A Sociological Study on Emotion Regulation in People Living with HIV/AIDS in China (A Sociological View of AIDS) [1st ed. 2021] 9811614938, 9789811614934

Citation preview

A Sociological View of AIDS

Rongting Hou

A Sociological Study on Emotion Regulation in People Living with HIV/AIDS in China

A Sociological View of AIDS

This series, an academic masterpiece on AIDS research in the Chinese sociological community in the past two decades, analyzes in detail, and from various perspectives, the situations of a range people with AIDS. By providing valuable theoretical insights and assessing countermeasures, it not only allows readers to gain a thorough understanding of AIDS-related social realities, and promotes the interpretation and implementation of social policies and the role of sociology in AIDS prevention and treatment, but also helps to coordinate the interests and needs of all parties involved in order to handle relationships between different groups of people and to promote the formulation and adjustment of relevant policies, laws and regulations.

More information about this series at http://www.springer.com/series/16458

Rongting Hou

A Sociological Study on Emotion Regulation in People Living with HIV/AIDS in China

Rongting Hou Inner Mongolia University of Science and Technology Baotou, China Translated by Leilei Liu Xinxiang Medical University Henan, China

Zhiquan Zhang Xinxiang Medical University Henan, China

ISSN 2662-5954 ISSN 2662-5962 (electronic) A Sociological View of AIDS ISBN 978-981-16-1493-4 ISBN 978-981-16-1494-1 (eBook) https://doi.org/10.1007/978-981-16-1494-1 Jointly published with Huazhong University of Science and Technology Press The print edition is not for sale in China (Mainland). Customers from China (Mainland) please order the print book from: Huazhong University of Science and Technology Press Translation from the language edition: 艾滋病人群情感调适的社会学研究 by Rongting Hou, et al., © Huazhong University of Science and Technology Press 2018. Published by Huazhong University of Science & Technology Press. All Rights Reserved. © Huazhong University of Science and Technology Press 2021 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publishers, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publishers nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publishers remain neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Foreword

The book is based on the Ph.D. thesis of Hou Rongting. This English version is translated by Liu Leilei and Zhang Zhiquan from Xinxiang Medical University. In guiding graduate students to write theses, I hold a basic belief that students must have something to say before they can write, and that writing must be supported by theoretical thinking before they can finish the writing. I want to explain two important concepts in this belief: having something to say (i.e., having something) and having theoretical framework (i.e., how to say). Students who claim to follow the school system but have nothing other than their courses and lessons are usually not chosen by our institute. In other words, the chosen graduate students must have some life experiences worth discussing, for instance, their own experiences, or their relationships with others. This is called having something to say (i.e., having something). What theories (how to say) to use when he or she is going to start writing the thesis next? I am a believer in the saying “to believe everything in books is worse than to have no books at all”. If my students believed everything in books and could not discuss things with me, it would be a nightmare for me. “Can discuss” and “can debate” are the essence of “can say”. But at the beginning of discussion and debate, we will suddenly fall into the historical flood of thought, and we will enter the vast world of literature. In the spring of 2013, I received a message that a Ph.D. candidate from Renmin University of China was coming to the Department of Psychology at Fu Jen Catholic University to study for a “double training doctoral degree”. I got a general idea of his work before Renmin University of China and his sociology studies after he was enrolled. After a few letters between us and my careful evaluation, I decided to let him have a try. Our Ph.D. students usually take fiveor six years to complete their courses, and with the time to write their thesis, it is common for our Ph.D. candidates to study for seven or eight years. After the summer vacation, I met the student mentioned above, Hou Rongting at the beginning of the 2013 school year. He can only use two academic years to finish his study here. In addition to taking courses as required, he took all three courses I had opened in each semester, including an elective course for undergraduates, as well as a master’s and doctoral courses in my institute. In short, he took all the time to learn. The assigned readings I’ve given to each course do contain some very advanced theories, v

vi

Foreword

like “relational psychoanalysis”, as well as some very classic (but never-obsolete) subjects, like “spiritual life”. My students are required to read the profound works of many scholars who emerged in the United States after the 1990s, without Chinese translations, and works of philosophers in the Song Dynasty, without modern Chinese versions. Many students’ learning attitude, compared with Rongting, I must admit, is inadequate. So, I found out very quickly that he is a student who has something to say and is willing to have theories. We took the time to draw up a plan for the writing of the thesis. The book includes social work, psychological intervention, and the researcher’s introspection. “Interdiscipline” is the general term for this kind of research, and the researcher needs to break through any intellectual barriers between knowledge rather than breaking down barriers between disciplines. The topic is how HIV-infected people can firmly believe that they live because of certain interventions or assistances, which is a “spiritual” issue. However, psychology may not be able to deal with such issues face to face. The “psychoanalysis” we discuss must be cross-examined by western scholarship from its origin and by the ancient and present knowledge transmitted by Chinese. In the year I began to supervise Rongting, my own research project (not to follow someone else’s “project”) was to write a paper on philosophy and psychology, “The Moment of Healing: A Multicultural Cross-Discussion of Mindology and Healing”. There are no “discipline boundaries” in my question, both in thinking and writing. I won’t ask students to imitate my research, but to a certain extent, this academic attitude will manifest itself in the supervision relationship. Young scholars who can’t use this as their ambition to learn will certainly work very hard. On the other hand, the fully immersed study will soon generate motivation for learning, so that thesis writing becomes a work of “can discuss” and “can debate”. After discussing with me, Rongting chose the essentials of Kohut’s selfpsychology (self-psychology, also known as autologous psychology) and turned it into a method of psychological intervention, and practiced it in the objects he wanted to assist, that is, some HIV-infected people. At the most fundamental level, I explain the goal of this thesis writing: to enable infected people to gain a new life through “psychological motivation” caused by “psychotherapy”. This fundamental proposition forms a very directional discourse in the understanding of Rongting, called “being-to-death” and “dying to live”. Whether or not the language used in this proposition constitutes a “neologism”, this is a challenging proposition for the researcher himself, for intervention, and for the objects of intervention. Nevertheless, he finished his thesis writing with something to say and with theoretical framework, but with no waste of a moment and efficiency in the course of studying while discussing. Students in Taiwan would neither do it nor could do it so efficiently. I don’t have to write a summary of the book. As long as I explain how the unprecedented “double training doctoral degree” like this is done, the rest is for the reader to read. If you’re a graduate student, how do you get started with topics like this? How do you write it down? How to combine the practice with theoretical thinking? In the course of writing this book, there is an ice-breaking discussion, which appears

Foreword

vii

in the first chapter of the book. Rongting shows his understanding in the tone of my explanation like this (not exactly the words in the book). A brief explanation for “helping profession”: it’s a system of knowledge and practice that encompasses a wide range of disciplines. In human civilization, it is linked to the saying “God helps those who help themselves”. But in modern society, the concept of “God help” has gradually been replaced by “social support”, and “self-help” is “the ultimate purpose of all these social supports”. We can use the word “self-help” to express the purpose of “social worker” for social support. It echos a proverb which goes like this, “it is more helpful to teach people how to fish than to just give them fish”. However, the “helping profession” requires a system of discourse like Kohut’s self-psychology. The key word Kohut needs to explain is his own creation of “self-object”, which, with the joint effort of the helper and the object in need, is nothing more than to form a “self-help relationship”. If this process is further developed through sophisticated theoretical development, it may form a complex set of knowledge/practice discourses that require hundreds of thousands of words to be clarified. When I saw an understanding like this in Rongting’s writing plan, I realized that the power of knowledge had been generated in his thinking, and I knew that this relationship between teachers and students would develop comfortably for a limited time. I really just want to explain how to start. Also just want to say, like me, a good scholar can let knowledge be produced “without external demands”. In the guiding relationship of a doctoral thesis, the supervisor’s actual job is simply to “inject impetus”, rather than pushing students into the thesis writing as if the ducks were pressed on the shelf. I’m glad that in my coaching career, I met Rongting in the fall of 2013 who completed this compact and unprecedented work before the summer of 2015. December 2017

Wei-Li Soong Fu Jen Catholic University New Taipei City, China

Contents

1 Research Subjects and Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1 Research Subjects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1.1 Living Conditions of AIDS Population . . . . . . . . . . . . . . . . . . 1.1.2 My Story with AIDS Research . . . . . . . . . . . . . . . . . . . . . . . . . 1.1.3 Research Subjects: Emotional Ups and Downs in the Course of Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2 Research Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2.1 Theoretical Support at the Methodological Level . . . . . . . . . 1.2.2 Comprehensive Application of Various Research Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.2.3 Specific Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3 Research Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3.1 Informed Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3.2 The Principle of Harmlessness Before Benefit . . . . . . . . . . . . 1.3.3 The Rigorous Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Literature Review and Theoretical Perspective . . . . . . . . . . . . . . . . . . . . 2.1 Research on Emotional Sociology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1.1 The History of Emotional Sociology . . . . . . . . . . . . . . . . . . . . 2.1.2 Research Status of Emotional Sociology . . . . . . . . . . . . . . . . . 2.1.3 Future Trend of Emotional Sociology . . . . . . . . . . . . . . . . . . . 2.1.4 Localisation and Indigenisation of Emotional Sociology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 AIDS Research from the Perspective of Sociology . . . . . . . . . . . . . . 2.2.1 International AIDS Research . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2.2 Domestic AIDS Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2.3 Emotional Research on AIDS Population . . . . . . . . . . . . . . . . 2.3 Theoretical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3.1 Theories of Emotional Sociology . . . . . . . . . . . . . . . . . . . . . . . 2.3.2 Research Perspective of Subject Construction . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 1 1 4 7 11 11 12 14 16 17 18 18 19 21 21 22 24 30 32 34 34 38 41 43 43 49 51 ix

x

Contents

3 Acquired “Needs Deficiency” Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 Deficiency in the Need of Self-Verification . . . . . . . . . . . . . . . . . . . . . 3.1.1 The Disintegration of Core Self . . . . . . . . . . . . . . . . . . . . . . . . 3.1.2 Disability of Sub-Identities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1.3 Stigma of Role-Identity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 Deficiency in Needs for Profitable Exchange Payoffs . . . . . . . . . . . . 3.2.1 Fair Medical Treatment Denied . . . . . . . . . . . . . . . . . . . . . . . . 3.2.2 Identity Information Used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 Deficiency in Needs for Group Inclusion . . . . . . . . . . . . . . . . . . . . . . . 3.3.1 The Changes of Primary Life Circle . . . . . . . . . . . . . . . . . . . . 3.3.2 The Exclusion of the Employment and the Community . . . . 3.3.3 The Alienation of Family Members and Friends . . . . . . . . . . 3.4 The Absence of Trust Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4.1 Crisis of Trust—Disappointment Due to Expected Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4.2 Dependency Dilemma: Withdrawal Caused by Trust Breakdown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 Need for Facticity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5.1 Coexistence with Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5.2 Stigmatisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

57 58 60 62 64 66 66 70 71 72 78 80 82

4 Acquired “Expectations Deficiency” Syndrome . . . . . . . . . . . . . . . . . . . . 4.1 The Ambiguity of Expectation States . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1.1 The Helplessness of Role-Taking . . . . . . . . . . . . . . . . . . . . . . . 4.1.2 Confusion Deriving from Status . . . . . . . . . . . . . . . . . . . . . . . . 4.2 Limitations of Expectations Fulfillment . . . . . . . . . . . . . . . . . . . . . . . . 4.2.1 Lack of Homogeneity in the New Categoric Unit . . . . . . . . . 4.2.2 Universal Category Hindering Clarity . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

95 97 98 106 114 115 118 121

5 Acquired “Punishment” Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 Punishment in Institutional Domains . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1.1 Ideological Restrictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1.2 Rejection of the Symbolic Media . . . . . . . . . . . . . . . . . . . . . . . 5.2 Uneven Capital Distribution in Stratification Systems . . . . . . . . . . . . 5.2.1 The Loss of Bourdieu’s “Four Capitals” . . . . . . . . . . . . . . . . . 5.2.2 Negative Accumulation of Emotional Capital . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

123 124 125 127 133 133 136 138

6 Emotional Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 The Formation of Emotional Repression . . . . . . . . . . . . . . . . . . . . . . . 6.1.1 The Painful Experiences of Disappointment and Sadness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1.2 Intensification and Attunement of Shame and Guilt . . . . . . . 6.2 Re-transformation of Negative Emotions . . . . . . . . . . . . . . . . . . . . . . .

141 144

83 85 86 87 89 92

144 145 148

Contents

xi

6.2.1 Displacement and Projection . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2.2 Sublimation and Reaction-Formation . . . . . . . . . . . . . . . . . . . 6.3 External Presentation of Emotions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3.1 The Departure from Corporate Units . . . . . . . . . . . . . . . . . . . . 6.3.2 The Diffuse of Anger in Categoric Units . . . . . . . . . . . . . . . . . 6.3.3 Persistent Deterioration of Macrostructures . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

148 149 152 153 154 156 158

7 Emotional Attunement: The Dynamic Mechanism of Being and Manifestation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 Emotional Being and Manifestation . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1.1 Conflict and Game . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1.2 Structure and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1.3 Interaction and System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 Social Effects of Emotional Attunement . . . . . . . . . . . . . . . . . . . . . . . 7.2.1 Negative Emotions and Social Changes . . . . . . . . . . . . . . . . . 7.2.2 Positive Emotions and Social Structure . . . . . . . . . . . . . . . . . . 7.3 Research Reflection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

161 161 162 165 168 171 171 173 176 177

Chapter 1

Research Subjects and Methods

1.1 Research Subjects 1.1.1 Living Conditions of AIDS Population AIDS emerged insidiously in the US in the 1980s, and ravaged the world in the following 30 years or more. So far, it has claimed tens of millions of lives. It is known as “the Black Death of the twentieth century” because of its infectivity and high mortality. The AIDS problem has been described as the most serious public health problem in the twentieth century. What is more serious is that the epidemic has been extended to this day and has not slowed down. The full name of AIDS is Acquired Immune Deficiency Syndrome. After the human immunodeficiency virus (HIV) invades the human body, it destroys the CD4 cells and T lymphocytes of the body, thereby blocking the cellular and humoral immune processes, and reducing the body’s ability to fight infection and disease. The destruction of a large number of T lymphocytes will cause what we call immune deficiency, and eventually lead to the paralysis of the immune system, resulting in the spread of various diseases in the human body and progression to AIDS. If untreated, the disease will be fatal. Generally speaking, there are no symptoms in the initial stage of HIV infection. However, as the HIV virus replicates, reproduces and develops in the body, the immune system of individuals begins to be attacked and gradually loses its defense function, and the infected people are more vulnerable to the so-called opportunistic infection. In other words, AIDS is a syndrome that contributes to a variety of clinical symptoms, rather than a single disease. According to the 2016 report of the Joint United Nations Programme on HIV/AIDS (UNAIDS), there were about 36.7 million (30.8–42.9 million) people living with HIV/AIDS (PLWHA, also called the infected people) in the world, of which 34.5 million (28.8–40.2 million) were adults, 2.1 million (1.7–2.6 million) were children (less than 15 years old). In 2016 alone, 1.8 million (1.6–2.1 million) © Huazhong University of Science and Technology Press 2021 R. Hou, A Sociological Study on Emotion Regulation in People Living with HIV/AIDS in China, A Sociological View of AIDS, https://doi.org/10.1007/978-981-16-1494-1_1

1

2

1 Research Subjects and Methods

cases were newly infected. But up to now, there is no specific drug that can completely cure AIDS, and no effective vaccine that can completely prevent HIV infection and transmission. With the deepening of the global research on AIDS, the highly active antiretroviral therapy (HAART, commonly known as cocktail therapy or antiviral therapy) developed in the mid-1990s has effectively controlled HIV, significantly prolonged the lives of many PLWHA, and reduced the chance of infecting others. Despite their significant side effects, the efficacy of antiviral drugs makes AIDS a chronic infectious disease that can be controlled by long-term use of antiviral drugs. China as the world’s largest populous country is not immune to AIDS as it spreads globally. In terms of the epidemic trend of AIDS, the epidemic has experienced three stages in the past 30 years: the introduction period (1985–1988), the spread period (1989–1993), and the rapid growth period (1994–present). In June 1985, an infected person from Argentina died of complications in Peking Union Medical College Hospital in China. Since then, several cases of hemophilia had been found to be infected with HIV due to the use of blood products imported from abroad. Although only a few cases were found, this had fired the first shot of AIDS invasion in China (Wang & Zhang, 2003). In the early 1990s, there was an epidemic of HIV infection among intravenous drug users in Yunnan Province. The epidemic was not only large in scale, but showed a trend of “encircling the cities from rural areas”. That is, it spread from rural areas at the border between Yunnan Province and Myanmar to large and medium-sized cities in Yunnan, and continued to spread. The transmission rate of HIV infection in China began to accelerate significantly. In the mid-1990s, there were widespread infections with AIDS in the Central China due to illegal paid blood collection and supply, and the epidemic showed a rapid upward trend under the strong attack of HIV. So far, the epidemic has spread to all parts of China. So China has become one of the countries with the fastest spread of AIDS in Asia. As of May 31, 2017, China had reported 708,158 cases of HIV infection and AIDS patients, 219,050 deaths of HIV infection, 413,369 cases of HIV infection and 294,789 cases of AIDS patients living. What’s more, because of the window period, incubation period and stigmatisation of HIV, nearly half of the infected people do not know they are ill, or refuse to be examined, which increases the risk of HIV transmission according to the data in China in 2014 and 2015. HIV spreads from people with high-risk behaviours (gay men, needle-sharing injection drug users, sex workers and clients) to the general population through sexual transmission, and the infection rate of homosexual transmission. AIDS is not a common disease that can be cured only through medical or biological methods. The spread of HIV through blood, sexual behaviour and other channels, and the stigma associated with it since its birth make AIDS a serious social problem. Now, AIDS in China has spread from high-risk people to the general population, and has formed a kind of fear of “talking about AIDS” in society. This is not just because there is no cure of AIDS. AIDS itself is not lethal, and can be effectively controlled through continued use of antiviral drugs. As far as its infectivity is concerned, the HIV virus will die if it stays in the air for a few seconds or minutes. Its transmission route is only limited to a few limited transmission modes such as blood and body fluid, and it is not as infectious as viruses such as SARS virus, hepatitis virus, tuberculosis

1.1 Research Subjects

3

virus and the like. But, AIDS has become the most feared disease in today’s society, and gradually evolved from a pure medical problem to a major public and social problem affecting social security and stability. Firstly, the transmission route of AIDS includes the most insidious human transmission through sexual behaviour (hepatitis virus can be transmitted as such, but there is no such stigma as AIDS), which makes AIDS people take on a dirty image, an image even more filthy than that of syphilis. In addition, AIDS is associated with drugs, homosexuality, sex workers and multi-partner sexual behaviour, and so on. As a result, it has become the target of stigma, and the infected people have been humiliated. Secondly, when the disease destroys the human immune system, the individual is infected with other diseases due to the defective immune system. For the infected people, the disease destroys their immune system, making them unable to resist the invasion of other viruses and causing the disease, which is known as an opportunistic infection. This kind of disease rarely occurs in the general population, such as Kaposi’s sarcoma, Pneumocystis carinii pneumonia (PCP) and cytomegalovirus pneumonia, etc., and their symptoms (especially shown in the reports of scrawny and festering infected people) are often chilling. Thirdly, due to the compromised autoimmune system, the infected people are very likely to experience a relapse of the disease which does not have an obvious efficacy and spreads like the invasive cancer. This brings a lot of worry and fear to them. And these problems, like HIV, often co-exist with them, and become the heavy burden in their life and emotion. Finally, AIDS has spread to the general public, and becomes a form of infection and emotional isolation through relationships. That is to say, two people meeting by chance or passing by usually do not have any relationship or emotion, and will not be infected. AIDS impacts the most core circle of human beings. If the differential mode of association proposed by Fei Xiaotong, one of the foremost Chinese social anthropologists, is used to describe the interpersonal relationship of the Chinese, the fact of being infected, just like the stones thrown into the lake, will stir up thousands of waves in the lives of the infected people. More importantly, the scope of its spread moves from the inside out. It is their most intimate people such as their loved ones or sexual partners who are the most vulnerable to infection. It is the infected people, their sexual partners and family members who suffer from fear and stigmatisation of infection. What’s more, after infection, it is their most intimate or important people who suffer first. Then, through the rupture of the most intimate relationships, along with social stigma and shunning, the infected people are faced with the rupture and loss of relationships around them, which leads to emotional ups and downs. To sum up, it has become an unspeakable secret for the infected people to be infected. They have to suffer from the physical torture and the negative emotions of being, such as fear, anger and sadness caused by the infection, and may express a combination of negative emotions including shame, guilt and alienation. For society as a whole, there are concentrated outbursts and expressions of negative emotions and their cocktail forms, affecting the harmony and stability of society.

4

1 Research Subjects and Methods

1.1.2 My Story with AIDS Research When thinking about my story with AIDS research, I realize that I have completely forgotten when I heard the word “AIDS”. But two things remain deep in my memory. Firstly, AIDS is a formidable and incurable infectious disease, which can be transmitted, and the infected people are terrible when they die; secondly, I only remember that AIDS is transmitted by blood. It was a public event happening in 2003 that made me turn my attention to the social problems caused by AIDS. In 2003, the epidemiological investigation by antiepidemic workers in Hohhot City of the Inner Mongolia Autonomous Region of China revealed that 13 people were infected with HIV due to direct or indirect blood transfusion. The blood was illegally collected by one county hospital of Hohhot City from October, 1998 to September, 2000. This had been the first major medical accident of HIV infection through blood transfusion caused by illegal blood collection since the implementation of the Law of the People’s Republic of China on Blood Donation on October 1, 1998. Different from AIDS transmission mainly through sexual behaviour in most countries of the world, the first AIDS epidemic broke out among intravenous drug users in China’s southwest border areas. After that, the government made major policy adjustments for AIDS prevention and control, including the publicity and education of AIDS, and the promotion and implementation of the “Four Frees and One Care” policy. Specifically, the policy refers to free antiviral treatment for AIDS-infected farmers and people with financial difficulties in towns and cities, free and anonymous blood tests in key areas of the AIDS epidemic, free access to schooling for children whose parents die from AIDS, and free AIDS counseling, screening and antiviral treatment for pregnant women in the demonstration area of comprehensive AIDS prevention and control in hope of reducing mother-to-child transmission. It also includes AIDS people who are in financial difficulty into government assistance to give them necessary life relief and actively support them to participate in production activities. Although the author has long been familiar with the three major transmission routes of AIDS (through blood, sexual behaviour, and mother to child transmission), he does not understand why HIV is sexually transmitted, not to mention how mothers and infants are infected, and knows even less about the policy. In a word, though terrible as it is, AIDS stays far away from the author. In 2007, the author participated in the qualitative and quantitative survey of AIDS prevention project carried out by the Institute of Labour Science under the Ministry of Labour and Social Security of the People’s Republic of China (officially renamed as the Ministry of Human Resources and Social Security of the People’s Republic of China on March 31, 2008) and the International Labour Organization, which was the first time that the author had bond with AIDS prevention and control. At that time, the author was exposed to so-called high-risk groups, such as female sex workers and male guests (mainly miners in Southwest China and truck drivers). For the author, AIDS prevention was only about increasing the condom use rate and clearly distinguishing among the infection routes of AIDS. KABP was the mainstream thought of

1.1 Research Subjects

5

AIDS prevention and treatment, that is, there was a significant correlation between individual knowledge, attitudes, beliefs and practice. Unexpectedly, this cooperation marked the beginning of the author’s story with AIDS research. In 2009, the author participated in the evaluation survey on the survival care of the infected people initiated by an AIDS Service Organization (ASO). This was the first time that the author came into contact with the infected people, including adults infected through blood transfusion during surgery, children infected through motherto-child transmission, and people infected through sexual behaviour. Of course, we contacted some infected gay men at that time. In retrospect, there was a widespread debate on the “nocence” and “innocence” of the infected people at that time. Those infected through blood transfusion and mother-to-child transmission were believed to be innocent and more likely to win the sympathy of the society. But people infected due to such lifestyle problems as intravenous drug use, sexual misconduct or homosexual sex behaviour deserved ill of others, among whom those men who have sex with men (MSM) were especially discriminated against and deserved such treatment. Their living conditions were much more severe than now. There were still many difficulties in detection, diagnosis, medication, treatment of opportunistic infections and other diseases, and the use of medical insurance. Therefore, under the impetus of the international community, domestic and foreign funds, and non-governmental forces, and by tacit consent of governments at all levels, a large number of non-governmental organizations (NGOs) have been set up for the intervention of the infected people. Our investigation can be carried out due to the strong assistance of these NGOs. With their help, we can find the infected people, gain their trust, and finally complete the investigation. At that time, the academic circles in China showed great enthusiasm about the research on AIDS, focusing on the prevention and treatment of AIDS. Although the psychological status of the infected people, especially their emotional ups and downs and expression, has always been a phenomenon recognized by almost any discipline, including clinical medicine, public health, epidemiology, psychology, sociology and other humanities, it has never been seriously considered as a “problem”, but only as a common sense. In addition, compared with the severe AIDS epidemic, the fear, anger and sadness for the disease are usually considered insignificant. The year 2013 witnessed the sustained and rapid development of China’s economy, and the last round of financial support to China from the international community and international NGOs on AIDS prevention and control. After the final round of capital investment in China by the International Foundation, mainly by the Global Fund to Fight AIDS, Tuberculosis and Malaria and the China-Gates Foundation HIV Prevention Cooperation Program (China-Gates HIV Program), which marked the end of the financial support, China’s non-governmental ASOs were facing many new problems. As one of the evaluations of the China-Gates HIV Program, the research project that the author participated in focused on the support and care of the infected people and explored how relevant organisations, including NGOs, could work together to care for and help them. It was based on this investigation that the author had an in-depth understanding of the infected people. The author always half jokingly said we carried out the research

6

1 Research Subjects and Methods

while “eating, living, and labouring” with them, and found that many infected people were not as what they had been imagined. They should have been worried about the disease, pessimistic, disappointed, unwilling to contact with others, and maybe some of them would have resented the society. During the contact, the author found that some of them were far more optimistic than the author and full of confidence in life, and could always hear their exhortations: “Keep healthy. Many young people are dying of overwork, because they always stay up. Instead, we are more concerned over our health than ever before.” Once the ASO held any activities, they were more active and orderly. The “halfway house” (in fact, a three-bedroom house) that provided free living for homeless infected people was like a warm harbor. During the investigation, the author found that many ASOs had focused on the support and care for the infected people since their establishment, although these NGOs, also known as grass-roots organisations, can not be registered in the civil affairs departments. However, such organisations established voluntarily by the infected people not only survived for many years, but gained excellent reputation among the AIDS population. Most importantly, infectious diseases hospitals and Centers for Disease Prevention and Control (hereinafter referred to as CDC) at all levels in China relied on and trusted these organisations. Their presence not only increased the condom use rate of the local infected people, but increased the testing rates of all kinds of epidemiological data such as rates of initial screening, epidemiological survey and detection. More importantly, it was the presence of these organisations that made the infected people no longer lonely. Many infected people did not need to silently bear fear and helplessness caused by infection. An infected person once said that “we have found our organisation”, which contained a high degree of recognition of them, and brought change and hope to the AIDS population. Through the research of the project, the author found that the AIDS population held higher recognition of “their own organisation” than doctors and medical staff of CDC. “Their own organisation” is the first to help and support them, from seeking medical advice to how to survive and live better. The presence of these organisations composed of volunteers and a few regular full-time staff working all year round helps to deal with all the difficulties. Of course, they are far less professional than medical staff in providing medical treatment, and less professional than social workers in helping others and themselves. But, it is often difficult for professional social workers to have a comprehensive understanding of HIV/AIDS when engaged in related work, just as one infected person claimed that “In fact, you don’t understand my fear!” when evaluating social workers. We should know that such evaluation is a query to the professionalism of a professional social worker. On the contrary, those infected people who come from the grass-roots level, with the help of the ASOs, can not only face up to the fact of being infected, but provide good support and care for other newly confirmed cases to improve their living status. It is in this investigation that the author’s doubts arise. Does this kind of support come from a few talks, some medical information, a few comforting words, or the

1.1 Research Subjects

7

so-called “empathy” such as “so is everyone” and “I understand your feelings”? Why can such support play such a huge role in infected people? How should they control and regulate their negative emotions? All these have aroused the author’s research interest.

1.1.3 Research Subjects: Emotional Ups and Downs in the Course of Illness The prevention and treatment system of AIDS has long been dominated by medical science. The AIDS population earnestly hopes that the AIDS problem can be thoroughly solved through the development of medical technology. But this will be a longterm and arduous task, because AIDS has walked out of the boundary of medicine and become a serious social problem. From the viewpoint of physiopathology, it can be said that AIDS is one of the most terrible diseases in human history because it is an infectious and incurable disease which requires the use of antiviral drugs for life, and may cause opportunistic infections at any time due to the autoimmune deficiency. The infected people do not die from the disease itself, but from other diseases or complications caused by opportunistic infections. The treatment of such a disease should be differentiated from that of the traditional disease from the very beginning. The author has no intention and can not explore the pathology of the infected people, because in any case, they have been patients. But from the viewpoint of psychology, faced with the incurable AIDS, the physical and mental torture caused by its various complications, and the fear of the surrounding people, it is somewhat a fantasy for them to become mentally healthy. Their mental problems have received more and more attention from scholars. From a sociological perspective, HIV infection has developed from a fatal disease to a chronic infectious disease, which produces new social and cultural problems. Although the international community has set up the goal of “Getting to Zero” in its AIDS response, and experts now openly expect “the beginning of the end of AIDS”, the current state of AIDS development and living conditions of the AIDS population, especially their emotional state, remain a troubling reality. As an unequal cross infection, AIDS affects and restricts the survival and life of the infected people in institutional culture at the macro level, social structure at the meso level and interpersonal interaction at the micro level. The infected people generally experience the “fear and avoidance” of their families and friends, and stigmatisation of social construction. They are often faced with such dilemmas as being denied medical treatment, being unable to find a job, having no money to see a doctor, not being accepted by their families, and not being recognized by the society. Because of this, the prevention and care of AIDS population has taken a path of de-medicalisation from a sociological perspective. Although this road is full of thorns, a lot of relevant research has emerged, such as the care and attention given to the infected people from such aspects as social capital, social support and social policy, which of course includes the attention to their emotions. But this kind of attention is rarely understood

8

1 Research Subjects and Methods

more deeply, and it is simply regarded as anxiety, worry and fear, which is ultimately caused by both the disease and social factors. However, there is a lack of research on the presence and expression of emotions in the infected people, especially the analysis and construction of emotions from the subject perspective. Although one ASO that the author knew provided good support and care services for the infected people, after further contact and interviews with many of them, especially after focusing on their experience of “dying to live” (Hou, 2015), the author gradually found that many could not sleep at night or eat well, and had nightmares after being diagnosed with HIV. They often have such emotional feelings as fear, dread, guilt, worry and despair, and always think of dying to end their coexistence with HIV. They have experienced the same affliction as all other diseases, and experienced the stigmatisation unlike any other. What’s more serious is that many infected people experience subtle and even violent changes in their emotions while suffering from many stigmas and illnesses. These emotional changes may include complaints caused by unsatisfied needs in interpersonal interactions, inexplicable resentment at the lack of access to health care, guilt and self-blame for the disgraceful pathways of infection, and even the resentment at the socio-culture and the institution. They hold that the use of antiviral drugs is a conspiracy, and that epidemiological survey and sentinel surveillance are designed to control and isolate them. From time to time, the author has heard of cases in which the infected people have taken it out on others, organisations or even society, and even reacted in an aggressive manner because of their personal problems. For example, there were incidents of killing people in anger because of discrimination, and rumors of infected people stabbing people with syringes to take revenge on society. Although the stabbing incident was later proved to be fictional, the strong feelings of dissatisfaction, resentment and alienation of infected people towards themselves, others and society are existing facts. Therefore, the author believes that it is of great significance to analyse the presence and expression of emotional ups and downs in the course of life (illness) of infected people dying to live. Actually, there are not so many infected people who can face the HIV virus calmly, regard it as a gift of life, stay strong and live a better life. For most of them, the process of “dying to live” is a process of emotional ups and downs. The policies of HIV/AIDS prevention and control widely implemented in China, including the “Four Frees and One Care” policy, has provided certain guarantee for the treatment of infected people, the side effects and drug resistance of antiviral drugs are being gradually reduced, and various ASOs are exploring ways to provide support and care for infected people all over the country, but their living environment and conditions are still not satisfactory. Firstly, there are regional and group differences in the implementation of AIDS prevention and control policies; secondly, access to and use of drugs are to some extent related to social status, and there are some problems such as overmedication; lastly, research on the support and care for the infected people tends to be more focused on their life and survival problems and research on emotional support for them is often lacking or inadequate. Therefore, it is particularly important to analyse the dynamics of the presence and expression of negative emotions.

1.1 Research Subjects

9

Heidegger discusses the reality of emotions in Sein und Zeit (Being and Time). In his opinion, emotion is usually regarded as a subjective matter, which is caused by a moment of interest and has no cognitive significance. Yet, human existence is found to be inserted into a meaning-centred world, that is, the problem of human existence in such a world is raised (Spiegelberg, 1995). Based on this, the author explores the dynamics of emotional being and expression from the perspective of subject construction, which can reflect the significance of the subject (human beings) in some basic befindlichkeit by arousing and expressing emotions. Negative emotion is chosen as the object of study because, in Heidegger’s view, it is a kind of existence as a burden, and reflects a severe reality that has to exist. Heidegger coined a vivid but clumsy word geworfenheit (the state of being thrown). In other words, people are thrown into the world to understand the meaning therein. One or more kinds of negative emotions, including fear, anger and sadness, represent the deepest feeling in our way of being, bringing us into contact with our world as a whole and with social existence and our existence in all possible ways, and presenting us with reliable ways of interpreting the world (Spiegelberg, 1995). Therefore, at least in terms of intervention, this theory can help us better serve so many HIV-stricken people, and help to maintain and promote social harmony and stability. Although we recognise the “authenticity” of HIV infection in medicine, with the further progress of AIDS-related research, the author believes the disease has richer spiritual and emotional meaning. For the AIDS population, HIV is a powerful master living in their body as well as a loyal servant, which is a kind of dialectical existence. Firstly, the disease destroys the immune system of the AIDS population, making it impossible for them to fight off other viruses that can cause the disease, which is medically called an opportunistic infection. In particular, conditions such as Kaposi’s sarcoma, although rarely seen in the general population, tend to present a chilling manifestation. The autoimmune deficiency makes the AIDS population frequently ill and the therapeutic effect ineffective. Therefore, the first thing they have to deal with and confront is their relationship with infection, so as to regulate the negative emotions caused by infection. Secondly, the disease, a kind of transmission through “relationships”, inevitably causes emotional concealment and ups and downs among the AIDS population, and affects them in the micro-interpersonal interaction and needs satisfaction. Thirdly, there is a certain degree of inequality and hierarchical differences in HIV transmission and treatment. People of different social status or classes have different likelihood to be infected or receive antiretroviral treatment. Therefore, at the meso level, there is a social difference in the emotional being and expression of the AIDS population. Finally, at the macro level, the stigma and discrimination associated with HIV have become a kind of culture that affects individuals and the entire AIDS population. The infected people experience unfair treatment in such a cultural context, threatening the long-term social stability. Every infected person makes an unconscious use of the disease with the central goal of solving the conflict of various emotions caused by the infection, and of achieving his or her own wishes in an alternative form. They must face the reality,

10

1 Research Subjects and Methods

and bear all the consequences of what they have done with courage, at all times and in all places. In the process, they are dealing with the conflicts and emotional ups and downs of various relationships with themselves, others, meso-structures and macroinstitutional cultures. In the course of these interactions, their emotions undergo many changes, both in their being and expression, which are instrumental in their attainment of enlightenment about life, growth and themselves. All of these require a true understanding of AIDS, and the emotional development of a transformed relationship with HIV can ultimately be beneficial. It is for the above reasons that this book focuses on the being and expression of emotions in AIDS patients. Emotional being and expression are so called because emotions are not an immediate concept (feelings are immediate), but have a cumulative and energetic nature. Therefore, in the study of emotions, the author includes temporal characteristics and proposes the concepts of emotional being and expression by borrowing Heidegger’s discussion of being and expression in Sein und Zeit (Being and Time). In addition, it’s understandable that the discussion of emotions can not be divorced from their biological and social construction, but this is not the case for every infected person. Many infected people say that death follows them when diagnosed with an infection: “You may never know the next stop is death”. But in the company of death, many of them have been reborn in a kind of nirvana. The emotional turmoil is not simply attributed to hard-wiring and cultural constructs, but rather to the spectral sequence. There are unconscious emotional catharsis we cannot explore directly, conscious emotional suppression due to social circumstances, and even a transformation of emotional attributions due to a distant preference for the external world. Subject construction is so called because, in the process, the infected people are dealing with the conflicts of various relationships with themselves, others and the environment, so as to obtain insight into life, growth and themselves, and the emotions expressed by the self on this basis. Therefore, this book attempts to analyse the emotional changes in the process of “dying to live” among the AIDS population, and to explore the ways in which the infected people deal with the emotional turmoil (the breaking with the original social reality and emotional ups and downs) and emotional re-expression (emotional suppression and attribution from the individual’s perspective) at the micro, meso and macro levels after the crisis (the confirmed diagnosis of infection), that is, to explore the being and expression of emotions from the perspective of the subject. Based on this, it pushes people’s behavioural strategies and action logic at the micro level to the socio-cultural and social structures at the macro level. From the perspective of theoretical application, this book attempts to discover and explain the emotional regulation therein, and analyse the mechanism of emotional being and expression. The author expects that more infected people will reduce their mental pressure, increase their confidence in life and actively and optimistically “live to see the success of research and development of antiviral drugs”, so as to help achieve the expectations and goals of the country and the whole society for AIDS prevention and treatment.

1.2 Research Background

11

1.2 Research Background 1.2.1 Theoretical Support at the Methodological Level There has always been a debate over paradigms in scientific research. The word “paradigm” was first proposed by Thomas Kuhn, an American philosopher of science, in his book The Structure of Scientific Revolutions in 1962. Guba defines “paradigm” as “a basic set of beliefs that guide action” (1990: 17). The paradigm deals with the first or the ultimate principle, which is the product of people’s construction. It defines the researcher’s world view, that is, a way to examine and observe the world. Guba believes that each research paradigm usually involves four categories: ethics, ontology, epistemology and methodology. Ethics is concerned with how the individual lives in this world as a moral person. Ontology raises the basic question of what the best way to know the knowledge of the world is. Epistemology cares more about the relationship between researchers and the known world (Denzin & Lincoln, 1994) and methodology is the theory of the way by which people understand and transform the world. From the perspective of ethical axiology, this study is inclusive, neither advocating nor having the ability of advocating the so-called value neutrality. From the perspective of ontology, constructivism assumes a relativistic ontology, and holds that there are pluralistic realities, that is, emotion is a reality constructed by the subject. From the perspective of epistemology, it is a creative discovery in the intersubjectivity that emphasizes the communication between each other. From the perspective of methodology, it is a dialectical method similar to hermeneutics that emphasizes the process of mutual construction. It is called emotional being and expression because it is not appropriate to talk about life and death because death is far away from the author. But for the infected people, HIV has become a part of their lives since the time of confirmed diagnosis, making them feel the threat of death at all times. The awakening and expression of emotions, as a social force, is affected by the whole social interaction and reality, and through the expression of emotions, it reacts to social interaction and reality. Turner’s emotional theory has been inextricably linked with psychoanalysis since its establishment. This study, based on Turner’s emotional theory and combined with modern psychoanalysis, explores a self-help system supporting the expression of negative emotions at the micro, meso and macro levels, so as to support and care for the infected. But, this book can not focus on their whole life experience as psychoanalysts in clinical settings, not to mention their privacy and childhood life, and only focus on their emotional changes caused by infection. In a word, this study is a psychoanalytically-informed qualitative research. Undoubtedly the life course of AIDS people has changed after infection, and it is precisely after infection that they have started a new life. Therefore, the author tries to analyse how they face the “God’s gift” and explore what kind of social reality affects emotions, and how emotions present and react to social reality at the micro, meso and macro levels, so as to form an emotional dynamic at the social level.

12

1 Research Subjects and Methods

1.2.2 Comprehensive Application of Various Research Methods From the perspective of research methods, qualitative research has many research orientations, such as grounded theory, ethnography, narrative research, phenomenology, hermeneutics, action research, etc. Phenomenology, as the basis of qualitative research, values the existence of human subjectivity, and focuses on the structure and essence of the individual’s real-life experience, arguing that the way of bringing about action is of intrinsic significance in the subjective world of actors. Thus, the researcher, as a subjective participant, stirs in self-perception, shared subjective construction with research subjects and constant self-reflection, and understands the subjective meaning of the subjects in an equal and interactive way. This study adopts three qualitative research methods, namely narrative research, participant observation and literature research, and emphasises that researchers can understand things from a specific standpoint and explore the real emotional dynamics constructed in the process of interaction between the infected people and various social factors. (1)

Overall Framework of Narrative Research (Illness Narrative)

Narrative, as a form of social construction, includes the speaker, listener and the socio-cultural context. The story constructed by the narrator is shaped by culture (Hydén, 1997). Illness narrative is the process of interpreting and discussing the experience of illness through the narrator’s own body and mind, encompassing the narrator’s emotional expression, social recognition and cultural construction. It is a way of interpreting oneself and one’s surroundings, a process of constructing or repossessing oneself through the search for the present self and constant narration. The patient, as the subject of the illness, is the protagonist who experiences the whole process, and describes the changes in life, effects and emotional expressions brought about by the illness, as well as their perceptions and interpretations of the social reality around them. Unlike the overview and definition of illness in the biomedical system, illness narrative allows patients to present their experiences of illness and emotional changes as social realities for investigation and research (Hydén, 1997). When properly used in research, narrative provides researchers with a key to understanding the subject construction of the research subjects. The emotions between people are constructed from the context, and the fluctuation of emotions is revealed through such relationship. And presenting the emotional construction of the infected people in a narrative way is helpful in understanding the process and action strategy of them in the life world. Thus, this study chooses to use narrative as a means of expressing the being and expression of emotions through the narratives of the infected people, describing their life experiences, perceptions and interpretations of emotions after infection, reflecting the understanding and construction of them as subjects, and then exploring the dynamics of the operation of emotions and analysing its impact on society.

1.2 Research Background

(2)

13

Supplementary Notes of Participant Observation

Gold proposes that the role of the participant observer can be arranged into a continuum of involvement in and alienation from membership in the social context, i.e., the complete participant, the observer as participant, the participant as observer, and the complete observer (Gold, 1958). Traditional qualitative research methods prefer the latter two in that they hold that researchers should follow the observation methods of natural science to directly observe the research objects in the natural state and their community environment, and obtain the most direct, concrete and vivid perceptual knowledge. The emphasis on the independent position of participants means that on the one hand, they should be placed in the observation situation, on the other hand, they have to step out of the role of participants, which is derived from the objective observation of natural science. After the end of the observation, participants are asked to come out of the situation they have integrated into to avoid value relevance. In the author’s opinion, participant observation has its certain scope of application in some qualitative studies, and researchers can have an insight into the development of events as “bystanders”. As the research objects of this book, the infected people are often more sensitive than ordinary people, more worried that their privacy will be leaked, and have instinctive defense and resistance to strangers or new comers, due to the stigma and discrimination brought about by AIDS. In addition, if the researchers conduct a kind of participant observation on the research objects, especially those in marginal groups, it is difficult to obtain their trust and real sympathy. Thus, the author uses participant observation in this book, or tries to be a complete participant or at least an observer as a participant. Firstly, it will be extremely difficult to find the infected people without the guidance or introduction of important insiders because they are hidden and special. It is necessary to obtain their trust in order to obtain their cooperation because they distrust and reject “outsiders”, including doctors. Thus, based on the above considerations, the author brought himself into the ASO through the introduction of its founder. The founder naturally became the gatekeeper for the author to enter the “field”. Secondly, by giving full play to the tradition of “eating, living and labouring” between the researchers in our group and the subjects, the author helped the ASO with some paperwork and did some other work within his ability, becoming a volunteer or member of the organisation and gaining the trust of them. This meets the requirements of qualitative research, and provides a guarantee for obtaining accurate and detailed information. At the same time, by participating in the work, the author built a relationship of mutual support with the infected through his own practice, and reduced their defensiveness, and finally gained access to the expression of their language, behaviour and emotion in the daily life. On the one hand, this kind of participant observation has laid the foundation for the development of narrative research; on the other hand, it has made it possible for the author to personally experience the life experiences and inner feelings of many infected people, and form many understandings and perceptions.

14

(3)

1 Research Subjects and Methods

Literature Research Through the Whole Text

Literature research lays the foundation of social investigation and even all researches. Through the analysis of existing literature, the author can systematically understand existing research results and ideas in the academic community, know existing research perspectives and main viewpoints, sort out the history and current situation of research objects, and find breakthroughs and deficiencies herein. After the formal determination of the research direction and theme, literature research is helpful for researchers to read and comment on the contents related to their own materials, to exchange ideas between their own research and existing literature after the survey is completed, which is helpful for the understanding and analysis of the materials. In a word, literature research runs through the whole process of the research and is the basis and forerunner of all researches.

1.2.3 Specific Operation In terms of the specific operation methods, the research objects will include the infected people and relevant interveners as the author studies the subject construction of the emotional being and expression of infected people in the course of “dying to live”. For this specific group of people and organisation, the author will try to consider their concealment and sensitivity when selecting the research subjects. The study aims to be as representative as possible, while avoiding one-sidedness and maximising information saturation; meanwhile, it aims to be simple and easy to use, so as not to cause unnecessary problems for the organisation and the infected individual. In addition, the author has to select research subjects based on the principle of harmlessness before benefit. With the help of one ASO in A city, 30 infected people were selected as research objects in the study through contact and observation. In order to maximise the difference and information saturation, we try our best to cover various types of infected people from multiple categories in the selection of interviewees. In terms of disease classification, the research objects include four categories, namely, those who have just been tested positive but not taken antiviral drugs, those who have been given drugs but not had any opportunistic infections, those who have had opportunistic infections, and those who are receiving treatment for opportunistic infections or other diseases. In terms of the identity composition of infected people, they include the main founders, full-time staff, active volunteers and ordinary infected people in the ASOs. In terms of sexuality and routes of infection of infected people, they include heterosexual and homosexual people, and those infected by sexual behaviour or blood transfusion and selling. The author tried to interview people infected by intravenous drug use, but there are fewer such infected people who can be contacted, and they are often more sensitive. As a result, the interview requests are always rejected, so this group of infected people is not covered.

