Fear, not stigma

The problem with fear is that it often leads to irrational ideas

Has the disease called Covid-19 become a stigma? No, I don’t think so. It is spreading and the total number of cases in Pakistan is going up rapidly. And so is the number of cases in Lahore. But becoming a stigma takes a bit more than just being a bad disease involving a lot of people.

What has happened is that people are now taking it seriously. Until recently, many ordinary Pakistanis took a rather cavalier attitude towards this disease and getting infected with it. As the virus has spread, people are starting to worry about getting infected. This worry can escalate into fear.

The problem with fear is that it often leads to irrational ideas. It is such irrationality that is being expressed increasingly through anger against those already infected, sort of blaming the victim. Still, it is difficult to ostracize those that cannot be recognised.

Outside of hospitals where Covid-19 patients are being treated, primary spread of this virus is by those that are infected but not yet sick enough to be recognised as being infected. If there was a physical ‘stigma’ or obvious sign that a person is infected then we might see a different sort of attitude of the general public towards those infected.

However, there is no particular class of people that are primarily getting infected. We have two former prime ministers, a former chief minister of the Punjab who is now leader of the opposition in the National Assembly along with other rich and famous types that have become infected. Clearly, then it is not possible to accept that any of these people are being ostracised. No stigma here.

The word stigma is now used for almost any type of discrimination based on medical, social, physical or religious differences. During my time in the United States (US) when the HIV-AIDS epidemic was still in its early days, I witnessed what was clearly a ‘stigma’ attached to this disease.

At that time HIV-AIDS was essentially a death sentence so there was great fear of getting infected. Known categories of people primarily infected were stigmatised. That, however, easily meshed with existing social mores that already ostracised gay men, sex workers and intravenous drug abusers.

Once ‘regular’ people started getting infected with HIV-AIDS, usually through contaminated blood transfusions during surgery, the stigma attached to this disease waned. Perhaps, the most noted example was that of Arthur Ashe, a famous tennis player who developed HIV-AIDS after a heart surgery.

The stigma about HIV-AIDS is still alive and well in Pakistan as is the stigma about anything that has to do with sex. Two years ago, I submitted an article to The News on Sunday titled The Coming HIV Epidemic. The editors changed it to Truth And Shame (TNS, April 1, 2018). Shame is what stigmas are all about. In fiction, the most famous stigma is probably the ‘A’ worn by Hester Prynne in Hawthorne’s novel, The Scarlet Letter. The letter A stood for adulteress.

From a historical perspective, the one disease that has been stigmatised through much of human history is leprosy. So much so that the very word leper is now synonymous with being a social outcast. The reason for a stigma attached to this disease is that it produces visually appreciated disfigurement of the face and the body.

Interestingly, leprosy and tuberculosis (TB) are very similar diseases. Since infection with leprosy produces obvious physical deformity while TB does not, so the patients suffering from them are treated differently. Dying from TB was considered a ‘noble’ death. While leprosy though painful and disfiguring caused fewer deaths and yet, was considered much worse than TB.

Those of us that have seen old Urdu-Hindi movies from the middle of the previous century might remember a recurrent plot line. Many of these movies had love triangles that were almost always resolved when one vertex of the triangle – usually a male, died a graceful and almost a saintly death from TB. But never from leprosy.

Then there is the stigma attached to social class and menial occupation that we as Muslims copied in its entirety from the Hindus we lived with for a few centuries. A perfect example of this is what happened to me a few months after my return from the US when I took over as the head of cardiac surgery in Mayo Hospital.

It was an old habit that I would spend some time with my staff at the beginning of the work day. I walked into the nursing office in the operating theatre where the head nurse offered me a cup of tea, an invitation that I accepted.

But then she said that I would have to wait because she didn’t have a ‘clean’ cup available. I pointed to a clean cup sitting on the table. She said that I can’t use that saying it is for the ‘sweeper’. I knew exactly what she meant so I laughed and said to her I have just come back from the land of the sweepers. And I have been drinking coffee from cups used by sweepers and sweepresses.

So coming back to where I started from, it is not any stigma but rather unadulterated fear that we are seeing. Reason did not work to encourage social isolation and distancing but fear is starting to work, and that is a good.

The writer has served as professor and chairman at the department of cardiac surgery, King Edward Medical University

Coronavirus:Fear, not stigma