult predicament for many individuals. The increasing amount of research on concealable stigmas necessitates a cohesive model for integrating relevant findings. This article offers a cognitive-affective-behavioral process model for understanding the psychological implications of concealing a stigma. It ends with discussion of potential points of intervention in the model as well as potential future routes for investigation of the model.

http://psycnet.apa.org/journals/bul/133/2/328.pdf

The psychological implications of concealing a stigma: a cognitive-affective-behavioral model.

Information management is an important component of coping with illness and illness-related uncertainty. Normative theory and research on information seeking and avoiding in health contexts can help explain why some information management activities are more adaptive than others. Challenges and dilemmas of information management include relational demands (e.g., the need to coordinate the behaviors and goals of the participants) and contextual features (e.g., cross-cultural considerations or channels available for information seeking and providing). Issues that need to be addressed in a normative approach include (a) how information management goals can be accomplished while still accounting for other goals (e.g., identity management or relational maintenance), (b) what roles interpreters can play to facilitate effective cross-cultural information exchange (e.g., as cultural informants), and (c) how information seekers can best manage conflicting or overwhelming information when confronted with messages from multiple channels.

Information Seeking and Avoiding in Health Contexts

People with chronic and acute illnesses experience uncertainty about their prognoses, potential treatments, social relationships, and identity concerns. In a focus group study of people living with HIV or AIDS, we examined how social support may facilitate or interfere with the management of uncertainty about health, identity, and relationships. We found that support from others helps people with HIV or AIDS to manage uncertainty by (a) assisting with information seeking and avoiding, (b) providing instrumental support, (c) facilitating skill development, (d) giving acceptance or validation, (e) allowing ventilation, and (f) encouraging perspective shifts. Respondents also reported a variety of ways in which supportive others interfered with uncertainty management or in which seeking support imposed costs. Problems associated with social support and uncertainty management included a lack of coordination in uncertainty management assistance, the addition of relational uncertainty to illness uncertainty, and the burden of others' uncertainty management. Our study reveals strategies respondents used to manage costs and complications of receiving support, including developing an active or self-advocating orientation, reframing supportive interactions, withdrawing from nonproductive social situations, selectively allowing others to be support persons, and maintaining boundaries.

Social support and the management of uncertainty for people living with HIV or AIDS.

Despite increasing interest in the negative impact of stigma, a comprehensive theoretical frame to the discursive management of stigma is lacking. This paper advances stigma research by integrating disparate areas of stigma research and highlighting the co-constructed and materially influenced process of stigma management to create a theory and typology of stigma management communication. It is argued that stigma is shifting and determined by both the stigmatized and stigmatizers and that all stigma management communication can be organized into four quadrants based on individuals' acceptance/denial (a) of the existence of a stigma and (b) of the stigma's applicability to that individual. The result is a typology of stigma management strategies and a framework of propositions and directions for future applied research.

Stigma Management Communication: A Theory and Agenda for Applied Research on How Individuals Manage Moments of Stigmatized Identity

The purpose of this study was to develop a theoretical model of communal coping in postdivorce families and other naturally occurring groups. This framework builds upon previous models of communal coping (C. A. Berg, S. P. Meegan, & F. P. Deviney, 1998; R. F. Lyons, K. Mickelson, J. L. Sullivan, & J. C. Coyne, 1998) in its identification of appraisal and action dimensions. However, the current model extends this work in five important ways by: (a) providing a more complex picture of the interdependent nature of coping; (b) extending current thinking about the transactional and fluid nature of the coping process; (c) addressing the different levels of responsibility for stressors within groups; (d) articulating how coping is affected by group dynamics, like group norms, power, and differences in perspectives; and (e) demonstrating the influence of context and the type of stressor on the coping process. The dimensions of the model are discussed in terms of the literature on communal coping and group processes.

Toward a Theoretical Model of Communal Coping in Postdivorce Families and Other Naturally Occurring Groups

Activist organizations are a relatively unique collective setting for people living with an HIV infection or AIDS. Communication within these organizations includes educational and motivational practices designed to facilitate change for the group and for its individual members. In this study, we examined differences between activist and nonactivist individuals (N = 174) with HIV or AIDS. Results demonstrated that, in comparison with nonactivists, activists (i) used more problem-focused coping and less emotion-focused coping, (ii) had greater knowledge of HIV-treatment information sources, and (iii) had greater HIV social network integration. We speculate that there are two reasons for these differences: (i) there are behavioral and psychological predisposing factors that lead to membership in an activist group, and (ii) the educational and motivational environments established through the relationships of activist group members (i.e., the social tasks of the collective) lead to changes in individuals.

Social Activism, Self-Advocacy, and Coping with Hiv Illness

The forms and functions of peer social support for people living with HIV

The pragma-dialectical theory of argumentation presents an ideal model of critical discussion in which a proponent advances a standpoint and defends it against the challenges of an opponent (van Eemeren & Grootendorst, 1992). Van Eemeren, Grootendorst, Jackson, and Jacobs (1993) elaborated the theory with a method for reconstructing and improving argumentative discourse. They described higher-order conditions needed to achieve a "correct, justified, and rational" (p. 25) conclusion. First-order conditions are the basis for resolution-oriented interactions and include rules of the discussion (e.g., "Parties must not prevent each other from advancing standpoints or casting doubt on standpoints." "A party that advances a standpoint is obliged to defend it if the other party asks him to do so." "A party may defend his standpoint only by advancing argumentation relating to the standpoint." see van Eemeren & Grootendorst, 1992, p. 208). Violations of the first-order conditions lead to fallacious moves in the argument: Shifting or evading the burden of proof is a failure to meet one's obligation to defend a standpoint that has been challenged (van Eemeren & Houtlosser, 20(2). Second-order conditions "correspond, roughly, to the psychological makeup of the arguer" (van Eemeren et aI., 1993, p. 32) and include requirements such that the participants (a) are disinterested in the outcome (i.e., willing to change positions); (b) are able to offer valid reasoning and to account for multiple lines of argument; and (c) are skilled and competent in the subject matter under 23

Lance S. Rintamaki

Papers

Social Activism, Self-Advocacy, and Coping with Hiv Illness

The forms and functions of peer social support for people living with HIV

Pragma-Dialectics and Self-Advocacy in Physician-Patient Interactions

Social Identity and Stigma Management for People Living With HIV