1.2 Research Background

15

In addition, due to the differences in the infection of AIDS between men and women, the number of women infected with HIV in the interview is relatively smaller, and the route of infection is relatively single, which is a fact that this book can not change. See Table 1.1 for details of the infected people. In terms of data collection, this study mainly uses two qualitative research methods: narrative (illness narrative) and participant observation, because these Table 1.1 Interview Case No

Gender

Route of infection

Education

DCYJ01

Male

Gay man

University

Occupation Unemployment

DCYJ02

Male

Blood transfusion

High school

Unemployment

DCYJ03

Male

Heterosexual behaviour

Junior middle school

Enterprise

DCYJ04

Female

Heterosexual behaviour

Junior college

ASO

DCYJ05

Female

Heterosexual behaviour

Primary school

Farmer

DCYJ06

Male

Gay man

Junior middle school

Enterprise

DCYJ07

Male

Gay man

High school

Enterprise

DCYJ08

Male

Gay man

High school

Enterprise

DCYJ09

Male

Gay man

High school

Unemployment

DCYJ10

Male

Gay man

Junior middle school

Enterprise

DCYJ11

Male

Gay man

Junior college

ASO

DCYJ12

Male

Heterosexual behaviour

High school

Government-affiliated institutions

DCYJ13

Female

Heterosexual behaviour

High school

Enterprise

DCYJ14

Female

Heterosexual behaviour

Junior middle school

Unemployment

DCYJ15

Male

Heterosexual behaviour

Junior college

Highway system

DCYJ16

Male

Blood transfusion

High school

ASO

DCYJ17

Male

Gay man

Junior middle school

Enterprise

DCYJ18

Male

Gay man

University

ASO

DCYJ19

Male

Heterosexual behaviour

Junior middle school

Enterprise

DCYJ20

Female

Selling blood

Junior middle school

ASO

DCYJ21

Male

Gay man

High school

Enterprise

DCYJ22

Male

Gay man

University

ASO

DCYJ23

Male

Gay man

Junior middle school

Retired

DCYJ24

Female

Blood transfusion

High school

ASO

DCYJ25

Male

Heterosexual behaviour

University

Professional

DCYJ26

Male

Gay man

University

Social enterprise

DCYJ27

Male

Gay man

University

ASO

DCYJ28

Male

Gay man

High school

ASO

DCYJ29

Male

Heterosexual behaviour

Junior middle school

Enterprise

DCYJ30

Male

Gay man

High school

ASO

16

1 Research Subjects and Methods

methods are more suitable for infected people. As mentioned earlier, due to the particularity of infected people, only by building basic trust with them can researchers reduce their defensiveness, make them open their hearts and mouths, and obtain their true feelings and ideas, which is the original intention of the author’s investigation. There is no outline in the interview, and the interviewees are required to describe their life/illness process before and after infection. The interview aims to construct the rupture of various relationships and emotional changes of the infected people, and explore their emotional expression in the process of relationship construction. The interview, which is not limited to the direct discussion of emotions for the infected people, aims to construct their emotional identity through the interaction with the author, in such a field of intersubjectivity. Focusing on their statement, it emphasizes an interactive process of talking, a process of “chatting” around the theme of being infected, accompanied by the author’s questioning. Its main purpose is to give full play to their subjectivity, and promote them to think and feel in the chat with the author. It will be conducted in a separate closed room because it involves their privacy. First, the identity of the author and purpose of the investigation will be explained to them in detail, and then the oral informed consent and recording permission will be obtained before the interview. After the interview, the author will prepare a corresponding gift as a reward, and inform that there may be a follow-up visit, hoping that they will cooperate. In the process of the participant observation, the author visited the ASOs on many occasions, and “ate, lived and laboured” with the infected people. Not only did the author participate in their daily work, including assisting in meetings and daily tasks, but helped to draft relevant documents and accompanied them to the street offices, hospitals or CDC to handle relevant procedures. In getting along with them, we obtained their perceptions and feelings about their own emotions, other community members and even the macro social structure through observation, auditing and chatting. After returning to his residence, the author quickly recorded the observed phenomena and his personal feelings, and sorted out the interview content. There are many kinds of collected data, including the data obtained through on-site observation, records obtained through interviews, some casual feelings and diaries, and other relevant materials obtained on the spot. Thus, it is necessary to classify, summarize, compare and sort them out separately according to the original words as far as possible, and establish files for qualitative analysis. After that, it is necessary to separate many cases into different parts, form concepts according to the needs of research design, make codes, find their internal relations, and summarize the corresponding common problems.

1.3 Research Ethics Internationally, the focus on research ethics in social surveys started in the midtwentieth century, with the “Tuskegee Syphilis Study” as a key event. Funded by the U.S. government, the Study has carried out syphilis tests on but not treated

1.3 Research Ethics

17

black people for over 40 years since 1932, which has made the US government notorious and become a negative example in the history of medical ethics. Since then, international attention has been paid to the study of ethical issues, in which respect, benefit and fairness have been stipulated as three basic principles of ethics research. This is especially true for AIDS research. Regardless of the public’s fear of AIDS, infected people often hide their true identity due to the stigma and infectivity of the disease. Many of them are at the bottom or margin of society. Their marginal status and moral discrimination put them in a vulnerable position not only in society, but also in the research. Therefore, in order to “protect themselves”, they show obvious resistance to and perfunctory attitude towards any “surveys”. This situation prompts the author to keep an eye on and reflect on the research methods and related problems of ethics research. This study focuses on the illness and emotional expression of the infected people after infection, and often involves lots of their personal information. Although their names and other characteristics can be hidden in the writing of the book, the insiders may often infer and speculate based on their illness and personal performance, which can cause them to worry about the real statement. This also prompts the author to always think about how to let them open their mouths during the interview, obtain more real information from them, alleviate their psychological burden, implement confidentiality guidelines, and try to defuse the “privacy barrier” in sociological survey. These special factors prompt the author to rely on his own strength, and maintain interpersonal relationship with the infected people through equal interaction and exchange. The author enters the ASO with the help of key people, and wins their trust in eating, living and labouring with them. Based on equal exchange, the author relies on empathy to feel, understand their living conditions and emotional fluctuation, and finally completes the collection, collation and analysis of the interview material.

1.3.1 Informed Consent Informed consent refers to the need for researchers to obtain the consent of the subject or participant in any field of scientific research with human beings as subjects. Specifically, when a potential subject or participant obtains all the necessary information about the study and fully understands it, he or she voluntarily makes a decision on whether to participate in scientific research or whether to withdraw in the course of scientific research without coercion, undue pressure or inducement. In this study, at the beginning of the survey, the author explains in detail to the subjects the main purpose and research methods of the study, so that they clearly know the way of presentation of interview data in the book, and the right to request changes in the way of research and withdrawal from research. In addition, the author presents to the infected people the research he has carried out, the ethics education he has received and his observance of the research ethics, in order to win their trust,

18

1 Research Subjects and Methods

and to ensure the authenticity of the data and the possible follow-up visit. Because of the personal privacy of infected people involved, the author did not sign formal informed consent with them, but rather took its oral form, and emphasized that they could interrupt the interview at any time.

1.3.2 The Principle of Harmlessness Before Benefit This study will not only occupy much time and energy of infected people, but may cause their fear of exposing their identity because it involves their personal experience and emotional changes. Therefore, the first and fundamental “harmlessness” in this study is to keep confidential, that is, not to disclose the information of the interviewees, including text description and recording materials. In terms of text description, the author will not ask their names or illustrate their personal information, only using the form of DCYJXX (XX stands for the sequence of their interview). The interview needs to be recorded, so the author makes a recording with the permission of the infected person, and promises that the recording material will only be used by the researcher and destroyed in time after use (the recording material has now been destroyed). In addition, the interview involves the personal life and emotional expression of the infected people, and requires a certain amount of time from them. Thus, this study embodies the principle of allowing them to benefit from the survey. During the interview, the author uses empathy to understand their emotional experience, so that they feel the support and care of the author. Apart from that, the author tries to exchange information and emotion with them, not only talking about “their world”, but talking about “our world”, instead of purely asking them to cooperate. This is the most basic principle of interpersonal interaction. After the interview, the author gives them gifts as a token of gratitude. The above principle of harmlessness before benefit can make them really feel the author’s concern for their lives and respect for their value of life, and can bring them a certain degree of return.

1.3.3 The Rigorous Survey The survey of social sciences should be accountable to the research participants surveyed, and to other social science researchers. This study attaches great importance to this principle in the course of interview, and strives to verify the accuracy of the data through various channels in case of discrepancy of information. The data survey and analysis should strictly abide by relevant norms. The personal information of the infected person is blurred in the book, in order to prevent others’ guess and speculation. The necessary technical treatment has been done for some of the interview content and materials that have to be cited, and efforts have been made to present the most complete and accurate information to the peers in the presentation

1.3 Research Ethics

19

of the research content. In the author’s view, the accurate and true presentation of survey data is not only the embodiment of the professional level of researchers, but the observance of academic norms and research ethics, and the expression of the most sincere gratitude to the infected people.

References Denzin, N. K., & Lincoln, Y. S. (1994). Handbook of qualitative research. Sage. Gold, R. (1958). Roles in sociological field observation. Social Forces, 36, 217–223. Guba, E. (1990). The alternative paradigm dialogue. In E. Guba (Ed.), The paradigm dialogue. Sage. Hou, R. (2015). Dying to live: Restoration of the self for people living with HIV/AIDS. Fu Jen Catholic University. Hydén, L.-C. (1997). Illness and narrative. Sociology of Health & Illness, 19(1), 48–69. Spiegelberg, H. (1995). The phenomenological movement (B. Wang & J. Zhang, Trans.). The Commercial Press. Wang, R., & Zhang, Y. (2003). Sociological problems caused by AIDS. Chinese Cadres Tribune, 3, 32–36.

Chapter 2

Literature Review and Theoretical Perspective

2.1 Research on Emotional Sociology Sociology has a long past, a short present and an uncertain future, and so is emotional sociology. The development of emotional sociology almost runs through the whole process of sociological research. Since its foundation more than 100 years ago, the classic founders of sociology have studied emotion, but not made any further explanation on the details of emotion (Cooley, 1902; Durkheim, 1965; Marx, 1885; Mead, 1934; Pareto, 1963; Weber, 2010). Emotion has not run through the whole history of sociological research; any organisational theory about human interaction does not consider emotion as its core content. The research on emotion has been in a hidden state (Turner & Stets, 2005). Emotional sociology has only risen in the last two decades. Especially since the late 1970s, sociologists have begun to study emotion systematically (Heise, 1979; Hochschild, 1975, 1979, 1983; Kemper, 1978, 1987; Scheff, 1979; Shott, 1979). At present, emotional research has become a new discipline. In every decade, many theoretical and empirical researchers will join in the research of emotional sociology. By the middle of the first decade of the twenty-first century, emotional sociology has become the frontier of micro-sociological research, bringing new insights into emotional research (Turner & Stets, 2005). However, the existing research mainly focuses on micro sociology. Few researchers regard emotion as the key link between the micro level and the macro level, or study the macro dynamics of emotion from the perspective of sociology. Thus, we can say that although emotional sociology is still in a period of vigorous development, if we only focus on its micro level, it will inevitably have an uncertain future.

© Huazhong University of Science and Technology Press 2021 R. Hou, A Sociological Study on Emotion Regulation in People Living with HIV/AIDS in China, A Sociological View of AIDS, https://doi.org/10.1007/978-981-16-1494-1_2

21

22

2 Literature Review and Theoretical Perspective

2.1.1 The History of Emotional Sociology Due to the biological and perceptual characteristics of emotion, the early research on emotion is related with medicine and psychology. Medicine focuses on the physiological mechanism of emotion generation, while psychology on the individual process of emotion generation. Starting from the individual itself, most researches of emotion regard emotion as the individual’s psychological characteristics, and analyse the motivation for emotion generation, emotional demand, type of emotion and dimension of measurement. In fact, emotion is the psychological characteristic of individuals, and the result of interaction and choice between individuals. When individuals put emotion into the corresponding social system, emotion becomes a constructive factor, which has a significant influence on the establishment and maintenance of the system, such as religious organisations, national cohesion and social appeal. In the establishment and maintenance of the system, emotion promotes the formation of social conditions that can bring emotional power into play. But, the tendency of individualism that psychology has in the study of emotion makes it difficult to apply psychology to the study of the interaction between emotion and social system. By putting people in a certain background, sociology investigates how social structure and culture affect the arousal and change of individual emotions. On this basis, the unique emotion theory and emotion research from the sociological perspective have gradually formed (Turner & Stets, 2005). If we review the research history of sociology, we will find that the study of emotion has always been in a hidden state. The sociological research on emotion theory abroad can be traced back to the nineteenth century. Among the founders of sociological classics, few people specially study any details of emotion. Only under some theoretical frameworks can we see the fragmentary points of emotion research. For example, in solving the problem of social order, Auguste Comte, the founder of sociology, emphasised the role of emotion, demonstrated his positivism with emotion, and believed that all sciences controlled by human beings must be influenced by subjective factors such as emotion. In order to achieve a good social order, emotion is an important component of human nature whose effect can not be ignored. Durkheim’s analysis of ritual and positive emotional arousal marks the beginning of the construction of emotional theory. He puts forward the concept of arousing collective emotion for the first time in his research on collective unity, which provides enlightenment for various emotion theories later. In his study of the religious beliefs and rituals of Australian Aboriginal, he puts forward a set of key mechanisms, in which rituals guiding all people and their behaviours are guided by a series of beliefs. In this way, emotions are closely related to cultural values, beliefs and norms. He further believes that common presence, mutual perception, common concentration of attention, rhythmic synchronisation, common mood and group symbolisation will awaken emotions, and when emotions are awakened, ritual elements are endowed with important values, which will gradually enhance emotions. In this way, emotion

2.1 Research on Emotional Sociology

23

becomes a kind of collective emotion, which is awakened in the ceremony of collective unity, and such collective emotion is the basis and link of social unity, and becomes the source of social classification (Durkheim, 1965). It can be said that Durkheim’s greatest contribution to the study of emotion is to construct the collective emotional foundation of social order (Guo, 2007a). Tönnies places greater emphasis on the “community” emotion formed on the basis of the primary group, and the emotional bonding of pre-modern societies, i.e. traditional societies. He divides human will into the essential and arbitrary will, in which the former is based on emotional motivation and the latter based on ideological motivation. A good social group is not established by individuals according to their will, but by individuals and their pre-existing emotional attachment, i.e. based on emotional motivation (Jia, 2000; Tönnies, 1957). In contrast, Simmel’s interpretation of emotion reveals a strong sense of pessimism. In The Philosophy of Money, he thinks that the use of money improves the relationship between people, promotes social unity, and enables individuals to have more freedom of choice to participate in various exchanges to obtain different interpersonal relationships. Although the use of money helps people contact with a variety of other people, it makes them more closed and lonely. The reason lies in that the emergence of money makes people tend to calculate the quantity and ignore emotional factors in the special interactive process of transaction (Simmel, 1990). Based on this, Simmel presents us with a world of emotional withering controlled by money. In his discussion of legitimacy, status, tradition and rationality, Weber brings emotional activities into sociology, and believes that the iron cage of rationality imprisons emotion and marks the category of emotion (Weber, 2010). But he does not elaborate on the details of the dynamics. In his ideas on class consciousness and conflict mobilisation, Marx clearly points out that the personal emotional belonging is forcibly torn apart by the non-individual forces of capitalism. He regards emotion as a subjective phenomenon determined by economic structure. But he idealises the emotional world in that he believes an ideal society is not only a society with highly developed productivity, but a society in which emotions are liberated and return to good human nature (Marx, 1885). Although he includes negative emotional theory in his concept of alienation, Marx does not further explore emotional details. In addition, Pareto’s concept of sentiment provides a useful beginning for the study of emotional sociology, but it has not been fully developed. Earlier than any other founders of classical sociology, Cooley puts forward the theory that pride and shame are important dynamics in interpersonal behaviour (Cooley, 1902), and has a profound impact on modern sociological theory. It is worth noting that the theme of emotion is almost completely absent from George Mead’s theory, but Mead proposes a theoretical model commonly adopted by contemporary theorists in the study of interpersonal behaviour (Mead, 1934), which is beyond the reach of any other classical sociologists. It is not surprising that scholars have tried over the years to refine Mead’s comprehensive theoretical

24

2 Literature Review and Theoretical Perspective

framework which have omitted the theme of emotion because he has little discussion on emotion. But when researches on emotions finally emerge, the symbolic interactionists (successors of Mead’s social psychology school) lead the research direction. As sociological research further develops, Goffman’s thought on the presentation of self in daily life (1959), Parsons’ structural functionalism (1966), and Luhmann’s systems theory (1995) point out that emotion is consistent with the structural needs of social system, and put forward relevant ideas in their studies of emotion. Generally speaking, the classical sociological writers have not conducted a systematic study of emotion, but they have opened up a way for the follow-up study of emotional sociology.

2.1.2 Research Status of Emotional Sociology In the late 1970s, emotional research became a research direction in sociology. After over 30 years of development, it has gradually become a systematic research field of sociology. During this period, the fruitful results the theoretical and empirical research of emotional sociology has achieved have made it develop into one of the frontier fields of sociology. Although the research activities in this field are in full swing, there are still many conceptual and methodological problems that have not yet been solved. For example, such terms as affect, sentiment, feeling and emotion are used quite loosely in the emotional theory, and some researchers have defined the meaning of these terms. It can be seen that although emotional sociology as a research field is becoming increasingly mature, some basic concepts are still in dispute. The definition of these concepts is not only about the refinement of terminology, but reflects the generalisation, understanding and interpretation of emotion through the diverse use of terminology. Opinions are often divided on the discussion of the nature of emotions in particular. In addition, the limited research methods and single theoretical perspective of emotional sociology limit the accumulation of related research materials. Thus, it is necessary to sort out its research status and controversial issues. First, the first argument under the theme of emotion is whether emotion is a biological attribute fixed in the neural structure of the brain (Maryanski, 1986, 1987; Maryanski & Turner, 1992), or is constructed by social culture. The debate on the essentialism and constructionism of emotion will continue to exist and can not be completely solved in the near future, but it is beneficial to understand the current situation of the debate. Most sociologists agree that physiological changes lead to emotional generation, but social constructionists argue that emotional arousal results from cultural conditioning, in which people acquire emotional vocabulary, emotional logic, feeling rules and ideology (Kemper, 1981). In addition, constructivists point out that the activation of emotional arousal on the basis of physiology presents a diffuse and abstract state, and cannot produce a specific emotion. People must describe these ways of physiological activation through the labels and behavioural expectations

2.1 Research on Emotional Sociology

25

provided by culture (Berger, 1988). Although some constructivists recognise the existence of some basic emotions based on fixed neural structures, such as fear, anger, happiness, sadness and disgust, they quickly point out when these emotions occur and how they are experienced and expressed are highly regulated by culture (Barbalet, 1998). Evolutionary and biological theorists interpret human emotional ability as the result of increased biological adaptability. So they believe that many emotions of substantial significance to human interaction and social organisations may be fixed in the human brain in modular units (Wentworth & Yardly, 1994). In addition, it is undeniable that emotional arousal depends on the activation of the body system, but the process of arousal is restricted by social structure and culture. In the sense of integration, the above two views are reasonable. The experience and expression of fixed emotion is the product of learning (Thamm, 2004). When people master a lot of emotional culture, they understand which kind of emotion is appropriate in different situations and how to experience and express this emotion. But even this vacillating compromise cannot ignore such a central question: How many emotions the body system can control? Only a few basic emotions based on biology, such as fear, anger, sadness and happiness, or the varieties of these basic emotions or more complex emotions, such as shame, guilt, compassion, jealousy, pride? Are all of them fixed in the human nervous structure? Turner believes that the appropriate solution to the debate on whether emotion is a biological attribute or social and cultural construct is to take a compromise. On one hand, these emotions have the biological attributes. On the other, the arousal, expression and use of these emotions are often restricted by social culture, and the social situation in which individuals live will have an influence on people’s emotional arousal and expression (Turner & Stets, 2005). Second, in emotion and experience, most sociologists and researchers define experience as conscious awareness of emotional state (Goffman, 1961; Gordon, 1981; Hochschild, 1979). But the research results of psychoanalytic researchers illustrate the fact that many emotions are not consciously recognised by people and thus cannot have specific experiences (Scheff, 1988; Turner, 2000). Accordingly, these emotions are below the level of conscious awareness. Others may be able to detect this emotional arousal through their bodies and sounds, but they are still not aware of their own emotional arousal. Thus, if sociological theory and research only focus on conscious experience, the research will have a lot of limitations because many emotions below the level of awareness will affect how individuals act and how others respond to them. Therefore, unconscious emotion is of sociological significance and needs to be integrated into theoretical and empirical procedures (Turner & Stets, 2005). But most sociological theories and empirical studies tend to focus on experience rather than emotion. For example, the well-known dramaturgical theory (Goffman, 1961), cultural theory (Hochschild, 1979), ritual theory (Collins, 1975, 1981), interaction theory (Mead, 1934), Social exchange theory (Homans, 1974) and structural theory (Kemper, 1989) are all based on the analysis of people’s conscious experience and expression. Only evolutionary theory with strong psychoanalytic associations (Turner, 2002) is more concerned with the emotion of subliminal consciousness.

26

2 Literature Review and Theoretical Perspective

Sometimes, emotion in the unconscious memory system can be expressed, but not experienced; sometimes, the individual doesn’t realise that he’s activated by some emotion, and this situation continues until he is aware of other people’s reactions to his unconscious emotional expression. In addition, defense mechanism is activated in the process of suppressing emotion. Emotion when suppressed to a certain extent will be transformed into a new emotional form. For example, in Thomas Scheff’s theory, suppressed shame leads to sudden outbursts of anger (Scheff, 1988). Sociologists have been very reluctant to study defense mechanism due to the difficulty in its operation in theory and practice. How should researchers conceptualise the transformation of a suppressed emotion into another type of emotion the individual is, or not, aware of? People are often confused about how to explain why they feel angry, guilty, sad and the like, which are either suppressed or suddenly transformed from the suppressed emotions in a high-intensity way. Sociologists can not ignore the study of this methodological problem in their research, and the primary reason lies in that unconsciousness plays a key role in the interaction between people and the effectiveness of culture and social structure. Sociology also needs to expand its theoretical and empirical procedures, so that it can measure the whole emotional arousal of people, not just the interview content and questionnaire surveys. Sociologists have been reluctant to integrate the research tradition of psychoanalysis, mainly because it is not easy to measure its dynamics with traditional sociological methods, and new measurement methods are still being developed. In particular, more dynamic theories should be used to guide the development of such measurement method. The theories should be able to explain when and why emotions remain unconscious, or when they enter the individual’s conscious system and are perceived as experiences. These problems still remain unsolved. Among them, discourse analysis can be said to be an effective method. By examining the interaction, it shows how we view emotional suppression and how suppressed emotions affect people’s cognition and behaviour (Potter & Wetherell, 1987). Third, all the emotional theories of sociology view emotions as motivational forces that inspire and guide behaviour in the arousal of emotion and presentation of emotional motivation, but sociological researches still do not have such focus. According to the exchange theory, when people pursue rewards, they also expect to pay the least cost when they get rewards (Homans, 1961). The value of the goal which can produce reward effect or lead to punishment is determined by the positive or negative emotions aroused by the goal. The symbolic interaction theories distinguish the different effects of emotion and motivation to a certain extent. These theories usually regard emotion as an unbalanced state related to environment (Burke, 1991; Heise, 1979). For symbolic interactionists, the expectation associated with identity is the most important, because people seek to confirm their identity in the environment and obtain the support of identity from others. When an individual interprets the response of others as the confirmation and support of his or her identity, he or she will experience positive emotion (Burke, 1991; Heise, 1979; Stryker, 2004). On the contrary, the individual will experience the negative emotion. So, first of all, people may adjust their behaviour and observe whether others make a confirmation response. In addition, we can adjust the

2.1 Research on Emotional Sociology

27

interpretation of other people’s behaviour to prove that such inconsistency may not exist actually. If identity is not confirmed continuously, people will force themselves to adopt an identity confirmed by others, or leave the environment to seek a new situation that can confirm their identity (Stryker, 2004). While the expectation associated with identity is important, it has many other sources. For example, the expectation states theorists emphasise that power and authority are the embodiment of the relationship between status and privilege and expectation, as well as the relationship between status and privilege and emotion (Houser & Lovaglia, 2002; Ridgeway & Johnson, 1990). In addition, expectations can be derived from the culture in the situation (rules, values, ideology, knowledge stocks), the structure of the situation (network, mode, power-status differentiation), demographic variables, the ecological resources of the situation (available time and space), and the memory of past interactions (Turner, 2002). It can be said that almost any kind of recognition of the environment can establish expectations. If the expectation is realised, positive emotion will be generated, which encourages the individual to continue to act in this direction; if not, negative emotion will be produced, which forces the individual to change his behaviour, expectations or degree of integration in the environment. The expectation states theory emphasises the expectation associated with power and privilege, and the influence of expectation related to the expected gain and loss of power and status on emotion, and holds that people try to keep expectation consistent with behaviour (Berger, 1988). It is surprising that these research orientations have focused on the issues in limited fields, but have rarely attempted to explore the convergence between theories across the boundaries of fields. Turner believes that one of the ways to do this is to define and classify the expected sources of influence: self and identity, cultural norms, values and beliefs, components of social structure (differentiation of positions, power, privileges, forms of networks, demographic and ecological variables of situations), and exchange profits (related to costs, investment, and fairness rules). Then, based on this, we can define the attributes of expectation for generating these resources to investigate the special emotions that people experience, including such negative emotions as fear, anger, shame, guilt, depression and anxiety generated when expectations are not realised, and such positive emotions as satisfaction and joy generated when expectations are fulfilled (Turner & Stets, 2005). In this way, it is possible to form a more balanced theory rather than four or five central point theories that are scattered, each with their own terms. Fourth, culture can affect emotion, while emotion is the driving force of cultural commitment. Culture influences emotions by setting expectations of what should happen and what can happen. Emotion endows cultural symbols with meaning and power, while the meaning and power can be adjusted to guide people’s behaviour and maximise the mode of social organisations. The dramaturgical theory is the first to emphasise that emotion is the key link between cultural rules and behaviour. Social emotional culture (including feeling and display rules reflected in the broader emotional ideology) limits the emotions that people should feel and express (Hochschild, 1979, 1983). At this time, emotional culture embeds people into such a situation: if people experience emotions that conflict with expectations,

28

2 Literature Review and Theoretical Perspective

they will experience a new sense of alienation. When emotion is subject to chronic stress, the emotion that people experience or expect people to experience will sometimes deviate from the emotion people must express. Just as cultural forces force people to engage in emotional work, the operation of emotional work is a kind of force, because emotional work forces people to comply with its rules in strategic behaviour. If, to a certain extent, people continue to experience certain emotions, which confront the feeling and display rules in the situation, there will be pressure to change the rules or the social structure, and the activation of negative emotions is thus an important force of constructive cultural change. However, not all emotional expression deviates from emotional culture. The dramaturgical theory (Goffman, 1959), cultural theory (Hochschild, 1983) and ritual theory (Collins, 2004) emphasise the activation of positive emotions at the micro interaction level, forming people’s commitment to the socio-cultural structure. To a certain extent, culture is of significance to activate people’s emotional reaction. When people participate in face-to-face interaction, emotions are activated, thus forming rhythmic synchronisation, common definition of situation and collective pleasure (Collins, 2004). If represented by other symbolic forms (objective things, signals or words), cultural symbols will be rich in more meanings and can better arouse the emotions and meanings that they refer to in culture. They can be spread among group members, and activated when individuals are introspective alone, and these aroused emotions strengthen the group culture. Thus, emotion makes culture a meaningful power that activates cultural regulation. Although only a few theories have discussed the relationship between the biological basis of emotion and culture, Hammond once pointed out that the link between the biological basis of emotion and culture is the key to cultural maintenance (Hammond, 2004). Representational symbols have the power to activate the emotional system of the body. In essence, they are the marks of body feelings because symbols activate the emotional system of the brain, giving culture the power beyond the individual. If cultural symbols had no connection with the biological basis of emotional arousal, their power to regulate behaviour would be weakened. Thus, without the activation of the body, culture will only be recognised and lose the power to push people to act according to cultural codes. Cultural sociology has long recognised the link among rituals, emotion and the meaning of symbol systems. In this connection system, emotion is the hub because rituals are guided by the representational symbols that awaken the emotional response. But the process of emotional arousal is the activation of a series of physiological processes, which is ignored by cultural sociologists. The body as a biological system is not a black box that can be excluded from the analysis of cultural sociology. Cultural symbols affect the body system that produces emotions, and emotions caused by body reactions generate commitment to representational symbols. Symbols become body markers that can activate emotions generating commitment to cultural codes. According to the activation of the body system that can be marked, the nature of emotional response and the association of emotional response and cultural symbols will change. Thus, cultural biology is a very important field of sociological research although often neglected.

2.1 Research on Emotional Sociology

29

Finally, in terms of emotion and social structure, although emotional action can maintain or change the structural arrangement of society, social structure limits the nature of emotional arousal. But there are only tentative studies on the interaction between social structure and emotional arousal. Network theorists emphasise that network density is an important feature of social structure (Markovsky & Lawler, 1994). Moreover, exchange network theorists have further proved how reciprocal exchange relations generate positive emotions (Lawler & Yoon, 1993, 1996, 1998). If we look at exchange from a broader perspective, the confirmation of self meaning is exchangeable. In this sense, identity theory connects the stability of positive emotions with the development of social structure. For example, Burke and Stets’ research (1999) shows that the recognition of each other for both spouses in a marriage will activate positive self feelings, mutual trust, positive attachment and commitment to their spouse. This recognition maintains the continuity of the interaction, and even so when it is considered beneficial to interrupt the relationship. Therefore, we can find the characteristics of maintaining the stable elements of social structure from the micro level of marriage interaction. Generally speaking, any form of reciprocity tends to produce positive emotions. When emotion is aroused, people’s commitment to exchange partners, the whole network and network culture will increase. It is true that people often make commitment to the relationship that is not the best choice for exchange, because the commitment reduces the cost consumption caused by uncertainty and strengthens the power in the exchange, adding additional resources for the exchange relationship. Meanwhile, the generation and expression of emotion generates commitment to the social structure. Power inequality and privilege or status play an important role in emotion. People with great power and high status will receive positive rewards that accompany obedience and respect; those who are oppressed by power and have to obey rarely experience positive emotions (Houser & Lovaglia, 2002). Gaining power and privilege will generate positive emotions, while losing power or privilege will make people experience negative emotions, such as shame, sadness, fear and anger (Kemper, 1990; Thamm, 2004). Thus, to a large extent, structural inequality will correspond to the distribution of positive and negative emotions. People with higher positions will experience more positive emotional arousal than those with lower positions, and this state will make emotion a resource of unequal distribution. But if people with higher positions overuse their power, and their subordinates consume too much cost, the subordinates will have negative emotions, reduced attachment to structures, or conflicts with their superiors (Molm, 1997). Many complex interfering variables can weaken or intensify subordinates’ negative emotions, one of which is the cultural standard of fairness. If the resources in the structure are allocated fairly compared with investment and contribution, fewer conflicts will occur; subordinates will accept such inequality because they think it is fair. Another interfering variable is attribution. If people attribute their position in the structure and the allocation of resources to their own actions, this status quo will be more likely to be maintained (Houser & Lovaglia, 2002). However, under the influence of distal preference for positive consequences and proximal preference for

30

2 Literature Review and Theoretical Perspective

negative consequences, people tend to regard positive outcomes such as personal success and harvest as self-induced, and attribute negative consequences that may bring negative effects to others in interaction or to the social structure at the meso and macro levels (Lawler, 2001), which is the reason why people with lower status are more inclined to make external attribution than those with higher status. When people make external attribution, they tend to regard resource allocation as unfair, which leads to conflicts. This motive, fuelled by a strong sense of anger, such as revenge, will evolve into conflict, which will help restore equality in the distribution of resources, and overthrow those who exploit others. Some interesting theories and studies have explored how emotions motivate people to form a commitment to social structure and culture, or vice versa, that is, how emotions lead people to retreat from the legitimacy of social structure and culture. All studies agree that people pursue positive emotions and avoid negative ones, but for sociologists, the goal of research is always to explain how emotional arousal affects social structure and culture, and how these elements affect emotions. Although a variety of theoretical and empirical studies tend to converge in the future, sociologists get used to carrying out research under the traditional framework of specific theoretical or empirical studies, such as exchange theory, expectation states theory, power and status theory and identity theory, but they do not further expand the research vision of these theories. The convergence of theoretical and empirical research results means that it is possible to develop a rationale for the relationship among emotion, motivation, culture and social structure in future research. For sociologists, it is a time to transcend the shackles of specific theoretical frameworks and bring together diverse sources of research.

2.1.3 Future Trend of Emotional Sociology To sum up, emotional research under the framework of sociology mainly focuses on the micro level, and most of the sociological theories focus on the role of culture in restricting interpersonal interaction through emotional ideology, feeling and display rules (Hochschild, 1983). In addition, logical, general or special cultural resources and representational symbols limit interpersonal interaction (Collins, 2004). Meanwhile, social structure influences interpersonal interaction through the network and the distribution of power and status in the network. Reciprocal interpersonal interaction can not only strengthen existing cultural patterns and structures, but generate pressure leading to change. Emotion is the key to the dynamics of culture and social structure, and the key to interpersonal interaction. This fact means that the research design is methodologically oriented towards social psychology. Although this research design is appropriate, the research bias on emotion gives rise to some important problems, and ignores the social forces at the meso and macro levels. A considerable number of meso and macro studies focus on collective behaviour, social movement, revolution, racism, terrorism, and other social phenomena that arouse strong emotions. But in the actual research, there is little intersection between

2.1 Research on Emotional Sociology

31

socio-psychological research of emotion and sociological research of emotion at the meso and macro levels. Some sociologists, such as Collins, Scheff, and Jonathan Turner, have established the relationship between the micro level and the macro level, but these theorists except Scheff have not collected data to prove such connection. Social psychologists have done a lot of emotional research, because emotion is fundamentally people’s response to socio-cultural situations. The sociopsychological research of emotion has recognised that emotion is the power to establish or destroy the connection between people and macro structure. Thus, the research on these macro processes should not adopt the micro research approach under the framework of social psychology, and vice versa. For example, James C. Davies’ revolutionary theory (1962) adopts the dynamics of the expectation states. Whatever the merits or demerits of this theory, Davies believes that revolutions occur when the gap between expectations and actual conditions suddenly increases, and all similar studies on riots actually emphasise the sudden arousal of emotions. But these macro research methods and the research under the framework of social psychology are like sailing ships groping their way forward at night. So, for social psychologists, it will be beneficial in their study of emotion to use a variety of research methods, including historical analysis, observation, ethnography and other qualitative research methods, which should become the future development direction of emotional sociology. Meanwhile, people can have strong or weak emotional response in the interaction that is often not face-to-face (sometimes only through the computer), or when reading other people’s stories that they do not know, which shows that emotional arousal and expression is fundamentally significant. These facts clearly show that some important mechanisms are being explored in these studies. But high-intensity emotional arousal is generally not allowed in such research programs, so such new forces as defense mechanisms are less activated. As a result, most of the emotional sociological researches are precise and controllable measurements of weaker emotional states. Of course, it is difficult for the experimental scheme arousing high-intensity emotions to pass the review of the ethics committee, but such difficulty cannot rule out the fact that most sociological research only involves one end of the emotion spectrum. One of the methods to study higher-intensity emotions is to use observation and interview in the natural environment. Observation and interview as the research methods are less controllable, but they will help us open the door of emotional theory and study higher-intensity emotions. In addition, previous sociological studies tend to care about conscious emotion, but ignore the unconscious state of emotion. It is generally believed that the research on unconscious emotion is applicable to psychology, especially psychoanalysis. Turner et al. believe that the study of emotion in sociology should focus on conscious emotion as well as unconscious emotion (Turner & Stets, 2005), but they did not put forward operational methods on how to study unconscious emotion. In the author’s opinion, we can use psychoanalysis to study unconsciousness, and present the unconscious emotion through other carriers (such as relationship). Especially in Chinese society, the people’s emotion is “non-representative” (Kipnis, 1997) which requires the help of certain relationship or ritualised etiquette, and the ritualisation of emotion comes more from the maintenance of social relations than from the sincerity of emotion

32

2 Literature Review and Theoretical Perspective

(Kipnis, 1997). Through the analysis of the relationship, the study of the maintenance and construction strategy of people’s relationship can reflect their conscious and unconscious use of emotion, which is not the direct research on unconscious emotion, but enriches the exploration of emotion including unconscious emotion to a certain extent.

2.1.4 Localisation and Indigenisation of Emotional Sociology As an “exotic” emotional sociology, there should be huge room for discussion in the context of Chinese society. But the related research on emotion theory in China’s sociological research is seldom seen. The existing research results are rare and nonsystematic, and lack localised and indigenised emotional sociological research based on the characteristics of Chinese social culture and relationships. There are two reasons for this. Firstly, the psychology of emotion differs from sociology which strictly abides by the traditional division of disciplines, and the irrational characteristics of emotional research make it very disadvantageous in the environment currently dominated by rational sociology. Secondly, the research on emotional sociology in China does not attract enough attention while the relevant research abroad starts relatively late. Chinese scholars such as Guo Jingping (2007b, 2007c, 2008, 2013), Pan Zequan (2005), Wang Ning (2000), Wang Peng (2013, 2014) and Cheng Boqing (2013) have conducted extensive research on emotional sociology. Guo Jingping (2007b, 2007c, 2008) brings the emotional theory into the field of emotional sociology in her research. By examining the theories of Western emotional sociology, she presents the development process of emotional theory, analyses and elaborates on the emotional theories of the main representatives. At the micro level, she combines the research of emotional theory with specific social phenomena, and sets proposition hypotheses from a special perspective to analyse specific social phenomena. In his article entitled On the Social Approach to Emotion—Research Notes on Emotional Sociology, Wang Ning (2000) holds that the current emotional sociology focuses on the study of the symbolic and social modes of emotion, analyses the modes of social acceptance, communication and support of emotion, and emphasises the importance and necessity of interpreting emotion from the sociological perspective. In his article entitled Emotion Sociology: A Sociological Perspective to Study, Pan Zequan (2005) analyses the sociological construction of the theoretical paradigm of emotional sociology at the micro and macro levels. At the micro level, the construction of social behaviour and symbolic mode is analysed; at the macro level, emotion is involved in the production and reproduction of social structure, which emphasises the social category of emotion. Based on this, he puts forward several issues of emotional sociology, such as the social practice of emotion, the institutionalised imprint of emotion, the emotional process and meaning in social interaction.

2.1 Research on Emotional Sociology

33

Wang Peng (2013, 2014) analyses the dual effects of emotion on social order from the micro and macro perspectives. He believes that the self production of emotional resources in different social strata will maintain and strengthen the existing social stratification system, lead to the reproduction of social inequality and may bring about social changes. Cheng Boqing (2013) analyses the sociological significance of emotion, discusses the key aspects and mechanisms that affect emotional phenomena in the context of modernity, and finally attempts to explore the current emotional problems in Chinese society and the significance of emotional dimensions in social construction from the perspective of sociology. In addition, with the development of Western emotional anthropology in recent years, many anthropologists in China have begun to study emotion. Yan Yunxiang (2003) once pointed out that “human relationship refers to feelings and has multiple meanings in practice. At the individual level, it covers the basic principles of moral behaviour in interpersonal communication. It is also widely used to refer to the emotional understanding of others”. Yan Yunxiang (2003) and Mayfair Mei-hui Yang (1994) in their studies on human relationship in Chinese society point out that the emotion in human relationship is one aspect of emotion. Zhang Hui (2013) believes that the attention to emotion in Chinese studies by scholars at home and abroad is at a very marginal position, emphasising the increasing importance of emotional anthropology in Chinese studies and the possible contribution of relevant analysis to understanding Chinese society. After reviewing the development of emotional anthropology, Song Hongjuan (2014) puts forward the concepts of “directional emotion”, “dominant emotion” and “recessive emotion”, and suggests adding the method and perspective of emotional anthropology to the empirical study of Chinese society and focusing on the emotional world of ordinary people and their daily life experience. To sum up, the research on emotion theory from sociological perspective mainly covers two aspects, namely the micro and macro levels. The micro level focuses on the specific emotional types and the emotional process in the interaction, emphasising the emotional operation, emotional self-control and human initiative in the process of control. At the macro level, emotion is placed in a more grand socio-historical background, emphasising the influence of emotion as a constructive factor and force on social system. Of course, the two levels are not completely separated in the specific research because the individual emotional operation at the micro level will be more or less mapped to the construction process of social systems at the macro level, and the specific culture, concept and atmosphere formed herein will have a profound impact on the individual involved, and thus affect the operation and control of individual emotion. In short, sociologists have done a lot of theoretical groundwork in emotional research in the past 30 years, which is enough to bring about a large number of propositions and hypotheses. However, the review of existing research on emotion shows that the research is carried out at a single level, such as the micro or macro level, or slight emotion triggered in the laboratory is analysed, or emotion is analysed statistically by quantitative research method, or positive emotion is analysed. Based on the analysis of emotional theories in China and beyond, this book explores the

34

2 Literature Review and Theoretical Perspective

being and expression of strong negative emotions from the perspective of subject construction by analysing the illness course and emotional changes of PLWHA, so as to explore the dynamics of strong negative emotions from the micro to the meso level and then to the macro level.

2.2 AIDS Research from the Perspective of Sociology 2.2.1 International AIDS Research Throughout the past 30 years of international sociological research on AIDS, the author finds that from the mid-1980s, Judith Auerbach et al. (1994), Benjamin Bowser (1989), Marmor et al. (1984), Martin Levine (1989), Beth Schneider (1988), Rose Weitz (1987, 1991) and other pioneers began to publish researches on AIDS in important social science journals such as Social Problems, set up AIDS related courses in universities and colleges, organised various sociological conferences annually on AIDS, and built the Sociologists AIDS Network of the American Sociological Association. It can be said that these pioneers have promoted the sociological research of AIDS. But it is a fact that AIDS research articles are difficult to publish in the flagship journals of sociology, which fortunately changed a lot in the last decade of the twentieth century. Nowadays, sociologists have conducted a wide range of research on AIDS worldwide (Mojola, 2011; Swidler & Watkins, 2007), and have made great contributions to AIDS policy, support and community response. With the deepening of interdisciplinary research on AIDS, many prominent sociologists have published AIDS research in medical and health journals. Many articles have been published in Social Science and Medicine, AIDS Care, AIDS Journal of Health and Social Behavior, the Sociology of Health and Illness, and many other public health journals, including the American Journal of Public Health. In addition, more and more sociologists have devoted themselves to the study of AIDS, and published academic research articles in journals of sociology and social sciences, such as Social Problems and Social Forces. However, the sociological research on AIDS remains at the periphery of “mainstream sociology”. Sociologists’ research on AIDS mainly focuses on the inequality in AIDS transmission. Various forms of inequality rendered through racism, sexism, class subordination, heterosexism, and other forms of exclusion intersect and interact with one another, creating what Collins (1990) calls interlocking systems of oppression. It requires us not only to attend to difference, subjectivities, and categories of identity, but also to consider how dimensions and dynamics of dominance generate and sustain structural, group, and interpersonal inequalities (Watkins-Hayes, 2014). Why does the prevalence of HIV vary greatly in terms of race, gender, class and sexuality? In fact, most epidemiological studies emphasise individual risk behaviours, and the key to sociological research is to place these behaviours in a

2.2 AIDS Research from the Perspective of Sociology

35

larger social context. The latter considers the role of risk environments in HIV transmission, and the exogenous factors that may contribute to HIV risk (Rhodes et al., 2005). Studies have shown that physical and social spaces generate relationships between structural-, community-, and individual-level HIV risk. These relationships are largely shaped by a complex array of public policies, macroeconomic changes, racialised and gendered organizing principles, dynamics of sexual and drug networks, neighborhood resources and deficits, and individual behaviours (Watkins-Hayes, 2014). Social group identity, however, is not a firewall for HIV risk. As Treichler and others have noted, the risks of HIV are not associated with inherent demographic characteristics (Treichler, 1999). In the United States, the virus is most commonly transmitted through unprotected sex and the sharing of drug injection equipment, but these risk behaviours occur in a context that unequally distributes both vulnerability and protective resources (Watkins-Hayes, 2014: 435). Other scholars incorporate structural explanations for HIV risk. Diaz and colleagues encourage scholars to think about HIV risk as an outcome of social oppression, showing that experiences of social discrimination and financial hardship among gay Latino men are strongly correlated with encountering risky sexual situations that place them at risk for HIV transmission such as sex involving drug or alcohol use or partners who resist condom use (Diaz et al., 2004; Mizuno et al., 2012). In line with this social oppression framework, Ayala and colleagues find that reported experiences with homophobia, racism, financial hardship, and lack of social support were associated with unprotected anal intercourse (Ayala et al., 2012). Ghaziani and Cook generate a conceptual framework to explain the hypothesised link between self-identified gay and bisexual men and new HIV infections. Although intended to promote HIV/AIDS awareness and encourage gay communitybuilding and promote cultural identity, these weekend-long parties may inadvertently encourage the spread of HIV by creating an environment in which unprotected sex frequently occurs (Ghaziani & Cook, 2005: 42–43). Not all sociologists have emphasised the cultural and structural dimensions of HIV. In his work on sexual narratives of Mexican gay and bisexual immigrant men in San Diego, Fontdevila (2009) focuses on the micro-level interactions that facilitate HIV transmission, emphasising protective versus trusting frames during sexual intercourse. Protective cooperative frames promote self-protective barriers such as condom use, whereas trusting cooperative frames depend on trust, trustworthiness, and reciprocity of information about HIV status between sexual partners. Individuals often move between frames during sexual intercourse, reacting to contextual cues and deciding in the moment whether to use condoms. In terms of heterosexual sex and HIV transmission, recent trends show that AIDS cases transmitted by male-to-male sexual contact and injection drug use have decreased, whereas heterosexual transmission cases have increased in the US (Espinoza et al., 2007). Infections among women account for much of this rise (Espinoza et al., 2007; Hader et al., 2001). HIV is more efficiently transmitted from men to women during vaginal or anal intercourse than vice versa, owing to women’s longer exposure to infectious fluids and increased risk of tissue injury (Bolan et al.,

36

2 Literature Review and Theoretical Perspective

1999; Nicolosi et al., 1994). Nevertheless, research overwhelmingly suggests that the social dimensions of gender roles and hierarchies are also key drivers of the dramatic increase in HIV prevalence among women. As Farmer and colleagues note, those hurt most by gender inequality, racism, and stigma worldwide are the most vulnerable to the vagaries of the epidemic (Farmer et al., 1996). Women are more likely to be forced into survival-focused behaviours such as transactional sex for money, housing, protection, employment, and other basic needs; power-imbalanced relationships with older men; and other partnerings in which they cannot dictate the terms of condom use, monogamy, or HIV testing (Farmer et al., 1996; Gupta, 2004). There is also evidence that sexual violence places female victims at risk for HIV infection (Bensley et al., 2000; Wyatt et al., 2002). Sobo captures the complexity of women’s sexual agency in Choosing Unsafe Sex, arguing that the expectations and understandings that undergird heterosexual unions encourage unprotected sex. Women may be more vulnerable due to “wishful thinking engendered by women’s hopes for their relationships and their desires to preserve status and self-esteem” (Sobo, 1995: 1). Such risk denial is inextricably linked to the need to believe that their unions meet expectations, that they are wise enough to parse risk, and that the men in their lives are monogamous. In terms of intravenous drug use and HIV transmission, sociological approaches have been adopted to consider HIV risk through injection drug use, which was the reported mode of transmission for 16% of those living with HIV in 2009 (CDC, 2012, 2013a). In 2005 some leading scholars, including Tim Rhodes, Philippe Bourgois, and Samuel Friedman, published a review of literature on the social-structural production of HIV risk associated with injection drug use (Rhodes et al., 2005). In addition, sex workers face high HIV infection rates in part because of inconsistent condom use, high numbers of partners, and drug use, as well as circumstances that may hinder access to HIV prevention resources such as stigma, mental health issues, lack of access to health care and other social services, and poverty (Campbell, 1999; CDC, 2013b; McMahon et al., 2006). Discrimination and social stigma likely contribute to the high HIV rates among transgender women (male-to-female). In a study conducted in New York City from 2007 to 2011, 51% of transgender women diagnosed with HIV had documentation in their medical records of substance use, commercial sex work, incarceration, and/or sexual abuse, compared with 31% for other HIV-positive people who were not transgender (CDC, 2013c). The epidemic among young people is now receiving increased focus. Youth ages 13 to 24 comprised 16% of the US population in 2010, yet accounted for 26% of all new infections (CDC, 2013a). These numbers show that sociological research on HIV among youth is urgently needed. In their analysis of data from the National Longitudinal Study of Adolescent Health, Mojola and Everett find that sexual-minority young women in each racial and ethnic group have a higher prevalence of risky sexual behaviours than their heterosexual counterparts (Mojola & Everett, 2012). As a result of sociologically driven inquiry, researchers are increasingly advocating structural HIV prevention, which consists of not only “targeted interventions

2.2 AIDS Research from the Perspective of Sociology

37

fostering changes in individual behaviour, but also interventions creating local environments conducive to, and supportive of, individual and community-level behavior change” (Rhodes et al., 2005: 1027). Studies suggest that groups that have been socially or economically marginalised are especially vulnerable to HIV infection. The research overwhelmingly suggests that people are differentially exposed to HIV on the basis of their social locations in ways that mirror exposure and vulnerability to damaging structures of inequality (Watkins-Hayes, 2014). In recent years, advances in and access to treatment—including effective drug therapies and better monitoring of viral loads and T cell counts—have greatly improved the capacity of HIV-positive people to carry out their normal routines and experience longer life expectancies. But the medical management of HIV challenges individuals to manage their physical and mental health within a social context that can be stigmatising or limited in resources (Adam et al., 2003). Sociologists have been keenly interested in the social management of HIV, addressing issues such as stigma, disclosure, social support, and the social significance of both HIV-positive status and the larger AIDS epidemic (Ciambrone, 2003). Coping with HIV has often meant simultaneously managing its physical demands and experiencing a social status that can diminish connections, existing resources, and social standing (Derlega & Barbee, 1998). Individuals with HIV often seek to reclaim a “safe” moral identity by looking for social meaning in their diagnosis and heavily controlling the conditions under which they disclose their status (Stanley, 1999). Finally, economic issues can be critically important for HIV-positive individuals (Ezzy et al., 1999; Massagli et al., 1994; Yelin et al., 1991). With the advent of HAART, many express a desire to return to work (Ghaziani, 2004), but a range of factors can discourage such a move: the unpredictability of anti-viral drug effects, potentially debilitating medication side effects, the potential for being unable to secure disability insurance coverage, difficulties with transitioning back into the labor force after a long absence, non-health-related employment instability, HIVrelated symptoms, the effects of long work hours and work stress on health, potentially unhealthy work environments, difficulty in managing medical appointments and elaborate drug regimens while working, and the fear that disclosure might result in losing one’s job (Brooks et al., 2004; Ferrier & Lavis, 2003; Nixon & Renwick, 2003; Timmons & Fesko, 2004). Nevertheless, for AIDS people, their economic stability actually depends on the diagnosis of HIV, and the fact of being infected severely weakens their ability to be employed and to pursue wealth. Institutional ties become important to help highly economically marginalised HIV-positive people avoid situations that will likely further endanger their health such as homelessness, drug addiction, and risky sexual relationships (Watkins-Hayes, 2014).

