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En Situation Précaire: Poverty, Stigma, and Mental Health in Geneva, Switzerland

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En Situation Précaire: Poverty, Stigma, and Mental Health in Geneva, Switzerland EN SITUATION PRÉCAIRE: POVERTY, STIGMA, AND MENTAL HEALTH IN GENEVA, SWITZERLAND By RYAN P. THEIS A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2010 1 © 2010 Ryan P. Theis 2 To my family and friends for their love and support, to Dorin, Nadim, and Tania for their trust and friendship, and to all in Geneva who find themselves in a “precarious” situation 3 ACKNOWLEDGMENTS I would first like to thank Allan Burns for his guidance as my advisor, professor, and committee chair over many years of graduate school, and as my mentor in applied anthropology. Dr. Burns and my committee, Willie Baber, William Chen, and Elizabeth Guillette, have been a valuable influence for me, and it was through their encouragement that I sought to pursue a niche between anthropology and public health, to travel and learn a foreign language, and to be resilient to the challenges of academia. There are many who, over the years, have helped me to develop as a professional and as a person, and without whom this work would not have been possible. I am grateful to Nabih Asal for his leadership as my professor and mentor in epidemiology, and Elizabeth Shenkman for her guidance in health policy and program evaluation. With much admiration, I thank Alice Allen, Charlie Gass, and Hal Clarendon for showing me what I am capable of, and capable of becoming, physically, mentally, and spiritually. I owe many thanks to my colleagues in Switzerland – Hans Wolff, Patricia Hudelson, Antoine Stähli, Nicolas Senni, and all those in the clinics and social services of Geneva who helped me to realize my doctoral work. In particular, I acknowledge the doctors, nurses, and social workers of UMSCO, the social service workers and volunteers at CSRG, and the faculty of the University Hospitals of Geneva whose warm welcome helped to ease my transition to living in a foreign country, and whose valued input contributed greatly to this study. Credit is due to my research assistants Géraldine Bugnon and Ayari Félix for their enthusiasm, adaptability, and hard work during my final months in Switzerland. 4 I extend sincere gratitude to the many homeless and unemployed social service clients whose trust and helpfulness were critical to the success of this study. I thank Dorin, Nadim, and Tania for allowing me to follow them in their private lives, to witness their trials and tribulations, and to hear their stories. I gratefully acknowledge these and other informants, who, with little to gain personally from their participation, agreed to help out of their respect for others living in précarité. Lastly, I thank my friends, family, and counselors who have given me constant support over the years, who encouraged me to keep trying when I was overwhelmed, and who congratulated me when I found success. 5 TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................. 4 LIST OF TABLES ............................................................................................................ 9 LIST OF FIGURES ........................................................................................................ 10 ABSTRACT ................................................................................................................... 11 CHAPTER 1 INTRODUCTION .................................................................................................... 13 Stigma and the Sociopolitical Dimensions of Poverty ............................................. 15 Study Rationale ...................................................................................................... 18 Social Exclusion and the Production of Urban Poverty .................................... 19 Poverty, Identity, and Mental Health ................................................................. 26 Geneva, Switzerland: Setting For an Ethnographic Study ...................................... 29 Study Approach and Research Questions........................................................ 33 Dissertation Outline .......................................................................................... 35 2 STIGMA THEORY AND THE ANTHROPOLOGY OF POVERTY: TOWARD A SOCIAL, PSYCHOLOGICAL, AND CULTURAL SYNTHESIS ............................... 38 “Spoiled Identity”: Early Concepts of Stigma and Deviance in Sociology................ 40 Labeling and Stigma in Social Psychology ............................................................. 47 Cultural Models of Stigma – The Contribution of Anthropology and Ethnography .. 57 The Anthropology of Deviance ......................................................................... 62 Ethnographic Studies of the Poor ..................................................................... 67 Stigma in Multidisciplinary Synthesis ...................................................................... 76 3 POVERTY IN GENEVA: THE BALANCE OF STIGMA AND SOCIAL ACCEPTANCE ....................................................................................................... 78 A Visitor’s Snapshot of Geneva .............................................................................. 78 Poverty and Social Support in Switzerland ............................................................. 82 A Typology of Stigmatized Identities in Geneva ...................................................... 90 Homelessness and Begging ............................................................................. 90 Unemployment ................................................................................................. 94 Being an Immigrant .......................................................................................... 97 Social Support in Geneva ..................................................................................... 103 Social Assistance Organizations .................................................................... 104 Day Centers and Soup Kitchens .................................................................... 110 Homeless Shelters ......................................................................................... 113 Social Support as a Response to Stigma.............................................................. 116 6 4 RESEARCH APPROACH: QUESTIONS, INFORMANTS, PLACES, AND METHODS ............................................................................................................ 121 Research Questions ............................................................................................. 122 Informants ............................................................................................................. 124 Informant Demographics ................................................................................ 126 Informant Profiles ........................................................................................... 128 Précaire informants .................................................................................. 129 Social service informant ........................................................................... 132 Study Sites ............................................................................................................ 132 Participant-Observation ........................................................................................ 135 Qualitative Interviews ............................................................................................ 141 Cultural Domain Analysis ...................................................................................... 145 Methods of Analysis .............................................................................................. 148 Field Notes ..................................................................................................... 149 Interview Transcripts ...................................................................................... 151 Stigmatizing Encounters ................................................................................. 153 Interpretation .................................................................................................. 155 5 LABELS AND STEREOTYPES OF PRÉCARITÉ ................................................. 162 Exploring Personal Labels as a Cultural Domain .................................................. 164 Free Lists ........................................................................................................ 167 Pile Sorts – 34 Labels for “People in Précarité” .............................................. 173 Label groupings ....................................................................................... 175 Aggregate grouping – the “answer key” and its visualization ................... 179 Cultural consensus and competence ratings ........................................... 182 Paired Comparisons ....................................................................................... 184 Stereotypes of Précarité in Geneva ...................................................................... 189 Stereotypes of Poor Immigrants ..................................................................... 192 Stereotypes of Alcoholics, Addicts, and Drug Dealers ................................... 196 Stereotypes of Unemployed/Underemployed State Beneficiaries .................. 197 Stereotypes of the Homeless ........................................................................
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