It is the unacceptable truth that, in a country where one in 111 people have a significant disfigurement to the face (Changing Faces, 2017), there remains a negative stigma which shames and isolates this sector of society. These disfigurements can be moderate or severe, acquired or congenital, the result of trauma, illness or genetics, but the common theme amongst them is their effect on the psychosocial wellbeing of the individual and their integration into society.
In 21st century Britain, anti-discrimination laws prevent open discrimination against people for a myriad of reasons that mark them as ‘different’. In terms of disfigurements, however, these are unclear; ‘severe disfigurement’ is cited as a protected characteristic in the Equality Act (2010), but no definition as to what constitutes ‘severe’. This qualification may legalise some discrimination and allow it to continue in society. Some may argue that disfigurements to the face are obtrusive to social interaction, as the face is the focus and the source of social information, using this as both a reason and explanation for why employment discrimination is statistically higher in customer-facing roles (Tartaglia et al., 2005). Links may also be drawn to society’s obsession with beauty; if attractive applications are favoured over non-attractive applicants (Marlowe, Schneider & Nelson, 1996), people who deviate from a ‘normal’ appearance completely are then pushed further out of favour. Discriminators noted their perceived ‘unattractiveness’ of a facial disfigurement. While this is defined as discrimination by potential employers, it is not necessarily without basis. Negative reactions are typical, and many employers cannot risk the loss of business that hiring someone with essentially (perceived) lower social skills would cause. Giancoli and Neimeyer (1983) showed these fears were not unfounded; pictures of people with facial disfigurements ranked least in likability, behind wheelchair users and non-disabled people, all of whom had ‘normal’ faces despite being otherwise ‘different’. This lends credibility to the theory that it is particularly facial disfigurement that evokes negative reaction and stigmatisation. It is repeated in Houston & Bull’s (1994) avoidance experiment, where strangers chose seats further from confederates with mock facial disfigurements on trains, as these people had been judged instantly on appearance alone.
In a vicious cycle, an individual’s prejudice towards those with facial disfigurements must be caused by societal bias. As Smith and Collins (2009) pointed out, person perception is formed on the basis of wider cultural perceptions, suggesting the media’s portrayal of facial disfigurements is an integral part of the stigmatisation. This begins with the term ‘disfigurement’, which the Collins English Dictionary (2017) defined as something which ‘spoils’ the appearance of someone. This derogatory root is just the premise of the stigma that surrounds people with facial disfigurements, accentuated by repeated non-exposure or misrepresentation of these individuals. They are scarcely portrayed in the media and those who do appear often feature as an extension of their disfigurement. The Channel4 programme ‘The Undateables’ depicts people with disfigurements trying to find love, under the implication that they are ‘undateable’ because of their appearance. In popular cinema, the film ‘The Dark Knight’ uses a facial disfigurement to transform a character from virtuous to evil. The James Bond franchise’s idea of a villainous appearance for Blofeld, Alec Trevelyan and Le Chiffre is having facial scars. Repeatedly, the marker of evil in films and television is someone who looks physically different, with the same kind of facial disfigurements that real, good people live with every day. Whether this visual depiction and lack of true representation is a cause or effect is unclear, but nonetheless strengthens the negative stigma. The lack of true proportionate representation in the media creates a ‘strangeness’ around people with facial disfigurements, which can be cited as the reason for negative reactions towards them, rather than a conscious attitudinal bias. Changing Faces (2010) cited staring as the primary response towards facial disfigurements; this is an automatic ocular response to not recognising what we are seeing (Garland-Thompson, 2009), so one might then reason that increasing the exposure of facial disfigurements in the media would reduce staring, as people would not recognise it as something abnormal but rather another celebrated difference in our society, alongside race and gender. While studies such as Ryan et al., (2012) suggest that negative responses to facial disfigurements are similar to those of contagious diseases like influenza, and therefore claim stigmatisation stems from an evolutionary fear for survival, most modern empirical research would argue this is not the case. To quote Heinemann (1990), it is more just a case of people ‘not knowing what to do’ when meeting a person with a facial disfigurement, rather than harbouring internal biases. This is backed up by Blasocvich et al. (2001), whose experiment saw physiological responses reveal that participants experience more stress when interacting with a confederate with stimulated birthmark than one without.