38

2 Literature Review and Theoretical Perspective

2.2.2 Domestic AIDS Research Although modern medicine has confirmed that the mode of transmission of HIV is limited to three forms: mother to child transmission, blood transmission and sexual transmission, and the “Four Frees and One Care” policy provides drug protection for infected people, drugs can not solve all of their problems. As the current popular perspective of physiology-psychology-sociology shows, drugs can only be used to treat infected people, but can not solve such problems as the side effects of drugs, death, helplessness and other psychological problems due to the infection, as well as the prejudice against AIDS under the influence of the mainstream national values. In fact, this is inseparable from people’s ideas and ethics in China for thousands of years. The spread of AIDS in China is often contrary to the Confucian tradition and social mainstream values, so the infected people are considered to be the marginal or vulnerable groups in the society against the mainstream values. Thus, the problem of AIDS has evolved from a pure medical one to a major public one affecting social security, which covers medicine, epidemiology, public health, biology, psychology, sociology and other fields. Having a roughly identical development process with the international AIDS research mentioned above, the research on AIDS prevention and control by Chinese sociologists remains at the periphery of the mainstream sociology study. Nevertheless, as we enter the twenty-first century, AIDS attracts more attention from sociologists in China, and accordingly the sociological research on AIDS prevention and control has made great progress. Generally speaking, the research on AIDS can be divided into two aspects: prevention and treatment. The prevention of AIDS can be roughly divided into the following aspects: research on AIDS and sex workers by Pan Suiming and Huang Yingying; research on male homosexuality by Zhang Beichuan et al.; research on AIDS and blood by Jing Jun et al.; research on the sociocultural construction of AIDS by Weng Naiqun; research on HIV/AIDS among ethnic minorities and women by Zhang Yuping, Xia Guomei et al. Generally speaking, the sociological research on AIDS prevention and control can be carried out from two aspects, namely, the socio-cultural roots of AIDS and the susceptibility of vulnerable groups. There are representative researches by Weng Naiqun, Pan Suiming and Jing Jun on the socio-cultural roots of AIDS. Weng Naiqun uses the existing texts to investigate the socio-cultural construction of AIDS, and further analyses the sociocultural dynamics of AIDS transmission based on his own field research. He argues that the research on AIDS must involve various socio-cultural backgrounds (Weng, 2001), and the spread of AIDS is closely related to political and economic structure and socio-cultural system (Weng, 2003). Further, the spread of AIDS implies social inequality and the imbalance between social change and the socio-cultural system (Weng et al., 2004). Weng Naiqun et al. investigate the socio-cultural roots of AIDS from the perspective of anthropology, while Pan Suiming and Huang Yingying analyse the problem of AIDS in China from the perspective of sociology. In their

2.2 AIDS Research from the Perspective of Sociology

39

view, AIDS in China is not a simple epidemic, but a social problem with Chinese characteristics which appears after some social problems, so it has quite distinct tendency of social choice. They conclude that: “The current situation of AIDS epidemic in China is more caused by various social factors than by the “natural “spread of HIV” (Pan et al., 2006). And Jing Jun’s analysis of the risk of AIDS in China further demonstrates the political economy of AIDS, in which he uses the “Titanic Rule” to explain the close relationship between social class, risk difference and injury degree. In other words, the lower the social status, the greater the risk of injury. Meanwhile, there are more and more wrong knowledge and fear in risk awareness. He believes that “The AIDS risk faced by vulnerable groups in China at the objective level is accompanied by with their risk perception, fear, and attitudes and behaviours with discriminatory elements” (Jing, 2006). This means that the poor are more vulnerable to AIDS than the rich. In terms of the susceptibility of vulnerable groups, Zhang Yuping explores the risk and vulnerability of Chinese ethnic minorities during the AIDS epidemic from the perspective of “cultural survival”. She believes that there are complex root causes for ethnic minorities to become high-risk groups, including poverty, unemployment, low education level, social discrimination and lack of information (Zhang, 2005). The research on female infected people shows that the spread of AIDS is a problem closely related to gender. Xia Guomei et al. point out that from the perspective of gender, women’s unfavorable socio-cultural status make them more likely to fall victim to AIDS, and the difficulty of curbing AIDS will lead to more serious gender inequality (Xia & Yang, 2006). Zhang Kaining et al. strongly call for the conscious integration of gender in AIDS research (Zhang & Zhu, 2005). In AIDS control, China has issued a series of AIDS prevention and control policies including the “Four Frees and One Care” policy, and has drawn on the successful international methods, such as promoting condom use, methadone replacement and detoxification therapies, needle exchange programs and following the HIV case manager program introduced in Taiwan of China. Favourable results have been achieved in the treatment of AIDS and behaviour change of infected people. In 2003, the Chinese government formulated and issued a series of decisions and major measures, including the “Four Frees and One Care” policy and the “Demonstration Area of Comprehensive AIDS Prevention and Control”, which are regarded as effective strategies to reduce the harm of AIDS by the international community. In addition, the promotion of condom use, needle exchange programs and methadone replacement therapy began to receive the support from the country. Generally speaking, the control of AIDS in China is mainly reflected in the following two aspects. The first is preventive measures for high-risk population. At present, sexual transmission has gradually become the main way of HIV transmission in China. Sex workers in places of entertainment have many high-risk behaviours of HIV infection and transmission, including multiple sexual partners, frequent change of sexual partners, low condom use rate, sexual intercourse and group sex during menstruation, which increase the risk of self infection and transmission to others. Increasing attention has been paid to the spread and infection of AIDS among homosexuals.

40

2 Literature Review and Theoretical Perspective

Male-male sexuality among male homosexuals make them very vulnerable to HIV due to the skin damage after severe friction. The survey shows that multiple sexual partners and very low condom use rate are common among male homosexuals (Cai et al., 2005). As a result, gay men have become a high risk group for HIV infection in many countries (Shao & Cao, 2005). In terms of prevention measures for AIDS population, Prof. Pan Suiming introduces the core concept of “bridge population”, and believes that they are the main risk groups of AIDS transmission. According to the theory of “social network of sex”, the “bridge population” is no longer the so-called commercial sex workers, but ordinary men in the sexual relationship (Pan, 2001). With the transmission of AIDS from high-risk population to general population, it is of great importance to conduct health education and behaviour change for general population, especially bridge population. At present, China’s AIDS epidemic has entered a period of rapid growth and begun to spread from high-risk groups to the general population. Blood transmission is only one of the ways of AIDS transmission, but it can not be ignored that blood has the highest probability of infection. Thus, the system to ensure the safety of blood products is one of the ways to reduce social susceptibility. Transmission of HIV through blood is the most threatening way to make AIDS a “national disaster” in China (Wang et al., 2007). In addition, non-governmental organisations (NGOs) for AIDS prevention and control have experienced rapid development and played a huge role in AIDS control in China. The number of NGOs in AIDS control increases rapidly after 2002. This trend is related to the outbreak of AIDS in North China at the beginning of the twenty-first century and the change of China’s AIDS control policies in 2003. These NGOs mainly include: those registered organisations established with government background such as Chinese Association of STD and AIDS Prevention and Control, and organisations established in various localities, dominated by governments at all levels, but not under the jurisdiction of similar organisations at the central level, such as the Association of STD and AIDS Prevention and Control in one city, etc. In addition to the NGOs registered in government departments and recognised by national laws, there are three types of grass-roots organisations that cannot be registered in government departments in large numbers (ASOs, NGOs and foundations). According to the information contained in the 2012 China HIV/AIDS CSO/CBO Directory, NGOs account for over 80%. Among them, nearly 65% are ASOs which are composed of infected groups in different places and aim to solve the survival difficulties of the groups. At present, the main projects carried out by these NGOs focus on three aspects: publicity and education, behaviour intervention, and care and assistance. Firstly, publicity and education are mainly committed to promoting the popularisation of AIDS prevention and control knowledge, and related research, training and other activities (Ren et al., 2005; Zhang & Wu, 2012). Secondly, targeted behaviour intervention is carried out for adolescents, women, migrant population, drug addicts, homosexuals, entertainment service personnel, etc. (Du et al., 2012; Liu et al., 2010).

2.2 AIDS Research from the Perspective of Sociology

41

Thirdly, specific care and assistance methods mainly include discrimination reduction training, providing psychological care for infected people, helping them to help themselves and adopting AIDS orphans, etc. (Li, 2010; Wang et al., 2013). According to a survey conducted by the NGO Research Institute of Tsinghua University in 2005, 157 NGOs in 24 provinces, cities and autonomous regions such as Yunnan, Xinjiang and Henan included 61 NGOs of the first type (38.9%), 32 of the second type (20.4%), 8 of the third type (5.1%), 5 engaged in legal aid (3.2%), 8 engaged in fund raising and funding (5.1%) and 43 engaged in comprehensive prevention and control (27.4%) (Wang & Liu, 2006). Nevertheless, there is no NGO specialised in psychological counseling or emotional support for infected people, and there is a lack of relevant professional staff and working mode.

2.2.3 Emotional Research on AIDS Population Psychology can hardly be used in AIDS prevention, but it can be widely used in the emotional research of infected people. Drugs can make them keep “healthy” for a long time, and the viral load in the blood can reach zero in the medical test, but antiviral drugs can not completely eliminate HIV. Thus, the fight against HIV is a long-term task, and it is essential to provide certain psychological care and emotional support for AIDS patients, in which the role of “emotional therapy” can not be ignored (Wu et al., 2002). The academic research on the emotion of AIDS population mainly focuses on quantitative research, mainly in the field of psychology, and sociological research on emotion is very limited, especially for AIDS people. The academic research on the emotion of AIDS population can be summarised as follows. First, due to the infectivity and stigmatisation of AIDS, the infected people are often alienated, discriminated against and refused by society, thus prone to have various negative emotions (Yu, 2000). Secondly, many antiviral drugs will cause mental burden on drug users due to their side effects, and the use of alcohol and narcotics in the service process will aggravate the mental and emotional burden of the infected people (Ma & Zhang, 2013). Thirdly, the emotional problems of infected people are closely related to their past high-risk behaviours. Studies by Wu Junqing et al. have shown that the debate on the routes of infection often leads to different emotional reactions among infected people. Among them, the proportion of intravenous drug users who commit suicide is higher, and those who are sexually transmitted have the strongest sense of shame (Wu et al., 2004). To sum up, the previous studies generally lack the grasp of the infected people’s emotions, and the analysis of their emotions from the perspective of emotional sociology is in a state of “collective silence”. And the support for them has been operated in a kind of non-professional and non-operational mode, thus awakening their negative emotions. Thus, it is necessary to analyse and grasp their emotions from the perspective of emotional sociology at the micro, meso and macro levels. This will

42

2 Literature Review and Theoretical Perspective

extend the research scope of emotional sociology and provide guidance for their emotion regulation. Generally speaking, China has made great achievements in AIDS prevention and control, including the contained spread of AIDS to a certain extent and improved living conditions of AIDS population. Nevertheless, there is often implementation deviation between the existing concepts and actions for AIDS prevention and control, which is mainly reflected as follows. First, the prevention of AIDS is over-emphasised in China’s AIDS prevention and control policies. On the one hand, the policies emphasise that “the enemy should be kept out of the country” to control AIDS; on the other hand, they shift the focus of control to high-risk groups, which once led to a trend of “everyone finds himself in danger”. This thinking line expands the standard and operation method of behaviour in public health to the classification and characterisation of individuals and groups in social stratification, which objectively provides a theoretical basis for the rampant AIDS discrimination and becomes one of the main reasons for the ineffective prevention and control of AIDS. Secondly, AIDS is constructed as a social problem. Although the basic consensus that “social problems should be solved by the whole society” has been spread for many years, there are some deviations during the implementation. Since the early 1990s, the idea of “multi-sectoral cooperation” in AIDS prevention and control has been regarded as the leading idea of the government. In fact, the so-called “panacea” is just the ideological remnant of the “omnipotent government” present in the planned economy period, which goes against the trend of division and specialisation of social management at that time. In addition, this idea mainly stays at the level of public power, which seriously restricts the participation of other social forces and hinders the process of the whole society to jointly solve the AIDS problem. Thirdly, although a variety of NGOs have sprung up and achieved increasingly significant results in AIDS prevention and control since the twenty-first century, the idea of “community subject” has not been extended in the field of AIDS so far. Theoretically speaking, there is still some tension between social governance and community subject, and in practice, there has been community resistance and conflict. Although this idea is likely to push the cause of AIDS prevention and control in China to a better new stage, it often lacks sufficient attention and full application in the actual prevention and control, and lacks a new integration force to lead the development of other aspects of society. Finally, although NGOs play an irreplaceable role in supporting and caring for the infected people all over China, the grass-roots organisations providing services for them are different and the working methods of these organisations often vary to suit measures to local conditions even if some achievements have been made. Although various organisations will pay attention to their psychological state, there are often feelings like “actually you don’t understand my fear”. Generally speaking, psychological support and care for AIDS people have not attracted due attention. What we first think of is still the “treatment” of AIDS. It is true that health is the most important and necessary thing. Seeking social resources to “solve the survival and living problems of AIDS population” is beyond reproach, and it plays a great

2.2 AIDS Research from the Perspective of Sociology

43

role in helping AIDS people out of their predicament. However, in the psychology of AIDS population, the corresponding interventions and support are not enough; and the psychological motivation and support treatment from the perspective of psychoanalysis and psychotherapy have been beyond the ability of many grass-roots organisations.

2.3 Theoretical Perspective 2.3.1 Theories of Emotional Sociology Looking back on the development history of sociology, we know that the themes of emotions have been scattered sporadically, and have not been fully explored. Even in the rapid development of emotional sociology in the later period, there is still a heated debate between social constructionists and positivists. After the debate is over, researchers begin to establish their respective areas of concern. Nevertheless, they often focus on specific fields such as gender effect, group process, and sociobiology, but neglect to examine the whole picture of sociology of emotions. Some pessimists even argue that emotional sociology has been divided into unrelated knowledge systems. In fact, emotion can be the maintainer of interpersonal relationship, and the undertaker of macro social structure and its cultural generation. Of course, emotion can also become a force to divide society. In essence, the uniqueness of human beings lies in the fact that individuals rely on emotions when social ties are formed and complex social structures are constructed. By linking experience, behaviour, interaction, organisation with the movement and expression of emotions, emotion can not only help to form social structure and culture, but also produce alienation, thus breaking social structure and culture. It can be seen that emotion, as a social institution, has gradually become the key link between the micro level and the macro level. (1)

Analytical Framework of Emotional Sociology

Turner proposes a holistic framework for the study of social problems. He divides social reality into three levels: micro level, meso level and macro level, and further points out that the micro-level social organisations are embedded in the meso-level social structure, and further integrated into the macro structure. Each level of social organisations has its own power to promote the formation and operation of distinguishable social structure (Turner, 2007), as shown in Fig. 2.1. The analysis of emotions in this book is based on such an understanding. At the micro level, emotion is one of the important forces to promote interpersonal encounters. Turner points out that the universal human needs promote all encounters, including the need for self verification, the need for profitable exchange payoffs, the need for group inclusion, the need for trust and the need for facticity. These universal needs are also called transactional needs. Emotions arise when the transactional

44

2 Literature Review and Theoretical Perspective

Fig. 2.1 Levels of social reality (Turner, 2007)

needs are met, exceeded, or not met. Generally speaking, when people’s needs are not fulfilled, they will experience negative emotions such as anger, fear and sadness, or a mixture of them. On the contrary, when people’s needs are realised, they will experience different degrees of satisfaction, joy and other general positive emotions. Turner believes that the more emotion is aroused, the more obvious the involvement of interpersonal energy in individual behaviour (Turner, 2007; Turner & Stets, 2005). It is these human transactional needs that presuppose a set of expectations for the interactive objects, which are influenced by the meso and macro structures embedded in them. Although the two parties of the interaction can usually form their interactive and unique culture and structure, the meso and macro structure and culture define how to meet the transactional needs when interacting with people. At the meso level, there are two structural types, namely, corporate units regulated by norms, ideology and value through labour, and categoric units distinguished by race, gender, grade and other social categories and carrying cultural evaluation and norms of how people in these categories should act (Turner & Stets, 2005). Turner believes that it is a general rule that the more embedded the two parties of the interaction are embedded in clear corporate and categoric units, the clearer the expectations on how to meet

2.3 Theoretical Perspective

45

the transactional needs, and the clearer the boundary of expectations, the more likely the needs will be realised. These meso-structures are further embedded in organisational systems such as kinship, economy, politics, religion, education, science and medical care, which are restricted by their unique culture, including values, ideology and generalised symbolic media, which are further regulated by the culture of the corporate and categoric units to which both parties belong. Turner argues that emotional changes in interaction must be analysed from a more comprehensive structural and cultural context. At the meso level, the two parties of the interaction are embedded in the corporate unit and social category, and enter into the macro-level organisation field through expansion. When people continue to receive positive rewards and meet the expectations and requirements of rewards and punishments of the meso and macro structures in which they interact, people will have a commitment to others, as well as to the meso and macro social structure and culture. On the contrary, when the individual fails to meet the transactional needs or is punished in the interaction, people will experience the aroused negative emotions, and reduce or cancel the corresponding commitment (Turner & Stets, 2005). If enough people experience the negative emotion, which is affected by the meso-structure, the macro society and culture embedded in it may change. Thus, just like Scheff’s research orientation, Turner tries to establish a sociological theory of emotions, which links the micro, meso and macro fields of social unity. Emotional arousal shapes the ebb and flow of interpersonal interaction and relationship, strengthening people’s commitment to social structure and culture. Meanwhile, the interaction of the two people is restricted by the meso and macro levels as well as these structures and cultures. Moreover, if negative emotions are aroused, these commitments will be weakened even if not broken, and may lead to social changes at the meso and macro levels. Turner introduces the activation of defense mechanisms when individuals awaken negative emotions into the sociological theory of emotions, making an indissoluble bond with psychoanalysis. He believes that when individuals experience pain caused by negative emotions, defense mechanisms will be activated to avoid such painful experiences. And there are two kinds of defense mechanisms. If the individuals’expectation is mildly inconsistent with their response, they can alleviate the pain caused by such inconsistency through selective understanding and explanation, or by arousing the positive memory of the past. Nevertheless, if it can not be solved in this way, a more powerful defense mechanism will be activated (Turner, 2007). According to Turner, inhibition and attribution are the two most important defense mechanisms. Inhibition refers to the exclusion of negative emotions caused by inconsistency from consciousness to reduce the level of emotional energy. But it often leads to another outbreak of emotion in a more intense manner which will lead to a new round of inhibition and the next more intense emotional explosion. In short, inhibiting such cycle will make the individual fall into an emotional dilemma (Turner & Stets, 2005). Attribution is another important defense mechanism, which can be divided into internal and external attribution. Internal attribution has a proximal bias, which tends

46

2 Literature Review and Theoretical Perspective

to attribute individual achievements to their efforts, arousing positive emotions. On the contrary, external attribution has a distal bias, in which individuals will attribute their failure to others, or to the further meso-structure and even the macro social culture, arousing negative emotions and pointing to these meso and macro structures (Turner & Stets, 2005; Turner, 2007). Generally speaking, it is very useful for each researcher engaged in specific research to grasp the work of other researchers in the same field from a strategic perspective, and sometimes it is possible for them to find out how to integrate their theories. Turner notes that most sociological research on emotions is micro and rarely focuses on the power at the meso and macro levels, which determines the distribution of power and status, and controls the vocabulary, ideology and rules used by people in small groups when they meet. Thus, Turner describes himself as an armchair theorist who has been trying to look for a new theory of emotions, a general sociological theory arising from the combination of symbolic interactionism, expectation states theory and psychoanalytic tradition. Yet, he has never collected any materials that can be used to prove his theoretical ideas though most of the existing theories have research materials that can prove their correctness. He always tries to draw the theoretical components for his research from many theoretical studies, and then puts forward relatively comprehensive and dynamic theories by synthesising theories in a formal manner. In other words, Turner is more concerned with the theory itself than its test. This book attempts to follow Turner’s idea of theoretical integration, based on his symbolic interactionism with psychoanalytic components, combined with the perspective of subject construction and the new development of contemporary psychoanalysis, to test and supplement his theory. As Turner points out, it is important to integrate the elements of existing theories into more comprehensive ones. When such theoretical integration is put into practice, it is beneficial to distinguish the work of theoretical researchers and empirical ones (Turner & Stets, 2005). (2)

Definition of Emotional Being and Expression

Previous literature reviews of emotion research show that many research perspectives focus on emotion, and the need of providing the definitions is highlighted: What is emotion? What are the meanings of sentiments, moods, affect, feelings and other related words when we study emotions? (Gordon, 1981; Heise, 1979; Hochschild, 1983). Surprisingly, there are few definitive answers to these questions (Van Brakel, 1994). It can be said that opinion is divided on the understanding of emotion. There may be as many research orientations as there are answers to this question, so it is difficult to summarise a unified concept that covers each other. Here, this book no longer attempts to define emotion, but adopts the method of taxonomy to include emotion based on its components. Firstly, emotion is a kind of motivation power, which makes people have a subjective sense of experience, and gives them strength to guide the direction of action. Collins uses the term emotional energy to discuss how emotions initiate behaviour,

2.3 Theoretical Perspective

47

and divides emotions into positive and negative emotions in terms of effect (Collins, 1990). Secondly, from the perspective of the biological and social nature of emotion, Turner holds that emotion has both universality and cultural differences in expression and understanding. Generally speaking, the four universal emotions, namely, happiness, fear, anger and sadness are considered as the primary emotions (Izard, 1977; Kemper, 1987; Turner, 2000), and each has three levels of intensity, namely, low-intensity, medium-intensity and high-intensity (Turner, 2000). These emotions can be easily identified by facial expressions, or other resources can be used as clues to express and explain primary emotions, such as body posture, voice, etc. (Ekman & Friesen, 1975). In addition to these primary emotions, there are many other emotions called secondary emotions, such as shame, guilt, pride and resentment, which are influenced by cultural norms and a variety of social structures and positions. Secondary emotions are generated from the first and second mixing of primary emotions and are influenced by social culture (Turner, 2000). Thus, this book follows the above-mentioned classification of emotions, and divides emotions into four types: primary positive emotions, primary negative emotions, secondary positive emotions and secondary negative emotions. This term is used to include the phenomena shown by other words used by theorists and researchers such as sentiment, emotion, emotional experience, etc. In view of the fact that the infected people mainly experience a variety of negative emotions and the combined forms of their negative emotions in the course of dying to live, and Heidegger’s recognition of the importance of studying negative emotions on the meaning of life, this book mainly analyses the activation, awakening and expression of primary negative emotions (fear, anger and sadness) and secondary negative emotions (such as guilt, shame and alienation), and attempts to develop its core concepts based on the inference of positive and negative emotions. There has always been a dispute over the composition of emotion between social constructivism and biological essentialism. According to Myers, emotion consists of three parts: physiological arousal, expressive behaviour and conscious experience (Myers, 1986). Physiological arousal is like a racing heart when you’re scared, speeding up the pace of escape is an expressive behaviour, and conscious experience includes the thinking process. Most sociologists believe that emotion is socially and culturally constructed, and people’s feelings result from cultural socialisation and participation in social structure. When cultural ideology, belief, norms and social structure are closely linked, they define what is experienced as emotion and how these emotions defined by culture should be expressed. In this sense, emotions are socially constructed. Gordon points out that the origin of emotion is not biological, but cultural. Social members learn from others vocabulary (linguistic labels), expressive behaviour, autonomous response, and the shared meaning of each emotion associated with different types of interpersonal relationships (Gordon, 1990). Emotions arise from socially relevant interactions where the individual has learned the appropriate emotions and how to use them in different interpersonal relationships (Turner & Stets, 2005).

48

2 Literature Review and Theoretical Perspective

Nevertheless, constructivists ignore the close relationship between emotional activity, experience and expression, and the body (Wentworth & Yardly, 1994). Although emotions are almost always limited and guided by socio-cultural situations, their nature and intensity are affected by biological processes, even if this kind of emotion is activated in the typical socio-cultural situation. Once the body systems of emotions are activated, they are not completely limited and guided by the culture-specific vocabulary and norms. Thus, we must always consider the biology of emotions as a critical element in understanding how they operate. Emotions emerge as the brain activates four body systems: the autonomic nervous system, the neurotransmitter and neuroactive peptide systems, the more inclusive hormonal system, and the musculoskeletal system (LeDoux, 1996; Turner, 2000). Through the above analysis, we find that the views of social constructionists are one-sided because they do not realise that the power of culture and social structure can not completely replace the role of neural allocation on emotion though their argument is not entirely wrong. Similarly, neuroscientists, who fail to understand the forces exerted by socio-cultural choices on human evolution, often fail to explain how different neural module units related to emotional responses are deployed in the brain. In recent years, in their efforts to understand the biology of emotions, many sociologists have recognised the reciprocal relationship between biology and socio-cultural processes (Kemper, 1990; TenHouten, 1999; Turner, 1999, 2000). This book adopts Turner’s classification of emotion from the perspective of sociology. Emotion includes the following components: firstly, it involves the biological activation of key body systems; secondly, it is defined and restricted by the socially constructed culture, which stipulates what emotions should be experienced and expressed in specific situations; thirdly, it involves the application of linguistic labels provided by culture to internal sensations; fourthly, it involves the overt expression of facial expressions, voice, and paralinguistic moves; fifthly, it is the perception and evaluation of situational objects or events (Turner & Stets, 2005). On this basis, the author believes that emotion is a conscious or unconscious expression of the subject’s experience and consciousness. Thus, emotion can be reconstructed by the subject to reflect different forms of existence and expression. Based on the above five points, the author further puts forward the concept of emotional being and expression. In the tradition of western philosophy, “being” has always been regarded as the eternal essence behind the phenomenon, which has nothing to do with time. Taking Descartes’ theory as the mainstream, western philosophy regards man as the subject and nature as the object, measures nature with a dualistic attitude of “subject and object”, and takes manipulating and conquering nature as the highest purpose (Zhao, 2014). Heidegger thinks that this way of thinking has a misunderstanding of “being”: “being” as an observable and eternal existing state, and an objective entity outside the body presented in front of the eyes. Heidegger believes that being is a temporal process, which has a power of control and aggregation. Being, as a verb, symbolises the “will be” (Heidegger, 1977). Heidegger answers the question of being with its “ontology”: To understand the meaning of being, we must start with “man”, a special being. In other words, being must be related to human beings (Zhao, 2014).

2.3 Theoretical Perspective

49

This book is not to explore Heidegger’s philosophical thinking on being and its ontology, but to introduce the concept of “emotional being” to reflect the changes of various emotions in daily life by borrowing the timeliness of being and its correlation with human beings. Firstly, emotions cannot exist out of the biological nature of human beings. Secondly, in interpersonal interaction, the arousal of emotions is more affected by self, others and socio-cultural environment. The aroused emotions can be divided into positive and negative emotions, as well as conscious and unconscious emotions, but these emotions have their specific forms. Finally, the process of emotional change is often temporal, with its past, present and future, as well as the diachronic state of past-present-future. To sum up, this book investigates the emotional being in these three dimensions and puts the reconstruction of the subject in the context of hard-wiring and social culture to arouse all emotional experiences and feelings. Although the word “expression” is not directly used in his discussion, Heidegger reforms the concept of “manifestation” in Husserl’s phenomenology, emphasising its leading position for the subject and ontology. Expression is the manifestation itself, without the subject or the manifestation of anything. It is always the basic feature of the presence, and the being in the expression transcends the opposition between the subject and object. Thus, the emotional expression described in this book refers to the construction, expression and outbreak of emotions by the subject based on emotional being. It should be on a spectrum of dispersion between the two poles of biological essentialism and social constructivism, and should not be the black box. It is a diffuse expression that transcends opposition and is a dynamic manifestation in different relationship states. It is neither the activation of a series of physiological processes, nor the hidden words of cultural sociologists, but a living “reality” of emotional actions. Through a variety of specific self feelings, emotional experience pervades people’s inner body and experience stream. The expression of emotions not only affects the individual, but also causes the individual to act violently when it loses control. In this world, the rules and customs of daily life are broken and set aside. In the emotional world, temper tantrums, violent actions, fainting episodes, weeping, tearful confessions, impassioned statements, rapid-fire escape, excessive profanity, slamming of valuables, and risk-taking behaviour may be forms of emotional expression. It is not entirely rational or deterministic. It is a world filled with a myriad of nuanced things, peculiar symbols, and intrinsic indirect contents. It comes into being in specific social situations and in the process of one person’s emotional attitude towards another. It reflects the expression of emotional energy and the transformation of emotions, thus forming a cycle of arousing, expressing, transforming and re-expressing emotions.

2.3.2 Research Perspective of Subject Construction Pan Suiming and Huang Yingying put forward the perspective of “subject construction” for the first time in 2007. According to them, the subject is often treated only as

50

2 Literature Review and Theoretical Perspective

an object whose complaints and experiences are suppressed for a long time in previous studies. This perspective advocates taking the researcher as the active subject, “taking phenomena as the result of the subject construction, focusing more on the aspects of the subject construction process based on the subject’s feelings and experiences rather than the researcher’s cognition” (2007: 180) and giving prominence to the researcher’s experience and understanding. The introduction of such perspective has realised the shift of concern from the objective reality or socio-cultural construction to the subjective tendency and expression of the subject. The initiative of giving meaning is given to the subjects who are “being expressed”, and they are taken as “subjects” to express their own experience and narration (Bao & Pan, 2015). Nevertheless, subject construction does not only mean the transformation of research perspective, but can be used as a theoretical tool to understand and explain social phenomena. This book applies the perspective of subject construction to the emotional research of PLWHA, which has the following meanings. Firstly, subject construction provides a new research perspective. The study of emotions has long been in the debate between hard-wiring and social construction. The introduction of the perspective of subject construction just moves away from the dilemma of the study of the infected people’s emotions to the active construction and expression of their emotions in the course of the illness narrative. Secondly, the perspective of subject construction provides an understanding and explanatory tool for the emotional being and expression of PLWHA. They can explore the reasons for the negative emotions in the past in their natural state, and attribute and explain those negative emotions that have been suppressed or transformed. The arousal and expression of emotions are different, and the emotions expressed in the same situation vary from person to person. Even though the type of emotions may be identical, their intensity and transformation ways may be different. Thus, subject construction is the re-construction based on hard-wiring and social construction. Finally, subject construction embodies a process of intersubjectivity. From the perspective of psychoanalysis, intersubjectivity focuses on the interaction between the two different constructed subjective worlds (Shane & Shane, 1993). Influenced by this, the positions of the author’s interviews and participant observation remain within the so-called intersubjectivity field. The purpose of using the perspective of subject construction is to focus exclusively on the effect of interaction between the author and PLWHA, in the belief that adopting this perspective can affect their reconstructions of emotions in a decisive way. In other words, in their illness narrative, the representation of emotional being and expression should be understood as a two-person event, i.e., as a result of the interaction between us. Thus, every emotional representation is understood only in a field which is composed of the subjective inner worlds of two interacting individuals, connected by the empathy of intersubjectivity. During the interview, their deepest emotional states and needs can be empathically understood by the author. In turn, the author will encourage them to develop their capacity for self-reflection. In short, the subject construction no longer views the research process as reflecting the subjective meaning in an objective way, but rather acknowledges that the

2.3 Theoretical Perspective

51

researcher’s theoretical background, value presuppositions, and subjective experiences permeate the research, and emphasises that research results are the product of intersubjective construction (Bao & Pan, 2015).

References Adam, B., Maticka-Tyndale, E., & Cohen, J. (2003). Adherence practices among people living with HIV. AIDS Care, 15(2), 263–274. Auerbach, J. D., Wypijewska, C., & Brodie, H. K. (Eds.). (1994). AIDS and behavior: An integrated approach. National Academies Press. Ayala, G., Bingham, T., Kim, J., Wheeler, D., & Millett, G. (2012). Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and Black men who have sex with men. American Journal of Public Health, 102(Suppl. 2), 242–249. Bao, Y., & Pan, S. (2015). Differences-seeking approach in qualitative method and its theoretical foundation. Sociological Review of China, 2, 89–96. Barbalet, J. M. (1998). Emotion, social theory, and social structure: A macrosociological approach. Cambridge University Press. Bensley, L., Eenwky, J., & Simmons, K. (2000). Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking. American Journal of Preventive Medicine, 18(2), 151–158. Berger, J. (1988). Directions in expectation states research. In M. Webster & M. Foschi (Eds.), Status generalization: New theory and research. Stanford University Press. Bolan, G., Ehrhardt, A. A., & Wasserheit, J. N. (1999). Gender perspectives and STDs. In K. K. Holmes, P. F. Sparling, P.-A. Ma˚rdh, S. M. Lemon, W. E. Stamm, et al. (Eds.), Sexually transmitted diseases. McGraw-Hill. Bowser, B. (1989). Crack and AIDS: An ethnographic impression. Journal of the National Medical Association, 81(5), 538–540. Brooks, R., Martin, D., Ortiz, D., & Veniegas, R. (2004). Perceived barriers to employment among persons living with HIV/AIDS. AIDS Care, 16(6), 756–766. Burke, P. J. (1991). Identity processes and social stress. American Sociological Review, 56, 836–849. Burke, P. J., & Stets, J. E. (1999). Trust and commitment through self-verification. Social Psychology Quarterly, 62, 347–366. Cai, W., Feng, T., Tan, J., et al. (2005). A survey of the characteristics and STD/HIV infection of homosexuality in Shenzhen. Modern Preventive Medicine, 32(4), 328–330. Campbell, C. (1999). Women, families and HIV/AIDS: A sociological perspective on the epidemic in America. Cambridge University Press. CDC. (2012). Estimated HIV incidence in the United States, 2007–2010. HIV Surveillance Supplemental Report, 17(4), 1–26. CDC. (2013a). HIV in the United States: At a glance. CDC HIV/AIDS Fact Sheet, Nov., CDC, Atlanta, GA. CDC. (2013b). HIV risk among adult sex workers in the United States. CDC HIV/AIDS Fact Sheet, Sept., CDC, Atlanta, GA. CDC. (2013c). HIV among transgender people. CDC HIV/AIDS Fact Sheet, Nov., CDC, Atlanta, GA. Cheng, B. (2013). The sociological significance of emotion. Shandong Social Sciences, 3, 42–48. Ciambrone, D. (2003). Women’s experiences with HIV/AIDS: Mending fractured selves. Hawthorne. Collins, R. (1975). Conflict sociology: Toward an explanatory science. Academic Press. Collins, R. (1981). Sociology since midcentury: Essays in theory cumulation. Academic Press. Collins, R. (1990). Stratification, emotional energy, and the transient emotions. In T. D. Kemper (Ed.), Research agendas in the sociology of emotions. State University of New York Press.

52

2 Literature Review and Theoretical Perspective

Collins, R. (2004). Interaction ritual chains. Princeton University Press. Cooley, C. H. (1902). Human nature and the social order. Scribner’s. Davies, J. C. (1962). Toward a theory of revolution. American Sociological Review, 27(1), 5–19. Derlega, V., & Barbee, A. P. (1998). HIV social interaction. Sage. Diaz, R., Ayala, G., & Bein, E. (2004). Sexual risk as an outcome of social oppression: Data from a probability sample of Latino gay men in three US cities. Cultural Diversity and Ethnic Minority Psychology, 10(3), 255–267. Du, J., Shen, T., Huang, L., et al. (2012). Study on the case management patient establishment of HIV infected populations in Wuhou District of Chengdu. Modern Preventive Medicine, 39(4), 865–866. Durkheim, E. (1965). The elementary forms of the religious life. Macmillan. Ekman, P., & Friesen, W. V. (1975). Unmasking the face: A guide to recognizing emotions from facial clues. Prentice-Hall. Espinoza, L., Hall, H., Hardnett, F., Selik, R., Ling, Q., et al. (2007). Characteristics of persons with heterosexually acquired HIV infection, United States 1999–2004. American Journal of Public Health, 97(1), 144–149. Ezzy, D., DeVisser, R., & Bartos, M. (1999). Poverty, disease progression and employment among people living with HIV/AIDS in Australia. AIDS Care, 11(4), 405–414. Farmer, P., Connors, M., & Simmons, J. (Eds.). (1996). Women, poverty, and AIDS: Sex, drugs and structural violence. Common Courage Press. Ferrier, S., & Lavis, J. (2003). With health comes work? People living with HIV/AIDS consider returning to work. AIDS Care, 15(3), 423–435. Fontdevila, J. (2009). Framing dilemmas during sex: A micro-sociological approach to HIV risk. Social Theory and Health, 7(3), 241–263. Ghaziani, A. (2004). Anticipatory and actualized identities: A cultural analysis of the transition from AIDS disability to work. The Sociological Quarterly, 45(2), 273–301. Ghaziani, A., & Cook, T. (2005). Reducing HIV infections at circuit parties: From description to explanation and principles of intervention design. Journal of the International Association of Physicians in AIDS Care, 4(2), 32–46. Goffman, E. (1959). The presentation of self in everyday life. Anchor Books. Goffman, E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. Anchor Books. Gordon, S. L. (1981). The sociology of sentiments and emotion. In M. Rosenberg & R. H. Turner (Eds.), Social psychology: Sociological perspectives. Basic Books. Gordon, S. L. (1990). Social structural effects on emotions. In T. D. Kemper (Ed.), Research agendas in the sociology of emotions. State University of New York Press. Guo, J. (2007a). Emotion as ‘subjective social reality’—A new sociological interpretation. Social Science Research, 3, 95–100. Guo, J. (2007b). The developmental path of Western sociological theories of emotions. Society, 27(5), 26–46. Guo, J. (2007c). Three issues of and discussions on the sociology of emotions. Academic Forum, 6, 155–160. Guo, J. (2008). Sociology of emotion: Theory-history-reality. SDX Joint Publishing Company. Guo, J. (2013). A brief study of the sociology of emotional capital. Shandong Social Sciences, 3, 49–54. Gupta, G. (2004). Globalization, women, and the HIV/AIDS epidemic. Peace Review, 16(1), 79–83. Hader, S., Smith, D., Moore, S., & Holmberg, S. (2001). HIV infection in women in the United States: Status at the millennium. JAMA, 285(9), 1186–1192. Hammond, M. (2004). The enhancement imperative and group dynamics in the emergence of religion and ascriptive inequality. In J. H. Turner (Ed.), Theory and research on human emotions. Emerald Group Publishing Limited. Heidegger, M. (1977). On time and being (Joan Stambaugh, Trans.). Harper Torchbooks.

References

53

Heise, D. R. (1979). Understanding events: Affect and the construction of social action. Cambridge University Press. Hochschild, A. R. (1975). The sociology of feeling and emotion: Selected possibilities. Sociological Inquiry, 45, 280–307. Hochschild, A. R. (1979). Emotion work, feeling rules, and social structure. American Journal of Sociology, 85, 551–575. Hochschild, A. R. (1983). The managed heart: Commercialization of human feeling. University of California Press. Homans, G. C. (1961). Social behavior: Its elementary forms. Harcourt, Brace, and World. Homans, G. C. (1974). Social behavior: Its elementary forms (Rev. ed.). Harcourt Brace Jovanovich. Houser, J. A., & Lovaglia, M. J. (2002). Status, emotion, and the development of solidarity in stratified task groups. Advances in Group Processes, 19, 109–137. Izard, C. E. (1977). Human emotions. Plenum Press. Jia, C. (2000). History of foreign sociology (Rev). China Renmin University Press. Jing, J. (2006). Titanic’s Law: An analysis of AIDS risk in China. Sociological Research, 5, 123–150. Kemper, T. D. (1978). A social interactional theory of emotions. Wiley. Kemper, T. D. (1981). Social constructionist and positivist approaches to the sociology of emotions. American Journal of Sociology, 87(2), 336–362. Kemper, T. D. (1987). How many emotions are there? Wedding the social and the autonomic components. American Journal of Sociology, 93, 263–289. Kemper, T. D. (1989). Romantic love and like and romantic love and love. In D. D. Franks & E. D. McCarthy (Eds.), The sociology of emotions: Original essays and research papers. JAI Press. Kemper, T. D. (1990). Social structure and testosterone: Explorations of the socio-bio-social chain. Rutgers University Press. Kipnis, A. (1997). Producing guanxi: Sentiment, self and subculture in a north China village. Duke University Press. Lawler, E. J., & Yoon, J. (1993). Power and the emergence of commitment behavior in negotiated exchange. American Sociological Review, 58, 465–481. Lawler, E. J., & Yoon, J. (1996). Commitment in exchange relations: Test of a theory of relational cohesion. American Sociological Review, 61(1), 89–108. Lawler, E. J., & Yoon, J. (1998). Network structure and emotion in exchange relations. American Sociological Review, 63(6), 871–894. Lawler, E. J. (2001). An affect theory of social exchange. The American Journal of Sociology, 107(2), 321–352. LeDoux, J. E. (1996). The emotional brain: The mysterious underpinnings of emotional life. Simon & Schuster. Levine, M. (1989). The motives of gay men for taking or not taking the HIV antibody test. Social Problems, 36(4), 368–383. Li, N. (2010). The success and bottleneck of NGOs in Chinese HIV/AIDS prevention and control. Chinese Medical Ethics, 23(3), 123–125. Liu, L., Liang, Y., & Zhou, Z. (2010). Explore on the model of HIV/AIDS comprehensive intervention among the female sex workers carried out by NGO. Preventive Medicine Tribune, 16(7), 577–579. Luhmann, N. (1995). Social systems (John Bednarz, Jr. & Dirk Baecker, Trans.). Stanford University Press. Ma, D., & Zhang, B. (2013). A case of methamphetamine-induced mental disorder combined with AIDS. Medical Journal of Chinese People’s Health, 25(2), 92–93. Markovsky, B. N., & Lawler, E. J. (1994). A new theory of group solidarity. Advances in Group Processes, 19, 109–137. Marmor, M., Des Jarlais, D. C., Friedman, S. R., Lyden, M., & el-Sadr, W. (1984). The epidemic of acquired immunodeficiency syndrome (AIDS) and suggestions for its control in drug abusers. Journal of Substance Abuse Treatment, 1(4), 237–247. Marx, K. (1885). Capital (S. Moore & E. Aveling, Trans.). International Publishers.

54

2 Literature Review and Theoretical Perspective

Maryanski, A. (1986). African ape social structure: A comparative analysis. University of California, Irvine. Maryanski, A. (1987). African ape social structure: Is there strength in weak ties? Social Networks, 9, 191–215. Maryanski, A., & Turner, J. (1992). The social cage: Human nature and the origins of society. Stanford University Press. Massagli, M., Weissman, J., Seage, G., & Epstein, A. (1994). Correlates of employment after AIDS diagnosis in the Boston Health Study. American Journal of Public Health, 84(12), 1976–1981. McMahon, J., Tortu, S., Pouget, E., Hamid, R., & Neaigus, A. (2006). Contextual determinants of condom use among female sex exchangers in East Harlem, NYC: An event analysis. AIDS and Behavior, 10(6), 731–741. Mead, G. H. (1934). Mind, self and society. University of Chicago Press. Mizuno, Y., Borkowf, C., Millett, G., Bingham, T., Ayala, G., & Stueve, A. (2012). Homophobia and racism experienced by Latino men who have sex with men in the United States: Correlates of exposure and associations with HIV risk behaviors. AIDS and Behavior, 16(3), 724–735. Mojola, S. (2011). Fishing in dangerous waters: Ecology, gender and economy in HIV risk. Social Science & Medicine, 72(2), 149–156. Mojola, S., & Everett, B. (2012). STD and HIV risk factors among US young adults: Variations by gender, race, ethnicity and sexual orientation. Perspectives on Sexual and Reproductive Health, 44(2), 125–133. Molm, L. D. (1997). Coercive power in social exchange. Cambridge University Press. Myers, D. G. (1986). Social psychology. McGraw-Hill Companies. Nicolosi, A., Leite, M. L. C., Musicco, M., Arici, C., Gavazzeni, G., & Lazzarin, A. (1994). The efficiency of male-to female and female-to-male sexual transmission of the human immunodeficiency virus: A study of 730 stable couples. Epidemiology, 5(6), 570–575. Nixon, S., & Renwick, R. (2003). Experiences of contemplating returning to work for people living with HIV/AIDS. Qualitative Health Research, 13(9), 1272–1290. Pan, S. (2001). New problems for sociology from AIDS research. Sociological Study, 2001(4), 39–43. Pan, S., & Huang, Y. (2007). “Subjective construction”: Methodological revolution in sexuality research and potential development in Chinese context. Sociological Study, 3, 174–193. Pan, S., Huang, Y., & Li, M. (2006). The “problems” of AIDS in China. Social Sciences in China, 1, 85–95. Pan, Z. (2005). Emotion sociology: A sociological perspective to study. Journal of Social Science of Human Normal University, 34(4), 52–56. Pareto, V. (1963). The mind and society: A treatise on general sociology. Dover Publications. Parsons, T. (1966). Structure of social action: A study in social theory with special reference to a group of recent European writers. Free Press. Potter, J., & Wetherell, M. (1987). Discourse and social psychology: Beyond attitudes and behaviour. Sage. Ren, X., Jiang, Y., Shao, A., et al. (2005). An assessment of information need and supply for multisectoral response in HIV/AIDS prevention and control. Modern Preventive Medicine, 32(9), 1224–1227. Rhodes, T., Singer, M., Bourgois, P., Friedman, S., & Strathdee, S. (2005). The social structural production of HIV risk among injecting drug users. Social Science and Medicine, 61(5), 1026– 1044. Ridgeway, C. L., & Johnson, C. (1990). What is the relationship between socioemotional behavior and status in task groups? American Journal of Sociology, 95, 1189–1212. Scheff, T. J. (1979). Catharsis in healing, ritual and drama. University of California Press. Scheff, T. J. (1988). Shame and conformity: The deference-emotion system. American Sociological Review, 53(3), 395–406. Schneider, B. (1988). Gender, sexuality and AIDS: Social responses and consequences. In R. A. Berk (Ed.), The social impact of AIDS in the US. ABT Press.

References

55

Shane, M., & Shane, E. (1993). Self psychology after Kohut: One theory or many. Journal of the American Psychoanalytic Association, 41, 777–797. Shao, C., & Cao, N. (2005). Male to male sexual contact and sexually transmitted diseases. Chinese Journal of Dermatology, 38(5), 259–261. Shott, S. (1979). Emotion and social life: A symbolic interactionist analysis. American Journal of Sociology, 84, 1317–1334. Simmel, G. (1990). The philosophy of money (T. Botomore & D. Frisby, Trans.). Routledge. Sobo, E. (1995). Choosing unsafe sex: AIDS-risk denial among disadvantaged women. University of Pennsylvania Press. Song, H. (2014). A review of Western research on the anthropology of emotion. Social Sciences Abroad, 4, 118–125. Stanley, L. (1999). Transforming AIDS: The moral management of stigmatized identity. Anthropology & Medicine, 6(1), 103–120. Stryker, S. (2004). Integrating emotion into identity theory. In J. H. Turner (Ed.), Theory and research on human emotions. Emerald Group Publishing Limited. Swidler, A., & Watkins, S. C. (2007). Ties of dependence: AIDS and transactional sex in rural Malawi. Studies in Family Planning, 38, 147–162. TenHouten, W. D. (1999). Explorations in neurosociological theory: From the spectrum of affect in time consciousness. In D. D. Franks & T. S. Smith (Eds.), Mind, brain, and society: Toward a neurosociology of emotion. JAI Press. Thamm, R. (2004). Towards a universal power and status theory of emotion. In J. H. Turner (Ed.) Advances in group processes. Emerald Group Publishing Limited. Timmons, J. C., & Fesko, S. L. (2004). The impact, meaning, and challenges of work: Perspectives of individuals with HIV/AIDS. Health and Social Work, 29(2), 137–144. Tönnies, F. (1957). Community and society (Charles P. Loomis, Trans.). Michigan State University Press. Treichler, P. (1999). How to have theory in an epidemic: Cultural chronicles of AIDS. Duke University Press. Turner, J. H. (1999). The neurology of emotion: Implications for sociological theories of interpersonal behavior. In D. D. Franks & T. S. Smith (Eds.), Mind, brain, and society: Toward a neurosociology of emotion. JAI Press. Turner, J. H. (2000). On the origins of human emotions: A sociological inquiry into the evolution of human affect. Stanford University Press. Turner, J. H. (2002). Face-to-face: Toward a sociological theory of interpersonal behavior. Stanford University Press. Turner, J. H. (2007). Human emotions: A sociological theory. Routledge. Turner, J. H., & Stets, J. E. (2005). The sociology of emotions. Cambridge University Press. Van Brakel, J. (1994). Emotions: A cross-cultural perspective on forms of life. In D. D. Franks, W. M. Wentworth, & J. Ryan (Eds.), Social perspectives on emotion. JAI Press. Wang, D., Ye, H., & Ye, H. (2007). A survey and analysis of blood safety and HIV issues. Journal of Clinical Hematology (Blood Transfusion & Laboratory Medicine Edition), 4(5), 230–234. Wang, M., & Liu, Q. (2006). Development of NGOs in the field of HIV prevention and treatment and related policy recommendations. Jiangsu Social Sciences, 4, 130–134. Wang, N. (2000). On the social approach to emotion—Research notes on emotional sociology. Sociological Study, 4, 122–125. Wang, P. (2013). The social stratification model of emotional sociology. Shandong Social Sciences, 3, 55–59. Wang, P. (2014). Social order and social control based on a sociological perspective of emotions. Tianjin Social Sciences, 2, 75–79. Wang, R., Dong, L., Li, H., et al. (2013). Analysis on Xi’an NGOs’ participation in AIDS prevention and control. Chinese Journal of AIDS & STD, 19(11), 828–831. Watkins-Hayes, C. (2014). Intersectionality and the sociology of HIV/AIDS: Past, present, and future research directions. Annual Review of Sociology, 40, 431–457.

56

2 Literature Review and Theoretical Perspective

Weber, M. (2010). Basic concepts of sociology (C. Hang, Trans.). Beijing Publishing House. Weng, N. (2001). Socio-cultural constructs of AIDS. The First Chinese Conference on AIDS and STD Prevention and Control. Weng, N. (2003). Socio-cultural dynamics of AIDS transmission. Sociological Studies, 5, 84–94. Weng, N., Du, J., Jin, L., & Hou, H. (2004). The flow of the heroin, sex, and blood and its products and the transmission of the venereal diseases and AIDS. Ethno-National Studies, 6, 40–49. Wentworth, W. M., & Yardly, D. (1994). Deep sociality: A bioevolutionary perspective on the sociology of human emotions. In D. D. Franks, W. M. Wentworth, & J. Ryan (Eds.), Social perspectives on emotion. JAI Press. Weitz, R. (1987). The interview as legacy: A social scientist confronts AIDS. Hastings Center Report, 17(3), 21–23. Weitz, R. (1991). Life with AIDS. Rutgers University Press. Wu, J., Yang, Y., Li, W., et al. (2004). Psychological needs of patients with HIV/AIDS. Chinese Journal of Public Health, 20(7), 883–884. Wu, Y., Zhang, F., & Shan, L. (2002). Care and psychological support: An important link in the prevention and control of HIV in China. Chinese Journal of AIDS & STD, 4, 244–246. Wyatt, G., Myers, H., Williams, J., Kitchen, C., Loeb, T., et al. (2002). Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. American Journal of Public Health, 92(4), 660–665. Xia, G., & Yang, X. (2006). Social gender, population mobility and HIV risk. Social Sciences in China, 6, 88–99. Yan, Y. (2003). Private life under socialism: Love, intimacy, and family change in a Chinese village, 1949–1999. Stanford University Press. Yang, M. M. (1994). Gifts, favors, and banquets: The art of social relationships in China. Cornell University Press. Yelin, E., Greenblatt, R., Hollander, H., & McMaster, J. (1991). The impact of HIV-related illness on employment. American Journal of Public Health, 81(1), 79–84. Yu, X. (2000). HIV/AIDS-related mental health issues. Chinese Mental Health Journal, 14(4), 247–250. Zhang, H. (2013). Predicament and prospects of the research on anthropology of emotion. Journal of Guangxi University for Nationalities (Philosophy and Social Science Edition), 35(6), 60–65. Zhang, K., & Zhu, Z. (2005). Integrating gender perspective into the HIV/AIDS project. Collection of Women’s Studies, 6, 30–33. Zhang, N., & Wu, M. (2012). The involvement of NGOs in the prevention and treatment of AIDS: The case of Gansu Province. China Social Organization, 6, 19–23. Zhang, Y. (2005). HIV/AIDS prevention among Chinese minorities. Journal of Guangxi University for Nationalities (Philosophy and Social Science Edition), 27(2), 32–37+52. Zhao, D. (2014). A brief history of modern western philosophy (2nd edn). Peking University Press.

Chapter 3

Acquired “Needs Deficiency” Syndrome

The notion of universal human need-states does not enjoy great popularity in sociology. Yet, a quick review of existing sociological theories documents that most posit need-states that motivate individuals to behave in certain ways (Turner, 2007a). For symbolic interactionists, it is the need to verify self; for exchange theorists, it is the need to derive profits in exchange payoffs; for expectation-state theorists, it is the need to meet expectations; for ritual theorists, it is the need to derive positive emotional energy; for ethno-methodologists, it is the need to sustain a sense of a common reality; and so it goes for virtually all micro-level theories. The same can be said for more macro-level theories. For instance, Émile Durkheim (1951) posited a human need to feel integrated in the group and to be regulated by cultural norms in order to avoid the pain, respectively, of egoism and anomie; Marx argued that humans have a need to avoid alienation and determine what they produce, how they produce it, and to whom they distribute the results of their labour; and, more recently, Niklas Luhmann (1988) implies a psychological need to reduce complexity, while Anthony Giddens (1984) argues for a need to achieve ontological security. Thus, we do not have to look very hard to see that sociologists theorise need-states for humans and, to some degree, these needs motivate individuals to behave in certain ways and, thereby, channel energies in face-to-face interaction. In turn, this channeling of interpersonal energies can have effects on the formation of culture and social structures, and vice versa. Human needs are prevalent in all micro interactions, and forces such as “needstates” often influence the being and expression of emotions. When needs are realised, people experience variants of satisfaction-happiness; whereas when they are not met, they will experience negative emotions of potentially many varieties—primary and secondary. Based on the previous studies, Turner proposes five universal human needs: (1) needs for self-verification, (2) needs for profitable exchange payoffs, (3) needs for group inclusion, (4) needs for trust, and (5) needs for facticity. He calls these universal needs transactional needs because each and every time individuals interact in face-to-face encounters, these need-states are activated and direct the © Huazhong University of Science and Technology Press 2021 R. Hou, A Sociological Study on Emotion Regulation in People Living with HIV/AIDS in China, A Sociological View of AIDS, https://doi.org/10.1007/978-981-16-1494-1_3

57

58

3 Acquired “Needs Deficiency” Syndrome

flow of interaction (Turner, 2007a). When these needs are consummated, positive emotions are aroused; and, conversely, when they are not realised, negative emotions are aroused. In Turner’s view, universal human needs drive all interactions. If the five needs are ranked according to their power levels, the first one is the most powerful force on the interpersonal behaviour, and the influence of other needs gradually decreases according to their levels (Turner, 2002, 2007a; Turner & Boyns, 2001). As a unique vulnerable group in society, AIDS people face many difficulties and challenges in their survival and life. Compared with the general public or other groups, their transactional needs are often more urgent, and too difficult to be understood and met. Due to the invasion of HIV, they are given such a different identity or label as “AIDS population”, with the result that they are stigmatised by their own behaviour, and considered as the source of HIV infection. Every infected person hopes to engage in effective interpersonal encounters, which can meet the universal transactional needs to re-recognise self, and obtain a realisable future. Nevertheless, once the identity of the infected people is made public, they are often faced with the “fear and distance” of society at large. What’s more, they will be caught in an embarrassing situation where only the HIV virus accompanies them, so it is difficult to realise their interpersonal encounters at the micro level. With the spread of the news of being infected in human interaction (rather than the spread of HIV itself), their interpersonal relationships gradually break down. There is a general lack of trust in them, not only in the scientific evidence that daily contact does not lead to HIV infection, which results in a lack of institutional trust, but in the interpersonal trust to interact with each other and to meet their needs. As a result, they have to wear masks to live, and dare not interact in their real identities or can not gain sympathy and love from the public as patients or vulnerable groups. They not only suffer from acquired immunodeficiency syndrome in the biomedical field, but from acquired “needs deficiency” syndrome in interpersonal encounters at the micro level. Inspired by acquired immunodeficiency syndrome, the author puts forward the acquired “needs deficiency” syndrome to show that the transactional needs of infected people in encounters are generally not satisfied. In this chapter, the author attempts to adopt Turner’s classification of five basic needs of encounters to analyse the satisfaction of transactional needs and the change process of emotional being among infected people, and explore the arousal process of emotions herein.

3.1 Deficiency in the Need of Self-Verification The psychologist James was the first to put forward the concept of “self”. Later, the “looking glass” put forward by Cooley and the self theory by Mead successively introduced self into the sociological research. Ralph Turner and others demonstrate the tradition that argues for the central place of self in human affairs, and this tradition has been further developed by the symbolic interactionists (McCall & Simmons, 1978; Stryker, 1980) and by dramaturgical approaches to interaction (Goffman, 1959).

3.1 Deficiency in the Need of Self-Verification

59

On this basis, Turner further believes that self is both a set of cognitions and emotional valences about a person that is mobilised in face-to-face interaction; and because interaction is so mediated by the give and take of gestures, it involves a considerable amount of negotiation. During these negotiations, individuals mutually communicate not only who they are but their willingness to accept the selfpresentations of others. With a sense of self on the line during interaction, the emotional states are dramatically raised because individuals want to have their views of themselves verified. Indeed, interaction is dominated by the reciprocal presentation of self and the willingness of audiences to verify this self. Humans carry cognitions about themselves that are emotionally valenced; and because these cognitions are emotionally charged, they are more salient and more likely to elicit further emotional responses during the course of interaction (Turner, 2007a). Thus, in most interpersonal interactions, people present differentiated selves, and their emotional responses change depending on the self presented. After summarising the extensive research literature on the self conducted by symbolic interactionists, particularly theoretical and empirical studies by McCall and Simmons (1978), Stryker (1980), and psychological studies related to the self (Higgins 1987, 1989), Turner proposes three levels of self, namely, core selfconception, sub-identities and role-identities (Turner, 2007a), as shown in Fig. 3.1. In general, core self-conception generates the highest emotional responses, especially when the individual demonstrates a failure of self-presentation. The other end of the spectrum of self-presentation is role-identities, which generate the lowest intensity of emotional response, while sub-identities generate a stronger emotional response than role-identities and a weaker emotional response than core self-conception, falling somewhere in between. In real life, the infected people undergo enormous changes in interpersonal interactions, and experience emotional ups and downs. Especially after being diagnosed with HIV, they often experience a feeling of “I’m going to fall apart”. From the Fig. 3.1 Levels of self (Turner, 2007a)

60

3 Acquired “Needs Deficiency” Syndrome

perspective of self psychology, their selves may be at risk of disintegration (Hou, 2015), which indicates a stronger need to verify self. Through interactions with others, they attempt to gradually achieve self-identity, i.e. a process of knowing “who I am and what kind of person I am”. The pattern of interpersonal interaction changes dramatically before and after infection, and the perception of self changes as well, because of their ambivalence and fear of self-perception, and the ‘stigma’ of AIDS. This can lead to the internalisation of stigma and fear, either actively or passively, and the belief that “I am such a person with AIDS”, thus evoking stronger negative emotions such as fear, sadness and guilt, as well as a cocktail of negative emotions.

3.1.1 The Disintegration of Core Self Core self-conception, as the most important in the need to verify self, refers to the core experience of ‘who I am’ in all situations and what others perceive as ‘his or her self’. This core self is typically the basis for thought and reflection about self outside of encounters. Each person with HIV has a different “initial experience of HIV”. Before they are diagnosed with HIV, they have their own experiences and perceptions of self. But the moment they are diagnosed with the infection, an additional label of HIV infection or AIDS patients is added to their identity. Meanwhile, their previous sense of “who I am” is quickly deconstructed, resulting in a sense of self-denial and despair that “I’m just a rotten person”. You know, from childhood to adulthood, I have always been very outstanding in everyone’s eyes. My parents are senior intellectuals, and I have always been a celebrity in the eyes of everyone around me. They are proud of me. Before I was diagnosed with HIV, I spent almost half of the year flying around all over the world. At that time, taking airplanes was still very expensive, and most people couldn’t afford that. When I was in hospital, nurses came to see me and told me that they love me although I am gay. But, all of a sudden, I felt like the sky is falling. I don’t think I will get infected. At that time, I was lonely, very sick. I know I am finished. I am a rotten person, and there is no hope of life. I send a message to one of my friends and say, “I’m gay, I have AIDS, and I’m dying.” (DCYJ18) The infection was detected during a blood draw in the hospital. At first, the diagnosis was not confirmed and the doctor said that it would take a week for the results to come out. It was the most difficult seven days in my life. I kept praying to get through this difficult time. I vowed that as long as this time was safe and sound, I would clean up my act. But on the third day, I couldn’t help going to the hospital. The doctor just said that the result had not come out. Later, I went to a temple by myself. I bought a bundle of incense, went to the Bodhisattva, knelt for over an hour, and left until the temple was about to close. Later, I was still tested positive. At that time, my mind was blank. I was sitting on the bench outside the doctor’s office. I was in a trance and my legs were weak. There was only one thought in my mind: I’m dying. I’ll rot to death and die a horrible death. (DCYJ19) I actually knew I was finished when they came to do the screening because so many people had already died of it. The diagnosis wasn’t confirmed at that time and we didn’t talk anything about it. Then the results showed that my husband and I were tested positive, and my husband died shortly after that. I knew that was it and I had nothing to look forward to. I used to think about earning money or something, but now I know that even if I earn much money, I won’t

3.1 Deficiency in the Need of Self-Verification

61

survive to spend it, so I’m resigned to my fate. If there was some merit in selling blood to pay the fines for extra children, then getting this would be the biggest sin of all. (DCYJ20)

The destruction of immune function of the infected people by the HIV virus will be likely to cause skin inflammation and ulceration, and some diseases that are not likely suffered by ordinary people. These diseases are collectively referred to as opportunistic infections. These diseases, combined with media coverage of “AIDS patients”, have formed the stereotype that “I’ll rot to death and die a horrible death”. In addition, due to the social stigma and moral criticism of AIDS people, such as “getting this is the biggest sin of all”, they suffer an instant blow, destruction and mental collapse after the confirmed diagnosis, thus awakening negative emotions such as fear and sadness. In addition, this core self is built up through role-taking with others and seeing their responses to self presentations in what Cooley termed “the looking glass” provided by others’ gestures. As individuals gaze into the looking glass, they also derive self-feelings; and for Cooley the central feelings were pride and shame. That is, individuals are always in a state of low-level pride or shame as they record others’ responses to self and generate self-evaluations. When people are recognised and admired by others, they will feel proud of themselves; on the contrary, when denied and questioned by others, they will feel slightly shameful. However, Turner argues that when people evaluate themselves through role-taking, their emotional responses are not limited to pride and shame, but are a combination of multiple primary negative emotional states (Turner, 2007a). When I was healthy, I preferred to work because I’d like to show my worth. You know, I’ve studied at school for so long. In other words, if I don’t go to work and stay at home every day, I felt like I am wasting time, so why live? I might as well not take my medication and die before it’s too late. My mother also told me this, but she said that since this was the case, it didn’t matter anymore, so I should do what I could. (DCYJ01) In fact, when you say you are infected with HIV, people are eight feet away from you immediately, as if we are covered all over with viruses. One time I went to the epidemic prevention station to get a diagnosis report, which required my signature, but I didn’t have a pen, so I had to borrow the female doctor’s. After I signed the report, the doctor wrapped the pen in a piece of white paper and threw it in the dustbin, right in front of me. I didn’t say anything, because I had this disease. People discriminate against us so much that in the end, even we can’t look up to ourselves anymore. Sometimes I think how nice it would be to be a normal person. (DCYJ02)

Generally speaking, over time a more stable, trans-situational self emerges by adulthood and becomes the principle gyroscope directing an individual’s behaviours. The core self is thus relatively stable, and it represents the basic collage of feelings that persons have about who and what they are, and what they deserve from others in encounters. As the arrows in Fig. 3.1 denoting emotional intensity and cognitive awareness emphasise, the core self is the most emotionally valenced aspect of self, and yet, people often have difficulty putting into words just what this core self entails. However, when they are informed that they are tested positive, many infected people

62

3 Acquired “Needs Deficiency” Syndrome

experience negative emotions such as fear and shame, and experience belittlement, fear and stigma from those around them, causing their relatively stable selves to disintegrate and their core selves to experience the intense emotions of shame and denial that shocks their core selves.

3.1.2 Disability of Sub-Identities The second level of self is what Turner terms sub-identities (Turner, 2002). These are emotionally valenced conceptions that individuals have about themselves in institutional domains and stratification systems. For example, a person will have a sense of themselves as a father, husband, son, consumer, business manager; and each person will attach evaluations to conceptions of themselves in the macro-structural domains and class positions that are salient to them. A person might see self as a negligent father but a dedicated manager who brings home resources that assure high rank in the stratification system. Each of these emotionally valenced cognitions— father, manager, place in class systems—constitutes a sub-identity, and together they lead individuals to see and evaluate themselves as a particular kind of person. Individuals have a much clearer conception of their sub-identities than their core selfconceptions; and, indeed, if we ask an individual about how they see themselves as husbands and fathers, we can usually get more precise information than if we ask them about what kind of person they are in general. However, this clear and precise sub-identity is complicated and blurred due to the infection, with the result that AIDS becomes not just a disease, but a stigmatising symbol, representing labels such as homosexuality, drug addiction, promiscuity and the source of HIV infection. In society, there is a deep-seated social discrimination and fear that “you may be infected with AIDS at a glance of AIDS patients”. Because of this, it is no longer possible for many infected people to maintain their subidentities, and such identities become blurred with the rupture of the surrounding relationship, which arouses negative emotions such as sadness, anger and regret. I regretted telling them about the infection, but it was so hard to keep it to myself that I told my family, hoping they would understand. But my elder sister, who was pregnant, ran away before she could finish her meal, and wouldn’t let me go home for fear of contagion, and even for fear of infecting the baby in her belly. Although my mother didn’t say anything, I often saw her weeping all alone in tears, so I simply didn’t go back to live there, and pretended that my mother never had me. I can’t even provide for her old age, so I can’t add to her burden. (DCYJ03) My husband died of this disease and I was infected. We came from a small town, so everyone soon learned about our situation and began to alienate us. Not long after my husband’s death, my daughter was about to start school. But to my surprise, the parents of my daughter’s classmates went to the school and the local education bureau to jointly claim that they would not let my daughter go to school with their children. The school then made a separate class for my daughter who was only in Grade 2 in a primary school, and designed a separate class for her, which was called Class 2-4. In other words, she was the only student in this class and there was only one teacher. It was actually a difficult time for her. After a month of study at school, she didn’t want to go to school and said, “Mum, they all said, why is this little

3.1 Deficiency in the Need of Self-Verification

63

kid so strange?” And she was not allowed to eat at school. There was no other way, so my parents took her to another place to study. That’s really all there was to it. I just did not go to work and stayed at home alone. It was a difficult time because my husband died suddenly, my daughter was taken away and I lost my job. Even if I lost my job, I was enough mature to cope with this. My poor child should be protected. She was so young and didn’t understand what was going on, so my parents took her away. People looked at her and said: Why does your daughter look like a little mouse? She has small eyes and is very timid, not daring to speak or do anything, and she seems to be so when she goes outside. The teacher also said that she doesn’t talk or communicate with others. I’m not a good mother or daughter. (DCYJ04)

The interviewee labelled DCYJ04 is one of the few women I have come into contact with. She is working for an ASO, and I have the impression that she speaks and acts with great courage. When talking about the work of the ASOs, undoubtedly, she is an excellent staff member. Yet, when talking about her own family members or children, she sheds tears several times in silence. I could deeply feel her sadness and helplessness, and even a sense of failure. She feels sorry for her daughter for not having done her duty as a mother, and even for her parents, who have to go through hardships and leave their own homes for this. The desire to be a good mother, daughter, wife and other sub-identities is thus dashed, and the negative emotions such as remorse and sadness are aroused. The infected people have anxiety and fear of AIDS, a complex and potentially communicable disease that affects their own immune system. They actively or passively cut off the possibility of assuming other sub-identities in order to protect themselves and others. Although taking medicine can inhibit the HIV virus, you should always mind your health. You can’t be too tired. There are something that you can’t eat when taking medicine. At the beginning, I still insisted on going to work. But later, when everyone said, “let’s have a meal and sing a song together”, I was worried about my health and didn’t dare to go. But it’s not a solution to always put off things. I often have to stay up late to work unbearably, so I quit my job. Of course, they don’t know about my infection. I have been idle at home and always felt particularly useless. (DCYJ21) I feel very sorry for my child, and I am most worried about infecting him. He has been with his grandparents since four years old. For over ten years, I usually send some money back, and can see him only several times a year. Every time I go back, I am furtive, not daring to let the villagers know. It is only during winter or summer vacations that I can take him over and live for a few days. He has been with his grandparents for long, and does not like to come with me. (DCYJ20) I was just diagnosed with HIV less than a month ago. I haven’t told them yet. I don’t know what to do, and my husband hasn’t been checked yet. Since I was tested positive, I’ve been up almost all night, not knowing how to tell my family, not knowing if this would be contagious. The other day my daughter came back from holiday and said she wanted to hug me, but I pushed her away, which scared her. Then I had to say that I had back pain and didn’t dare to hold her. Maybe I’m not a good mother or wife, who knows? (DCYJ05)

Generally speaking, compared with core self-perceptions, individuals focus more on sub-identity, which is the most actively expressed identity in the self-concept and a successful embodiment of ‘who I am’ and ‘the individual’s sense of self’. This leads to an increase in the emotional responses that accompany sub-identities embedded in the more general self-concept. Conversely, the sub-identity is not well

64

3 Acquired “Needs Deficiency” Syndrome

evidenced or becomes blurred, as in the case of the infected people, when the fear, grief and self-denial caused by the infection and the exaggerated infectivity, lethality and immorality make the public deny their identity and role, break the various relationships and emotional connections around them, and affect their sub-identities. This not only strains their family relationships, deprives them of work opportunities, conditions and capacities, but leads to self denial and blame, resulting in a sense of incompetence and uselessness, making them unsure of what kind of “self” they should be in the family, work and society, and unable to give themselves positive identities. As a result, the individual’s self-perception is badly hit, leading to self-denial and shame, and a sense of confusion and disorientation.

3.1.3 Stigma of Role-Identity A role-identity is the conception that a person has of self in a specific role within a particular social structural context (Turner, 2002). To some degree, role-identities fade into sub-identities, but role-identities are more situational: What kind of teacher am I in the school? What kind of husband am I at home? What kind of father am I when taking care of children? Indeed, in almost all sets of iterated encounters, individuals develop relatively clear cognitions and evaluations of themselves in specific roles. Goffman puts forward the concept of “spoiled identity” in his research on “stigmatisation” (Goffman, 1963). He defines stigma as a certain ‘humiliating’ characteristic that individuals have in their interpersonal relationships, which gives their possessors “spoiled identities”, and thus severely degrades them. As for the infected people, when their sub-identities become blurred, they expect to maintain their old relationships while trying to develop new sub-identities based on the need to interact. Nevertheless, the stigmatisation among the public makes it extremely difficult for them to maintain and establish the identities, and the existence of a relatively homogenous role-identity, especially when their identities are exposed, this spoiled or stigmatised identity will become their main or even single identity. I will choose to die alone, say, in a mountain. My family members do not know that I have this. I can not tell them, otherwise they will be sad. Some time ago when I was hospitalised, my parents who knew about it insisted on seeing me, and I told them I was infected with tuberculosis, and was being isolated so as not to let them come. In fact, it’s good to be alone, because at least you don’t have to worry about being exposed all day long, or to be suspicious of the slightest hint of suspicion from others. (DCYJ06) But you can’t hide it from the people around you. And, slowly, it gets out. Yet the disease is a touchstone. I used to have a lot of people very close to me, including some of my relatives and friends, but now they have started to distance themselves from me. Every time when I eat with my family, I use disposable bowls and chopsticks. Later, I simply do not go with them because I feel uncomfortable. (DCYJ07) My parents live in a flat, and all of a sudden the news gets out. It blows up, and everyone knows about it. Many people would point the finger at my parents, and I had a fight with them because of it, but I think, if possible, I will defend myself, and if not, it doesn’t matter. I don’t force it because I don’t need to associate with them anymore. (DCYJ18)

3.1 Deficiency in the Need of Self-Verification

65

Up to now, I have blocked almost all my former colleagues and classmates in the communication channels including my mobile phone number, Tencent QQ number and WeChat number. Instead, I am contacting the infected people that I know, and people from the official organisations, the government, or the hospital. Though many intimate friends of mine are inquiring about my location, I don’t want to contact them much because I think there is too much inconvenience for me to do this job. (DCYJ08)

Some sub-identities and role-identities will activate stronger emotional responses when they are very important to the individuals. For example, if a person considers himself or herself to be just an ordinary worker, and there is no strong emotion attached between the worker identity and the view of self, the emotional response generated by proving or not proving the self is relatively low. But, if the person thinks very highly of the role of a father, the emotional response generated will be very strong when such role is not proven. For the infected people, it is precisely their identity that really allows them to present and prove themselves. Now I can’t go back home and I’ve lost my job, so I guess this (the ASO) is a home for us. I don’t have any contact with my old friends and most of the people I know here are infected with HIV. We can not share some of our inner words with others elsewhere, but here we can get together to talk at will. I share a house with someone else outside here, but of course, he doesn’t know what I do. In fact, we all wrap ourselves up very tightly. For example, we take our medication with us in a special bottle. The rest of the packaging was thrown away long ago. This cannot be noticed by others. Slowly, we develop a kind of self-protection. Your life is over once people know about it. So, except here, I won’t admit my identity elsewhere, including the hospital. Of course, there are records of drug administration there. (DCYJ09)

In general, if a person considers a specific role of his own to be important in proving his identity and self, people implicitly decide which level of self-conception or sub-identity is manifested in the specific role during encounters, and the emotional overtones carried will increase when the individual presents this role-identity to others. The infected people’s expectations of role-identity cannot be justified. On the contrary, their stigmatised identity, which they least want to be verified, is always mentioned, and develops into their only role-identity in any situation, which hinders the satisfaction of their needs for encounters and causes them to experience strong negative emotions such as anger and shame. The salience of the self at these three levels can vary across interaction events, but all interactions have the potential to evoke emotions because the self is emotionally loaded at each level. In line with the tendency of symbolic interactionists, Turner considers the need for self-verification to be the most important need. When the responses of others verify the self, the individual will experience positive emotions (Turner, 2002). Conversely, the individual will awaken one or more negative emotions and their combined forms. As far as the infected people are concerned, the expectation of verifying their self needs can not be fulfilled. Instead, they are faced with the disintegration of their core self-conception, the disability of their sub-identities and the stigmatisation of their role-identity. Instead of fulfilling their self-related needs, they recognise that they are directly or indirectly limited by the corresponding encounters, and experience negative emotions such as fear, shame, sadness and their combined forms. They

66

3 Acquired “Needs Deficiency” Syndrome

experience fear spontaneously because of HIV infection, shame in their evaluation of selves influenced by the moral rules of society and sadness from the encounters, and spontaneously choose to withdraw from the encounters in order to protect themselves.

3.2 Deficiency in Needs for Profitable Exchange Payoffs All interactions involve an exchange of resources, in which one person gives up resources in order to receive resources provided by others. The nature of the resources available and their value to persons vary enormously, but the critical point is that interaction always revolves around an exchange of resources. Individuals have needs for earning a “profit” in the exchange of resources. Profit is, however, a complex cognitive and emotional process but, at its core, individuals are motivated to receive resources that exceed their costs and investments. Costs are the resources forgone to receive a given resource from others and the resources that must be “spent”; investments are accumulated costs over time that a person has to receive a particular resource (Turner, 2007a: 109). When individuals make a profit in their exchanges with others, they experience positive emotions; and when they do not, they experience negative emotions and their combined forms. The infected people are no different from us in the daily lives, but are often concerned about exposing their identity as infected people in specific interactions, which may cause unnecessary problems. Nevertheless, in some specific interactions, they have to acknowledge and reveal their identity in order to seek better interactions or exchange of benefits. Since 2004, China has implemented the “Four Frees and One Care” policy for HIV prevention and treatment, and some of its cities have introduced corresponding supplementary provisions. At present, the infected people can go to designated medical institutions to have access to free antiviral drugs, and can have medical insurance and social insurance. There are also a number of ASOs that provide testing, medication, care and other services. But when they reveal their identity in the hope of benefiting from the interactions, they find that they do not receive the resources they are entitled to, but instead become a tool for others to make profits, which may lead to an outbreak of negative emotions.

3.2.1 Fair Medical Treatment Denied There is an extensive literature on “justice” in exchange relations. George C. Homans was the first to bring such considerations back into sociology in his analysis of “distributive justice.” For Homans, calculations of distributive justice revolve around assessments of one’s own costs and investments relative to rewards received, compared to the cost, investments, and rewards received by others. When individuals perceive that the resources received are proportionate to their costs/investments, they will perceive that distributive justice prevails if the resources received by others in

3.2 Deficiency in Needs for Profitable Exchange Payoffs

67

the situation are proportionate to their respective costs/investments (Homans, 1961). Later, Homans moves to an approval-aggression argument that emphasises expectations: when individuals do not receive rewards that are expected, they become angry; and when they receive expected rewards, they experience positive emotions (Homans, 1974). Subsequent sociological theories on justice has elaborated on this early formulation by Homans. Guillermena Jasso presents a theory of justice in highly formal terms, arguing that individuals compare their shares of resources to their conception of what a “just share” would be, with justice being the logarithmic function of the ratio between a person’s actual shares to just shares and with the further proviso that it takes more of an over-reward than under-reward to generate a sense of injustice. Jasso also introduces the notion of expectations by arguing that individuals assess rewards and punishments relative to expectations for rewards and punishments, with a smaller amount of punishment generating as much injustice as will greater amounts of punishment. According to Jasso, individuals’ calculations of justice also involve comparisons with others; persons will experience positive emotions when their rewards exceed those of others and negative emotions when their rewards are less than others (Jasso, 1993, 2001, 2006; Markovsky, 1985, 1988). Jasso’s and others’ analyses of justice lead me to view that a person’s conception of “just shares” is related to the reference points that they use in developing this conception of just shares and the ideologies and norms about what is fair in a situation (Turner, 2007b). Together these two forces—reference points and ideologies—generate an expectation state for what resources are available and what would constitute a “just share.” And, to the degree that actual shares correspond to conceptions of just shares, a person will experience positive emotions; and to the extent that there is incongruence between actual and just shares, negative emotions will be aroused, although it will take much more of an over-reward to produce a negative emotion like guilt than under-reward to generate emotions like anger (Turner, 2007a). For the time being, it is impossible to completely cure PLWHA. To date, there is no effective cure for AIDS and no vaccine has been developed to prevent HIV infection. The “Four Frees and One Care” policy advocated by the Chinese Central Government, especially the policy concerning free access to antiviral drugs, has given hope to many infected people that HIV can be controlled by continuous use of antiviral drugs like hypertension and diabetes. Nevertheless, when they hopefully go to the hospital for medication, they find that seeking treatment in designated hospitals is not as smooth as expected. The over-testing and over-prescription by doctors, and the side effects and tolerance of the medication have become the reason for their refusal to take medication or seek treatment, and the source of negative emotions. The medication is free, but there is a medical check-up before taking medication, which is necessary and reasonable because the doctors need to check your physical state and then prescribe appropriate medications. The cost for medical check-up for the first time is a bit more expensive, about 800 RMB, but the cost for everything else should be very low. The problem is that the hospital is trying to generate revenue so the doctors are overprescribing medications for thorough liver function tests, but actually it is fine to have routine tests. At first, we didn’t know that or dare to say anything, and we just checked whatever we were told. Later on, people from the ASO said that there was no need for such tests. I was very annoyed then, but what could we do? We had to put up with it and try to change doctors if possible,

68

3 Acquired “Needs Deficiency” Syndrome because not all doctors behave like that. We usually have two doctors here, among whom one female doctor is more concerned about us, and we are willing to ask her for medication. So a large number of people consult her for treatment on Thursdays. On the contrary, the other doctor is very bad and we don’t consult him at all unless we have no other choices. If you consult him, you will spend more money, and my information may be leaked. (DCYJ01) We want to regularly take the anti-viral drugs provided by the central government for free. But, many doctors in Y Hospital prescribe lentinan, a kind of supplements for infected people to boost their immunity. For example, a doctor called R is usually smiling and nice to us, but he is a man who smiles and prescribes lentinan for you. After that, you have to accept it gladly. If you say that you don’t take it, he will prescribe some other tests. Anyway, you spend much money on those drugs which do not cure the disease. (DCYJ07) They said, “It’s very obvious that you have to be checked here. We are responsible for the testing results here instead of elsewhere, because I am not sure of the accuracy of the results elsewhere.” Or some doctor, after seeing that you are paying for this medicine, will prescribe it to you for a full month’s use, and you say that a box will do. The doctor says in a female voice, “You have to keep taking it for a month.” You say “I will buy it in the pharmacy outside.” The doctor says in a female voice, “Can you take the drugs sold outside? They’re all fake!” Additionally, syphilis, genital warts and other STDs should be treated with longacting penicillin, which is the most effective drug. But hospitals rarely sell penicillin for the sake of economic efficiency, and pharmacies just don’t stock it, because it is much cheaper than cephalosporin. (DCYJ10)

Generally speaking, the infected people can only go to the STD/AIDS clinics or the dermatology or STD clinics set up at the designated hospitals for free antiviral drugs. When they go to the hospital at the risk of exposing their identity, they are subjected to unfair treatment such as over-prescription and over-medication, which is contrary to their expectation. In addition, the fear of exposure of their identities makes many of them dare not have medical insurance when seeking medical treatment even though the treatment of some diseases and the use of some drugs are covered by medical insurance. This is compounded by the fact that there are only a limited number of antiviral drugs available, once an infected person develops drug resistance, there are very few alternatives, and most second and third line drugs are completely self-funded, making them unaffordable for most infected people. To be honest, some people are covered by medical insurance, but many dare not use it, including me, because one of my relatives works in the social security bureau. Although it is generally impossible for him to transfer my file, I still have this concern. What should I do if it gets out? So I’m basically at my own expense, and worried about the exposure of the privacy of my infection. (DCYJ06) I am covered by health insurance. But I don’t know if it will cover the cost of HIV treatment in the future and I definitely don’t want my employer to know about my infection. But if an opportunistic infection occurs, I would have to disclose my condition if I would like to be covered by health insurance, which is a contradiction. I don’t know if the government will solve this problem in the future. (DCYJ19)

Apart from medical insurance, many poor infected people, like healthy people, can apply for the Minimum Livelihood Guarantee (MLG). However, this system must be linked to the household registration system, and the procedure for applying for MLG is complicated, which is likely to expose the identity of infected people and cause inconvenience and worries to them.

3.2 Deficiency in Needs for Profitable Exchange Payoffs

69

We have to firstly get a work capacity assessment and then go to many departments to apply for MLG. When the procedure is done, my information is leaked out. Do I dare to reveal it in the place where I work? How dare to? I don’t even dare to go there though with so much courage. (DCYJ08) The head of the residents’ committee responsible for medical insurance was a former colleague of mine and he already knew about my infection. He was pushing me to tell him about it. Then I told him because I had to apply for medical insurance, and asked him to keep it a secret for me. (DCYJ03) It didn’t go well when I apply for medical insurance. I told him that I was HIV positive, and then I gave him my confirmation report. They did not acknowledge it because the report was anonymous at that time. I had no choice but to run to the CDC to have my blood drawn again, where I asked the staff to give me another test and add my name and ID number in the comments column below. Later on, I gave them all my reports, including those of hepatitis B and C, before I got the application done. (DCYJ02)

Even if the process is successful, the result should be publicised, which is fatal for the infected people. In reality, many of them have lost their jobs and are living in poverty due to their own conditions or discrimination. Faced with problems such as hospitalisation and medical treatment, they desperately want to hold on to that last straw, and are so worried about the exposure of their identity that they prefer to be destitute and unable to afford medical treatment rather than return to their domiciles of origin. In an encounter, the most immediate reference point is another person or others. The characteristics of others are often used to determine what would be a just share for them and for the person making the calculation. There is an extensive literature within the expectation-states theoretical research program that documents the effects of status characteristics of persons in determining expectation states for their performances; and it is just a short conceptual step to note that these expectation states also contain cognitions about the type and amount of resources that they should receive (Turner, 2007a: 112). At present, although the HIV virus is forever present in the bodies and lives of infected people, most of them are hopeful about the control and treatment of AIDS. Although they do not have much hope for a complete cure, they still have a clear expectation that they will fight the HIV virus and “live to see the success of the development of antiviral drugs” through long-term use of antiviral drugs. They expect to use free antiviral drugs as advertised, to treat HIV as a chronic disease like diabetes and hypertension, to use their health insurance as ordinary patients, and to apply for government assistance as all vulnerable groups. Nevertheless, when they consider these as reference points, they find that they have to face over-prescriptions and over-testing in the medical process, suffer from side effects of first-line drugs, and experience the plight of having no access to medical treatment, fear to use medical insurance, failure to take medications, and failure to receive social welfare, which is completely contrary to the original expectation of equitable access to medical treatment. Thus, we can say that it is important and useful to determine what factors are used as perceptions of fairness for PLWHA, because the negative emotions they have are very different from their expectations. In the encounter, they offer their status in exchange for access to treatment for HIV and

70

3 Acquired “Needs Deficiency” Syndrome

benefit from it, but the reality is just opposite to the transactional needs for benefit. The moral codes of fairness and justice they expect are altered by their status, causing them to experience negative emotions in these encounters. These emotions are mainly moderate anger, although sometimes sadness may be present.

3.2.2 Identity Information Used In AIDS prevention and treatment, NGOs play a huge role in the testing, care and treatment of PLWHA. With the influx of foreign funds such as “The Global Fund to Fight AIDS, Tuberculosis and Tuberculosis” and “China-Gates HIV Program”, many non-governmental ASOs have sprung up in China, many of which are formed spontaneously by PLWHA who play a positive role in providing detection and care. However, as the emergence of ASOs has been accompanied by an influx of foreign funds, the funding has been set up in a one-sided pursuit of data and implementation. As a result, many of these organisations use the expectations and recognition of the infected people as a tool and capital to implement their projects, greatly damaging their enthusiasm and benefit evaluations, causing them to have negative perceptions that “care is exploitation and intervention is exchange”, and fuelling resentment and discontent among them. There are all kinds of grassroots organisations, some of which do a really good job. If it wasn’t for L’s help, I probably wouldn’t be alive today. But some of the organisations that have appeared later have used us as the tools to get their projects done, and they have done a rotten job. When we mention the AIDS project, we don’t go anywhere else except for a few familiar organisations. They just use us. For example, they ask us to attend training lectures. In fact, it’s a blood draw. They say they are to share some medication experience with us. In fact, it’s just to take photos to complete their task. We are their tools, so we seldom go anywhere else except here. (DCYJ08) Many organisations call you on December 1 (World AIDS Day), ask you to go to dinner or give you gifts. Some even give out money. They just ask you to attend activities, fill in forms or questionnaires, take blood tests and take photographs. Of course, there are those who do research and write reports like you. Anyway, they pay for all. I used to resent it because I thought I was a tool for them to make money. Don’t trust them, they talk as if they have done everything. In fact, they have fooled us, the government and the foreigners. At first we were very enthusiastic about it, but later we realised that they did it for something. I couldn’t remember what the project was several years ago. Anyway, as long as you came, you got gifts. I went to five organisations in one day and received five different things that I could use anyway, like an electric kettle and aloe vera cream. Some organisations just gave out money to us. Now we all understand that. (DCYJ22) The organisation is nothing like what we expect. They complete their projects by selling our blood and information. When I first called them just a few days before December 1, they were particularly enthusiastic and told me a lot about attending the activities, saying that they would reimburse my travel expenses. So I went there, only to find that we were asked to write our ID numbers, leave our phone numbers and names, and have our photos taken. They told us that our faces in the photos would be adjusted technically for sake of privacy. As a result, nothing else has been gained. (DCYJ11)

3.2 Deficiency in Needs for Profitable Exchange Payoffs

71

Don’t mention others. The members of the ASO in our community are not sincere to us at all. They are using us for their work. Many groups do it very informally, and as soon as they have money, they can form a group and then apply for research programs sponsored by Chinese Association of STD and AIDS Prevention and Control. They don’t have much work experience. They just trick their comrades into coming over and say they will give out gifts or something. Some even give out money directly, which can be used to pay for the blood. They will give us RMB38 for one blood sample drawn. It’s not care but rather exploitation. (DCYJ03)

The infected people are willing to show up in a range of activities because they originally expect more support and help from the ASO, including psychological support. One member of the ASO said, “we help to solve the problems in their survival and life”. It is the hope to profit from such interactions that they are willing to reveal their identity and disclose their HIV-related privacy, such as the route of their infection. But, instead of receiving the care and attention they expect, they experience the suffering of being used, which fuels negative emotions such as anger. Once the need for profitable exchange payoffs is satisfied by the actions of others in the encounters, people will feel more comfortable. Such need is thus a fundamental process in encounters. In essence, it is present in all micro-encounters. For example, if the infected people benefit from the exchange process with the ASO, and if they experience fairness and justice in seeking medical treatment, they will not only gain support, help and care, but confidence in coping with HIV. From the perspective of emotional sociology, they can also experience moderately strong positive emotions. Further, if the support and care provided by the ASO is well implemented, and if national medical care for them is well delivered, they will experience a higher intensity of positive emotions, and even gratitude. Unfortunately, when they receive antiretroviral treatment hopefully, and when they interact at the expense of their privacy, their expectations of benefiting from the exchange process are not realised, but instead they are faced with situations such as over-prescription and over-medication. Over time, they often experience strong negative emotions such as anger, sadness. In some cases, this can lead to social excesses such as conflict and misbehaviour.

3.3 Deficiency in Needs for Group Inclusion People form their identity and perceptions of society in micro-encounters. People in different environments interact with each other in different ways. The interactionism holds that emotions and emotional control are formed in micro-encounters (Shott, 1979). Turner further points out that people always seek the need of group inclusion during encounters. People will experience positive emotions when they feel a sense of group inclusion, and conversely, they will experience one or more negative emotions if they feel rejected or isolated by a group (Turner, 2007a).

72

3 Acquired “Needs Deficiency” Syndrome

The degree of group inclusion is often related to the closeness of people’s relationship with the group, and different types of relationship and closeness often determine the degree of group inclusion. From a social exchange perspective, Kwang-Kuo Hwang suggests that resource dominators measure their relationships with each other before deciding which exchange rules they will use to interact and integrate with each other (Hwang, 2010). In this model, the interpersonal relationships considered by resource dominators necessarily contain an instrumental component, and are divided into emotional, mixed and instrumental relationships according to the amount of emotional components (Hwang, 2006). Accordingly, we can classify interpersonal group inclusion into: emotional group inclusion, which consists mainly of inclusion into primary life circles based on marriage, family and sexual relationships; instrumental group inclusion, which is based on inclusion into workplaces and communities; and mixed group inclusion, which refers to inclusion into one’s own circle of friends and relatives. For PLWHA, whether their identity is revealed or not, the fact of being infected is like a stone thrown into calm water, bringing about the breaking and restructuring of relationships from the inside out and the isolation of the various circles around them. The first to be affected is emotional inclusion represented by the primary life circle, in which the infected people are faced with the “dangers” brought by infection and are more likely to have emotional turmoil. As their identity is gradually revealed, the instrumental groups, mainly in the workplace and community, have difficulty in the inclusion due to social stigma and fear, in which they are forced to leave their jobs, take the initiative to escape, move away from their communities, or even leave their homes alone. The dilemma of inclusion of mixed groups is somewhere between instrumental and emotional inclusion. As one infected person put it, “AIDS becomes a touchstone for my friends and family. Some of them are my brothers whom I grow up with, and others are my close friends. They never contact me again, but I don’t blame them.”

3.3.1 The Changes of Primary Life Circle According to Professor Pan Suiming and colleagues, love, marriage and sexuality can be regarded as three separate objects of sociology, but as the intermediary between individual life and social functioning, they are actually a systematic and holistic existence. Extending the basic concepts of social groups in sociology, we can regard them as the ‘primary circle of human life’ (Pan & Hou, 2013), as shown in Fig. 3.2. The strongest emotional ties of all are those between fathers and sons, and those between husbands and wives, which are also the strongest ties for human beings. The “primary life circle” is the deepest, most direct and important human relationship. The three most fundamental elements of human activity—biological, psychological and social—and their interactions are most fully reflected in this relationship. This is why it is often said that “the family is a small world, while the world is a big family”. The agricultural society of all ethnic groups has similar saying of “getting

3.3 Deficiency in Needs for Group Inclusion

73

Fig. 3.2 Primary life circle (Pan & Hou, 2013)

married before pursuing a career”, and regards marriage or family as the necessary stage and main symbol of a person’s overall maturity. To this day, the Chinese are still very concerned about how to manage the relationship between career and family, while governments in developed countries often have various family policies. All these show that human beings do have a richer and more rewarding experience in this “primary life circle”, which cannot be replaced by other social lives such as “career”. The impact of AIDS on primary life circles is serious and deadly. Firstly, the fact of being infected puts fear and stigma on the couple and their families. Not only are the infected people isolated from the world, but their family members are ‘alienated’ accordingly. Secondly, sexual relationships are affected. As HIV is sexually transmitted, many infected people have sexual relationships only in name after confirmed diagnosis of HIV, and their sexual partners will be tested. Due to the infectivity and incurability of HIV, their sexual relationships often end and even resentment develops. Thirdly, like others, they have the same desire to live, survive and love, which is their fundamental motivation to live. But, in reality, if one of the two lovers is diagnosed positive for HIV, love basically comes to an end. Lastly, it is about childbirth. On the one hand, sexual activity poses a risk for infection because HIV is transmitted sexually; on the other hand, although motherto-child blocking technology can be used to reduce the likelihood of infection in the baby, it does not have a 100% success rate, so what if the baby is born HIV positive? Are there side effects of the mother-to-child blocking medication, even though the children are not infected with HIV? What happens to the children afterwards? Will they become AIDS orphans? Will their survival and life be different because of their parents’ infection? These problems cause AIDS people to decide not to have children, even when they are pregnant.