On the other hand, there is much empirical evidence to suggest that the individuals themselves have a significant effect on the stigma they experience, even enough to eradicate the negative reactions altogether and surpass their non-disfigured counterparts in employment and social environments. It is generally accepted that facial disfigurements, especially acquired ones, can be to the deficit of an individual’s psychosocial wellbeing. Rumsey (2004) states that up to 54% of people with facial disfigurements suffer with significant psychosocial difficulties, including increased anxiety, lower self-esteem and general unhappiness (Millard and Richman, 2001), beginning from childhood. However, despite the negative attention (e.g. teasing, staring) the children received, mitigating factors which dramatically affected their perceived stigmatisation were cited. Harris (1997) said that an individual’s own perception of the visibility of their disfigurement was the best predictor of psychosocial and body image disruption, with visibility correlating to increased self-doubt in social interactions, as the disfigurement becomes an additional stressor. When disfigurements can be disguised (e.g. using cosmetic camouflage to disguise a port wine stain), the individual increases in immediate confidence but has a constant fear that their disfigurement will be ‘discovered’ (Coughlan & Clarke, 2002). An individual’s self-doubt in these situations is one of several reasons they can often struggle to form successful and substantial relationships, therefore remaining isolated from society, but can be alleviated by undergoing social skills training (Robinson et al., 1996) This is inkeeping with Bull & Rumsey’s (1998) findings that good social skills result in more positive interaction between people with facial disfigurements and the public, as well as better body image adjustment for those with acquired disfigurements. Most research focuses on acquired disfigurements due to the complexity of the change in one’s social identity. This is in contrast to those who have a congenital disfigurement, as their disfigurement has likely already been assimilated into their body image, and they have become habituated to the reactions of others and learned successful coping strategies (Newell & Marks, 2000). The time to acquire these skills seems to be the difference in the severity of psychological issues experienced by people with congenital and acquired disfigurements (De Sousa, 2008). This research describes the effect of trauma-induced facial disfigurements, i.e. from random attacks or accidents, as being perceived more as ‘unfair’ and ‘unnecessary’. As a result, anger is a common reaction post-trauma, with individuals either blaming themselves or those around them. In turn, this makes it harder for an individual to accept their ‘new face’ and occasionally lead to idealisation of their pre-trauma appearance. Consequentially, individuals can become isolated from friends and family, and due to the longevity of trauma recovery, it can permanently damage relationships. In a cruel cycle, the lack of perceived social support then leads to poorer adjustment. At its most extreme, De Sousa (2008) defined this withdrawal as ‘social death’ and an individual’s social skills are unlikely to ever fully recover and therefore properly re-integrate into society. Newell & Marks (2000) were able to demonstrate a significant link between people with facial disfigurements and people with social phobias, demonstrating the extreme effect of an individual’s poor adjustment to their disfigurement. It’s therefore unsurprising that common characteristics attributed to these individuals are ‘quiet’, ‘shy’ and ‘unsociable’. They are also evaluated to be lower in interpersonal competence and less emotionally stable (i.e. more anxious and depressed). These perceptions continue the stigma surrounding people with facial disfigurements; affecting not just those who adhere to this stereotype, but also those who struggle against it.
In the last century, equality has come a long way. Differences like gender, race and sexuality are celebrated aspects of our cohesive nation, while facial disfigurements have remained the ‘last taboo’. While it is clear that both society and the individuals must accept responsibility for the stigma surrounding facial disfigurements, it seems as though the individual has the most immediate and effective power to eradicate it. The advocates of people with facial disfigurements are becoming louder, for example with the introduction of Face Equality Day and documentaries by Katie Piper, a champion who was an acid attack survivor herself, and with better support for individuals adjusting to disfigurements, the negative stigma surrounding facial disfigurements has a limited life in continuing to divide society.