74

3 Acquired “Needs Deficiency” Syndrome

In short, the impact of AIDS is so great that the negative state of one single factor can cripple the primary life circle, or even cause it to collapse or disintegrate. Being infected does not just affect the family, but has an overall influence on the inclusion of the “primary circle”, which in turn systematically contributes to the negative emotions of the individual. The unique mode of HIV transmission, especially through sexual intercourse, often destroys the most primitive love between husband and wife and family relationships, which, combined with the stigma and fear of HIV in society and the fear of being infected through everyday contact, can pose a threat to family inclusion. I planned to hide it from my family because I didn’t dare to let them know. I used to take my grandson to and from school every day. Every time when I dropped my children off at school, I came here (the office of one ASO), where I kept my medication, because I couldn’t take it home. Here, I could take my medication and read some literary works related to homosexuality which I liked a lot. But, it didn’t last long. The children didn’t go to school every day but I had to take my medication every day. Slowly things are coming to light. After that my family were very cold towards me, especially my daughter and son-in-law. They ignored me and didn’t let me pick up my grandson anymore. I feel very uncomfortable at home, and even thought of committing suicide many times. Then XL (the name of a person) told me that I could live here. I just live here, and become a volunteer to help them manage their accounts. (DCYJ23) It’s such a difficult problem. There are many marriage-seeking groups online, say, QQ groups for AIDS people, so many of them. But I’ve asked many women with AIDS how they feel about that. They are indifferent, saying that “Let it be, or let fate take its course.” It’s hard to meet people who like each other and live together anymore, and it seems that you can’t find that feeling anymore. It’s just that it’s okay to live together. (DCYJ24) I was hospitalised in October 2007 and afterwards, at the persuasion of the doctor, I told my wife about my infection. As I feared, she reacted particularly strongly, asking for an immediate divorce, and never came back to the hospital. When I returned from the hospital, we were strangers, living in the same house every day and barely speaking to each other. The divorce was finalised a few days later. (DCYJ12) I was tested positive and so was he (my husband). All members of his family disappeared, which was particularly ridiculous. But I don’t think it matters if they accept it or not. I don’t blame anyone else, but blame it on my bad luck. His parents just don’t accept us or haven’t given a penny of help in five years. We can sell or give away any things in our home at our will. It’s our business. But they don’t want them because they think they’re dirty. I told them we’ve known that the disease is not contagious. I have a good liver function, and don’t have hepatitis or anything. Our child is normal, but they just don’t accept us and scold the child and me every day. For the first few days I ate and slept in the same room. Since I am not accepted, I rush back. (DCYJ13) I was ready to get married before I was tested positive, but I had been pregnant for almost two months and had to abort the foetus. We didn’t get married and my boyfriend got scared off (she laughed bitterly when she said this), but luckily he didn’t get infected. I feel less guilty about it. Now I have to take medications every day and I’ve lost him. (DCYJ14) After tested positive, I had even less intention of getting married and was even more determined not to get married. I don’t know if I was right in thinking this, but I think it’s okay to trade the positive test for the freedom not to get married. (DCYJ21)

In general, people have an instinctive urge to seek advantages and avoid harm. Especially when faced with a life-threatening event, they often hope to be supported

3.3 Deficiency in Needs for Group Inclusion

75

and comforted by others and find a haven of respite. However, the infected people are often afraid and unable to find such a haven after informed of their infection. In order to reduce conflict and protect themselves, many of them just choose to isolate themselves, and protect themselves by fleeing and closing themselves off. Although they bear the loneliness alone, they are relatively safe, and will not turn the harbor of primary life circle into a gulf of conflict and fear. Since the confirmed diagnosis of HIV, I have never been back home. My mother died early and my father was at home alone. I said I was abroad on business and usually used the internet to make phone calls, but I never went back. Five years have passed and I have always felt sorry for him. Maybe one day, I’ll die and he still thinks I’m abroad. It is good, because he won’t have to worry about me. (DCYJ22) They don’t know anything. I’ve been independent since I was a child. I left home before I graduated from senior high school and rarely let them worry. There was nothing they could do if they knew about it, and it was no use to make them worry for no reason, which would only add to their psychological burden. I have brothers and sisters in my family. They are all married and don’t know about it. I won’t tell them. I don’t go home very often, basically once a year. (DCYJ06) Living so far away, they were not able to help me with that. They were particularly concerned about my marriage and pushed me every day to find a girlfriend to get married. Then I came up with an idea and found an infected person in the circle. She happened to have an adopted child, so we went to get the marriage certificate and went back home. On May Day, my mother came over and parents on both sides met happily. They thought I was floating around in Beijing alone, and were relieved to know that I was married. (DCYJ09)

Professor Pan Suiming and colleagues argue that the primary life circle should be viewed from a more holistic perspective (Pan & Hou, 2013). The infected people are not faced with the separated marriage, love and sexuality, but a combination of the three and more. They are actively or passively isolated from the primary circle of life, and experience and suffer the emotional loss and helplessness alone, which in turn trigger negative emotions such as anger and despair among them. The interviewee labelled DCYJ25 is one such infected person. After graduating from university a few years ago, he returned home and became a civil servant. His family was quite well-known in the local area. He was infected due to an unusual relationship. When he had symptoms, he began to collect all kinds of information on the Internet. Fear began to grip me. At first it was anxious pain, really, really painful. Then I found this test strip on the Internet, which I thought was safe and hidden. So I bought one, but only addressed the parcel to L City. Then the courier called me when it arrived. I was driving my car to pick it up. I pulled over and did a check in the car. It took ten minutes to know the result. Driving back, I found that it was positive ten minutes later. While driving I was just crying in the car. The first person I thought of was my girlfriend, and all I could think of was that she must have been infected too. I was so greatly consciencestricken that I thought, “The mistake has been made and I must tell her.” The car didn’t turn around and I went straight to her. My girlfriend acted very calm that day. She said, “It’s okay. We’ll suffer together if we have this disease.” Then I spent the next two days buying six more test strips and asked her to be checked. The first test result was negative. At that moment, I was most relaxed. I forgot about myself and only thought about her. It’s funny that I fell on my knees all of a sudden

76

3 Acquired “Needs Deficiency” Syndrome in the room, looking up to the sky and shouting, “God, thank you for giving me the chance to keep her from getting infected.” My girlfriend cried then and said, “I don’t believe you’re positive! You have to check again so I can see it with my own eyes and I’ll believe it!” I checked again and it was indeed positive. That day I told her, “Now that everything is over, you have to start your own life. That’s all the time I can keep you company. You get out of here. I’ve held you up for so long.” But she didn’t agree. Then I set about getting ready to come here. We were engaged at the time, but I told my family that we broke up. (DCYJ25)

Hiding from his parents, he came to a strange city and started looking for information on AIDS-related treatment. At the Y Hospital he had his blood tested, received a confirmation report of his diagnosis and received counselling from his fellow patients. He then went home and decided to come and live here alone to avoid causing problems to his family. After that, I told my family that I planned to come here. Of course they didn’t agree. Born into a well-off family, I was a top student at school, and then was enrolled in a famous university. Later, I became a civil servant. I was the youngest cadre in the workplace and the earliest to be promoted, with a bright future. My parents are high-ranking cadres in our area who come from a relatively prominent family. There are no flaws in my environment, so no one could understand why I’m here and why I’m ruining my future. You know, once you become an outsider of the civil service, it is very difficult to return. In fact, I give it up. My family were against it and my mother was sad, but I couldn’t explain. All I could explain to them was that I just wanted to quit my job and didn’t like the position. My father was more open-minded and said, “If you really want to, it’s okay, but you can’t quit.” Then I came here, rented a house and lived here for six months without doing anything until the end of the Olympics. Why the end of the Olympics? It is because I could happily watch sports matches every day during that time. There were too many TV programs to think about anything else. Once the Olympics were over, there were no interesting programs to watch and I felt bored again. (DCYJ25)

He had been engaged to his girlfriend, which pleased both families. Everyone around them thought they were a good match. Although they have broken up, they still love each other; although he can keep himself hidden, he still contacts his exgirlfriend; although he loves her, he still endures the pain of telling his family that they have broken up. How to explain? It’s emotional discord, which is the most popular way of explaining such thing. I came here to make a go of it, so I linked the two things together and said I broke up with her because of this. That’s all. We still have all kinds of rumours going around. Some say I’ve got a new girlfriend here. My girlfriend comes from a decent family. In other people’s eyes, we are the best match, and the most talented and beautiful couple, the envy of everyone. This disease has ruined everything. Now we keep our relationship secret from others. We still have contact because we love each other, but no more sexual relations. (DCYJ25)

He was a leader in his workplace, and has a decent family background and a satisfactory life and job. But when he comes to a strange city alone, he has no friends, and all that is left is fear and loneliness. He doesn’t know where to go or what to do after work every day. Actually, I have nothing impressive compared with the experience of others. The biggest difference between me and others may be the change in my life. AIDS has completely turned my life upside down. Maybe that’s why they recommend me for this interview.

3.3 Deficiency in Needs for Group Inclusion

77

I had a good job and a lot of friends. I was financially well off, and very sociable, really (he shows an inexpressible look). But I don’t regret it either. I wasn’t too flamboyant in my glory days. I have never been so. It’s just that my job or status earns me respect from others. Some of the experiences I had in the past are quite good when I recall it. I’ve been a leader in my workplace. Among my peers, those who hold positions like me are at least seven or eight years older than me. This is something that others should be very jealous of. (DCYJ25)

I can’t help but ask: why, with such a big change, am I still willing to suffer so much? Have the original social relationships changed now? My previous friends, basically, have very, very little contact with me anymore. I hope they can have their own careers, and I don’t want them to know about my infection even when I’m dying. (DCYJ25)

He goes on to talk about the reasons for his fear of exposure. To protect my family! My family are still living in the local area. You know, if others knew about it, what could my family do with themselves? People would point the finger at them when they walk down the street. It would be an absolute bombshell if word got out in our area. For people in my hometown, the disease is too far away. If my identity was revealed, the event would be more explosive than if I was sentenced to death. Then our family would be surrounded by discrimination. They would have spread it around: “Their child has AIDS.” “That can’t be right?” “Stay away from him, stay away from their whole family!” Not only am I worried that my families’ lives may be affected, but worried that my parents, well-known in the local area, would lose face. The problem is face! As I told you earlier, we come from a small place and my parents are dignified people who value face a lot. Everyone knows how AIDS spreads. People there don’t have a good impression when AIDS is mentioned. They will think you are unclean, very dirty, unbearably dirty because the disease is associated with filth. Your family are also dirty. They stay with you all day long and carry HIV. How would they live afterwards? I’ve already felt sorry for this body my parents give me, so how can I bring them more pain? I kept putting up with it, and my family don’t know about it now. (DCYJ25)

He has not told a second HIV-negative person about his infection until the author has an appointment with him. He is grateful that he has not been exposed. You are the first healthy person I have told the truth to. Compared to my infected friends, I was lucky because I was prepared to get myself checked out. So nothing came out. (DCYJ25)

Although not exposed or discriminated against, he still discriminates against himself out of fear of the illness and exposure to it. It is mainly self discrimination for me. For example, two days ago, one of the close friends of my father introduced a girlfriend to me because he thought I was quite tall and good-looking. The girl was quite nice who came from a well-off family, and her father was a high ranking cadre. I did not decline, but I couldn’t say anything. I felt very bad about it. (DCYJ25)

Many infected people in the ASOs are unsuspecting of their fellows, and the exchange of information about their illnesses becomes a bond of comfort for them. The interviewee labelled DCYJ25, however, represents those who are reluctant to participate in the organisation’s activities and contact with their fellows.

78

3 Acquired “Needs Deficiency” Syndrome Knowing one more person means more danger, I guess. I’m still afraid of exposure, to be exact, terribly afraid. (DCYJ25)

The interviewee labelled DCYJ25 has difficulties in the inclusion in the primary life circle, but what brings the greatest emotional change to him is the primary circle composed of family, love and sexuality. He is one of the more capable individuals among the infected. Although he has difficulties in the active and passive inclusion in the circle, which is within his control a certain extent. But, for the majority of PLWHA, the rupture of the primary life circle triggers more emotional changes, especially negative emotions such as sadness and resentment.

3.3.2 The Exclusion of the Employment and the Community Besides the primary life circle, the most important influence on individuals is the employment and neighborhood. Many Chinese people haven’t yet got rid of the influence of the employment and neighborhood left behind by the planned economic system. Once the role of infected individuals is disclosed, unemployment, whether it’s from individuals’ willingness or the employers’ willingness, is inevitable. PLWHA, out of guilt, dare not fight for or defend their own rights. The news that I’ve been infected spread. We work in the highway departments of different levels. There’s a highway department here and one in YJ (the name of some place). Once the news spread, even my relatives were afraid of me. (DCYJ15) No, I didn’t say anything. What should I say? I was afraid that it would get worse. I just said, “I don’t want others to know this, otherwise my life will be worse. If I can’t live well, all of you won’t do.” I told him in a serious tone. He was kind and offered me one month’s salary. I handled resignation. It seemed that he probably told others not to spread the news. No one has mentioned this to me. (DCYJ09) If the employer finds out about my infection, I will definitely lose my job. Even if I was not dismissed, I will face pressure from my colleagues around me and cannot get along with others. So, I must resign, and I have to look for a new job for survival. (DCYJ08) I’m still at work, and the pressure of work is particularly high. Every day I have to take medication stealthily. Also, I had to ask for leave to take medication from the hospital every month. What’s more, I’m gay. There’s a lot of privacy about the gay circle. We can’t talk about kids, families like others. There are a lot of things that we can’t share with everyone. Now, there is this disease. Most of the times, we are not understood by others, especially when work is stressful. People may be suspicious. (DCYJ17) At that time, I was very coward. I was at a loss, without acquaintances in the hospital. I had to rely on Director X, but I was afraid to go to the hospital. To be honest, I had just been diagnosed for more than a year. I lived a lonely life in strange lands. Finally, I recovered and adjusted myself to face the fact bravely. Anyway, I dare not to go to the hospital. I was afraid that I would meet the acquaintances and the news would spread. So, I just see Director X for treatment. (DCYJ12)

It is generally considered that a neighborhood is defined as a community with common demographic characteristics and territorial relations organised through specific institutions and relationships within a certain geographical area (Deng,

3.3 Deficiency in Needs for Group Inclusion

79

2009). In a neighborhood, residents consolidate shared consciousness and interests and develop a sense of verification by each other through formal or informal communication and social interaction activities. We rented a three-bedroom apartment, and when we first moved in, we were all particularly happy because we finally had a house of our own. We were very excited, assigning work to everyone, working out duty roster, pooling some money and buying some household items. We moved there in the afternoon of the first day, and in the second half of the night, we were woken up by a banging on the door. A group of people, staff of the residential property and some security guards barged in. They asked us to move out, saying that the owners of the residents had reported that they could not allow AIDS patients to live here. We argued with them, and then YQ (the name of an infected person) got angry and picked up a beer bottle, saying that if they didn’t leave, he would beat himself and then beat them, so that they could infect the disease. They left. However, the landlord called early the next morning and told us to move out. He said he couldn’t do anything about it. Although he understood our situation, almost the whole neighborhood was looking for him, accusing him of that why he rented the house to HIV-infected people. He said he had no way and he would find someone to help us to move out within three days. (DCYJ22)

In fact, there are many organisations, providing temporary accommodation for infected people, had similar experiences. They might be treated relatively mild. The landlord made various excuses for not renting the house any more. For the interviewee labelled DCYJ22, he, with his friends, rented the vacant house for a low price in a high-end neighborhood from an acquaintance. Unexpectedly, on the very night they moved in, they were rapidly swept away. As for ordinary people living with HIV, they may move out of the neighborhood out of pressure and shame. My parents live in the same neighborhood with most of their colleagues. When the news of my being infected spread, it seems that there’s an explosion in the neighborhood. Everyone knows this. I couldn’t stay there. Even my parents were excluded. We can feel that there are always people talking about us. We can hear various comments. It’s an old neighborhood. The news spread quickly. Once, just as I got home, someone from the epidemic prevention station came and said that someone had reported that there were people with AIDS in our house. After that, we moved out. (DCYJ18) After working for many years, I had an occasional medical checkup and went to Hospital D to test for HIV antibodies. I was told to be tested positive. The staff of CDC immediately notified CDC of my hometown. Then, something incomprehensible happened. The CDC of my hometown rushed to our village home with a large number of people to frantically “disinfect”! It is so ironic! I have been living and working here for many years! Even if there’s need for disinfection, it should be the place that I live now to be disinfected. Why is my hometown, thousands of miles away, disinfected? Under the situation, the whole villagers knew that I contracted this “terrible disease”. Before I could psychologically accept the word “AIDS”, my life has been broken. My family and I had to face the discrimination, contempt and even insults from the whole village. My wife demanded a divorce, my son discriminated me, and my fellow villagers drove me to a desperate situation. In the same year, I was admitted to Hospital D because of an opportunistic infection. I attempted to commit suicide three times because of the psychological pressure and the pain of the disease, but failed. (DCYJ19) At that time, I have been crying. We lived in the neighborhood, and there were many people coming to play cards and so on. Once they knew this, no one came. You know, we live near the workplace, which is placed in front of our neighborhood. I can come across colleagues up and down the stairs. (DCYJ01)

80

3 Acquired “Needs Deficiency” Syndrome I disclosed on TV that I was infected. However, before I went home, the news had spread throughout the village. When I returned home, neighbors blocked my gate and scolded me, and even went to the government en masse to petition to not allow me to return home. People did not buy my family’s agricultural products and did not smoke the cigarettes I gave them; even my children were affected, no one played with him and his desk was separated; my wife was forced to leave me. (DCYJ16) I should say that I was evicted from home, and my family was broken up because of the disease. I first contacted the disease. Then my wife was infected. We didn’t expect to contract the disease. Later, she died of the disease. Because we were the first in the country to contract the disease, people knew this quickly. We were not accepted. I was afraid that my child would be affected, so I left my hometown. My child was brought up by my parents. (DCYJ19)

Although it is an indisputable fact that daily contact does not cause HIV infection, the workplace and neighborhood that are mainly instrumental in exchange cannot accept the presence of infected people among them, and PHWHA have to hide their roles in silence. Once their roles are disclosed, they must face the loss of their jobs and exclusion by the neighborhood. In addition to suffering from the HIV virus and the side effects of antiviral medication, they experience the rejection and the negative emotions such as worry, anxiety, sadness and anger, etc. In most cases, HIV-infected people experience a sense of group inclusion. When they fail to produce the sense, they may experience negative emotions such as sadness or anger, or even shame because of fearful of being excluded. When group inclusion is defined in moral terms, PLWHA may experience guilt. Later in life, if PLWHA continue to experience the negative emotions, and they fail to withdraw from the interaction in which they are not truly included, these negative emotions will transmute into detachment from the interaction.

3.3.3 The Alienation of Family Members and Friends Mixed group inclusion is a blend of both a certain emotional component and a certain instrumental component among family and friends. Thus, it has a somewhat more instrumental component compared to groups such as families, and a somewhat more emotional component compared to colleagues and neighbors. In the face of AIDS, once there is an infected person among friends and relatives, their rejection and isolation of the infected person more often discourages the infected person, finally the infected person chooses to sever connections. My relatives have voluntarily stopped contacting us since I contracted the disease. I didn’t contact them either. We have never contacted since then…… I have a sister-in-law. I explained to her many times. I said that my children didn’t contract the disease even if we dined together. Dining together won’t contract the disease. But no matter how I explained to her, she didn’t believe. Last time, I went to her house to have a dinner. I remembered that the first time I was given a blue porcelain bowl with a crack. The second time I was given the same bowl. I realised that this was not the unconscious arrangement. Once, I came back after going out, and I saw that the chopsticks I used have been burning. I realised that I couldn’t visit her house anymore. (DCYJ17)

3.3 Deficiency in Needs for Group Inclusion

81

After the infection, my cousin didn’t say hello to me. Me, either. She is afraid of me, that’s for sure. Then it’s not necessary for me to say hello to her …… I was isolated in this way for more than two years, occasionally someone came to our house, but they did not even take a sip of water. They just had a small talk for a while and leave. (DCYJ16)

In addition to relatives in kinship domain, there is nothing that has a more profound impact on the development of an individual than a peer group. Peer groups are small groups with common goals, and their influence on individuals is in line with the principle of “one plus one is greater than two,” which has a profound impact on individuals’ perceptions, behaviours, feelings, and pursuits. Therefore, due to the fear of discrimination and alienation from peer groups, PLWHA often choose to isolate themselves from their peer groups, narrowing down their social groups to the groups with only infected people. Now if there’s a tea party invitation, I don’t want to go at all. My heart has been closed off. Everything is meaningless. My ex-friends invited me out, and I didn’t want to go. I bought a lot of new clothes, and I didn’t want to wear. I sent all the clothes home and distributed to whomever would like to wear. Now I don’t know if there will be tomorrow for me. It’s just a matter of time no matter I take medicine or not. (DCYJ02) Perhaps there are a lot of people. Everyone who knows me knows about it. So, I can’t resume my former job. I can’t face ex-friends. Now my present friends are all HIV-infected people. No one is exception. I don’t have any contact with my former friends. Well, my heart was closed off. Perhaps some people would like to share with others. However, I don’t want to. (DCYJ02)

If the sense of group inclusion cannot be produced, the need that are aroused during encounters is often ambiguous. During encounters, the first concern is selfverification and to receive exchange payoffs. The need for group inclusion is ignored or unfulfilled, which result in the absence of individuals in encounters. If self is very salient in an interaction and feels abandoned, the higher intensity of negative emotions will be aroused. If there are certain resources that mark group inclusion, and hence self-verification are not received, the failure to verify self will be compounded by the inability to receive what a person may have come to expect as a just share. The person may feel sad or fearful. If group inclusion is defined in moral items, the person may experience shame and guilt. Simultaneously, if an individual always fails to gain a sense of group inclusion and has a feeling of exclusion, the individual often makes adjustments accordingly, such as running away from the group, or to say the least, gradually alienating from the group. Of course, some people will seek out groups that can replace them, but for PLWHA, it seems that only ASOs are helpful to some extent for their group inclusion. In this state, negative emotions such as shame and pain tend to be aroused, which usually affect micro-level encounters or, as a result, reduce commitment to the group with which they interact and choose to withdraw from it.

82

3 Acquired “Needs Deficiency” Syndrome

3.4 The Absence of Trust Needs As an old Chinese saying goes, Faith is the word of man. Faith is one of Five Constant Virtues which include benevolence, righteousness, propriety, wisdom as well. It wasn’t until the 1950s that the scholarly study on trust began to emerge from “The Prisoner’s Dilemma”. In the 1970s, Luhmann categorised trust into system trust and personal trust, in which system trust arises from people’s positive expectations of rational and universal systems (1979). For example, when we are crossing the street, we trust that a vehicle will not run a red light and hit us, and this is our positive expectation for the system. Personal trust arises from familiarity and emotional connection between people and is established in interpersonal interactions. It is generally considered as a premise for principal-agent relationships (Luhmann, 1979). In terms of the study on trust in China, Weber proposed that trust in Chinese society, based on kinship, that is, on family or quasi-kinship, is difficult to generalise (1993). Fukuyama further claimed that Chinese people have a strong tendency to trust only those who are related to them by kinship and distrust those outside their family and relatives (2001). In fact, it is well known that Chinese people’s interpersonal relationships are divided into close and distant relationships, which shows “differential mode of association” proposed by Fei Xiaotong (2008). The “differential mode” reflects the fact that, during interactions, individuals do not treat all people equally, but treat them differently according to factors such as kinship, geography, and emotions. Therefore, people always trust their relatives, or trust their friends and acquaintances. The routes of HIV transmission have become well known in recent years due to publicity on AIDS prevention. Of course, this is partly related to the influence of cognitive and behavioural changes such as KABP (Abbr. for Knowledge, Attitudes, Beliefs, and Practices). However, although the three routes of transmission, such as transmission through blood, sexuality, and mother-to-child, are well known, interpersonal interaction with an infected individual still leaves many people fearful. In the process of my research, I have always heard from healthy people, “What if, what if I’m infected?” HIV-infected people often say, “How could it happen so easily? For so many years, the scientific research on AIDS has showed that AIDS is much less contagious than hepatitis, tuberculosis, or SARS (Severe Acute Respiratory Syndrome).” Actually, the phenomenon reflects a lack of system trust, and HIV-infected people also hold this view. More importantly, it affects the interactions and personal trust between people and those infected with HIV. The absence of trust will bring worry and fear of PLWHA to the public. Additionally, it will easily arouse negative emotions of PLWHA, which will not only affect their survival, but also may affect the establishment of the social trust system and the stability of social system.

3.4 The Absence of Trust Needs

83

3.4.1 Crisis of Trust—Disappointment Due to Expected Behaviour Trust is based on the need to understand and anticipate the behaviour of others through role-taking and expectations of consistency, i.e., others’ behaviour is predictable. The media and the education community have been appealing to emphasizing that there are only three routes that HIV can be transmitted, and that daily contact and interaction do not transmit HIV virus, but the public, even PLWHA, remain be stuck in stereotypes of infected people and fears of HIV. However, individuals have need to be trusted, and PLWHA are no exception. Additionally, they hope that the public can believe in science, understand that they are not the source of infection and that daily contact does not lead to HIV transmission, and allow them to return to normal social life. There are too many examples. Everyone is afraid of getting infected. I repeat that dining doesn’t spread AIDS, and neither does saliva generally. People don’t believe this. We once set up a studio, employed teachers to teach infected people how to draw. Every time, there were twenty or thirty students. At first, the teacher was a foreigner, because foreigners are relatively open-minded. However, it cost high to employ a foreign teacher. Then we got to know a retired professor from Central Academy of Fine Arts. When we employed him, he said that he knew daily contact couldn’t spread HIV. Anyway, when we invited him to have dinner, he offered as an excuse that he’s busy. It’s impossible that he’s busy every day. Later, I asked him whether he’s afraid of being infected. He said yes. He said that he was getting old, and sometimes his gums would bleed or he would get mouth ulcers, so his family reminded him to be careful. Later, after several classes, the professor left our studio out of fear. (DCYJ20) In Beijing, there is less, but not without, discrimination. In non-infectious departments of X (hospital), the medical staff said, “put away your medical records, we don’t read them.” When I first went to the hospital for an opportunistic infection in my hometown, I thought I should tell the doctor about the infection. Because I had been doing experiments (experiments with antiviral drugs) in Y (hospital), and I didn’t feel anything bad about it. As a result, when hearing that I had AIDS, the doctor was scared to drop his pen and yelled, “Wash hands, he has AIDS.” It was a general hospital. At that moment, there were many people in and out of the consulting room. Suddenly it was quiet. All people were watching me, and I wished the floor would open up and swallow me. When I walked out, I felt that everyone was shunning me and talking about me behind my back. I hardly knew how I got out of the hospital, and I have never been to that hospital again. (DCYJ19) Soon after I was diagnosed, I couldn’t go to school. In fact, it sounded ridiculous. When the school (the high school) knew about the news, it spread. Many parents came to school and demanded that I had to be expelled and that I shouldn’t study in the school with their children. For me, I shouldn’t study in the school because CD4 count was less than 100 and my immune system was weak. Going to school would have increased the risk of opportunistic infections. But as it turned out, they came first and said they would transfer if I wasn’t expelled. Later on, I dropped out. I felt more devastated than I did when I found out about the infection. Because I had known about AIDS before, and there were people in my circle who were tested positive, but I hadn’t dared to check. (DCYJ07) I had a conversation with a chief physician about HIV, and when discussing the refusal to treat infected patients, he said, “If I were the doctor, I wouldn’t have operated on them.” He also said, “Do you really think people can’t get infected without blood contact? Do you think people won’t get infected with saliva contact? Are you sure that a hug won’t be infectious?

84

3 Acquired “Needs Deficiency” Syndrome These have just not been proven in medical studies. But it’s not exactly sure. For example, kissing. So, what if people get infected?” I was thinking in my heart, “it’s not going to happen. It’s impossible to be infected in these ways.” He continued to tell me, “I’m a doctor, I have to protect others.” I thought that if he didn’t have a sense of service, he shouldn’t be a doctor. There are a lot of diseases that are more contagious than AIDS. I was then questioned, “What if the infected person bites others? What will people do if he bleeds?” Anyway, people have awareness of risk averse too much. People thought that, “once there’s a little bit of risk, there’s a virus, you can’t even touch me.” (DCYJ26)

If the public no longer trusts PLWHA because of the lack of system trust, then the mistrust of relatives, loved ones and friends of the infected people, or their even stronger reaction to the diagnosis, although not beyond their expectations, also makes the expectations of PLWHA fall short again, bringing them physical and mental pain in addition to the disease, and increasing the possibility of negative emotional arousal. In fact, I know how scary this disease is and how scared everyone is. If it wasn’t me who was infected, but the people around me, I would have been worried and scared as well. I just didn’t realise that it was like this. They dared not to come near me, including my brothers. My mother was also quite scared that her grandchildren would contract the virus, and told them not to come and visit me in the hospital. (DCYJ01) I was sent to the Y Hospital after I got sick, and my family was informed. Y Hospital is a hospital for infectious diseases. And when they knew that I got this disease, no one else came and visited me except my mom and my sister. My sister didn’t get married at that time, and she lived with my mom. Though it was July and it was extremely hot, my sister was fully armed, wearing gloves and a mask. I had been in the hospital for more than three months, but my sister visited me once. She stood far away from me and stayed there for less than ten minutes. During this period, only my mom dared to sit on my bed. My mom always wore gloves when she washed my clothes. I knew Mom couldn’t know this, and it must be my brothers that have asked her to wear gloves. (DCYJ10) Soon after I was diagnosed, I told my partner. We didn’t have sex yet. I told him. He was scared and went to DT hospital for examination. He was fine. Then he quietly moved away. (DCYJ18)

For PLWHA, their sensitivity to the disease, coupled with widespread social discrimination and fear from the public, makes them expect to be cared for and trusted, and fear the loss that comes with this distrust. In the course of the interviews, I also participated in a number of activities organised by PLWHA. By chance, in some activity, I met one infected person who had planned to be interviewed. Some small action brought our relations closer, and I gained his trust. He took the teacup and toasted me. When we clinked the cups, he deliberately spilled a little of his tea into my cup to see how I would react. When I drank it all down, he laughed, put his hand on my shoulder, and told me many interesting things. In fact, it all depends on how we treat them and whether we have trust in them or not. This was his test for me, and even more so, his expectation for me. The trust that the infected person builds with me is based on his expectations of my response, and when his expectations are met, trust arises. However, in the real world, PLWHA experience various disappointments, so they lose trust in the society.

3.4 The Absence of Trust Needs

85

3.4.2 Dependency Dilemma: Withdrawal Caused by Trust Breakdown According to Collins, trust arises from the synchronisation of conversation and body language, in which the process of synchronisation tends to be consistent with people’s expectations. More generally, trust arises from being respected and relied on (2004). Many people would use the expression “vulnerable groups” to define PLWHA, and it is more likely to show care, support, and trust to vulnerable groups such as the disabled, the poor, and others, but PLWHA are exception. PLWHA also have the need for social interaction, for equal access to health care, for a sense of dignity and support that they can rely on. In reality, however, they are often not supported by their families, who believe that they affect the interaction of the whole family in society and bring about inevitable transmission; failure to gain respect from various groups, they are believed to deserve it; they are regarded as the source of HIV transmission and lack equal access to medical treatment; and they are not recognised by the society, who believe that they will cause unnecessary panic. It is required that AIDS should be prevented and treated according to the law. What law? The Regulation on the Prevention and Treatment of HIV/AIDS has been requested to come into force for a long time. How about the results? What can we do if we can’t get medical treatment? Take it all. One AIDS patient went to so many hospitals for his kidney stones, but no one operated on him, and finally kidney stones deteriorated into uremia at the early stage. He begged to do the operation. I called the leaders of the Ministry of Health, who in turn called the leader of department of Medical Affairs. Then the leader of the department called some leader of Y Hospital. The hospital agreed for a consultation. After the consultation, nothing was done. The patient was discharged. The man, fifty-year-old or so, held my hands and cried. You know what I thought about? At that moment I was filled with hatred for the society. AIDS epidemic has never been over, and it would be too abnormal for AIDS to be under control. (DCYJ27) In fact, you know, there are always people who say that we are too radical. Homosexual people are either promiscuous or messy. Besides sexual misconduct, we are regarded to make trouble, complain that we are discriminated or refused to be treated, and so on. You know, today, we live, but there is no guarantee for tomorrow. If I need to have surgery tomorrow, even if it’s just a small surgery like swollen anus, no doctor would like to do it. We find no one to trust, and we must face all kinds of discrimination. You know, we don’t need any special understanding. we just hope that we are equally treated and our illness are equally treated. (DCYJ28) In the past two years, there have been many cases of homosexuals or infected people being cheated out of money. The frauds know that they are afraid to be disclosed. Last year, an infected person received a text message asking for 20,000 yuan. Otherwise, the identity of his being gay and infected would be disclosed to the society and his workplace. In M (the name of some place), where gay men gather, they are often extorted money. Because even if the infected people were extorted, they won’t go to the police. What do they say if they go to the police? They say that they’ve been cheated in M, that they’re gay, they’re infected, they’re HIV positive… If they did, they would probably scare the cops off. (DCYJ22) Later, I’m afraid to go to the hospital. I do businesses by myself. (I’ve retired.) Many items are at our own expense. The expense, I think, is another thing. But getting medical care is really difficult. No matter how rich you have, once you tell the truth frankly, you are bound to be rejected and discriminated. That’s it. (DCYJ23)

86

3 Acquired “Needs Deficiency” Syndrome

What is terrible about HIV is that it destroys all trust in encounters. The infected individuals will be discredited. It is regarded that they are infected because of messy sexuality, drug abuse, homosexuality, etc. Thus, they lose the capital and conditions to be trusted. For PLWHA, they cannot voice their opinions, and their intense negative emotions being are also aroused. PLWHA are often under great psychological pressure, and they rarely have ways and channels to vent their feelings. They are more willing to share their feelings with those who pay special attention to them and make them feel particularly intimate and trustworthy. This is why many social workers, as well as case managers and volunteers, gain the extraordinary their trust. Many infected people’s emergency contacts are case managers, community volunteers, and so on. Because “the reason why I am still alive, XX (the name of someone) is my only hope”. Besides this, PLWHA often fail to feel sincerity and respect. In general, trust is based around people’s needs, and when someone does not gain trust in encounters, negative emotions can emerge. If the situation is important to the individual, these negative emotions will be primarily fear responses accompanied by anger. Without trust, the transactional needs of others will not be fulfilled. Nor can they trust verification from others at present or in the future, nor can people ensure that the resources exchanged now and, in the future, meet the needs of fair distribution. If they cannot trust others, their sense of belonging, to say the least, is weak. When they experience trust, other needs are more likely to be met, and the positive feelings that emerge from trusting others and from the self-verification gradually increase. In this state, the exchange of resources will gain benefits, the sense of belonging will be realised, and the emotion will be just as it appears. But trust is easily undermined, nothing can overcome the dilemma during the absence of trust in interpersonal interactions. When people fail to meet the needs, they will become fearful and angry, looking to leave the interaction occasion and, if possible, avoid it in the future. The generation of trust is usually straightforward. Individuals generate and gain trust in encounters, through words and actions. If individuals cannot gain trust in their interactions, then interactions with others will become highly ritualised and hypocritical. Usually, people will be biased against those who are untrustworthy and suspicious. In addition, if people feel sad, anxious, and angry because of failure to gain trust, they will feel alienated from these people, as well as from the culture and structure in which the interaction is embedded. In a sense, once all three primary negative emotions are aroused, and anger predominates in the sense of alienation, people usually feel untrustworthy of the social structure and culture in which they interact.

3.5 Need for Facticity That the need for people to feel that self and others in an encounter are experiencing a common world is part of subjectivity termed by Alfred Schutz. The study of

3.5 Need for Facticity

87

ethnomethodology builds on this basic idea by emphasizing that individuals employ folk methods to create accounts of reality (Schutz, 1967). Anthony Giddens further emphasises this idea in light of his philosophy that humans seek ontological security, which allows them to feel that things are as they appear (1984). These diverse approaches converge on a view of humans as needing to sense that they share a common world in order to interact. That is, self and others in an encounter are experiencing the common world. Second, they perceive reality of the situation as it appears. Third, they assume that reality has an obdurate feature, i.e., that individuals can experience certainty and facticity. Turner refers to these related states of need as “need for facticity,” because for an encounter to flow smoothly its participants must sense that they are experiencing and sharing a common factual world (1987, 1988, 2002). If need for facticity are met, individuals will experience positive emotions. Conversely, when these needs are not met or realised, they will experience negative emotions. HIV enters the human body without warning, and then affects the survival and life of PLWHA. Since the current medical technology cannot completely kill the virus, in a sense, the infected person and the virus are in a state of coexistence, “and only their own death can end the coexistence.” This co-existence with HIV makes them fearful of the future, and even dare not face words like AIDS and other related vocabulary, producing a different feeling of the real world from others. What is even more frightening is that with the invasion of the virus, the stigma from the general public has also “stayed” with infected people, reducing PLWHA in humiliated state. They can only show themselves in a mask, not daring to speak frankly about their real situation, but fearing about the privacy disclosure in encounters. Although they long for sympathy and support from others, they dare not share the common world.

3.5.1 Coexistence with Others AIDS typically includes such various and complicated labels as the chronic disease, the infectious disease, AIDS patients, homosexuality, messy lifestyle and promiscuity in life, etc. This socio-cultural stigma and discrimination prevent PLWHA from interacting with others, or even facing themselves as their true identity. Therefore, they are even more reluctant to say the word “AIDS” directly or to talk about all of AIDS-related things. At that time, I felt that if I got this disease, it would be like getting a death warrant. I couldn’t be cured. It happened that I lost weight very fast and I suddenly lost more than ten kilograms. At first, I said that I wanted to lose weight, but I was very afraid. I was afraid that I got the disease and I would be like those people in the pictures and ended with dying awfully. (DCYJ02) If I had not been hospitalised two years ago, I would not have mentioned this to anyone. I’ve never taking medicines. Of course, I’ve looked up a lot of information and consulted some people through QQ groups. I know a little bit about this disease. I just do my things in my own way. I’ve never been to any of the activities. Never. I thought, if it’s all like this, just fend for itself. There is no cure for this disease. Later, my health got worse and I was sent to

88

3 Acquired “Needs Deficiency” Syndrome the hospital to be rescued and have my blood drawn. I was sent to Y hospital. I came back to life, and then I started taking medicine. (DCYJ03) In fact, on the way back, all what I thought of was death. I had thought I was very brave, and I had a lot of preparations for the result, but I didn’t realise that I was still scared to death before I was diagnosed. I hoped to be hit to death by a car. At least, I could leave a sum of money for my parents. After getting out of the bus, I ran home as fast as I could; when I got home, I sat them in a daze for a long time. I used to eat a lot, and usually I could eat two bowls of rice (The interviewee uses his hands to give the sign of the size of the bowl). But I ate half a bowl of rice that day. After the meal, I said to my mom, “Don’t change the bowl anymore. I will use this bowl.” My mom felt that there’s something wrong and asked, “What’s the matter? What’s on your mind?” I answered: “Nothing.” My mom said: “No, it’s a big deal. Because I’ve never seen you like this.” I still said: “It’s okay.” Going back to my bedroom, I began to tidy my stuff. I wanna leave some money for my parents, so that they could live in comfort in their old age. I won’t tell them. I just wanna die alone. That’s what I’m thinking. (DCYJ19)

Most of PLWHA interviewed, or those who are willing to share their experience from being infected to the current state, accept the fact of their being infected to some extent. Nevertheless, words such as AIDS and HIV are mentioned quite infrequently in their daily conversation. Probably, it’s not because they deliberately avoid words like this, or they are afraid of these words, but because they develop mechanisms of self-protection and repression during their long-term encounters in the reality society. The reason why they have developed such a strategy of action is that they are worried about making others associate them with AIDS, and about sharing a different world with others around them. Not only infected people themselves, but also their family and friends are aware that not mentioning AIDS and the associated vocabulary is a way of composing their negative emotions. The more I worry, the more I want to get information about AIDS from various sources, especially from the Internet. Facing overwhelming information, I became fed up with those about AIDS. Because of great fear and pressure, I disliked talking about or hearing the news about AIDS. I hated and resented the word. Later on, when I heard about AIDS-related information, I became very angry. So, I changed the phone card, cutting off ties with the outside. I never went to activities organised by AIDS groups, and I didn’t go to the hospital for diagnosis. Perhaps it was the fear of AIDS that broke my willpower and destroyed my immune system. I was overwhelmed by the pressure and eventually fell ill. (DCYJ29) My son knew that I got this disease. He was only 4 years old when his father and I were diagnosed. Later, it’s probably that family members casually talked about the disease at his grandparents’ home, and he learned that. But he never asked me about it, and I never talked to him about it. I take medicine at nine o’clock every day, but sometimes I’m so busy that I forget about the time. As he grows older, he says that, “Mom, it’s nine o’clock”. He never says that you should take medicine or anything else. He knows all of this, but he never asks. He knows all of this. Other family members also care about me very much. When it’s nine o’clock, they will remind me of taking medicine. (DCYJ03)

The interviewee labelled DCYJ03 was infected together with her husband, who passed away shortly after being diagnosed. She was doing business alone. When she talked about her child knowing that she was infected, I think that she had a sense of guilt and relief for her child’s understanding from her look and expression. Though she shared her experience with me, her repeated statement “he knows all of this”

3.5 Need for Facticity

89

seemed to be addressed to herself. When talking about the concern from her family members, she’s more likely to experience the only comfort during encounters since the infection. Infected people expect to live in a real and common world with others. People living with cancer, another one of incurable diseases, do not have to conceal their illness. Instead, they often get the care, sympathy and support of others. However, PLWHA have to silently suffer from the blame of the “source of infection” and the moral criticism of “messy”, struggle to accept the state of living with the virus calmly, and hide the ups and downs of their inner emotions such as fear and resentment. I’ve heard of this disease before, and I know what it’s like in general, but I didn’t expect that I would get it. Through continuously taking medicine, it can be controllable, though there are drug reactions or drug resistance. Anyway, it’s very painful. Sometimes, I would rather have cancer, such as lung cancer, so that I can tell others, to say the least. I can be taken care. I take medicine sneakily, let alone tell others. (DCYJ06) This is my future life. The HIV virus exists in my body. Although the virus lives and dies with me, I cannot live with it. We regard the virus as a monster, in turn, we are regarded by the society as monsters. In the end, we gradually accept it and live in peace with it, but people in society don’t want to live in peace with us, which makes us feel suffering and hopeless. (DCYJ27) There was a group activity where we went to karaoke and poured out feelings. Some people said that it’s so hard for us to live. It seemed that we had never been dignified. At the beginning, we doubted our sexual orientation. Though we finally made it clear, we were never told that MSM could transmit AIDS. If there were more publicity for that at that time, many people would not be like this. Then we talked about expectations. Some people said that they didn’t know when antiviral drugs would come out. Some people say that they really want to live until that time. Someone said that he had dreamed that we would not be discriminated, as sung in a song, “we are family”. Then we cried. To be honest, infected people silently suffered a lot. (DCYJ11) I’m trying hard to forget the fact that I was infected and live a normal life. However, I have to take medicine every day, which shows that I am not a normal person. It constantly reminds me of the infected state. I cannot ignore this. To forget this is to give up my life. (DCYJ17)

Not all PLWHA avoid AIDS-related vocabulary and talking about their infection. On the one hand, this is due to the fact that the public is unable to understand how PLWHA live with the virus; and on the other hand, the different understandings of what AIDS refers to creates a different real world, which can only lead to greater harm to PLWHA. Consequently, they are unwilling to interact in reality with their true state, and therefore hide their true feelings.

3.5.2 Stigmatisation PLWHA are stigmatised because of the moral judgment and stigmatisation of AIDS in the society. Due to the stigma associated with AIDS in different domains, the disease is not accepted in social and cultural values, thereby becoming a secret that cannot be disclosed. Being fearful of revealing the fact of being infected, PLWHA

90

3 Acquired “Needs Deficiency” Syndrome

are often unable to confront discriminated attitudes and behaviours, and even less able to confront the source of discrimination. They have to hide the fact and belie their true feelings. What they perceive is not the same as what they show. The self cannot experience the sense of reality, so it cannot experience certainty and validity. There is too much discrimination against people living with HIV in this society. How many people can bravely stand up and say publicly that I have AIDS? Aren’t many of those who stand up also using false names? They are not in their hometown, you know. (He listed several names of infected people, whose real names are not known to us.) Even if he wants to stand up, he must consider his family. What about his parents and relatives? How do they live? (DCYJ08) Except for some people at Y hospital and CDC, no one knows the fact of my being infected. (At present, there are no friends or family members that know about his infection. ASOs helped him refer to Y Hospital) No one else. We hide a lot of things and dare not tell others. We always have to carefully consider what can be said and what cannot be said. I still keep many things hidden. Until the day I pass away, it’s good if no one has discovered the fact. Otherwise, what else can I do? (DCYJ25) My family members don’t know this. There is no need to let them know. My emergency contact is H (a staff member of an ASO). The nurse also asked me if I would not let my family know even when I was in the most critical condition. I think that it’s better not to let them know if possible. I think it will be bad for family members to talk about this kind of thing. If my parents are asked by the relatives about my condition, how they say that our son was infected with AIDS? Do you think so? So, I’ll hide the fact as possible as I can. In addition, my parents may not accept it. (DCYJ10) What I can say now, is that I don’t know what will happen tomorrow. If I need an operation one day and I am pushed to and fro, I will definitely die. I don’t need others’ understanding. I need equal access to medical treatment. If this is the fate, I’ll take it lying down. I was singled out in the hospital as if I am no longer a human being in this world, but an animal, or even less than a human being. (DCYJ26)

Faced with the stigma and discrimination, they fear that they will not be accepted by the society after their identity exposure. Therefore, when asked about the causes of their symptoms, they often choose diseases that can be accepted by the society, instead of AIDS. When I was brought to the hospital, I told my brother to come, but I didn’t tell him about the disease. I simply told him that I got pneumonia because it happened to be complicated by tuberculosis at that time, so that he could accept it. (DCYJ11) It happened that I got tuberculosis. So, I used tuberculosis bacteria as an excuse. They didn’t further question the reason for my getting thin and frequent hospitalisation. That’s a coincidence. At first, I was also very worried. How did I make excuse for frequent fever? How to tell my parents? Later I was diagnosed to be infected with tuberculosis bacteria. I used this as an excuse to hide the truth. (DCYJ15) My mother didn’t know that I had the disease. They (his family members) just knew that I had TB. Because tuberculosis required quarantine, I refused when they offered to take care of me. I said that, “the disease was contagious, and it was contagious through breathing, and it could be contagious by sneezing. This is how I’m infected.” Their immune system is weak, so I wouldn’t let them come to the hospital. (DCYJ06) I felt ill on May 28. At that time, I was in a bad mood; I didn’t want to eat all the time; I was always worried. Finally, I felt ill that day. That was the first time that I was hospitalised. I had impacted stool. I stayed in the hospital for 28 days. After being discharged from the

3.5 Need for Facticity

91

hospital, the bowel movements were still not so smooth, but in general, the stomach didn’t hurt any more. I went to many big hospitals; there was no diagnosis of the disease. Because I dare not say it’s the disease. Later, on August 6, I remember very clearly. On August 6, the onset of the illness was the most severe one. At first, the onset was high fever and stomach ache. Initially, I had a high fever and stomach pain for a week; I didn’t poop for one week. It leads to my stomach bloating. Then I was hospitalised, and admitted to Surgical Inpatient Department. I didn’t want to live any more that night. I was putting on an IV drip. I wanted to go to the toilet. My dad helped to hold the IV bag. The ward was on the fifth floor. When I stepped into the bathroom, I ran to the window. I just wanted to commit suicide by jumping off the building and hide the fact of my being infected. I stepped out one of my legs on the windowsill, but my dad pulled me off. My dad strived to pull me off so that the blood vessels of my hand were torn. I cried in the bathroom. The doctors all ran over, carried me to the emergency room and asked me what was wrong. I only said, “Nothing, nothing”. They asked me so many questions that I couldn’t take it anymore. (DCYJ29)

Many infected people either explain the cause of the disease with studied understatement, or choose to say that it is a mild case of tuberculosis or pneumonia. This provides them with another form of rationalisation of medical treatment and with rhetoric of acceptance that can be used as another excuse and shield from blame. In addition, due to different routes of HIV transmission, there has always been a debate about whether some infected people are innocent. Those who are infected due to sexual indulgence, drug abuse, and homosexuality are often regarded to deserve punishment. Generally speaking, if I were not an infected person, I would be afraid of this disease. The most important thing is that if I was infected by surgical blood transfusion, people will be sympathetic with me and think that I’m unlucky. However, if it is due to drug use or sexuality, I will be considered to get what I deserve. Also, if a person with advanced lung cancer and a person with AIDS commit the same crime and are arrested, the former may be released for medical treatment, while the latter may become the focus of the news. The news may report that infected people took revenge on society and so on. As a result, the infected people have to live in infamy. (DCYJ28) Undoubtedly, many people will say that infected people get what they deserve. In fact, I also think so. We didn’t protect ourselves well. The former improper behaviours result in the consequence. In other words, if we didn’t behave in an improper way, and if we protected ourselves well, things would be different. We have to take medicines for the rest of life. Everything is on ourselves. We have to go into hiding. I think that infected people need more care and respect from their families. (DCYJ22)

The situation of facticity is very important to PLWHA. If needs for facticity are not met, then other negative emotions, such as fear, will emerge. However, the expression of negative emotions will further increase the problems in the situation, because the expression of negative emotions tends to hinder interaction and produce more intense feelings of sadness due to unsatisfied needs for facticity. Therefore, if PLWHA do not experience a common sense of meaning, that is, a common real world, then even a short interaction, an accidental trivial matter or a sentence will arouse the infected person’s negative emotions. Ethnomethodologists’ early use of “breaching experiments” provides us with research data on the emotions aroused when people do not meet needs for facticity (Garfinkel, 1967). Individuals would become angry at experimenters who had deliberately breached the interaction and forced others to use folk methods to try and

92

3 Acquired “Needs Deficiency” Syndrome

reconstruct assumption of a shared reality. Meeting needs for facticity is highly contingent on what transpires in the immediate situation, as individuals mutually role-take and present self. When needs are not met under these conditions, individuals are most likely to make external attributions to others in the encounter and direct variants of mild-to-moderate anger at these others. Therefore, if PLWHA cannot achieve a sense of reality, their other needs in the micro-interaction will also produce problems; if PLWHA cannot form a common reality with others, they cannot take self-verification. At the same time, when the common reality is a bubble in the air, it is also very difficult to achieve a sense of group belonging. When the common reality in the relevant situation is not resolved, trust is equally impossible. Therefore, I believe that these are the reasons why frustration (a moderate intensity of anger) emerges when people cannot construct a sense of reality in interactions. That is, if the satisfaction of other needs is hindered, then people will have a sense of anger directed at others.

References Collins, R. (2004). Interaction ritual chains. Princeton University Press. Deng, W. (2009). Dictionary of sociology. Shanghai Lexicogoraphical Publishing House. Durkheim, É. (1951). Suicide: A study in sociology. Free Press. Fei, X. (2008). From the soil: The foundations of Chinese society. Renmin Press. Fukuyama, F. (2001). Social capital, civil society and development. Third World Quarterly, 22(1), 7–20. Garfinkel, H. (1967). Studies in ethnomethodology. Prentice-Hall. Giddens, A. (1984). The constitution of society. University of California Press. Goffman, E. (1959). The presentation of self in everyday life. Anchor Books. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Simon and Schuster. Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94(3), 319–340. Higgins, E. T. (1989). Continuities and discontinuities in self-regulatory and self-evaluative processes: A developmental theory relating self and affect. Journal of Personality, 57(2), 407–444. Homans, G. C. (1961). Social behavior: Its elementary forms. Harcourt Brace Jovanovich. Homans, G. C. (1974). Social behavior: Its elementary forms. (Rev). Harcourt Brace Jovanovich. Hou, R. (2015). Dying to live: Restoration of the self for people living with HIV/AIDS. Fu Jen Catholic University. Hwang, K. K. (2006). Confucian relationalism: Cultural reflection and theoretical construction. Peking University Press. Hwang, K. K. (2010). Favor and face: Power game of Chinese. China Renmin University Press. Jasso, G. (1993). Choice and emotion in comparison theory. Rationality and Society, 5, 231–274. Jasso, G. (2001). Comparison theory. In J. H. Turner (Ed.), Handbook of sociological theory. Kluwer Academic/Plenum. Jasso, G. (2006). Distributive justice theory. In J. E. Stets & J. H. Turner (Eds.), Handbook of the sociology of emotions. Springer. Luhmann, N. (1979). Trust and power: Two works. Wiley. Luhmann, N. (1988). Theory of action: Towards a new synthesis going beyond parsons. Routledge. Markovsky, B. (1985). Toward a multilevel distributive justice theory. American Sociological Review, 50, 822–839.

References

93

Markovsky, B. (1988). Injustice and arousal. Social Justice Research, 2, 223–233. McCall, G. J., & Simmons, J. L. (1978). Identities and interactions. Free Press. Pan, S., & Hou, R. (2013). Dispersive and colorful: The post-revolution sexualized period in contemporary China. Sociological Review of China, 5, 12–21. Schutz, A. (1967). The phenomenology of the social world. Northwestern University Press. Shott, S. (1979). Emotion and social life: A symbolic interactionist analysis. American Journal of Sociology, 84, 1317–1334. Stryker, S. (1980). Symbolic interactionism: A social structural version. Benjamin Cummings. Turner, J. H. (1987). Toward a sociological theory of motivation. American Sociological Review, 52, 15–27. Turner, J. H. (1988). A theory of social interaction. Stanford University Press. Turner, J. H. (2002). Face-to-face: Toward a theory of interpersonal behavior. Stanford University Press. Turner, J. H. (2007a). Human emotions: A sociological theory. Routledge. Turner, J. H. (2007b). Justice and emotions. Social Justice Research, 20, 288–311. Turner, J. H., & Boyns, D. E. (2001). Expectations, need-states, and emotional arousal in interaction. In J. Szmatka, K. Wysienska, & M. Lovaglia (Eds.), Theory, simulation and experiments. Praeger. Weber, M. (1993). The sociology of religion. Beacon Press.

Chapter 4

Acquired “Expectations Deficiency” Syndrome

Turner believes that universal need-states establish a set of expectations and individuals almost always enter encounters with expectation states. Indeed, it is rare for a person to go into a situation with no knowledge of what to expect. And, if a person is not sure of what to expect when entering an encounter, this person will generally experience mild negative emotions such as anxiety, shyness, or hesitancy (Turner, 2007). There is, of course, a large literature on expectation states in sociology. Most of the research in this area is conducted with special emphasis on the expectation states that are associated with status (prestige) and power (authority). At times, the prestige and power structure are given to members of task groups as a proxy for the fact that many real-world task groups are embedded in corporate and categoric units; and at other times, research examines the emergence and change of expectation states during the course of interaction (Berger, 1988; Berger & Conner, 1969; Berger & Zelditch, 1985, 1998; Webster & Whitmeyer, 1999; Webster & Foschi, 1988). Although expectations from status and power are crucial to the flow of interaction, and the entire theoretical research tradition has produced incremental and cumulative knowledge, they are not the only source of expectations. And, in some contexts, they are not even the most important. The expectations come from a variety of sources, but they typically revolve around characteristics of self, others, and situation. They are often codified into what Affect Control Theory calls “fundamental sentiments” (Heise, 1979; Smith-Lovin & Heise, 1988) or what some researchers (Ridgeway, 2006) term “status beliefs”. Individuals are motivated by gestalt propensities to see congruence between their expectations for the actions of self and others as well as their expectations for the properties of the situation. When individuals’ expectations for self, other, and situation are realised, expectations states emerge and they will experience mild positive emotions and if they had experienced some fear about whether or not expectations would be realised, they will experience more intense variants of positive emotions like pride when expectations are met. The converse of this generalisation is that © Huazhong University of Science and Technology Press 2021 R. Hou, A Sociological Study on Emotion Regulation in People Living with HIV/AIDS in China, A Sociological View of AIDS, https://doi.org/10.1007/978-981-16-1494-1_4

95

96

4 Acquired “Expectations Deficiency” Syndrome

when the actions of self and others, or situation in general, do not measure up to expectations, individuals will generate negative emotions. There are, however, more options for negative emotional arousal because three out of the four primary emotions are negative. Individuals can experience fear, anger or sadness and the mix of the negative emotions. From this point of view, the realisation of the expectation states is a fundamental interaction of encounters. In essence, the expectation states are based on interpersonal behaviour in encounters. More importantly, expectation states are not only about the satisfaction of need-states at the micro-level, but also are directly affected by the embedding at the meso-level, and further affects the social reality at the macro-level indirectly. Another question emerges: What promotes the fulfillment of expectations during face-to-face encounters? Generally speaking, there are two basic types of structures at the meso level of social organisation: corporate and categoric units. The embedding, as well as other components, of corporate units and categoric units and corresponding culture, promote the fulfillment of expectations. Additionally, the extent of the mesostructure embedding within macro institutional domains and stratification systems also plays a role. That is to say, the encounters are further embedded within a higher level of social structure and culture, and then the expectations during encounters can be easily understood. Looking back at the course of fighting against the HIV virus, it is also a history of fighting against expectations. For PLWHA, their living conditions vary. Some infected people passed away soon after being tested positive for HIV, while some can live healthily for more than 20 years and involve themselves in the care of PLWHA, which can be summed up as “dying to live”. They help themselves in helping others, fulfilling the expectation of “live to see the success of the development of antiviral drugs” (Hou, 2015). Of course, there is the difference in the physiological and pathological factors of PLWHA and the satisfaction of their transactional needs in encounters at micro-level. Additionally, the embedded meso-level structure also has an impact on the survival and life of PLWHA to a certain extent. Their efforts to cope with the infection and the degree to which their expectation is satisfied also affect whether their negative emotions will be aroused. Generally speaking, the expectation states of most PLWHA are ambiguous or vague, which makes the fulfillment of their expectation more difficult. For example, PLWHA want to receive timely treatment from medical institutions, but they do not know how to achieve equal access to medical treatment. They hope to obtain corresponding support, care and help from the organisations, while they don’t know what status they are at and how to fulfill the expectation of being inclusive in the groups. Their lives are affected by factors such as gender, sexual orientation, wealth differentiation, and the way of infection, but they do not know how these factors promote clarity of their expectation. AIDS refers to acquired immunodeficiency syndrome. Therefore, I use the term “acquired expectation-deficiency syndrome” to describe the unfulfilled expectation of PLWHA. In this situation, it is easy to arouse their negative emotions. If the expectation states cannot be met for some reason, the negative emotions will be

4 Acquired “Expectations Deficiency” Syndrome

97

aroused and the intensity will be strengthened. On the contrary, if the expectation states are clear and can be satisfied, the initial negative emotions will be replaced by higher positive emotions. It can be seen that all these forces, including the common emotional language, social structures and cultural embedding characteristics, affect the fulfillment of expectations. Therefore, in this chapter, I attempt to further explore the social institutions at the meso level, that is, the influence of corporate units and categoric units on the realisation of expectations, and then analyse how the negative emotions are aroused and presented.

4.1 The Ambiguity of Expectation States Based on the research of human ecology, Amos Hawley has divided the meso-level social organisation into two types: corporate units and categoric units (1986). Turner borrowed from Hawley and believed that a corporate unit is a structure revealing a division of labour organised to pursue goals, no matter how ephemeral the goals may be. There are only three basic types of meso-level corporate units: organisations, communities, and groups. They are regulated by norms, ideologies and values, and the culture and structure of corporate units affect the force of micro-level social organisation (Turner, 2007). As Turner has emphasised, the operation of the micro dynamic mechanism is constrained by the social organisation embedded in it. If encounters are embedded in corporate units, and then in institutional domains and stratification systems, it is more likely to generate clearer expectations than interactions that are not explicitly embedded. If the expectations originating from corporate units are clear, people are more likely to meet such expectations, which can avoid negative emotions arousal because of unfulfilled expectations. Social organisation at the meso level often influence encounters through the dynamic mechanism of social forces such as roles and status. A large number of sociological theories and empirical studies often pay special attention to identity status when discussing micro dynamic mechanisms. There are very few researches on how corporate units and categoric units embedded in encounters affect the characteristics of roles and status. Similarly, only a few studies have discussed how institutional domains and stratification systems influence encounters through corporate units and categoric units (Turner, 2007). It can be seen that roles and status are the ways through which the meso- and macrostructure exert pressure on encounters. If we want to analyse how the dynamics of encounters promote the formation and operation of interaction, we must realise that these micro-level forces are, on the one hand, the connection points between individuals, and on the other hand, they are the connection points of larger-scale social structures. When these forces are at work, the emotions are not only affected by the process of interpersonal interaction, but also directly constrained by the mesolevel structure within which the encounters are embedded, and indirectly affected by the macrostructure.

98

4 Acquired “Expectations Deficiency” Syndrome

Therefore, if the clarity and realisation of expectations are stronger, the structural forces such as roles and status can operate in a way that increases positive emotions, thereby maintaining the intermediate structure of interactions. On the contrary, if the expectation is vaguer, the possibility of expectation realisation is weaker, then these structural forces are more likely to cause the arousal of negative emotions and hinder interaction. If negative emotions are suppressed, their intensity will increase or transform and challenge the mesostructures, which indirectly affects the macrostructures. The structure of corporate units within which an encounter is embedded determines the kinds of emotions that can be aroused, the way in which transactional needs are to be met, the normative expectations that apply, the distribution of status, and the roles associated with status. Therefore, the intensity of emotional arousal in encounters is highly constrained by the structure of corporate units. In addition to the social forces that meet the transactional needs of PLWHA at the micro level, the living world of PLWHA is inevitably affected by the mesolevel corporate units. The most typical one is the medical institutions at all levels that provide treatment for PLWHA, including designated specialist hospitals that are responsible for providing free antiviral drugs and treatment of secondary opportunistic infections. Although the designated specialist hospitals highly target specific diseases, they cannot fully solve all the medical problems of PLWHA, such as the implementation of major operations or the treatment of other diseases of PLWHA. Therefore, the medical institutions at all levels in this book not only refer to designated specialised hospitals for infectious diseases, but also include general hospitals from tertiary-A general hospitals to ordinary community hospitals and even private medical institutions as supplementary hospitals. In addition to medical institutions, at the beginning of the twenty-first century, with the influx of foreign concepts and funds on AIDS prevention, and with the acquiescence of domestic governments at all levels, many non-government organisations that help PLWHA have been established. Generally speaking, these organisations have not obtained the registration permission of government departments, but they are engaged in support and care services for PLWHA, and they have become the backbone of helping PLWHA effectively respond to the HIV virus. Therefore, it is particularly important to explore the impact of the operation of medical institutions and organisations of PLWHA on micro-level social forces, analyse its impact on the realisation of expectations from the perspective of roles and status, and explore the arousal of negative emotions in PLWHA.

4.1.1 The Helplessness of Role-Taking Sociologists have various understandings on the concept of role. For example: roles are the expectations for how people should behave in a situation (Moreno, 1953); roles are the behavioural component of status positions regulated by norms (Parsons, 1951); roles are bundles of resources that individuals employ to establish behaviours

4.1 The Ambiguity of Expectation States

99

that gain access to status (Baker & Faulkner, 1991); roles are strategic presentation of self (Goffman, 1967); roles are cultural objects that signify who people are, what they are doing, and how they should be treated (Callero, 1994). Although these views are not contradictory, they do suggest that roles have many facets and display layers. To use Ralph H. Turner’s term, when people present self in a situation, they are also role-taking. Role-taking occurs by viewing the role-making efforts of others. Individuals always seek to have their roles verified by others because it is through role behaviours that transactional needs are realised. Role-identities are tied explicitly to others’ verification of the role presented, but other levels of self (sub-identities and core self-conceptions) are also presented via roles; and so, individuals are highly motivated to have their roles verified because self is on the line. Similarly, many of the resources given to and received from others come via roles; and if these roles cannot be mutually verified, the flow of resources will be disrupted. Group inclusion is often achieved by others accepting the role being presented in a situation. Trust ensues when others verify a role because, once verification occurs, behaviours become more predictable and rhythmically synchronised; and markers of sincerity become clear. Facticity is achieved by individuals understanding each other’s roles because, with mutual verification of roles, the situation becomes more obdurate, giving people a sense that they do indeed share a common world (Turner, 2007). Thus, verifying a role has implications far beyond the role, per se. To explore the relationship between role positioning and emotional presentation, it is even more necessary to embed roles in meso-level corporate units. On the basis of summarizing previous studies, Turner proposes that individuals carry inventories of role in their stocks of knowledge (Turner, 1994) which they access when role-taking with another. Turner believes that in these stocks of knowledge, there are four basic types of roles, namely, preassembled roles, combinational roles, generalised roles and transsituational roles (Turner, 2002). The verification and making of these four roles must be embedded in corporate units or categoric units of meso-level to be realised. Generally speaking, when self is successfully presented and verified, the expectations of transactional needs are also met. Similarly, the expectations formed by other components of social structure and culture are also realised through the role-making and role verification. When roles are verified, there will be high-level intensity of emotions; when roles are not verified, the emotional intensity will be even higher. When roles are verified, and especially roles where self and critical resources are on the line, an individual will experience positive emotions such as happiness (pride, gratitude, etc.). The individual will sense that more than expectations associated with a role have been met; other expectation states associated with transactional needs, social structure, and culture are also likely to have been realised. Role verification ultimately affects individual behaviour like rewards, because many expectation states are interwoven with the roles presented in the corporate unit. On the contrary, when roles are not verified, or the role that the individual does not take is verified for no reason, negative emotions can take many turns. The individual will experience negative emotions such as sadness, anger or fear. If these emotions are experienced simultaneously, the individual will experience shame. If expectations derived from

100

4 Acquired “Expectations Deficiency” Syndrome

moral codes are associated with this role, the individual will feel guilt. Over time, this simultaneous activation of all three negative emotions may transform into a sense of alienation. An individual will reveal distance from the role that he or she has been forced to play, or choose to escape from these embedded corporate units. Medical institutions, as meso-level corporate unit associating encounters of PLWHA with macro-level institutional domains, play a huge role in the realisation of expectation-states of PLWHA. However, from the perspective of medical institutions, the individual, regardless of self and potential identities, must play the role of “patient” in the hospital. The doctors care about medical history and status of patients to treat effectively. Once the role of “infected individuals” is added, medical treatment for individuals would experience twists and turns. They are faced with unnecessary verification of the role of “infected individuals” or helpless efforts to conceal this role, which results in the ambiguity of their expectation states and the helplessness of achieving their expectations, and also triggers their emotional ups and downs. (I)

No Access to Treatment Caused by Preassembled Roles

Preassembled roles are widely known roles that are revealed by sets of gestures that are readily perceived and understood (Turner, 2007). When these roles are observed in the interaction, people can immediately extract all the components of the role from their stocks of knowledge and adjust their behaviour to play complementary roles. For example, the roles of mother, father, businessman, doctor, student, worker, etc. usually have to be connected to a certain institutional domain. Once the posture that marks this role is detected, people will more easily extract relevant information from stocks of knowledge to respond. With the popularisation of AIDS publicity, the role of PLWHA has also become a preassembled role, which exists in the perception and understanding of the general public, including medical staff. AIDS is regarded as a disease misunderstood as a combination of high infectiousness, high morbidity, high mortality and stigma. Although the country explicitly prohibits medical institutions and doctors from refusing to provide treatment and surgery for PLWHA for various reasons, and stipulates that PLWHA shall have equal rights of medical treatment. But when PLWHA actively or passively show their roles, the role of HIV virus carriers has become the only preassembled role in the cognition of medical staff, allowing medical staff to immediately extract the components of this role from their stocks of knowledge, thereby adjusting their behaviour to respond to PLWHA. On the contrary, PLWHA regards the preassembled role of medical staff as healing the wounded and rescuing the dying. As a result, in the playing of these two different preassembled roles, PLWHA will inevitably fall into a situation that there’s no access to treatment and surgical treatment has become an impossible task. I just went to TR Hospital to check my eyes. After I told him that I was a HIV carrier, he immediately said that you do not need any surgery in this case. The doctor said a lot. For example, there was nothing wrong with one eye, so it doesn’t matter if you have the operation or not. However, before I told him the infection, he suggested that I should have an operation; after that, he didn’t suggest that I have an operation, why? He refused the operation. Isn’t

4.1 The Ambiguity of Expectation States

101

this just shirking me? I have been tested for HIV antibodies before. The decision to go for the test at that time has nothing to do with eye disease. Because several gay friends suspected that they might be infected, and they all wanna be tested. I thought that I was with them. It’s better for me to be tested. If there’s no infection, I should pay attention to it. But what I have never known is that I couldn’t perform surgery after I was infected, and no hospital dares to perform surgery on me. Now I’m guilty and regretful. If I didn’t say anything at that time, the operation might be completed. It’s all because I didn’t know that it caused something wrong. …Later I went to another hospital, and one doctor in that hospital proposed a prerequisite: he can perform the surgery, but I must accept the media interview. What he wants is to enhance his reputation. He hoped that the surgery could be publicity for him. However, as a member of society, I have the right to refuse it. He can’t put the responsibility of the whole society on me alone, right? He could suggest that my accepting the interview was to reduce the discrimination. However, he couldn’t propose the prerequisite that if I didn’t agree, I wouldn’t have surgery. If what he said was a little bit euphemistic, I might agree. For example, instead of my real name in my hometown, I could use another name. They planned to take video recording of the whole operation. I would rather not have surgery than take this risk. I am not afraid about myself. I must protect my child. Since I have protected my child for so many years, I would continue. I don’t want him to live in discrimination. Growing up in discrimination brings harm to his young mind and he may form an unhealthy mentality. Some people say, are you unwilling to contribute to this society? I say that I have no obligation. I should have the right to choose. There are so many people in the world. Why not choose someone else? Even if I was chosen, I couldn’t be given a prerequisite, right? It’s not that I don’t pay. I’ll pay as much as I’m required. I never thought about doing this operation without spending money, begging someone or something. I go to the hospital to see a doctor and I give money. This is a matter of course. This is a fair deal. The hospital is to save the dying and heal the wounded, and this is the hospital’s duty. When one’s life reaches its end and when one need help, if he is abandoned, he definitely takes revenge on the society. I spend money to see a doctor, why do they refuse me? (DCYJ07) I was diagnosed with AIDS after the diagnosis of meningioma. At that time, I fainted on the street for no reason, so I went to the hospital for related examinations. The doctor told me that because the size of the tumor exceeded the scope that can be operated with gamma knife, it can only be removed by ordinary surgery. Taking into account economic reasons and other factors, I chose to return to my hometown for surgery. After I went back, I went to military region general hospital. Any doctor who didn’t know that I was tested positive for the infection would say that the operation was very simple. It was a very simple operation, and that the position of tumor was favorable for surgery. But I was admitted to the hospital for almost a week, and they still didn’t perform surgery on me. When I was first admitted to the hospital, the doctors, nurses, and other patients liked me very much, but later, they isolated me for various reasons and did not round up the ward. I went to ask them why they didn’t operate on me. The doctor told me directly that they were waiting for the response of the CDC and that I might be infected with AIDS. Later, I waited for a long time. I waited for more than two weeks without surgery. I had nothing to do. It was very boring. I went out for fun before 11 am during the day. I felt that I was in prison in those two weeks. I said to them: why would you dare say that you dare not perform surgery on me? I can live no more than a year or two, and I was trapped here. It’s too depressing! (DCYJ17) I need surgery because of an anal swelling, but I was rejected at all levels of hospitals in the town, county, and city. Then I came to XX hospital. Because I heard that there is a XX hospital and their anorectal department is good. Then I went here. But I intended not to say that I was infected. The doctor checked me carelessly, and then I was arranged the operation. When I was on the operating table, after the anesthesia, I thought that I was lucky to have the operation. As a result, before the operation, the doctor suddenly said to me: you cannot

102

4 Acquired “Expectations Deficiency” Syndrome

do the operation. I said: why not? He said: we just got the examination result, showing that you are HIV-positive. You can’t have surgery. I said: How can you check my HIV without my permission? I’ve no requirements in this regard. This is just an anal operation. For your anorectal department, this is a very small operation. You don’t need to check my HIV, at least you violated my privacy. However, it’s useless to argue. I was asked out. I cried and said all of this. But it’s useless, you know. He said: I also understand your feelings very well. Anyway, I can’t do the operation on you. Then I was pushed out. I don’t know the medical regulations. I have completed the physical examination before the operation. I’ve been on the operating table, and put on the anesthesia, finally I was pushed out of the operating room. It’s useless to cry… In fact, the operation was very fast, and it was completed in twenty minutes. But the doctor was still afraid of infection. Absolutely! Later, there was no alternative, I left after the effect of the anesthetic passed. (DCYJ01)

No access to surgery is one of the most marked problems in the medical treatment of PLWHA. When an ordinary patient needs surgery, doctors will strongly recommend it. But if the patient has been infected, he is not an ordinary patient. The only role he takes is an infected person. In the words of a doctor, “Everyone knows that HIV is transmitted through blood. The risk of such an operation is too high. I dare not do it for you, and no one dares to do it for you.” Because of the role as the infected individuals, it’s extremely difficult for them to have the operation. There was an organisation that disclosed the Tianjin “Xiaofeng Case.” Xiaofeng needed surgery for lung cancer. However, no hospital was willing to perform the surgery. In desperation, Xiaofeng falsified his case report privately and was finally operated successfully. The case rendered him in a state of contention. PLWHA actively or passively reveals their role of infected individuals based on their cognition of preassembled role of medical staff. However, in medical staffs’ opinions, it is a “significant” preassemble role, which in turn constrains the treatment for PLWHA. Their prospects of treatment have vanished. In particular, compare the changes of the medical staff’s attitudes between before and after knowing their role, it’s found that there was no equal access to medical treatment. In this situation, PLWHA not only fails to receive treatment, but engenders negative emotions such as sadness and anger. If there’s relatively large risk of infection in the treatment of severe illness of PLWHA, especially surgical problems, (of course, this is only “if”, because it is not the case), then for PLWHA, the treatment of even common diseases such as colds will be discriminated against and rejected in many places because of their role, thus they may miss the optimal time for treatment. PLWHA actively reveal their role as infected individuals out of the consideration for the medical staff, but they are discriminated against and refused to receive treatment. The preassembled role of infected individuals should have been a prerequisite to help medical staff make a correct diagnosis of an infected individual, but in reality, the infected individual has to gradually learn to hide the role. Some people who are infected even stop going to the hospital. “If you are sick, just stand it up by yourself. If you can go through it, you’ll survive. If you can’t, think about other ways”. This often leads to more serious consequences. When I ate, lived and worked with the infected individuals, I have also heard that many infected people failed to have timely treatment of some minor illness, which gradually deteriorated or even induced other

4.1 The Ambiguity of Expectation States

103

diseases, resulting in serious consequences or even death eventually. These infected people are not unwilling to go to the hospital for treatment, but unable to respond to the gap between expectation and reality, and the gap between expectation of treatment and reality of evasive refusal, which brings about their emotional ups and downs. In R hospital, I consulted a dermatologist. The dermatologist was very good. He gave me intravenous drip and told me not to say it. He said that I couldn’t get the operation if I told the fact. I had lung problems. And I was discharged from L hospital to R hospital for re-examination. I went to consult the director of the respiratory department. The director didn’t even give me intravenous drip. I called the dean of the hospital. The dean also refused to do it. He said that we gave you medicine, and you could take it to the community hospital. I said that you have doctors here, why can doctors of the community hospitals give me injections and doctors in your hospitals not give me injections? Is your hospital special? He said that they were afraid that the nurse couldn’t puncture well. I said that your hospital is a big one. The community hospital is a small one. In terms of technology, your skills are definitely better than them. What is the reason for this? Isn’t this discrimination? These hospitals abandoned us for their own benefits. I didn’t have the drip later. I didn’t check up again. It was the medicine plus my own attention to care and nutrition. My health slowly recovered, my breathing became normal, and I basically recovered. (DCYJ19) Not only AIDS patients, but also people with sexually transmitted diseases (STDs) went to that hospital. Some infected people were hospitalised, and they said loudly: “Don’t worry; we won’t say that you were hospitalised with AIDS.” (He imitated the intonation of the female medical staff.) They said that they would protect my privacy, but why did they say so loudly? I was taken the body temperature and weighed. The head nurse arranged the hospitalisation. The head nurse called the inpatient department and said, “I have an AI here.” (He imitated the intonation of the female medical staff.) (AI here refers to AIDS and it’s a kind of satire.) How harsh! She could say that there was a patient here. That’s enough. Why did she say AI? Everyone knows that it’s the STDs and AIDS clinic. She said there’s a patient. That’s enough. But she said there’s an AI here. Don’t you think that it’s harsh? I felt very uncomfortable when I heard it, but what can be done? The disease still needs to be cured. What could I do with them? (DCYJ10) It is said that there are two people in charge of this matter, and I’ve had dealings with them. I wanna say that they have poor medical ethics, and neither do others in the hospital! If I feel a little uncomfortable in my body, I’m arranged for examination and scan. It costs hundreds of Yuan each time. To what extent are they irresponsible? For example, once I felt uncomfortable in my lungs and I wanted a checkup, he wrote HIV everywhere. What’s the relationship between cold and HIV? They made a small talk there such as the count of CD4 in my examination result. I don’t care anymore, anyway. I am not from TJ (the name of the place in which the hospital is located). It doesn’t matter even if they say I am AIDS patient! Who knows me? (DCYJ12)

For the interviewee labelled DCYJ12, although he said that he didn’t care, I think that he actually minded being treated as an infected person in front of others judging from his tone. He even has some resentment. It is precisely because of such labelling that infected individuals often have to think twice about seeing a doctor for ordinary diseases, because they have to consider their role as infected individuals in a corporate unit such as a medical institution. They would consider their expectation, inner hurt and emotional arousal such as anger they may come cross. Obtaining treatment from a medical institution is the most basic need and expectation of any patient, especially those who are infected. However, this expectation was completely

104

4 Acquired “Expectations Deficiency” Syndrome

shattered because of the preassembled role of infected individuals, which inspires their combined emotional arousal such as alienation. Ralph Turner believes that people operate under an implicit assumption that the gestures emitted by individuals in an encounter are consistent with each other and mark an underlying role. Once role-taking allows individuals to discover this underlying role, the complementary role is orchestrated (role-making) so that cooperation can ensue. If, however, an individual cannot discover the underlying role, a person will experience negative emotional arousal—typically mild anger like annoyance or, if the other is powerful, variants of fear. Since human do not have the same level of innate bonding mechanism as most other mammals, these phenomenological and gestalt dynamics are critical to sustaining the encounter. If the underlying role being played by another cannot be determined early in an encounter, an individual will then need to work extra hard to discover the role; and if these efforts prove futile, then it is very likely that the encounter will be breached, setting off a chain of negative emotional arousal (Turner, 2002, 2007). (II)

High-cost Treatment Caused by Combinational Roles and Generalised Roles

For combinational roles, individuals also carry in their stocks of knowledge conceptions of how roles can be combined in particular situations. What is involved is a conception of how two or more preassembled roles can be spliced together in certain situations. For instance, a woman hosting a family gathering plays both the role of host and the role associated with her place in the kinship institutional domain. Individuals already know this combination of roles and, hence, can easily make the necessary adjustments to the combined behaviours of both roles (Turner, 2007). For generalised roles, individuals also carry in their stocks of knowledge understandings of what certain syndromes mean in all types of situations. For example, people understand what syndromes mark being upbeat, assertive, gracious, shy, reserved, serious, and diligent. These generalised roles can be attached to almost any other role, as would be the case for a serious student, upbeat mother, and assertive worker and so on. The generalised role is known, and coupled with another role that is also known a person easily role-takes and makes the necessary adjustments in his or her behaviours vis-à-vis another (Turner, 2007). For the encounters of PLWHA, especially for their medical treatment, the fact that they are infected has become the preassembled role and the only role for all medical staff, and the generalised role of the infected individual as an ordinary patient has therefore been ignored. However, the infected individuals due to non-opportunistic infections require the treatment, thus they have to choose some private medical institutions or small hospitals that demands high fees for surgery and treatment, only hoping that these medical institutions may not require AIDS-related testing and implement surgery and treatment. In this way, although they had the surgery, the cost is high and medical insurance reimbursement cannot be applied. The treatment can only be a speculative behaviour, because these medical institutions often implement small surgery or ordinary treatment, which cannot fundamentally solve the problem of medical treatment and surgery for PLWHA.

4.1 The Ambiguity of Expectation States

105

I didn’t take it seriously at that time, and I didn’t think that my life would be a mess even if I was infected. But later, I was refused by hospitals one by one. I realised the seriousness of the matter. I had believed that the infection was my own business, and my death was also my own business. But the fact is that I am like an alien in the hospital. I once got along with my friends, but suddenly I was the one who was thrown into hell. In the end, after a lot of setbacks, I spent a lot of money to perform the operation. I had a mild illness, without realising my retinal detachment. I just felt a little bit dizzy. When I first went for an examination, it was found that the retina was detached, which required surgery. It’s a small surgery. But the surgery was delayed by the hospital until my eyes were basically out of sight. I can say that I spent nearly double the price of others, and used some… how to say (He should refer to pull strings to perform the operation). It’s a little bullying. I was driven away by that hospital, so I left. After that, I changed to the largest hospital in TJ (the name of one city). Can’t the biggest hospital do it yet? In the end, I went to the hospital, and physical examination was also required. But I was tested positive for HIV, and driven away. They said that they didn’t have proper facilities for the surgery because of the virus. They told me to go to B City. It happened that someone from the CDC called me and I told them about the problem. They said they can coordinate, but they couldn’t change the hospital’s decision. Anyway, after a lot of setbacks, they arranged me in a ward for highranking government officials. It seems that they hope to isolate me. Although I didn’t know the infection routes before infection, I quickly searched the information after infection. I know that there will be no infection without body fluids or blood contact. As a doctor, he should know this. I understand why I was separated from others. The other patients may feel uncomfortable. Anyway, after twists and turns, I had the operation after almost a week, and I was discharged the next morning. Actually, the patient should stay in the hospital for observation after surgery. They didn’t care about the result. Anyway, after the surgery, you should leave the hospital. It’s as if I am a monster…I think this virus has been in China for a long time. If doctors find it scary, ordinary people will definitely find it even scarier. (DCYJ06) I went to six hospitals for this anal pouch, but to no avail. Finally, the young surgeon suggested that I go to a smaller hospital. And he advised me, “You may look for a smaller hospital, not a big hospital. Sometimes these hospitals are on TV for publicity and sometimes they hired people distributing flyers in the street.” The anorectal department of some small hospitals is still better. He told me to look for it and not tell the doctor. Usually in small hospitals, HIV test is not required. Then I went to PC Hospital. The operation method of PC hospital is different from the traditional operation method. They use a type of minimally invasive surgery. I ended up going to this hospital this time and I didn’t tell the doctor (I have AIDS) and then I got anesthesia and had the surgery. It took less than 20 minutes, and it was done quickly and in a while. But this hospital charged high, and I spent a total of 13,000 yuan. I paid 13,000 yuan for the treatment at PC Hospital myself, because I was not transferred from the hospital designated by the medical insurance, so the medical insurance cannot be reimbursed. I paid for it myself. I received the operation and I didn’t wanna go to another hospital anymore. (DCYJ17)

Humans carry in their large neocortex vast inventories of these basic types of roles; and if we think about the process of role-taking for a moment, this must be the case because individuals ascertain the role of others rather quickly and without great agony. If we had to search for the unique or idiosyncratic roles of others in each and every encounter, individuals would exhaust themselves. Moreover, people would be constantly experiencing mild fear in all situations as they frantically scanned gestures to see what role a person might be constructing in a situation. By having a

106

4 Acquired “Expectations Deficiency” Syndrome

large inventory of roles already stored in stocks of knowledge, individuals can see the initial gestures marking a role, quickly scan the inventory, and pick out the role that is being asserted in a situation. In most situations this process occurs rapidly and with great ease, but when we cannot “figures out where someone is coming from,” negative emotions are aroused because we are resentful that the other has not played a role that is stored in our stocks of knowledge (Turner, 2002). By concealing their role of HIV-infected individuals, PLWHA are both ordinary patients and infected individuals. In the combinational role, PLWHA exchange for the treatment by playing generalised role known to the public. Although small operations can be done, PLWHA cannot experience the joy of being cured like ordinary patients. Instead, it brings more anxiety. Because it makes them experience the hardships of treatment of the diseases even more, that is, inaccessible to equal medical treatment to ordinary patients. Just as some infected individual said: “I don’t wanna go to XX hospital anymore.” Regardless of whether the operation is successful or not, what the infected individual experiences is a sense of frustration and an emotion of sadness due to unfairness and neglect. In particular, what they are seeking treatment is not the currently incurable and infectious AIDS, but other ordinary non-communicable diseases that they suffer from as infected people. Although the role of PLWHA has been temporarily concealed, this role-making has made their expectations on the medical institution more ambiguous, and has also triggered many negative emotions such as the anger and resentment.

4.1.2 Confusion Deriving from Status Similar to roles, the concept of status has a number of meanings. In some analyses, status denotes a position within a social structure; for other researchers, status refers to differences in power and authority; for still others, status only denotes prestige and honor. These different uses of the concept of status do not have to be contradictory; each simply emphasises a particular dimension of status, while de-emphasizing other dimensions. For Turner, status will be defined as a position in a network of positions, occupied by an individual, standing in relation to at least one other position, occupied by another individual. Status positions evidence many potential properties, the most important of which, are the clarity and discreteness of the position vis-à-vis other positions and the level of power/authority attached to a position; Finally, each of these properties has effects on emotional arousal. It can be seen that under normal circumstances, people are always in a certain status, and thus have different resources, such as power. According to status and status-related resources, individuals play a specific role. At the same time, individuals also declare and confirm the status they own through efforts (Turner, 2002). There is a phenomenology of status, just as there is for roles, because individuals signal their status to others, and especially so when the corporate or categoric units do not establish individuals’ status relative to each other. Indeed, as the data from expectation states literature document (Ridgeway, 2006), individuals determine the

4.1 The Ambiguity of Expectation States

107

status of self and others very rapidly in an encounter; and they do so through roles. As individuals emit gesture, they are not only signaling the irrespective roles, they are also making claims to status relative to the status of others. In fact, emotions are often used as a strategy to assert claims to status, as is the case when a person exhibits assertiveness and confidence to make claims to high prestige and/or authority in an encounter (Ridgeway, 2006). Moreover, as status cues are given off in role-making, these cues clarify and fine-tune the roles that people are making for themselves. There is, then, a dynamic interplay between roles and status; role cues signal not only the role that a person is making for self but also the status that they claim which, reciprocally, works to provide additional information about role-making. Status-making efforts of individuals operate through role-making and provide critical information to others. Without information on status, it becomes more difficult to establish expectations for how transactional needs will be met, for what elements of culture are relevant, and even for what dimensions of social structure are salient. When individuals understand each other’s status, they feel more comfortable in their roles, and, as I noted earlier, when people are able to mutually verify roles, expectations for self-verification, for profits from exchanges, for group inclusion, for trust, and for facticity are more likely to be realised, thereby setting off the dynamics of positive emotional arousal. Conversely, when status cannot be easily determined, or if there is ambiguity or contests over status, role verification becomes more problematic and sets off negative emotional arousal. In the field of social management of PLWHA, with the launch of the “Global Fund” and the “China-Gates HIV Program” in the country, since 2003, ASOs have sprung up in China. Not only have the number of organisations increased rapidly, but also many organisations and alliances with national and even international effects are established. These organisations are different from government-run societies, and most of them are made up of PLWHA or people who are concerned about PLWHA. They have played a huge role in the prevention and intervention of PLWHA, but due to the limited management experience and intervention capabilities of the organisation, there are also many problems in the work. The most important of these factors is the lack of clear access and withdrawal mechanism, the uncertainty and illegality of the status of the organisation, and the lack of clear goals, which affect the achievement of the expectations of PLWHA and further arouse negative emotions of PLWHA. (I)

Ambiguous Boundaries of entrance and exit rules

Luhmann believes that when units are bounded clearly and when individuals understand when and how they are to enter or exit the corporate unit, they also bring with them understandings about the culture, structure, and expectations on them. On the contrary, corporate units that do not have clear boundaries, along with entrance and exit rules, can be ambiguous and amorphous, with individuals not entirely sure if they are in or out of the unit and unclear as to what expectations are salient and when they are to be invoked (1982). If goals are clear for members of corporate units, then people can understand those expectations and try to meet the expectations. In contrast, the members produce negative emotions, which will lead to conflicts and

108

4 Acquired “Expectations Deficiency” Syndrome

changes in the goals and culture, thereby changing the structure and culture of the corporate units. Throughout the development of ASOs in our country, the development of the organisations was in full swing before 2013. However, their rapid development has also resulted in many problems such as fewer staff, less office space, and less funds, and so forth. Some organisations are not developed in a standardised manner and lack legal procedures such as registration. Several people or even one person can establish an organisation. This situation will inevitably lead to lack of group inclusion for the members and lack of entrance and exit rules; it will inevitably cause the development of many organisations to fall into the dilemma of “projects for the sake of projects”, and often there are projects and people. No project, no people. PLWHA wander between various organisations like a revolving lantern, exchanging their personal information for material resources and financial support, but these activities deviate from, and obscure, the goals of the organisations. At the beginning, it was very helpful, because at that time, I felt so helpless. In the hospital, a doctor gave me their contact information. I called and then I went to participate in some of their activities, such as a lecture on drug compliance, or getting together to share and exchange experiences. At the beginning, I found that there are so many people like me, it is not easy for us to get together, and it can also bring emotional support. However, the group was not as good as others said. At the beginning, I had high expectations and enthusiasm, but then I gradually realised that we were just participants. If the group had a project, we were asked to get together to fill out forms, receive some presents, have a meal, and then we were dissolved. I felt that I was used. Later then, I rarely went there. (DCYJ03) Most of organisations conduct testing for homosexuals for free, and some only give emotional support formally. To some extent, some organisations play an important in tests (HIV positive). After the test, we have no value for them. For example, in CY (the name of some place), especially on December 1st (World AIDS Day) every year, we will receive callings from many organisations and be asked to participate in activities. we will be given a water bottle, or aloe cream. In short, as soon as there is a project or activity, someone will call us. Once the project is over, there will be no calls. It’s “project for the sake of the project”. (DCYJ23) For us, there’s no sense of group inclusion. The group is for the project. I thought that I could build a sense of group inclusion. You know, after that I was tested positive, I dared not go home. I’ve no job or friends. I’ve nothing. It happened that I received a call from the community organisation. I thought that I would have a try and may get emotional support. After all, people infected with the disease may pull together. But it turned out that we were used by the group for making profits. They are unwilling to do anything without profits. We went to any groups that distributed presents, or money, or treating meals. If there’s no project, there’re no activities. (DCYJ10)

During the interview, I found that the operations of many organisations are completely project-oriented, and PLWHA attend freely different organisations. Their attending in different organisations is to achieve free testing, care and support. Even if some infected people establish groups through some Apps, there is a lack of entrance and exit rules. As a result, most of PLWHA enter the organisation with great expectations, hoping to gain self-verification from the organisations, acquire knowledge and skills related to AIDS, build a sense of group inclusion, or rebuild a sense of trust and facticity in the real world, without disguising themselves. However, after

4.1 The Ambiguity of Expectation States

109

joining the organisation, the organisations turn out to be an institution which centres on “project for the sake of a project.” There are no clear boundaries for entrance and exit. Their participation in the activities has also become a kind of exchange for petty presents, and at the cost of their privacy, which makes infected people complain and feel angry about being used. (II)

Failure of embedding into institutional domains

If the corporate unit is embedded within an institutional domain, an explicit ideology will be generated and define the norms of what can and should happen in the domain. The culture and structure with more autonomous domains highly constraints the culture and structure of subordinate corporate units, and the ideology in the institutional domain will be revealed in the form of specific organisational rules. As a result, the corporate units may have boundaries, entrance and exit rules, and clear goals to protect the small and medium-sized social ecological environment resources in the institutional domain, which brings forth clarity of expectations to the members of the corporate units and further evokes positive emotions. On the contrary, if the embedding cannot occur, for the corporate unit and its members, the clarity of expectations will be unmet, thereby evoking negative emotions such as anxiety, sadness, and anger. In China, the registration of social organisations is under strict management and must meet high requirements. Although the country has lowered the requirements for supervising authorities, the legitimacy of the organisations is still hindered by insufficient registered capital, improper workplace, insufficient staff, censorable registration procedures, as well as susceptibility of AIDS patients and homosexuals, costs required after the registration. Therefore, there are few non-government organisations that have been approved to register in Civil Affairs Departments, reducing many ASOs in an illegal position and in a state of failure to embed in macro-level institutional domain. One year, I remember that I bustled about registration for a long time, but failed, due to insufficient funds. I had to go to TZ (the name of a city) for registration. It’s too difficult. There are many prerequisites for the registration. For example, the organisation should be equipped with the organisation director, sufficient capitals and staff and so on. At present, there are only two registered organisations: The Home of Red Ribbon and Love Homes. Therefore, many organisations are, to say the least, illegitimate. So, if there is a project today, the organisation will exist, and if there’s no project tomorrow, there will be no organisation. If it happens again the day after tomorrow, it will appear again, or a new organisation will be established. Such an organisation actually cannot generate a sense of security and trust for us. (DCYJ20) The name of the organisation registered shouldn’t associate with homosexuality. If you want to register, you have to change the name… At that time, someone wanted to register an organisation named “Gay Family”, which was disapproved. The authorities implicitly said that the words “Gay” or “homosexuality” couldn’t be used. (DCYJ26) In the long run, censorship rules for the registration may be more inclusive. However, there are currently few non-governmental organisations. If there are some, they must be with government ties. Otherwise, it’s difficult to pass the registration censorship. Although it’s said that there will be more easing, there are lots of prerequisites. In general, it’s still quite

110

4 Acquired “Expectations Deficiency” Syndrome

difficult. Infected people know that failure to pass the censorship is an expected outcome. No one cares about their present or future life. People get together for fun. This is why the members of the home of Red Ribbon and Love Homes are relatively stable compared to other organisations. (DCYJ22)

In the interview, I learned that there are very few AIDS-related social organisations that can be registered. Taking Beijing as an example, there are mainly Beijing Association of STD and AIDS Prevention and Control, The Home of Red Ribbon, Love Home, and Shijingshan AIDS Skin Disease Prevention and Control Association and so on. Outside of Beijing, there are very few social organisations that can be registered. Some organisations, out of their own development needs, had to obtain legal personality through industrial and commercial registration, in order to obtain legal status and sustainable resource protection. However, the ensuing need to pay taxes to carry out projects has increased the economic burden of the organisations. There is a big problem: tax. Because our organisation is registered by the Bureau of Industry and Commerce, we have to hand in the invoice and pay a 5% to 6% tax. If the organisation is registered by Civil Affairs Department, there will be tax exempt. But it’s too difficult. Currently, it seems that there’s no gay organisation registered by Civil affairs department. (DCYJ26) In addition, the establishment of an organisation requires directors, workspace, and wage expenditure. For many small organisations, they cannot afford the corresponding costs, and the project funds applied cannot or are not enough to pay for this expenditure. As a result, the cost and other risks increase. (DCYJ18) You know, after the withdrawal of China Global Fund, we have few funds. For example, I have a little bit of funds now. I affiliated the funds to Y Hospital. I don’t need to pay the management fee. After the registration, I don’t have to affiliate the funds. There will be no benefits. It doesn’t matter if there’s a registration or not. After the registration, I must employ financial staff. If the registration can bring more funds to the organisation from other institutions or the government, improve the management of the organisation, personnel development or work progress, the registration is a necessity. If there’re no changes and I still have to compete with other organisations for projects, it’s not necessary. (DCYJ20) You know, an organisation requires the cashier and accountants. The budget should cover the expenditures. The organisation should pay social security fees for staff. It will require eighty thousand or one hundred Yuan. You know, now I just pay 5% or 10% of the management fee on custodial account in the associations or foundations. It saves money. In addition, agency bookkeeping involves the problem of privacy disclosure. The infected people show their name and ID number to the accountants and receive labour fees, which may disclose their privacy. So, we decide to keep the funds in custody so as not to disclose the privacy of infected people. (DCYJ22)

The legitimacy of ASOs is questioned; the same is true for members engaged in the organisations. They are confused about their status, which further affects their work. Firstly, the organisations have no legitimacy and cannot sign labour agreement with the members, let alone give them a status of staff. Secondly, due to the requirements for salary, insurance and project implementation, their remuneration is often difficult to guarantee, which obscures their role. Whether they are volunteers, full-time staff or social workers is very vague, thus easily causing staff drain. For us, there’s no legitimate status. For example, during activities, we are charged for work certificate, but we don’t have one. We are volunteers engaging in preventing AIDS activities,

4.1 The Ambiguity of Expectation States

111

but we can’t offer any certificate. Actually, any type of certificate is OK, as long as it is legitimate. Though our purpose is legal, there’re no official documents to prove. Perhaps it’s improper for the authority to distribute the certificates. In fact, what we want is one certificate. That’s it. (DCYJ30) I think the current problem is unclear roles and responsibilities. Many of the things we do should be responsibilities of doctors. I think it’s not proper. Some people think that it makes sense that we work as doctors since we are social workers. They take it for granted. You know, the reason is the unclear roles and responsibilities. The problem must be solved. (DCYJ22)

Embedding would significantly increase the clarity of status. Although all ASOs understand the importance of registration and desire to achieve the legitimacy, they are faced with the dilemma that they have to choose the form of enterprises or various community organisations, workshops and working groups, most of which are not licensed by the civil affairs department and have more difficulty in affording the higher office costs required after registration, or are restricted by various policies and regulations. All of these constrain the development of organisations. On the one hand, it is difficult to form influential and professional social organisations like those in foreign countries, and on the other hand, it is also difficult for the government to manage them. The current management system, which reduces their roles unclear, hinders the healthy development of organisations and weakens their roles in AIDS prevention and control, is not conducive to the establishment of HIV organisations and the acquisition of legal status. Failure of embedding into institutional domains not only causes the illegitimacy of the organisation, but also brings about the illegitimacy of the staff’s status. They do not have a legal work status, but also many of them cannot even have regular income and insurance. It’s hard for them to have a clear and explicit goal, gain the fundamental trust of PLWHA, and obtain a kind of status recognition. It can be concluded that the status of the organisations is unclear and unambiguous, the expectation-states are usually unspecific and vague, and the rules and roles related to expectations will be uncertain. People are not sure about their roles and about the scope of role-making, which therefore cannot understand their own expectations and those of others. All these factors affect the clarity of expectation-states of infected people, which cause arousal of negative emotions such as complaints, resentment, which in turn leads to distrust of the goals of the corporate units, internal cultural conflicts and organisational changes, thus making it necessary to change the culture and structure of the corporate units. (III)

Lack of clear goals

Because of project-oriented, most of organisations lack clear goals. In terms of division of work, some organisations may specialise in the care of PLWHA, while others may focus on the detection of HIV virus for people. However, currently, the organisations apply for whatever projects they can, regardless of the goal of the organisation. If there’re clear goals for organisations and the corporate units focus on the goals, they will be clearly reflected in the division of labour and in the ideology and rules that are developed to achieve them. If the goals are not organised or unclear, it is impossible to provide guidance for the creation of a division of labour or the

112

4 Acquired “Expectations Deficiency” Syndrome

formation of cultural rules. Without clear guidance from structure and culture, people will be at a loss in their interactions, which leads to ambiguity of expectations and even conflicts. Although we have been emphasizing the autonomous status of ASOs in the field of HIV prevention and treatment, this does not mean that the development of the organisations does not require governmental support. Especially for the organisations that have not yet acquired legitimacy, most of them have limited access to resources and need government assistance. The most urgent need of the organisations at present is government financial support in the form of government purchase of services to coordinate the distribution of resources to achieve testing and care services for PLWHA. However, many organisations don’t understand government purchase of services and the procedures. What’s government purchase of services? What are the services that government purchases? Nothing. The Health and Family Planning Commission didn’t allocate this fund. The fund we use was actually from the project held by the Commission which cooperates with Municipal Association of STD and AIDS Prevention and Control or CDC of the districts. (DCYJ22) In the “Post-Global-Fund-Era”, most of ASOs are still waiting for the introduction of government purchase of services. On the one hand, they are eager to receive support from government purchase of services; on the other hand, they are worried about how to apply. It’s a long process. Many organisations have been at a standstill for a year, and their members have been looking for other ways to make a living. Those who remain in the organisations are still looking forward to the new policy, and do not want to let their years of experience go to waste. The main reason is the unsustainability of the project, once the project is over, there will no contact, volunteers have changed careers, and infected people cannot be contacted. Now the organisations are willing to offer quick tests, not to offer the care of infected people because of low income… I know that some staff of other grassroots organisations now go to work as drivers after the end of “Global Fund” and the “China-Gates HIV Program”, because there’s no government purchase of services, no registration. It is a pity. They are not very talkative. They are not good at communicating with others and writing. It’s very hard for them to apply the project which requires registration and writing application. They are good at caring for AID patients. They are good at this. (DCYJ20) For the government purchase of services, we have been waiting and watching; we are looking for a new field. That is to say, we want to know whether it’s proper. If there’s a little bit money, it can’t be done. We wait to determine whether we can do part-time jobs. It’s not realistic to do it full-time. (DCYJ26)

Since the government purchase of services in the field of AIDS prevention and control has not yet been fully implemented, and ASOs have long been accustomed to the support of “Global Fund” and the “China-Gates HIV Program”, they harbor an ambivalent attitude. On the one hand, they hope to survive completely on the government purchase of services; on the other hand, they have doubts. The organisations are not sure about their participation without the legitimacy, and how much the government purchased services will change. Faced with all the uncertainties, they mostly hold a wait-and-see and hesitant attitude towards transformation of organisations, which further affects their intervention work. The literature on expectation states emphasises the processes whereby status differences are affirmed and reaffirmed in the real world. Individuals come to know

4.1 The Ambiguity of Expectation States

113

each other during the iterated encounters and generate positive emotions. If the corporate unit fails to meet the expectations of its members, yet continues to use its members to force members to adjust their expectations and behaviours again, thereby resulting in anger among memberships. For the corporate unit, the members will unite to challenge its status, erode its legitimacy and question its value of existence. Nowadays, the groups are different from what we imagined. Their concern for infected people was mainly in name only. I found that the groups were busy applying for projects, intervening, mobilizing or researching. In fact, these activities, especially research, have little to do with us. We are often called to attend interviews. We can get 50 or 60 Yuan for each interview. Anyway, we take the interview for money. Then we leave after the interview. It seems that the groups serve for interviewers, not for us. In addition, they discuss that some groups have been registered, or slander some groups. Who has the time to care about us? When we are called to come, we’ll do if there’s nothing to do. After all, we can get presents or money. (DCYJ01) Usually, I don’t go to other activities except the activities held by this organisation. B city is such a big city that it takes a day to attend activities. It’s a waste of time. In these activities, people are very busy. There’s nothing to gain. They complain a lot. (DCYJ10)

If ASOs fails to meet the commitment of PLWHA to expectation states, intense negative emotions will be aroused. PLWHA will express anger because of being used by the organisations and generate resentment towards the ambiguity of expectations after joining the organisations. They will generate a sense of alienation from encounters and seek to withdraw, or express role-distance. If these dynamic mechanisms centred on negative emotions continue to exist, the unity of the group will be destroyed, and the group formed by iterated interactions may also be dissolved. When PLWHA feel that they fail to verify their roles, they usually feel sad. If the roles of self are highly salient, they will experience shame. If shame persists a long time and emerges from more than interpersonal interactions, anger will be aroused, beyond specific interactive objects, and directed towards macro social structure, such the corporate unit. Fundamentally speaking, interaction subjects are the source of positive emotions for people in face-to-face encounters. Treating the interaction subjects with anger and harsh words will inevitably be punished, which will further increase the sense of shame. If the interacting subject is unable to fight back at this rudeness, the suppressed shame will direct towards other persons. In particular, if the target is important to the individual and has the ability to punish him or her effectively (e.g., a doctor’s shirking and refusal to treat an infected person), anger is more likely to bypass the interactive object and point to a safe target, because it is easier to protect the self. It also helps to evade the punishment and avoid to be countered directly as well. For example, if an infected individual is treated unfairly during medical treatment, he is likely to vent his shame and anger at the hospital because it is relatively unlikely that the hospital won’t punish him directly. In contrast, if the infected person directs his shame and anger at the medical staff, he is vulnerable to effective punishment by staff because he is in a disadvantageous position. If corporate units are the target, individuals will express anger at the culture and structure of the corporate unit. If the anger persists over an extended period

114

4 Acquired “Expectations Deficiency” Syndrome

of time, people will direct this anger toward the institutional domain within which the corporate unit is embedded. If anger persists, anger towards corporate units will transmute from shame-based anger to shame-based alienation, and individuals will then develop role-distance and lower levels of commitment to the corporate unit and, if the alienation is sufficiently great, to the institutional domain. An individual who experiences shame consistently across a wide range of interactions in an institutional domain will be more likely to experience alienation from corporate units, when shame is diffuse and persistent, it usually produces higher intensity anger toward the social structure, and the tendency for external attributions resulting from anger often causes problems for the maintenance of the social structure and culture.

4.2 Limitations of Expectations Fulfillment Another type of structure of social organisation at the meso level is categoric units. This conception of categoric units is much the same as Peter Blau’s view (1977, 1994) of graduated (income, age, education) and nominal (gender, ethnicity) “parameters” and compatible with Miller McPherson’s conception of “Blau-space” (1991) in which social structures are conceptualised by the number of parameters defining ecological niches, the distribution of people across these parameters, and the networks among individuals in Blau-space. In this book, a categoric unit is a social distinction that affects how individuals are evaluated and treated by others. The only universal categoric units are age and sex/gender, but as societies become more complex and differentiated, new kinds of categoric units emerge—social classes and ethnicity, for example. The categoric units are evaluated by culture and how individuals in the units should act (Turner, 2007). At first, it may be difficult to visualise encounters as being embedded in categoric units, but the long research tradition within expectation-states theorizing should help confirm this view of encounters (Berger, 1988). Turner considers diffuse status characteristics, such as gender, ethnicity, and age as the evaluative criteria of categoric units; and there is sample literature documenting that how people interact at the level of the encounter, how they evaluate each other, and how they react emotionally are very much influenced by the differential evaluations of categoric units or diffuse status characteristics (Wagner & Berger, 1997). An encounter composed of all women or men, members of only one ethnic population, or incumbents in one social class will reveal dynamics that are very different than those involving both women and men, diverse ethnics, and several social classes. What occurs in the encounter is thus determined by the configuration of categoric units in which it is embedded. Conversely, the dynamics of what transpires in the encounter—and for our purposes, the emotional dynamics that occur—will have an effect on the salience of categoric units and potentially on the macro-level stratification system in which many categoric units are embedded (Ridgeway, 2000, 2006; Ridgeway & Correll, 2004; Ridgeway & Erickson, 2000; Ridgeway et al., 1998). Thus, we need to know what properties of categoric units have what effects on emotional arousal, and vice versa.

4.2 Limitations of Expectations Fulfillment

115

This book follows Turner’s classification of categoric units and divides the categoric units of PLWHA into general categoric units and new categoric units. The general categoric unit includes well-known demographic indicators such as the sex and age of PLWHA. New categoric units can be divided according to the degree of wealth of PLWHA in terms of the social stratum, and according to the routes of infection. In the interview, I found that these categoric units will affect the encounter and expectation states of PLWHA, but the transmission routes, gender and class most directly affect the realisation of expectation states of PLWHA and the arousal of negative emotions.

4.2.1 Lack of Homogeneity in the New Categoric Unit Similar to corporate units, increasing the clarity of expectations attached to categoric units can also promote positive emotions arousal; on the contrary, if categoric units’ expectations are vague, it will also make its members produce negative emotions. Turner believes that discreteness of the boundaries defining membership of categoric units will affect the clarity of expectations (Turner, 2007), or what Peter Blau calls “nominal parameters”. Discreteness draws a line; one is either in or out of the categoric unit. For example, people are denoted as either male or female. If discreteness is lost, in this case, it is difficult to determine where a person should be placed, and there is always some ambiguity, which reduces the clarity of expectations and the possibility of achieving expectations, but it will stimulate the generation of negative emotions. HIV virus is transmitted through blood, sexual behaviour, and mother-to-child transmission. However, when categorizing PLWHA, it is related to the moral conception of the general public. Therefore, it is difficult to avoid the inclusion of moral standards, that is, “origin” usually called by the infected individuals. Generally speaking, an individual who contracts the virus due to iatrogenic blood transfusion, including illegal blood collection and supply in the Central Plains, or a heterosexual individual who adheres to monogamy but is infected by the other party, will be regarded as having good “origin”. They often think that they are innocent. On the contrary, an individual who contracts the virus due to intravenous drug use, or disordered sexual relationship, or homosexuality will be regarded as having bad “origin” even if the individual is a homosexual who adheres to “monogamy”. The individual in the second type is often regarded as deserving retribution. This kind of moral judgment and classification method of “innocent” and “not innocent” breaks the categoric units classified according to the routes of infection, which often causes the ambiguity of the positioning of the infected, and affects the clarity of their expectation states and the possibility of achieving their expectations. Take HIV-infection for example. Being infected by different routes, the individual will be treated differently. If a woman is infected by her husband, she is innocent. I have seen a lot of cases in Y hospital and people are sympathetic with them. But if someone is infected through male-male courtship behaviour, he will be despised. So how can you treat them equally?

116

4 Acquired “Expectations Deficiency” Syndrome

Sometimes even our own positioning is confused. The last thing we want to mention is the infection routes. As long as we say that we are gay, or are considered as gay, it must be male-male sexual behaviour without condom. And this is what people, including you, are most interested in. Why? People will divide us into various ranks based on the infection routes, which makes us very uncomfortable. (DCYJ06) Take an example. I took a person to the hospital and he was diagnosed. Then the doctors of CDC (Centres for Disease Control) will ask how to contract the virus. A female doctor of CDC says frankly: “So, you got this due to male-male sexual behaviour”? My friend was very annoyed. (DCYJ18) In China, homosexuality is not recognised, and even regarded as deviant behaviour. We all know this, so everyone is generally relatively prudent, and few come out because the price is too high. However, a common problem with gay men is anorectal diseases, such as perianal cysts and genital warts. Every time I see a doctor, I will always hear similar questions: “Are you gay?”, “You have sexual behaviour without condoms?”, and “Are you infected?” I really wanted to leave. The tone of contempt conveys that the gay men deserve the infection. (DCYJ01) There is another example. At that time, we went to the L bar for testing. CDC brought two interns from medical university, one male and one female. The little girl born in the 1990s was very smart and lively. When epidemiological investigation was required, they asked about the recent situation. This girl was particularly calm, which might be related to that she’s a rotten girl. It’s very easy for her to accept this. She asked: “Did you wear a condom for sex recently?” The uncle is a little embarrassed. Then the little girl said: “All of us must raise our awareness of self-protection, no matter what kind of sexual intercourse.” (laughs) The uncle was very embarrassed at the end. In fact, this is a very good and very positive because they can accept it. But the uncle thought, “Oh, the girl, younger than me and more open than me”. In fact, this is a gradual adaptation process. (DCYJ10) In fact, in the circle, we also have ranks. The infected people have different opportunities and resources according to different backgrounds. Otherwise, how can Song Pengfei become an AIDS celebrity? How can Meng Lin disclose his identity? Not all infected people can do especially drug users or whoremongers. We also despise them. Of course, there are also many infected people who look down on us, gay men. It’s the same. The organisation set up by XX (someone’s name) said that all infected people should be treated equally. What’s the result? Only gay men attended the activities, and others were unwilling to play with us. (DCYJ15) Being infecting with AIDS is actually shameful. It is a kind of “dirty” disease, even if you are really infected by a blood transfusion. Now, when we organise activities and engage in the rights activities, there are only two types of people involving in these activities, either those who were infected by blood transfusion or gay people. People infected by blood transfusion feel wronged. No one else comes. Why, there’s nothing to talk about and the goal is different. When we fight for rights, we are always told that the gay community is debauched, and we always argue about this or that. To be honest, it is really difficult for us to win anything for ourselves, because homosexuality is not recognised in China. (DCYJ12) The infection routes are not good. Nowadays, few people are infected by blood transfusions. Therefore, the newly tested people are either drug users, whoremongers, or homosexuality. The opinions are not from others, but from the infected people themselves. (DCYJ05)

Although I categorised HIV infection routes in the book, for many infected people, they disapproved the categorisation and sometimes they cannot distinguish. This ambiguity instead creates a blurring of expectations among PLWHA. Generally speaking, homosexual groups are the most active in fighting for their rights, but it is the most difficult to fight for themselves. Other people infected by sexual

4.2 Limitations of Expectations Fulfillment

117

behaviour are dissatisfied with this classification and unwilling to accept it. As a result, people who are infected are contemptuous of each other, or are unable to make such detailed divisions and simply stop making the division. This results in a decrease in the clarity of the categoric units and furthermore affects the homogeneity of the categoric units. This homogeneity is mainly reflected in the same degree of emotional languages used by people in the same situation. There are cultural differences in the rules and phonemes of emotional language. When encounters take place in the same emotional language, expectations are more likely to be agreed upon, but if expectations are absent, ambiguous, or conflicting at the beginning of encounters, or if encounters lack a common emotional language and each person speaks his or her own language, expectations will be difficult to be met, and negative emotions such as disappointment and anger will be aroused. In addition, the degree to which the categoric units are embedded in a macrolevel stratification system and the degree to which resources are unequally distributed within this stratification system also affect the clarity of expectations. When different social classes have large differences, the classes themselves become independent categoric units. For example, the impact of poverty and wealth on PLWHA, whether in terms of encounters, the satisfaction of transactional needs, the risk of infection, medical treatment, or even social support, has a significant bearing on the social stratification of wealth and poverty, hence AIDS is also called “Acquired Income Deficiency Syndrome” (Weng, 2003). The reason that some infected people can live to present is actually inseparable from their financial means. Like LM, if he hadn’t gone to the black market in the early days to exchange dollars for medicines from abroad, he would not have survived several opportunistic infections. At present, although the country promises that infected people can take antiviral drugs for free, but basically, they are first-line drugs, and there are only a few kinds of drugs, once the drug resistance is developed, there are too few kinds of drugs to change. If you want to change second- and third-line drugs or whatever, all are at your own expense. If you can’t afford it, you’ll have to wait for death. (DCYJ22) Even if the medicine is free, the cost of testing is very high. In order to survive, I had to participate in the experiment of testing drugs, using myself as a test product, taking their new drugs, and then being given some living expenses and free regular inspections. Otherwise, I can’t even pay the inspection fee, not to mention the medicine. But that kind of experiment is risky, just like treating yourself as a monkey. But there is no way, I have to survive, and I have no money. (DCYJ03) Most diseases, including AIDS, inflict on the poor. The rich don’t have to worry. At least they can take second- and third-line medicines without so many side effects and drug resistance, and they don’t need to worry about making a living. You see, how many of people who come here are rich people who are running around for a little bit of money. So, can you not complain? Can you not fight for profit? Where is unity and consistency? (DCYJ11)

People carry in their stocks of knowledge information about what the demographic profile of an encounter means; and on the basis of these implicit meanings, they generate expectations for how transactional needs can be met, what roles can be played, what status positions can be asserted, and what elements of structure and culture are relevant. During the course of encounters, a key demographic indicator is income. People with low incomes often have very low expectations for AIDS

118

4 Acquired “Expectations Deficiency” Syndrome

treatment, not to mention their interaction with others and the social environment. This creates the ambiguity of the expectations on the one hand, and on the other hand, affects the emotional expression of PLWHA, especially those with low incomes. They often express their anger towards others and community, their blame for themselves, and furthermore, their resentment towards the institution and system, such as “Since ‘Four Frees and One Care’ is taken, there is still a charge for testing.” When faced with unreasonable diagnosis and treatment by medical institutions, they will develop negative emotions such as resentment. In summary, it can be seen that diversity in the characteristics of participants has large effects on what transpires in an encounter. Diversity comes from varying memberships in different categoric units. If the expectations of the members of the categoric unit are clearer and consistent, it is more likely that the expectations will be met and positive emotions will be activated. Conversely, if the expectations of the members of the categoric unit are vague, it takes more time and effort to achieve the expectations. If the expectation remains unfulfilled, negative emotions, such as anger, may be aroused.

4.2.2 Universal Category Hindering Clarity In addition to the infection routes, the categoric unit of gender also greatly affects the clarity of the expectation state. As the HIV virus spreads to the general public through sexual behaviour, the number of women infected with HIV is showing a rapid increase. However, in my interview, only six women infected with HIV were interviewed. If we follow the classification of the infection routes in the previous statement, they will claim their innocence. They are infected because of blood transfusion, or because their husband is infected after a blood transfusion. Women infected with HIV due to other routes have been silent. Physio-pathologically, women are more susceptible to HIV infection due to more prolonged exposure to infectious fluids or tissue injury (Bolan et al., 1999; Nicolosi et al., 1994). But it is irrefutable that, in terms of gender roles at the societal level, the reasons for the widespread prevalence of HIV among women stem from gender inequality and worldwide stigma. First, women may be more vulnerable to attacks and forced to exchange their sexuality for property, protection, or job opportunities and other survival needs, and are more likely to form a power imbalance with older men. Women are also often unable to demand condom use, monogamy, and HIV testing in sexual relationships (Farmer et al., 1996; Gupta, 2004). There is also evidence that sexual violence is also a factor in women’s infection (Bensley et al., 2000; Wyatt et al., 2002). However, women are often unable to effectively speak up and protect themselves in time. Over time, women will feel resentment toward gender division and develop negative emotions such as self-blame. This inequality among HIV-infected women lacks a way of expression.

4.2 Limitations of Expectations Fulfillment

119

I’ve always wanted to work for women infected with HIV, but I’ve not been able to do it. In fact, I’ve talked to some sisters in private, and I know that they have this kind of needs, especially because women living with HIV are also prone to cervical cancer and other diseases. So, I’ve been trying to do this work, but I can’t always gather people. People don’t want to come for fear of embarrassment and exposure. Another thing is that if a man contract AIDS in a family, then the family may still be maintained. However, if a woman is tested positive, then the family is definitely finished. Unless both of them are infected, their marriage may be possible to be maintained. So, women suffer a lot. They have a lot of resentment, regrets, against themselves, others, and the society, but they have no chance to express them until the final outbreak. (DCYJ20) If HIV-infected people are weak groups, then HIV-infected women must be the weakest of the weak. I had abortion because of AIDS. In fact, it is the society that exerts too much unfair treatments on women. Once a woman is infected with AIDS, it will be thought by others that it is because of that (sex), which makes us very hard to face the reality bravely. And it’s difficult for women to have test or take medicine. We can’t go to the gynecologist to get medicine, but have to go to the STD and AIDS clinic. Sometimes, it is a male doctor, which makes us feel very uncomfortable and depressed. (DCYJ14) There is no expectation, and the expectation has never been clear. The infection was caused by ignorance. Now, it’s too late. It’s a sin. In fact, we suffer day by day. We rarely attend any activities. In the Y Hospital, a doctor recommended us to participate. However, there are all men and homosexuals. What are we going to do? (DCYJ24) Contracting the disease will make people think that we are bad. If a man has the disease, people may still think that he may be taking drugs or selling blood. Of course, it was most likely that he was once a whoremonger. And once a woman has this disease, people first think of her as a prostitute, because the propaganda also says this kind of people is at risk. You know, AIDS will not arise out of thin air, it must be that an individual has done something bad, so for women, the impact of this disease is greater, and there’s no way for women to explain. (DCYJ13)

Generally speaking, women are often at a more disadvantaged position among PLWHA. In the categoric unit of gender, the expectations of women infected with HIV are very vague, or “never clear.” Many men infected with HIV are still fighting for medical treatment and rights protection, but for women, even if there are available resources, are unwilling to use them. For example, the cervical cancer screening program, “because there are few people involved, the program ends up with nothing.” Therefore, in this regard, women not only have a low possibility of fulfilling expectations, but they also have a backlog of negative emotions such as anger and guilt. To sum up, as Turner once emphasised, individuals are probably hard-wired to assume that gestures reveal congruence and mark an underlying role which can be retrieved from stocks of knowledge; and once retrieved and verified over the course of an encounter, the more expectations associated with roles will be realised. To some degree, the clarity of expectations in encounter is related to role-making, roletaking, and role verification; and the more individuals will understand what roles can be made and verified in an encounter as well as what status can be claimed. Similarly, the demography of an encounter—gender, class, and infection routes— will create expectations that guide individuals in role-making, role verification, and status-claiming (2007).

120

4 Acquired “Expectations Deficiency” Syndrome

Thus, if roles can be effectively made and verified, then the expectations arising from transactional needs, status positions, and culture are more likely to be clear. Roles offer the initial clues to others about what each person expects in an interaction, and with mutual verification of roles, other expectations arising from status and culture become clearer. And, when expectations associated with transactional needs, status, and culture are realised as individuals successfully play roles, individuals will experience positive emotional arousal. Conversely, when corporate units and categoric units do not provide clues about the range of roles that can be played, and when role-making and role verification do not ensue, expectations arising from other micro-dynamic forces are less likely to be met. Moreover, failure to meet expectations will also involve perceptions of being negatively sanctioned by others. When expectations are not realised, individuals will experience negative emotional arousal, activate defense mechanisms, especially when self and identity have been highly salient, and make external attributions. In addition, embedding increases the clarity of expectations; and the more encounters are embedded in corporate and categoric units, and the more meso-level units are embedded in institutional domains and stratification systems, then the greater will be the clarity of expectations attached to roles, status, and demography. And, hence, the more likely will individuals experience positive emotions. Conversely, the less embedded an encounter is in corporate and categoric units and the less mesolevel units are embedded in macro-level structures, the less clear are expectations for roles, status, and demography. As a result, individuals will be less likely to meet expectations and/or receive negative sanctions, causing them to experience negative emotions, activate defense mechanisms, and make external attributions. The more self is salient in an encounter, the more intense will be the effects of meeting expectations. Similarly, the more exchanges of resources, markers of group inclusion, trust, and facticity in an encounter are tied up in the verification of self (and the roles and status occupied by self) the more intense will be emotional reactions. If negative, individuals will experience shame and, if moral codes are invoked, guilt as well when expectations are not realised or when negative sanctions are experienced; and the more likely will these persons repress their shame and make external attributions revolving around anger. If society is targeted, the anger will be directed at the corporate unit and the categoric unit. Overtime, the anger will be combined with the other negative emotions in shame to produce alienation. It can be seen that there are generally two conditions that have a strong effect on expectations. The first is the clarity of expectations. If expectations are clear and not ambiguous, then individuals have a more realistic understanding of what may happen, and they are more likely to meet such expectations and experience positive emotions arousal. If individuals are not clear about their expectations, or their expectations are ambiguous or conflicting, then they will experience negative emotions arousal in encounters, mainly in the form of moderate fear and other changes. If expectations gradually become clearer and no longer present ambiguity or conflict, individuals will experience positive emotions arousal. If the actions and situations of self and others continue to meet this expectation, the positive emotions will be amplified. Conversely, if expectations remain less clear or cannot be met, then individuals

4.2 Limitations of Expectations Fulfillment

121

will experience negative emotions arousal, mainly emotions such as fear or anger, although sadness may sometimes appear. The second condition that has a strong effect on expectations is the similarity of language they employ. There are cultural differences in the rules and phonemes of emotional language, and these differences are mainly reflected in the aspects of class, race, gender, age, and subculture. When the interaction is carried out in the same emotional language, it is easier to reach agreement. If the expectations at the beginning of the interaction do not exist or are ambiguous, conflicting, or lack a common emotional language, and each speaks its own words, then the expectations will be difficult to achieve, and certain negative emotions will be generated.

References Baker, W. E., & Faulkner, R. R. (1991). Role as resource in the Hollywood film industry. American Journal of Sociology, 97, 279–309. Bensley, L., Van Eenwky, J., & Simmons, K. (2000). Self-reported childhood sexual and physical abuse and adult HIV-risk behaviours and heavy drinking. American Journal of Preventive Medicine, 18, 151–158. Berger, J. (1988). Directions in expectation states research. In M. Webster & M. Foschi (Eds.), Status generalization: New theory and research. (pp. 450–510). Stanford University Press. Berger, J., & Conner, T. L. (1969). Performance expectations and behaviour in small groups. Acta Sociologica, 12, 186–198. Berger, J., & Zelditch, M. (Eds.). (1985). Status, rewards, and influence. Jossey-Bass. Berger, J., & Zelditch, M. (1998). Status, power, and legitimacy: Strategies and theories. Transaction Publishers. Blau, P. M. (1977). Inequality and heterogeneity: A primitive theory of social structure. Free Press. Blau, P. M. (1994). Structural context of opportunities. University of Chicago Press. Bolan, G., Ehrhardt, A. A., & Wasserheit, J. N. (1999). Gender perspectives and STDs. In K. K. Holmes, P.-A. Mardh, & P. F. Sparling et al. (Eds.), Sexually transmitted diseases. (pp. 117–128). McGraw-Hill. Callero, P. L. (1994). From role-playing to role-using: Understanding role as resource. Social Psychology Quarterly, 57, 228–243. Farmer, P., Connors, M., & Simmons, J. (Eds.). (1996). Women, poverty, and AIDS: Sex, drugs and structural violence. Common Courage Press. Goffman, E. (1967). Interaction ritual. Anchor Books. Gupta, G. (2004). Globalization, women, and the HIV/AIDS epidemic. Peace Review, 16, 79–83. Hawley, A. (1986). Human ecology: A theoretical essay. University of Chicago Press. Heise, D. R. (1979). Understanding events: Affect and the construction of social action. Cambridge University Press. Hou, R. (2015). Dying to live: Restoration of the self for people living with HIV/AIDS. Fu Jen Catholic University. Luhmann, N. (1982). The differentiation of society (S. Holmes & C. Larmore, Trans.). Columbia University Press. McPherson, J. M., & Ranger-Moore, J. (1991). Evolution on a dancing landscape: Organisations and networks in dynamic Blau-space. Social Forces, 70, 19–42. Moreno, J. (1953). Who shall survive? Beacon House. Nicolosi, A., Corrêa Leite, M. L., Musicco, M., Arid, C., Gavazzeni, G., & Lazzarin, A. (1994). The efficiency of male-to female and female-to-male sexual transmission of the human immunodeficiency virus: A study of 730 stable couples. Epidemiology, 5(6), 570–575.

122

4 Acquired “Expectations Deficiency” Syndrome

Parsons, T. (1951). The social system. Free Press. Ridgeway, C. L. (2000). The formation of status beliefs: Improving status construction theory. Advances in Group Processes, 17, 77–102. Ridgeway, C. L. (2006). Expectation states theory and emotions. In J. E. Stets & J. H. Turner (Eds.), Handbook of the sociology of emotions. (pp. 347–367). Springer. Ridgeway, C. L., Boyle, E., Kulpers, K., & Robinson, D. (1998). How do status beliefs develop? The role of resources and interaction. American Sociological Review, 63, 331–350. Ridgeway, C. L., & Correll, S. J. (2004). Unpacking the gender system: A theoretical perspective on cultural beliefs and social relations. Gender and Society, 18, 510–531. Ridgeway, C. L., & Erickson, K. G. (2000). Creating and spreading status beliefs. American Journal of Sociology, 106, 579–615. Smith-Lovin, L., & Heise, D. R. (1988). Analysing social interaction: Advances in affect control theory. Gordon and Breach. Turner, J. H. (1994). Roles and interaction processes: Toward a more robust theory. In G. Platt & C. Gordon (Eds.), Self, collective action, and society. JAI Press. Turner, J. H. (2002). Face-to-face: Toward a theory of interpersonal behavior. Stanford University Press. Turner, J. H. (2007). Human emotions: A sociological theory. Routledge. Wagner, D. G., & Berger, J. (1997). Gender and interpersonal task behaviours: Status expectation accounts. Sociological Perspectives, 40, 1–32. Webster, M., & Foschi, M. (Eds.). (1988). Status generalization: New theory and research. Stanford University Press. Webster, M., Jr., & Whitmeyer, J. M. (1999). A theory of second-order expectations and behaviour. Social Psychology Quarterly, 62, 17–31. Weng, N. (2003). Sociocultural dynamics of HIV transmission. Sociological Research, 5, 84–94. Wyatt, G., Myers, H., Williams, J., Kitchen, C., Loeb, T., Carmona, J. V., Wyatt, L. E., Chin, D., & Presley, N. (2002). Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. American Journal of Public Health, 92, 660–665.

Chapter 5

Acquired “Punishment” Syndrome

Individuals rely on the symbol system to guide the face-to-face interpersonal interaction, and eventually construct large-scale social structure based on the blueprint outlined by cultural symbols. Embedding provides structural channels for cultural influences during encounters, and cultural resources at the macro-level will usually affect embedded corporate units and categoric units and thus affect micro-level encounters as well as the emotional arousal during the course. Accordingly, if new culture forms during the encounters, the meso-level social structure will provide approaches for symbolizing the culture, thus indirectly affecting meso- and macrostructures. Therefore, it is necessary to analyse how culture through the embedded meso-level structure produces rewards and punishment for encounters at micro-level, and thus arouses emotions. Reward and punishment are a course of interaction during the encounters. Individuals may provide different levels of support or no support. To a certain extent, reward and punishment are conducted in the presence of others, because individuals may consider others’ response as positive rewards or negative punishment. In addition, individual may also regard the satisfaction of expectation states and the degree of clarification as their due reward or punishment. Furthermore, social reality at the macro-level is composed of institutional domains, stratification systems and the country as well as the national system; institutional domains and stratification systems affect corporate units and categoric units, which can be regarded as positive rewards or negative punishment. Although there are so many potential and intricate changes, the relationship between emotions and rewards or punishment is explicit. If there is support, individuals will think that they get positive rewards, which usually arouse their positive emotions. On the contrary, if there is no support, individuals will regard it as the punishment for their performance, which arouses one or more negative emotions. This is because the punishment will hinder the interaction and split the unity. As Turner points out, in the construction of social solidarity, one of the biggest obstacles for human ancestors is three out of the four primary emotions are negative. Although © Huazhong University of Science and Technology Press 2021 R. Hou, A Sociological Study on Emotion Regulation in People Living with HIV/AIDS in China, A Sociological View of AIDS, https://doi.org/10.1007/978-981-16-1494-1_5

123

124

5 Acquired “Punishment” Syndrome

punishment urges individuals to adjust their own behaviour and expectations, the punishment will arouse negative emotions, including fear, anger, sadness, and the combined form of these negative emotions, thereby splitting the unity (2002). When individuals are in anger, fear or sadness, or the combined state of these negative emotions (such as shame, guilt, or alienation), the disturbance of social ties may affect the social solidarity. Even without the emergence of the combined emotions, punishment will also generate some primary negative emotions, such as dislike, disgust, hostility, depression, pain, and so on. These emotions cannot promote unity, and they will reduce the commitment to social structure and culture. For PLWHA, they use different cultural symbols from interactive subjects. And their identity or status in corporate units and categoric units is ambiguous, in terms of which they can’t use the same emotional factors and rules, and conduct roletaking effectively and calibrate their behaviour standards. Thus, it is more likely for them to be constrained or punished at macro-level social organisation. When infected individuals are punished, they tend to suspend the embedded face-to-face encounters and thus produce negative emotions. If there are acquired needs deficiency at microlevel interaction and expectation satisfaction deficiency at meso-level for PLWHA, there will be lack of reward at the macro-level and the restriction and punishment from social structure and culture because of HIV/AIDS stigma features. Therefore, I sum up the plight of PLWHA at the macro level as “Acquired Punishment syndrome”.

5.1 Punishment in Institutional Domains Social organisations at macro level are composed of institutional domains, stratification systems, the country and the national system. Institutional domains are those social-wide structures—economy, polity, kinship, religion, law, science, medicine, education and the like. These social structures evidently affect the culture. In terms of social structure, cultural infiltration is top-down, initially entering the macro level, and then the meso level, eventually the micro level encounters. The interactional processes at the micro level will therefore be constrained and affected by the macro social structure, especially the institutional domains. Similarly, the values of a corporate unit typically represent the adaptation to the specific environment embedded in it, and they are more likely to be a reflection of the struggles of the social classes, and will also be restricted and affected by the distribution of social resources. From the perspective of top-down, interpersonal interaction can challenge, strengthen or potentially change corporate units and categoric units; If there are enough changes at the meso level, the structures and culture in the institutional domains may also change. Although most of the interpersonal interaction strengthens and regenerates the structure of the meso level, and thus maintain social structures and culture at the macro level, negative emotions arousal also leads to cultural change at the meso and macro level. So, it is necessary for us to explore the course of emotional arousal caused by the structures and culture at the macro level, and explore the dynamic mechanism of restriction and influence.

5.1 Punishment in Institutional Domains

125

5.1.1 Ideological Restrictions The country and the national system usually have some essential values, namely abstract standard of “good and bad”, “right and wrong”, “appropriate and inappropriate”. These values are abstract, because they provide moral rules that can be applied to system of various kinds. In terms of institutional domains, the values are transformed to ideologies, and the abstract values are applied in specific domains, including economy, kinship, polity, religion, science, education, law and medicine, etc. For example, the abstract value “achievement” is converted to “individual and collective members should do well and succeed” in economic domain and becomes the moral standard of “what should happen” within a specific domain. Under the current social situation in our country, HIV virus or AIDS, the disease that belongs to the domain of biomedicine, should be researched by biomedical experts. But as a social problem, it has been highly ideological in the process of its transmission and spread, and has been given different significance in different institutional domains. In economic domain, AIDS is believed to bring enormous loss, or even a destructive impact, to a country’s economic development, because HIV can bring about labour shortage and increase business costs. The statement is also confirmed by the World Bank. In polity domain, AIDS has become a disease that is widely transmitted in developing countries. Most of PLWHA are in a state of poverty and marginalisation, which represents a worldwide problem of poverty and social injustice. In terms of kinship, AIDS often manifests as “one person getting sick and the whole family suffering.” AIDS has become a disease that spread through sexual “relationships.” Not only may PLWHA be rejected by their family members, even their family members will inevitably be “feared away” by the society. In the domain of medicine, AIDS is not just a medical problem that has not yet been overcome. The infected individuals are misunderstood as the source of infection and virus carrier. Being infected means no cure, high infectiousness, high lethality and stigmatisation, which weakens people’s health and ability to resist diseases. After the infection, the physical strength is not as good as before. I’ve changed two jobs, both because of high work pressure and often having to work overtime. As you know, once lifestyle is irregular, especially staying up late, CD4 count becomes even less. So, there’s no other way but to change jobs, but the more demanding you are, the harder it is to find a job and the lower your income is. Now, I can hardly support myself. If I ask for leave, the employer will deduct wages. I can hardly afford medicines at present. And I can’t tell the news to the employer. Or it’s probable that I will be fired. (laugh bitterly) In fact, the hospital should take this into consideration, such as arranging for outpatient collection medicines on Saturdays and Sundays. Or, I don’t wanna live anymore. Everyone is doomed to die. Yet, no one would like to die silently like this. (DCYJ06) Of course, I wanna find a job. I remember that I’ve been taught “economic foundation determines the superstructure” during school days, right? In fact, I’ve always wanted to find a job and do it well. I hope life’s not as it is now. Without a job, there’s no money and nothing can be achieved. But, when I’m looking for a job, I find that, for example, if I take an examination of civil service or public institution, including many other companies now, there will be a physical examination, and applicants may be tested for HIV. Of course, even if I go to an ordinary company, I can’t say that I’m infected with AIDS. You know, the work pressure and work intensity shouldn’t be too great. I can’t earn money first, and then

126

5 Acquired “Punishment” Syndrome

spend money to recover from illness, and I can’t afford it. The job shouldn’t be in conflict with taking medicine. And I can’t do physical jobs now. In short, because of HIV, I need to seriously consider the relationship among work, health and economic conditions. (DCYJ01)

It can be seen that although PLWHA are eager to return or continue to work, from the ideological perspective of the economic domain, “work” means working hard to complete the tasks and fulfilling the duties. PLWHA, however, are often restricted by a series of factors related to themselves, such as the potential side effects of taking antiviral drugs, the related symptoms of opportunistic infections, the effects of working long hours and work pressure, and the conflict between taking medicine and working hours, etc. These restrictions and possible punishment often result in lack of labour at the social level, changes in the employment relationship at the enterprise level, and health and work conflicts at the personal level, which may further undermine their ability of earning money. Thus, they will have negative emotions such as shame and resentment, etc. In the polity domain, the stigmatisation makes it impossible for PLWHA to even get some essential rights, such as equal rights of social security and medical insurance, fair medical treatment, free access to public places, and so on. The root cause of all this is because AIDS is equivalent to “plague” in modern social contexts. What is associated with PLWHA is not only death, but also deviant and abnormal behaviours such as homosexuality, sexual promiscuity, and illegal drug use. It is based on these ideologies in the political realm that AIDS is considered to be divine punishment and PLWHA deserve the punishment, thus arousing their negative emotions. Not only did we dare not take medical insurance, but we didn’t even get subsistence allowances. When they know that we contract AIDS, we would have nothing. There are only two kinds of people who can’t get the subsistence allowances: drug users and HIVinfected people. For drug users, if they don’t take the drug, they can also get the allowances. Why? Why do others live better than us and still receive subsistence allowances? But we can’t. Are infected people not human beings anymore? You know, it seems to be in Chengdu that infected people can’t go swimming or bathing in public baths. If they’ve got guts, they request everyone who goes there to have a blood test. In fact, these restrictions are punishments and repulsion for us. (DCYJ09)

In retrospect, at the domain of medicine, although there have been improvements in the treatment of AIDS, including effective antiviral drug treatment and better monitoring of the disease through T cells and viral load, and the quality of daily life of PLWHA and the extension of life expectancy, etc., the infectiousness of HIV virus and the stigmatisation in the society have brought about many obstacles in the domain of seeking medical treatment and medicine, especially failure to equal access to medical resources and medical services. Do you know “Xiaofeng Case”? How about that? There’s no hospital performing the operation for him. There’s no way for him. He secretly tampered with the medical record and was performed the operation. Doesn’t the hospital, including the Health Bureau, know the risks of surgery? All in all, it is discrimination. Xiaofeng’s surgery was successful. Premier Li Keqiang also inspected the matter, but so what? Now, we still can’t be performed the surgery. After “Xiaofeng Case”, the hospitals have learned the lesson. They have stricter management of medical records, which can’t be falsified. The outcome is that your surgery

5.1 Punishment in Institutional Domains

127

can’t be done. Is it good or not? They claim that they can’t perform the surgery. Because they are worried about the transmission. The worry is from the doctors, the hospitals, and even the whole society. Aren’t infected people worried? (DCYJ22) In fact, the hospitals’ refusal to treatment of infected people is not the behaviour of individual doctors, but the result of the propaganda. If there weren’t so much negative propaganda about AIDS, or the entire medical system hasn’t become profit-oriented, or everything went well without anything happening, perhaps there are doctors willing to perform operations on us. So, if the social environment will not change, the problem can’t be solved only through illegal practices of a few conscientious doctors. (DCYJ25)

Because of HIV-related stigma of AIDS, family members have also been severely affected. People often regard being infected with AIDS as a manifestation of vulgarity. It may not only cause the infection of the partner, but also put the entire family to shame. Under the influence of the views, many infected individuals had to leave their homes, and separate from their parents, wives and children. These restrictions and punishments are caused by the recognition in the domain of kinship that HIV infection is considered a kind of indulgence and betrayal. I was kicked out of the house because of homosexuality and AIDS. My dad disowned me even when he died, saying that he couldn’t bear being spoken ill of. My parents said that they would rather not have me as their son. They disowned me as if they had never given birth to me. AIDS is not only a disease; it is also a family scandal. It’s ashamed to tell family members, let alone others. Anyway, once we are infected, we are regarded as the source of infection wherever we go. Otherwise, why could infected people take revenge on society? That was an act of desperation. (DCYJ27)

Although AIDS has been transformed into different ideologies in various institutional domains, the ideologies have similar value recognition, that is, the belief that AIDS is bad, wrong, and inappropriate, is more likely to harm others and society. Because of these ideologies dominating in the institutional domains, HIVinfected individuals are not accepted in institutional domains, which also impacts embedded meso- and micro-encounters. When the interactive subjects are affected by the “inappropriate” ideologies, infected individuals cannot achieve recognition in various institutional domains. Infected individuals are affected by these ideologies and they will experience various difficulties such as being refused to get medical treatment, lack of access to subsistence allowances, limited job choices, hopeless survival expectation, which arouses negative emotions such as anger and meanwhile direct these negative emotions at macro social environment.

5.1.2 Rejection of the Symbolic Media In the institutional domains, there is also a cultural concept that is more ambiguous than values and ideologies, that is, “generalised symbolic media”. Although there is ambiguity and the concept of “generalised symbolic media” is less accurate, in my opinion, this is also an important aspect worthy of serious study. George Simmel may be the first researcher to fully realise the importance of generalised symbolic

128

5 Acquired “Punishment” Syndrome

Table 5.1 Generalised symbolic media of institutional domains Institutional domains Generalised symbolic media Economy

Money and other metrics of value that can be converted into money

Polity

Power or the capacity to control the actions of other actors

Law

Influence or the capacity to define what is just and right for actors as well as the ability to adjudicate social relations among actors

Religious

Sacred/supernatural or the ability to explain events in terms of the power and influence of non-observable forces

Education

Transmission of knowledge or the capacity to impart knowledge to actors

Kinship

Love/loyalty or the use of strong affective states to engender strong attachments and commitments among kin

Science

Verifiable knowledge/truth or the search for knowledge in the empirical world revealing truths about the operation of this world

Medicine

Health or the ability to sustain the normal functioning of the human body

media, which is reflected in his analysis of how money changes people’s behaviour, exchange and social relations (1990). Later, Talcott Parsons (1963a, 1963b, 1970) introduced these views, which were further developed by Niklas Luhmann (1982). Although these researchers have elaborated a set of important dynamic mechanisms, they have not been clarified the concept accurately. Each institutional domain has its own unique generalised symbolic media, which can be applied in encounters by individuals and members. On the basis of previous studies, Turner made a list of the dominant generalised sign media in each institutional domain, as shown in Table 5.1. Academia has not proposed a detailed classification of symbolic media, but the symbolic media used in encounters and communicating will be different, if the institutional domains are different from each other. From these generalised symbolic media, it can be concluded that there is always an evaluative element embodied in the media and subordinated to the ideologies in institutional domains. For example, the ideology of capitalism endows the medium of money with evaluative element, that is, what is a valuable goal; the ideology in the domain of kinship ensures that love and loyalty become moral goals among family members; in the domain of polity, the medium of power is highly infused with ideology; in the domain of medicine and health, health and normal physical competence are the pursued goals for everyone. It can be seen that the generalised symbolic media are not morally neutral, but are always embedded in the institution dominated by the ideology. Generally speaking, discourse in institutional domains is carried out through generalised symbolic media. As Luhmann once emphasised, symbolic media communication has become the basis for thematisation of a domain (1984). That PLWHA are excluded, restricted, and punished is because AIDS after entering into institutional domains is not only repelled by the ideology, but also conflicts with generalised symbolic media, which affects discourse in institutional domains. For example, in the domain of economy, money is the fundamental theme of discourse,

5.1 Punishment in Institutional Domains

129

but AIDS will not only cause economic recession, but also lead to a reduction in personal income and the occurrence of poverty. Similarly, truth and knowledge are primary topic for scientists in the domain of science, while AIDS is a difficult problem that scientific research cannot solve. Love and loyalty are the basic themes of kinship, but AIDS has left PLWHA with the stigma of betrayal and lousiness. In the domain of medicine and health, health and normal physical function are universal pursuits and desires. However, AIDS not only results in the lack of immune function, but also damages the physical function and health of individuals and may also improve the risks of infection in close contact. As the old saying goes, “after decades of hard work, the economic condition returned to the same level as it was before liberation overnight”. The result of infection is not just poverty because of disease, but also poverty caused by receiving antiviral treatment and other treatment for opportunistic infections, and so on. It also results in unemployment. You know, if we go to the hospital, we won’t be discharged without spending a few thousand Yuan. Let us not mention the discrimination against us because of the disease, we will also be despised because of poverty. A few years ago, I borrowed money from my elder sister, but my sister did not lend me any. Why? Because AIDS is like blowing a hole in the economic condition. How much is enough for treating the disease? Probably, she’s afraid that I can’t return the money. Of course, there are still some people who get sick because of poverty, people who sell blood and prostitutes that contracted HIV for earning money. What’s the result? They are poorer than before. So, are they not regretful for it? Er… about AIDS, if we don’t talk about it, people can’t tell it. But if we don’t have money because of this, and we don’t even have money to see a doctor, how do we get along? (DCYJ18) In fact, it’s said that it does not cost money to see a doctor for AID patients, but the fact is that the related examination costs are higher than the price of antiviral drugs. Many infected people can’t get medicine because they can’t afford the examination. In fact, this is putting the cart before the horse. Since the country has decided to allow infected people to get medicines for free, it should take related examination into consideration instead of letting hospitals secretly earn money from examination under the guise of free medicines. (DCYJ16) In fact, it is very shameful to be infected with AIDS. Whether we are homosexual or heterosexual, how could we possibly have contracted it if we behaved well? Nowadays, homosexual relationship is messy. In fact, heterosexual relationship is not much better. To put it bluntly, only those infected by blood transfusion are not ashamed. Being infected by other approaches is shameful. So, it’s reasonable that their partners were scared away, when knowing that they were tested positive. If I were the partner, I would also run away. To put it bluntly, we deserve it. Don’t say that people don’t show care or something. When they were enjoying themselves, didn’t they think about consequences? (DCYJ02)

More importantly, as Parsons and Smelser have argued, exchanges across institutional domains usually involve endowing a symbolic medium with another form (Parsons, 1963a; Parsons & Smelser, 1956); for example, the government exploits its power to establish the public school system and transmit knowledge legitimating polity. In addition, some media are more evaluative than others, and this feature is of great significance to how symbolic media operates in society. As Simmel argues, money is a neutral medium, because money is highly abstract and can be applied in a variety of situations, while other media, such as love or knowledge, contain more evaluative elements. Similarly, power has many characteristics similar to money, which can penetrate all social organisations. As Habermas has proved, money and power

130

5 Acquired “Punishment” Syndrome

can colonise the world, because they can penetrate into the institutional domains through other media (1973). Because of this, the feature of the media’s easy access to other institutional domains often obscures individuals’ feelings about rewards and punishment, and induces negative emotions arousal. For example, in the family, when parents seek to use money to “buy their kids’ love”, the reward will become vaguer, because money and love are tied together, which confuses the expectations of rewards and punishment in specific areas. If private enterprises fund scientific research in universities, the mix of money, truth, and knowledge will obscure the rewards for science. Therefore, to a certain extent, if multiple symbolic media mix up in an institutional domain, especially in the economic domain and the polity domain, the clarity of rewards will be affected in this institutional domain, even for social interaction. AIDS is a complex social problem, because the prevention and treatment of AIDS involves different institutional domains and is even more disturbed by the generalised symbolic media in different domains. In other words, the AIDS problem is initially involved in the medical domain, but as a result, it was affected by the generalised symbolic media in various institutional domains. For example, in the treatment of AIDS, although antiretroviral treatment is free, the infected individuals have to pay a lot for the examination and for the excessive medical treatment. Everyone knows that AIDS is not a problem that can be solved by medicine. For example, blood selling, if it is not profitable, how can so many people get infected? How about the current treatment? Although the medicine is free, you have to pay thousands of Yuan for examination, and you can’t be reimbursed (DCYJ17).

The “Four Frees and One Care” policy was proposed to evoke the expectation and gratitude of PLWHA, who are also willing to bear the side effects of antiviral drugs for recovery of their health and physical strength. But when they spend money on “dispensable check-up reports”, anger is thus aroused. Many infected people cannot receive antiretroviral treatment because they cannot afford the check-up. In this situation, negative emotions like resentment will be aroused in PLWHA. In the same vein, ASOs provide corresponding support and care for PLWHA, who in turn have become the resource of “project for the sake of the project”. The intervention method of “promising to help, actually to use”, in the words of the staff of the organisation, this “win-win model”, indeed has played a huge role in supporting and caring, but it arouses the strong dissatisfaction from infected people, and leads to mutual hurt as well. PLWHA lack faith in ASOs and gradually developed a sense of alienation from the organisation, which has obscured the satisfaction of the needs of infected people in encounters and the realisation of the expectations at the meso level. Consequently, they think that being infected with AIDS is punishment, thereby resulting in the emotion of sadness like throwing the handle after the blade. The AIDS groups are like dogs raised by the CDC (Centers for Disease Control and Prevention). Why? Because these groups actually know who are infected and control those infected people. Usually they give us small favors, such as distributing condoms, or dining us, etc. Then we are targeted and can’t run away. Think about it, if it weren’t for the seriousness of the epidemic, who would spend money to take care of us, drug users, homosexuals, or

5.1 Punishment in Institutional Domains

131

whoremongers? Why does the country spend money to treat us rather than others? Because it’s afraid that we infect others. These groups intend to stabilise us and target us. (DCYJ22) There is no such thing as a free lunch. It is said that everything is for infected people, but in fact it is intended to use all of infected people. For example, some groups give out money for blood testing. Because they can get 60 yuan for a testing from the project, and they give out 38 yuan for a testing, then the rest is their own. Aren’t they selling our blood? It is said that if one of the tests is found to be positive, they will get additional rewards. Even if there are no positive results, it is profitable for them. (DCYJ30) In fact, they have fooled us, the government, and the foreigners. At first, we were very enthusiastic about it, but later we realised that they did it for something. I couldn’t remember what the project was several years ago. Anyway, as long as you came, you got gifts. I went to five organisations in one day and received five different things that I could use anyway, like an electric kettle and aloe vera cream. Some organisations just gave out money to us. Now we all understand that. (DCYJ22)

The generalised symbolic media often affect individuals’ emotions through the embedded meso-level social structure and micro-level interaction. When individuals’ transactional needs in encounters are met, they will feel that the resources they achieve meet their expectations of just shares. As Turner once emphasised, just shares are the result of calculation, that is, calculating whether the cost and investment of an individual corresponds to the ratio of the cost and investment of others (2002). The process of fair calculation is affected by generalised symbolic media, in which the concept of just is usually transformed into norms of justice in corporate units and categoric units, and thus expanded to encounters embedded in corporate units and categoric units. For example, that “people should work hard to make money” is an implicit belief, and the amount of work is a criterion for evaluating people’s relative costs and investment. As a result, those who work hard get more money than those who do not work hard enough. Similarly, the symbolic media of love and loyalty in the kinship domain also have implicit norms about what is fair. In essence, people who give more love and loyalty to family members should receive more love and loyalty than those who give less to family members. In the domain of medicine, the symbolic media of health and good physical conditions also have implicit norms about what is fair. In essence, people who pay attention to medical treatment and regimen are more likely to be in good health. However, for infected people, they have already made great efforts to fight against the HIV virus. Instead of experiencing fairness and justice, they are stigmatised by the society because of the route the HIV virus is transmitted and considered to deserve the punishment due to messy behaviour, drug use, homosexuality and other deviant behaviours. Since its discovery, AIDS has always been accompanied by punishment and retribution. You also know this, right? For example, it was originally believed that the homosexual may inflict cancer, MSM (men who have sex with men) would give birth to HIV, and that it was punishment for drug abusers and whoremongers. Infected people get what they deserve. But later, someone was infected with AIDS due to blood transfusion, so there was a dispute between the guilty and the innocent, but the dispute was also based on punishment. (DCYJ20) If AIDS is just a disease, that’s a relief. However, at present, HIV infection means that the person is bad. He has to suffer retribution and lose everything, such as no money, no rights,

132

5 Acquired “Punishment” Syndrome

and even no qualifications to apply for a subsistence allowance. In other words, the infected person doesn’t even have the rights to see a doctor. He must be obedient! If the person has the ability, just take the medicine and don’t infect others. (DCYJ03)

Therefore, the generalised symbolic media provide important guidance on how to establish fair distribution, how to evaluate the costs and investment paid by individuals, and the relationship between the costs and investment and the reward and punishment. Like workplaces, schools, hospitals, communities, and other corporate units embedded in the macro structure, individuals always hold the implicit concept of fair distribution in a variety of situations. Turner believes that when the generalised symbolic media in the institutional domains cannot fully assert the dominance, the clarity of the concept of fair distribution will correspondingly decrease (2007). Take PLWHA as an example. If there is discrimination and prejudice against PLWHA in the medical domain, and there is profit of medical institutions in free antiretroviral treatment, and there is exploit and deception mingled in the support and care from the groups helping PLWHA, the clarity of the concept of fair distribution in the medical domain will be affected, thereby depriving PLWHA of experiencing the fairness and justice norms in the interaction and regarding the restriction and exclusion as punishment. The restriction and exclusion in these interactions is not just a personal behaviour, but also reflects the detriment and harm of the generalised symbolic media in medical domain, which arouses negative emotions such as anger and resentment in PLWHA. As Hochschild once emphasised, emotions that reflect feelings and the rules of expression guide interpersonal interactions. Therefore, every interaction is subject to expectations and guidance on how people should feel and express specific emotions (1983). These feelings and expression rules are usually contained in macro generalised symbolic media in which the interaction is embedded. This is because there is almost always a certain evaluation component associated with symbolic media. For example, if health is a generalised symbolic medium, and the ideology advocates that health is a representative of personal capability, then people with a healthy body have the right to feel and express pride, while those suffering from disease often feel either shame or sadness. Especially for PLWHA, they are not only physically invaded by the virus and unable to cope, but also considered as being insufficient to gain wealth in the economic domain, as being contrary to love and loyalty in the kinship domain, and as being detrimental to the safety of individuals and society in the polity domain. In particular, when the generalised symbolic media are combined with ideologies, as they usually show, the restrictions on emotional feeling and expression will be stronger, and these factors may further form the institutional chain of punishment (Collins, 2004). This pushes PLWHA to the marginalised position of the economic, polity, kinship and medical domain, allows them to experience unfair punishment and restriction, and arouses the negative emotions and the mix of emotions like anger, resentment, and sadness in PLWHA.

5.2 Uneven Capital Distribution in Stratification Systems

133

5.2 Uneven Capital Distribution in Stratification Systems It is generally believed that stratification systems refer to the unfair distribution of resources among the population. The formation of stratum is based on the different resources shared by individuals and different evaluations based on the different resources owned by individuals. The uneven distribution of valuable resources is the result of the operation of the institutional domains. Because the resources themselves are unequally distributed, resources are usually the generalised symbolic media of the specific institutional domain. For example, money originates from economy domain, power from polity domain, privileges of knowledge production from education domain, and health is related to medicine domain, etc. In particular, the operation of the institutional domains determines how much resources the public can obtain. For example, in the era of agricultural economy, most of wealth and power are in the hands of a few people, and the rest can only get very few resources. Conversely, in a market economy society, an open system and equal access to university education have reduced the unequal distribution of resources, especially in terms of power, money, education, and medical care. Bourdieu has successively demonstrated four types of “capital” allocated by a stratification system, namely, economic capital (money and those that can be purchased with money), cultural capital (taste, knowledge, manners, skills, habitus and lifestyle), social capital (position, network relationships, and status in corporate units) and symbolic capital (to legitimise other capitals owned by symbols). The unequal distribution of these capitals not only determines the structure of the entire class, but also determines the division within the class (1984, 1986). Looking back at the living conditions of PLWHA, because of the stigmatisation of AIDS, after being infected, individuals often experience various capital losses and unequal distribution of resources. For example, the interviewee labelled DCYJ25, he originally had a job as a civil servant in his hometown, with a good income, a welloff family, a relatively high level of education, and a certain social circle. However, after being infected, in order to conceal the fact and prevent his family from being ashamed, he left his hometown alone and started a lonely and wandering life. Not only did he lose all the capital he once had, but also experience emotional ups and downs. It is not uncommon, but a general state for PLWHA. After “AIDS comes”, PLWHA not only experience the various “feelings” caused by stigma and illness, but also the unbearable burden of life caused by the successive loss of various capitals. If we use the previous statement, the situation of PLWHA in the stratification system can be called “Acquired Capital Deficiency Syndrome”.

5.2.1 The Loss of Bourdieu’s “Four Capitals” Bourdieu believes that economic capital uses money as a symbol and property rights as an institutionalised form. It is composed of different production factors such as

134

5 Acquired “Punishment” Syndrome

land and labour, economic property, various incomes, and various economic benefits (1986). If we use Bourdieu’s definition of economic capital to study the survival and life of PLWHA in the economic domain, people living with HIV are bound to fail in this economic capital investment. They are often forced to lose their jobs because of the stigma of AIDS. They would voluntarily resign due to the impact of the virus on the health, or sell up for high medical expenses, and then many people became highly indebted. When I was diagnosed with AIDS, there was a sensation in the entire county. It was naturally that my colleagues knew that. The next afternoon, I received a call. You know, it was a call from the employer. They dared not to meet me. They said that they understood my family’s situation. Taking into account the impact of this disease on everyone, I was dismissed. They would offer me two more months of salary as compensation, saying that the money would be transferred to my bank card directly. They recommended that I shouldn’t go to the workplace any more, in order to avoid causing panic among others. I accepted it at that time. In fact, even if they didn’t call me, I was leaving. In this small county, it’s impossible that I continued to work there. I said that I wanted to pack my things. They asked me to go there at night, when everyone got off work. An old man was arranged to open the door when I went there. Later, the old man didn’t work there anymore. (DCYJ04) Although taking medicine can suppress HIV, we should always pay attention to your health. We can’t be too tired. We can’t eat this or that. At the beginning, I still insisted on going to work, but then I found that I couldn’t always eat out or go to KTV with others; I’m always worried about the health. I dared not go, but I couldn’t refuse it every time. In addition, I couldn’t always stay up late at work. Finally, I quitted the job. Of course, they didn’t know that I’m infected. (DCYJ21) Before being infected, I had been in business, and I had some savings and real estate. After the infection, I was always thinking about how to survive. Later, I heard that cocktail therapy proposed by He Dayi could fight HIV. So, in order to survive, I sold my house, went to the black market to exchange dollars, and then bought medicine from abroad. (DCYJ27) If there was some contribution for selling blood (Blood-selling is to earn money to pay fines for violating family planning policy), then contracting this disease is the biggest sin. There is nothing left. Later there came many swindlers selling TCM (traditional Chinese medicine), who were said to be specializing in the treatment of AIDS. Many people believed it, including us. As a result, they defrauded us of a lot of money. My husband also borrowed money for the medical treatment, including loan sharks. After all, even if we weren’t cured and may die, the borrowed money must be repaid, including the interest. (DCYJ20)

Even for many infected individuals with better financial conditions, each year they spend a lot of money for medicines, examinations, and opportunistic infections. In the words of PLWHA, “medical expenses have become my primary expenditure, and I always have to go to the hospital every year”. Therefore, although the use of antiviral drugs is free, the infection weakens their economic conditions and economic capital. It is not only difficult to transform with other capital, but also becomes their primary burden of life, which arouses the negative emotions such as shame and resentment. Social capital, or social relationship capital, refers to a collection of actual or potential resources, and those resources are inseparable from the possession of a certain persistent network. This network is familiar and recognised by everyone, and it is a network of institutionalised relationships (Bourdieu, 1986). Social capital is a kind of relational capital, which is related to the status of an individual in a specific

5.2 Uneven Capital Distribution in Stratification Systems

135

social network structure. It is actually constituted by the social obligations of people who have “encounters” with each other. There are various forms of encounters, including direct communication with face-to-face interaction and indirect communication with the aid of media; there are both formal role interactions in the institutional structure and informal role interactions in daily life. In social interaction, social capital of social members can be produced. As stated before, after being infected, PLWHA, transactional needs of which cannot be satisfied and expectations of which cannot be fulfilled, are deprived of social capital. For instance, they are excluded by family members/friends/the community due to role exposure, lose jobs due to health problems, and fail to participate in encounters with their real role and meet real needs due to the stigmatisation of the society, etc. In addition, social capital is the product of a conscious or unconscious investment strategy. These strategies include the choice of social relations, the “symbolic construction” of social relations, the accumulation and maintenance of social relations, and so on. Social capital has a strong ability to increase self-value. If used properly, “the social capital accruing from a relationship is that much greater to the extent that the person who is the object of it is richly endowed with capital” (Bourdieu, 1986). However, for PLWHA, their transactional needs cannot meet exchange of benefits in encounters, and it is even more difficult for them to gain the trust of their contacts. They experience the unfair distribution of resources in investment and return, and eventually they retreat and lose all capital. “Cultural capital” refers to those informal interpersonal skills, habitus, attitudes, language styles, educational qualities, tastes and lifestyles, etc. Generally speaking, cultural capital exists in three forms: the embodied state, the objectified state, and the institutionalised state. I’m neither going nor able to comment on cultural capital, but just borrowing the concept of cultural capital to present the status quo of PLWHA. As far as the infected people interviewed are concerned, from the perspective of education level or the institutional culture of cultural capital, the infected people are poorly educated. It is not difficult to understand, and we can know a thing or two about the infection routes. First of all, many PLWHA are infected through illegal blood collection and blood supply. Most of them come from rural areas and are poorly educated, such as the interviewee labeled DCYJ02, DCYJ16, DCYJ20 and DCYJ24. Secondly, some young infected people are forced to drop out of school because of the infection, and their education level is limited to that of junior and high school, such as the interviewee labelled DCYJ07. Finally, because cultural capital requires a certain amount of accumulation and represents a certain way of life, most of the infected people are relatively young and have been treated for many years. Therefore, in terms of cultural capital, they often lack the corresponding accumulation. Bourdieu subsequently proposed “symbolic capital”, which is a symbol that legalises other capital owned, such as reputation and prestige. However, PLWHA are often plagued by social stigma. In terms of political ideology, AIDS is regarded as “AIDS because of love”, which is a manifestation of the corrupt lifestyle and declining social system (Yao & Wang, 2014).

136

5 Acquired “Punishment” Syndrome

I was firstly tested positive in March. I had heard of AIDS, but I always thought that it was a “distant thing like a ghost that I had heard but had never seen”. I never thought that AIDS was so close to me. I used to think that AIDS publicity was like a leaflet distributed in a park. Although I knew it, no one would read it and no one would care. Because I have always believed that AIDS is a disease that foreigners can contract. Even if it is contagious, it won’t occur to me. People may never realise that the HIV virus is actually at side. (DCYJ16)

Because AIDS was first discovered in the United States and then broke out among gay men, coupled with early improper publicity at home, some members of the public and PLWHA have misunderstood the disease: AIDS was naturally considered as a disease happening in western society. From the perspective of kinship and moral ideology, AIDS is actually “AIDS because of love”, which is regarded as a disease derived from sexual promiscuity and homosexuality and a disease that is immoral and contrary to love and loyalty. The Chinese translation of the disease in Taiwan and Hong Kong is still discriminating. There is “love” in the translation, as its infection has been regarded as being related to love. But no one would think that the translation means real love, it’s considered to be explained as sex, promiscuity, etc. In particular, that more homosexuals are infected with AIDS is because MSM can get AIDS. Otherwise, where does HIV come from? Anyway, no matter what kinds of the statement, as long as there is HIV, there must be no love. (DCYJ26)

Therefore, from the perspective of symbolic capital, PLWHA generally lack positive symbolic capital. In the real society, if symbolic capital has the dual nature of being denied and recognised, it can also be said that the infected individuals generally lack “recognised” symbolic capital, but there is no shortage of “denied” symbolic capital.

5.2.2 Negative Accumulation of Emotional Capital As the research of emotional sociology is booming, emotional capital has also become a newly proposed form of capital in sociological research. Collins believes that “emotional energy is the common denominator of all social comparisons and choices.” It is an emotional benefit, which can also be carried out according to the optimisation principle like rational behaviour; the emotional energy does require not only material costs, but also “emotional resource invested on the cost side” (2009). And Collins, Turner, and Kemper all pointed out that “emotional capital” is unequally distributed among classes. If the construction of stratification systems is centered on the unequal distribution of resources, then those in a higher class will not only have higher level of economic, cultural, social and symbolic capital, but also have more positive emotional energy. On the contrary, those who are at a lower level or have fewer resources, such as most infected people, have less positive emotional energy. As a result, emotional capital is also unequally distributed in stratification systems. The reason is that the members of the higher class or the ruling class are those who have successfully met their needs, fulfilled expectations, and received rewards in the encounters. And encounters are

5.2 Uneven Capital Distribution in Stratification Systems

137

embedded in corporate units, and then in the resource allocation of the institutional domain; while for the members of the lower class or the oppressed class, especially PLWHA in the flow of interaction as analysed in this book, the transactional needs are not met at the micro-level interaction (see Chapter 3), the expectations of the corporate units and categoric units at the meso level have not been realised (see Chapter 4), and they have been restricted, excluded and punished by ideology and generalised symbolic media at the macro level, which caused loss of four forms of capital proposed by Bourdieu and negative emotions arousal. As Collins once pointed out, Kemper further emphasised that the distribution of material resources and power was positively correlated with positive emotional energy (Collins, 1975; Kemper, 1990). Therefore, if the expectations of PLWHA can be met, their needs fulfilled or the rewards got during encounters, they will be more self-confident, and this positive emotional “reservoir” can be used and invested to obtain new capital. On the contrary, when their needs cannot be met or they cannot achieve their expectations or are punished for it, they will not only lack self-confidence, but will also be less likely to have more emotions for use and investment, and thus lack access to more new resources. The result will arouse a lot of negative emotions. Furthermore, PLWHA have rarely obtained the life experience of a successful life, but are full of negative emotions of “first experience of AIDS”, including anger, fear, sadness, shame, guilt, etc. These emotional changes or cocktails forms of negative emotions result in insufficient self-confidence in obtaining other resources, and can’t escape the influence of failure. Therefore, we can also say that PLWHA experience “Acquired Capital Deficiency Syndrome” in stratification systems. If infected people are jerks, then those infected people with poor backgrounds will be regarded as jerks among jerks. Why? Because one symptom of opportunistic infections is skin ulceration, we have been treated as bad people in discrimination against the infected people from a very early time. In addition, a poor background such as taking drugs, the man has no money, otherwise there is no need to share needles. If a person takes drugs, it is estimated that his family condition is not good. Look at the drug addicts, aren’t they all that way? They are arrested and then released over and over again. If they contract AIDS at the same time, aren’t they jerks among jerks? Last year, I heard a policeman said that if they found an infected person in the process of arresting drug addicts, they would usually kick them on the buttocks and say “get off”. You see, if they contracted the virus, even the police would not arrest them. It would be disturbing if infected people were arrested. (DCYJ12) Actually, every infected person wants to live a good life. But being infected with AIDS destroys us all. At least you can’t do what you did before at work. You have to take care of your health. But the result is that you will definitely earn less money. Moreover, your physical condition is not as good as before, and it takes a lot of time to deal with AIDS-related issues. For example, there are a few famous celebrities with AIDS in the circle now. M is counted as one. He is always thinking about a new line of work, and he doesn’t continue to do it. Like S, who took photos with US President Clinton, how about? He has been out of this circle for many years, and in retreat. L, who did so well in the institution H (the name of some institution), has withdrawn now. Why? Though infected people bear and complain too much, they end up with failure and frustration. Finally, they have no spirit. (DCYJ30)

Generally speaking, individuals show more or less positive emotions or negative emotions between different institutional domains and stratification systems. The

138

5 Acquired “Punishment” Syndrome

cumulative effect of this situation creates unequal distribution of emotional energy, and thus forms another basis for stratification. Because AIDS cannot be cured, as well as other reasons, PLWHA often fail to experience positive emotions in the medical domain. But if they can succeed in other domains (such as economics, polity, education, family, etc.), they can also experience many positive emotions. This is because, no matter what level of negative emotion has been accumulated, it can be reduced to a certain extent because of the rewards and expectations obtained in other domains. For example, PLWHA who have been successful in the AIDS group or in the workplace not only own more wealth and status, they can also continue to experience positive emotions, which makes them feel confident about the resources arousing positive emotions. On the contrary, many infected individuals have rarely had a positive and successful life experience since they were infected. Their failures in various domains of resource allocation (economics, polity, education, family, medicine) have not been compensated by other domains, which will arouse stronger negative emotions. For example, many infected individuals have failed not only in education and economy domain, but also in family life; their negative emotions have therefore accumulated to a high level, and indirectly caused social change. It can be seen that different capitals are related in different stratification systems and institutional domains. It’s unnecessary for me to lay out all the theories of Bourdieu to draw a generalised conclusion: the culture of stratification systems, and the culture within classes, are a mixture of evaluative dimensions of the generalised symbolic media of institutional spheres, the ideologies of the spheres and capital forms (economic, cultural, social, symbolic and emotional capital) possessed by people. In this mixture, there have general level of evaluations of different social classes; to a certain extent, these evaluations are related to categoric units, and they influence status processes as diffuse status characteristics and on dynamics of normalisation in a face-to-face encounter. If corporate units have a new set of ideology and a symbolic medium of discourse and exchange, it can channel out the collective anger through certain channels, then the structure and culture of these corporate units can ensure that they are protected from negative external influence through local interactions. The success of these corporate units depends not only on the symbolic resources (ideology and symbolic media) that can operate, but also on various capitals, especially emotional capital, because emotional capital has become one of the most critical resources in any successful social movement.

References Bourdieu, P. (1984). Distinction: A social critique of the judgement of taste. Routledge & Kegan Paul. Bourdieu, P. (1986). The forms of capital. In J. Richardson (Ed.), Handbook of theory and research for the sociology of education (pp. 241–258). Greenwood. Collins, R. (1975). Conflict sociology: Toward an explanatory science. Academic Press. Collins, R. (2004). Interaction ritual chains. Princeton University Press. Collins, R. (2009). The micro-sociology of violence. British Journal of Sociology, 60(3), 566–576.

References

139

Habermas, J. (1973). Legitimation crisis. Heinemann. Hochschild, A. R. (1983). The managed heart: Commercialization of human feeling. University of California Press. Kemper, T. D. (1963a). On the concept of power. Proceedings of the American Philosophical Society, 107, 232–262. Kemper, T. D. (1963b). On the concept of influence. Public Opinion Quarterly, 27, 37–62. Kemper, T. D. (Ed.). (1990). Research agendas in the sociology of emotions. State University NY Press. Luhmann, N. (1982). The differentiation of society (S. Holmes & C. Larmore, Trans.). Columbia University Press. Luhmann, N. (1984). The differentiation of society. Columbia University Press. Parsons, T. (1970). Some problems of general theory. In E. A. Terryakian (Ed.), Theoretical sociology: Perspectives and developments. Appleton-Century-Crofts. Parsons, T., & Smelser, N. J. (1956). Economy and society. Free Press. Simmel, G. (1990). The philosophy of money (T. Botomore & D. Frisby, Trans.). Routledge. Turner, J. H. (2002). Face-to-face: Toward a theory of interpersonal behavior. Stanford University Press. Turner, J. H. (2007). Human emotions: A sociological theory. Routledge. Yao, X., & Wang, W. (2014). Stigmatisation in China: A theoretical perspective of political empathy. Journal of Yunnan Normal University (Philosophy and Social Science Section), 4, 120–126.

Chapter 6

Emotional Presentations

With a few exceptions (Scheff, 1979, 1988, 1990a, 1990b, 1997; Turner, 1999, 2002, 2006), sociological theories of emotions reveal a gestalt bias. Persons are conceptualised as a kind of cybernetic control system that when cognitions are inconsistent operates to bring them back into congruity (Powers, 1973). For example, Identity Control Theory (Burke, 1980, 1991, 1996; Burke & Stets, 1999) argues that individuals orchestrate behavioural outputs in line with an identity standard; then, they participate in “reflective appraisal” of the responses of others to these selfpresentations, and when others’ responses confirm the identity standard, behaviours continue along the same lines that brought self-verification. Conversely, when others’ responses indicate in “reflected appraisals” that behavioural outputs have not met the identity standard, individuals will experience distress and other negative emotions that lead them to adjust behavioural outputs, identity standards, or identities in order to bring identities, identity standards, behavioural outputs, and reflected appraisals into congruence. In the same vein, Affect Control Theory argues that individuals make comparisons between their fundamental sentiments or beliefs about actor, behaviour, other(s), and situation with their transient impressions. When sentiments about these elements—that is actor, behaviour, other, and situation—are not consistent with their transient impressions, they will experience negative emotions that motivate them to engage in behaviours or cognitive manipulations to bring them into line (see Heise, 1979; Smith-Lovin & Heise, 1988). These approaches do capture a very important cognitive propensity in humans; humans are hard-wired to search for consistency among cognitions. Yet, there is a methodological problem in most of these studies: they collect data on relatively low-intensity emotions; indeed, they would not be allowed by federal laws to arouse intense emotions in the labouratory experiments. When emotions are of relatively low intensity and where needs for self-verification are also not intense, these cybernetic processes may indeed be the way emotions operate to bring cognitions about self, other, behaviours, and situations into line or congruence. When the emotions are more intense and when needs for self-verification are very © Huazhong University of Science and Technology Press 2021 R. Hou, A Sociological Study on Emotion Regulation in People Living with HIV/AIDS in China, A Sociological View of AIDS, https://doi.org/10.1007/978-981-16-1494-1_6

141

142

6 Emotional Presentations

high, however, these cybernetic control processes for cognitive consistency may be disrupted by the activation of defensive strategies and mechanisms, revolving around varying degrees and patterns of repression. Congruence is achieved not by reshuffling cognitions, behaviours, and identities, but instead by denying the emotions that signal incongruence, with the result that the cybernetic control system is set off course. Indeed, repression often leads to behaviours that are increasingly out of line with expectations for the situation and for what others demand. The activation of defense mechanisms when individuals experience negative emotions shifts Turner’s theory towards psychoanalysis. The failure to meet expectations and negative sanctions from others are regarded as painful. When self is highly salient in an encounter, the failure to verify identity becomes intense. Consequently, defense mechanisms are invoked to protect self. Therefore, Turner borrows the theory of psychoanalysis and integrates defense mechanisms of negative emotions into the theory of emotional sociology, and proposes two defensive strategies. When expectations are incongruent with behaviours of others, the individual will adopt such strategy as selective perception, selective interpretation, or looking for positive memories related to past expectations being met. In this way, individuals avoid the pain caused by the incongruence between expectations and responses of others, which is consistent with the emotional conformity theory studied by many Gestalt psychologists. But Turner argues that if the incongruence cannot be alleviated in this way, the individual will activate more powerful defense mechanisms, mainly manifested in repression and attribution (2007). As stated previously, we can state that when transactional needs of PLWHA are not met, expectations are not fulfilled, or they are sanctioned (or to a less degree excluded) during the interpersonal interactions, PLWHA will experience negative emotions. The negative emotions arousal not only emerges from micro encounters, but also from the mesostructures and macro-level social cultures within which encounters are embedded. Generally speaking, the negative emotions of PLWHA are relatively intense. On the one hand, the arousal of negative emotions is related to major events such as life and death; on the other hand, negative emotions cover a wide range. In terms of the classification of emotions, there are not only three primary negative emotions, and they may worsen again and again during encounters, and present combinations of these emotions. Some people may think that these factors that lead to the arousal of negative emotions are necessary for individuals to reshuffle cognitions and behaviours. However, the negative emotions aroused do not easily dissipate. In fact, even if the infected individual bravely faces up to what has been done (for example, they finally accept the fact that they have been infected and that AIDS has developed into a controllable chronic infectious disease), and make the necessary cognitive and behavioural adjustments (such as insisting on taking antiviral drugs, paying constant attention to the maintenance and exercise of their body, and regulating their own behaviours), the readjustments cannot necessarily reduce anger, fear, sadness, shame, guilt, or other negative emotions directed at self. These negative emotions not

6 Emotional Presentations

143

only last for a long period of time, but some negative emotions may still be continuously aroused even after behavioural adjustments, making this negative emotion still linger in the infected individuals. For example, the infected individuals would never identify themselves with patients with diabetes or high blood pressure. The public, including medical workers, did not treat them as patients with chronic diseases (such as diabetes or high blood pressure). Therefore, in interpersonal interactions, the role of the infected individuals will continue to be disclosed, thereby arousing negative emotions. Therefore, from the perspective of emotional sociology, many negative emotions of infected individuals will not disappear through simple cognitive adjustments, but will activate the defense mechanisms. Once these negative emotions are aroused and presented again, not only their intensity and orientation may change, but it will also be difficult to make commitment to the interactive objects, or to mesostructures, macrostructures in which mesostructures are embedded. It is more likely to have an impact on the social organisation at the meso- and, even, macro-level. Thus, individuals seek not only congruence in cognition, but also self-protection. It is not surprising, then, that individuals try to protect themselves from punishment or from the pain caused by unfulfilled expectations and unmet needs. How do individuals’ behaviours of seeking advantages and avoiding disadvantages cope with their negative emotions? How will negative emotions be presented to impact on social reality at the micro-, meso- and macro levels? Turner advocates the integration of psychoanalytic research methods into the study of emotions, proposes an analysis of defense mechanisms of negative emotions and integrates them into the theory of emotional sociology. Therefore, a good command of, especially the study of, the defense mechanisms of negative emotions, is of vital importance to understand the intensity of the emotional presentation and the target of negative emotions. Generally speaking, negative emotions are painful, so individuals often repress their pain to change the characteristics of emotional arousal and emotional development in the flow of interaction. However, the intensity of repressed emotions will generally increase and consume a considerable amount of psychological energy. This results in any form of outward emotional energy being low at the formal level for an individual with repressed emotions. The individual will affect others with lack of emotional energy. When the repressed emotions accumulate to a certain level of intensity, the individuals will release the accumulated negative emotions with a high degree of emotional energy, which are often incongruent with what the situation recognises as appropriate. Therefore, it is very important for sociological theory of emotions to study the psychological dynamics of negative emotions repression. By repression, the individuals exclude negative emotions caused by the incongruence from consciousness. Repression reduces the level of individuals’ emotional energy in all situations. But at the same time, once emotions are repressed, the emotions, such as fear, anger, or sadness, will erupt and manifest inappropriately. Once these negative emotions are presented, individuals will be sanctioned by them, and then forced to repress their sense of shame and guilt. Individuals are caught in an emotional dilemma; they try to repress negative emotions, but the result is that negative emotions are presented in a stronger form, which in turn leads to stronger repression. The result can only be the

144

6 Emotional Presentations

next stronger outbreak and presentation, thus forming a cycle of negative emotion repression and reinforcement.

6.1 The Formation of Emotional Repression Negative emotions that are repressed are generally intensified or transmuted. This is mainly because repression has effectively concealed the high-intensity negative emotions from others and self. Once the negative emotions that are repressed escape the cortical censorship, they will be expressed, displayed and oriented to others. If self is the target of negative emotions, then the emotions won’t weaken, but will be presented in a more intense form; when the needs and expectations are unfulfilled or individuals are sanctioned in encounters, negative emotions repressed will be eventually displayed.

6.1.1 The Painful Experiences of Disappointment and Sadness The first category is disappointment-sadness. If the individual is unable to leave the situation or make appropriate attunement to meet needs, achieve expectations, or obtain rewards, then the individual may feel disappointed and sad for his performance. As we have seen in the previous analysis, after the interviewee labelled DCYJ27 learned that he was infected, he felt that the world was broken down, and experienced a sense of fragmentation. He thought that he was a “rotten person”, and that there was no hope in life, and he would die soon. He had only a vague understanding of AIDS at first, believing that he would rot, with many tumors in his body, and he would die soon. Not only was there no medicine to treat the disease, but the disease was extremely contagious and frightening. So, he endured the pain alone. In the face of death, disease, and the breakdown of the relationship around him, he deeply felt that what was more terrifying than AIDS was not death, but the loneliness because no one listened to him and helped him, the helplessness because he could not get any related information about AIDS, and the disappointment and sorrow caused by rumors. He might think that he would be scared to death before dying for the disease. All these are attributed “to my own fault, instead of living like this, it is better to choose death”, especially when his HIV infection became known to people around him. I began to wonder: should I struggle to live or choose to die? Actually, I have thought about committing suicide. And I’ve tried many times. When it happened that I was alone in B City, I thought that, “Death pays all debts”. I planned to jump off a tall building, but I was scared while I was standing there, and I lost the courage to jump off. I also thought of lying below the tracks of underground to suicide, but I held back while watching the tube passing by. I

6.1 The Formation of Emotional Repression

145

also tried to die in the pain, but after three straight days of coma, unbelievably, I woke up. (DCYJ27)

He was extremely upset for a time, not only because he was infected, but also because he lost his family, friends and even everything. Nothing is sadder than the realisation that death requires even more courage, when one planned to end the long-repressed emotion with death. It, in turn, leads to greater disappointment. Coincidentally, there are plenty of people who have had thought of committing suicide, after being infected with HIV, and many more who have ended their lives. I just wanted to commit suicide by jumping off the building and hide the fact of my being infected. I stepped out one of my legs on the windowsill, but my dad pulled me off. My dad strived to pull me off so that the blood vessels of my hand were torn. I cried in the bathroom. The doctors all ran over, carried me to the emergency room and asked me what was wrong. I only said, “Nothing, nothing”. They asked me so many questions that I couldn’t take it anymore. (DCYJ29)

The more likely reason is that PLWHA experience disappointment and sadness, even though the belief that “this is an incurable disease and living is a waste of time” cannot be ruled out. Unlike people living with other diseases (such as cancer and tuberculosis) who receive sympathy and care from others, PLWHA are stigmatised by society because of their infection. Therefore, they often wish to die, and even more so, to repress the negative emotions such as disappointment and sadness forever.

6.1.2 Intensification and Attunement of Shame and Guilt The second-order negative emotion is shame and guilt (from low-intensity shame to high-intensity guilt). Shame is a powerful emotion, and there are many ways to arouse it. But generally speaking, when an individual feels that he is very insignificant for a long time, he usually has a sense of shame, which leads to self-sanction and self-denial. I will choose to die alone, say, in a mountain. My family members do not know that I have this. I can not tell them, otherwise they will be sad. Some time ago when I was hospitalised, my parents who knew about it insisted on seeing me, and I told them I was infected with tuberculosis, and was being isolated so as not to let them come. In fact, it’s good to be alone, because at least you don’t have to worry about being exposed all day long, or to be suspicious of the slightest hint of suspicion from others. (DCYJ06) Since the confirmed diagnosis of HIV, I have never been back home. My mother died early and my father was at home alone. I said I was abroad on business and usually used the internet to make phone calls, but I never went back. Five years have passed and I have always felt sorry for him. Maybe one day, I’ll die and he still thinks I’m abroad. It is good, because he won’t have to worry about me. (DCYJ22) In fact, once we have diseases, we become extremely sensitive. After being infected with AIDS, I felt that I had problems in my body every few days. Later, I became very worried whenever there was something wrong with my body, and there was no one around me to take care. I never told my family about the infection. They would be sad when they knew it. I can’t let them down. (DCYJ03)

146

6 Emotional Presentations

When the individual’s shame is affected by moral codes, the individual tends to repress it. However, if the individual believes that shame emerges from selfexpectations that have not been met for a long time, he will experience guilt. I knew that was it and I had nothing to look forward to. I used to think about earning money or something, but now I know that even if I earn much money, I won’t survive to spend it, so I’m resigned to my fate. If there was some merit in selling blood to pay the fines for extra children, then getting this disease would be the biggest sin of all. (DCYJ20) When I was healthy, I preferred to work because I’d like to show my worth. You know, I’ve studied at school for so long. In other words, if I don’t go to work and stay at home every day, I felt like I am wasting time, so why live? I might as well not take my medication and die before it’s too late. My mother also told me this, but she said that since this was the case, it didn’t matter anymore, so I should do what I could. (DCYJ01)

Guilt can be repressed if it is sufficiently intense and chronic. Guilt emerges when persons feel that they have “done a bad thing”, but unlike shame which often is repressed, guilt can lead to proactive behaviours as individuals seek to make amends (Tangney & Dearing, 2002). For example, when the interviewee labeled DCYJ19 learned that he might be infected, because of a strong sense of guilt, he hoped to leave a sum of money for his parents through the car accident compensation. Although this thought and behaviour cannot be called proactive behaviour, it strongly reflects his desire to compensate his parents. In fact, on the way back, all what I thought of was death. I had thought I was very brave, and I had a lot of preparations for the result, but I didn’t realise that I was still scared to death before I was diagnosed. I hoped to be hit to death by a car. At least, I could leave a sum of money for my parents. After getting out of the bus, I ran home as fast as I could; when I got home, I sat there in a daze for a long time. I used to eat a lot, and usually I could eat two bowls of rice (The interviewee uses his hands to give the sign of the size of the bowl). But I ate half a bowl of rice that day. After the meal, I said to my mom, “Don’t change the bowl anymore. I will use this bowl.” My mom felt that there’s something wrong and asked, “What’s the matter? What’s on your mind?” I answered: “Nothing.” My mom said: “No, it’s a big deal. Because I’ve never seen you like this.” I still said: “It’s okay.” Going back to my bedroom, I began to tidy my stuff. I wanna leave some money for my parents, so that they could live in comfort in their old age. I won’t tell them. I just wanna die alone. That’s what I’m thinking. (DCYJ19)

Even so, if individuals feel guilty for a long time, especially when powerful moral codes and taboos are involved, the accumulated guilt will attack individuals’ overall sense of self-worth (rather than a specific “bad behaviour”). When guilt becomes more diffuse in this way, it is also repressed. If an individual represses his guilt, he will frequently experience the impact of guilt on self-verification, and if failure to attenuate the sense of guilt persists, the guilt will be transmuted into alienation, thereby reducing the level of commitment to social structures. Just like the interviewee labeled DCYJ25, he was infected because of an unusual affair; out of intense shame and guilt, he informed his girlfriend and arranged the HIV test for her. He’s grateful that his girlfriend was not infected, and then he chose to break up with his girlfriend, quit his job and leave his hometown. He lived alone in an unfamiliar city, alienated from the previous social relations and social structure.

6.1 The Formation of Emotional Repression

147

Helen Lewis’s analysis of transcripts of her own and others’ psychotherapy sessions led her to conclude that what was often seen as guilt by therapists is, in reality, shame. She concluded that shame can manifest itself as either “undifferentiated shame” in which the person has painful feelings but hides the shame by words and gestures denoting other emotions or as “bypassed shame” in which the emotion is not allowed to emerge fully because rapid speech and actions keep the person from actually experiencing the shame (1971). Thomas Scheff borrowed this distinction and, later, relabelled it as “under-distance shame” and “over-distance shame”, with the former corresponding to Lewis’s “undifferentiated shame” and the latter “bypassed shame”. In “under-distance shame”, the person feels emotional pain but does not acknowledge that it is shame, whereas in “over-distance shame” the person does not even acknowledge emotional pain, much less the shame (1997, 1988). These kinds of distinctions can be useful, but I regard denial as the master defense mechanisms, in terms of the manifestation of shame. In other words, denial is a kind of selective perception, which protects the true self by denying behaviours, others or one’s own certain actions, and thus, punishment or failure to meet expectations becomes a temporary abnormality. The alternative is that, in face of punishment from others or failures to meet expectations, individuals apply selective perception to evade great pressure. The more I worry, the more I want to get information about AIDS from various sources, especially from the Internet. Facing overwhelming information, I became fed up with those about AIDS. Because of great fear and pressure, I disliked talking about or hearing the news about AIDS. I hated and resented the word. Later on, when I heard about AIDS-related information, I became very angry. So, I changed the phone card, cutting off ties with the outside. I never went to activities organised by AIDS groups, and I didn’t go to the hospital for diagnosis. Perhaps it was the fear of AIDS that broke my willpower and destroyed my immune system. I was overwhelmed by the pressure and eventually fell ill. (DCYJ29) I carefully read through the test sheet several times, including the name and positive reaction. You know, it’s not a joke. Later, I went to the provincial CDC (called the Epidemic Prevention Station at the time) for re-examination. Because I never thought that I would contract this disease. How could this disease occur to me? (DCYJ27)

Individuals, in various indirect ways, deny the pain of negative emotions and unwillingly have cognitive awareness of the emotional pain, whether they are shame, guilt, or anger. But this denial can also lead to negative evaluation of self; and this defense mechanism may present more intense emotions, as punishment from others instead becomes the centre of attention. A person may repress any of negative emotions, such as disappointment, sadness, shame, or guilt, but these emotions will eventually erupt in intense spikes of anxiety, anger or depression. Over time, the repressive censors will become more complete and, as a result, the emotion will increase not only in intensity but also be transmuted into a new emotion, most typically anger which is then directed away from self. It’s said that there are two doctors in charge of this matter, and I have also known their reaction. They have no medical ethics. I was asked to have the checkup or scan even if there’s a slight discomfort. It cost me hundreds of Yuan each time. I was not feeling well in my lungs, but he wrote HIV on the test sheet. What do you think the common cold has

148

6 Emotional Presentations

to do with HIV? They were still talking casually about CD4 count and so on. I don’t care anymore; even if they said I was an AIDS patient. After all I am not from TJ (the name of a city). Who knows me? (DCYJ12)

In general, emotional repression will intensify negative emotions, with disappointment and sadness being the most likely emotions to emerge. Denial, on the other hand, is the least likely emotion to emerge, because denial interferes with interaction, which makes the individual more marginalised. Shame and guilt are likely to emerge, but I believe that shame and guilt are more likely to transmute into alienation. In a sense, alienation allows anger to be expressed peacefully in a passive, aggressive manner and directed towards others outside of the self.

6.2 Re-transformation of Negative Emotions Once the repression mechanisms of negative emotions are activated, other defense mechanisms will be activated accordingly and bring about the re-transformation of negative emotions. These transformation mechanisms mainly include displacement, projection, sublimation and reaction-formation. What is particularly important about these specific defense mechanisms of repressed emotions is that the different defense mechanisms cause repressed emotions to be transformed into new emotions of different types and directed at different targets, and these new emotions and their directed targets become detached from the micro encounters and thus become forces that influence the meso and macro social structures.

6.2.1 Displacement and Projection Displacement almost always transmutes (whatever the negative emotions repressed) into anger at safe targets that cannot easily fight back: others who are not powerful, corporate or categoric units and at times, the macro-level institutional domain and stratification system in which corporate or categoric units are embedded. Displacement, then, will generate tensions and conflict because anger is targeted outward, and this anger is often highly intense. In R hospital, I consulted a dermatologist. The dermatologist was very kind. He gave me intravenous drip and told me not to say it. He said that I couldn’t get the operation if I told the truth. Later, I had lung problem, and I was discharged from R hospital to another hospital for re-examination. I went to consult the director of the Respiratory Department. The director didn’t even give me intravenous drip. I called the dean of the hospital. The dean also refused to do it. He said that they gave me medicine, and I could take it to the community hospital. I said that, “you have doctors here, why not give me injections? Why I can be given injection only in community hospital? Is your hospital special?” (DCYJ19) I say that I have no obligation. I have the right to choose. There are so many people in the world. Why don’t they choose someone else? Even if they choose me, they can’t propose a

6.2 Re-transformation of Negative Emotions

149

prerequisite, right? It’s not that I don’t pay. I’ll pay as much as they need. I never thought about doing this operation without spending money, begging someone or something. I go to the hospital to see a doctor and I will give money. This is a matter of course. This is a fair deal. The hospital is to save the dying and heal the wounded; this is the hospital’s duty. When one’s life reaches its end and when one need helps, if he is abandoned, he definitely takes revenge on the society. I spend money to see a doctor, why do they refuse me? (DCYJ07)

Projection involves much less transmutation because the emotion about self is simply imputed to another—whether fear, sadness, anger, shame or, guilt. Projection is not disruption, but it can directly transmute and present negative emotions. We want to regularly take the anti-viral drugs provided by the central government for free. But, many doctors in Y Hospital prescribe lentinan, a kind of supplements for infected people to boost their immunity. For example, a doctor called R is usually smiling and nice to us, but he is a man who smiles and prescribes lentinan for you. After that, you have to accept it gladly. If you say that you don’t take it, he will prescribe some other tests. Anyway, you spend much money on those drugs which do not cure the disease. (DCYJ07) Later, I heard from people in the community (ASO) that there was no need to have the tests at all. I was very annoyed, but what else I could do, so I had no choice but to endure it. If it didn’t work, we tried to see another doctor, because not all doctors are like that. There are usually two doctors here. Dr. S is nice to infected people, and we are willing to take medicine from her. Therefore, on Thursdays, there are a lot of people taking medicine. Dr. L is not very kind, and we don’t go to see him if we are not in a critical position. Otherwise, we must spend more money and our personal information may be disclosed. (DCYJ01)

Although the defense mechanisms such as displacement and projection make the negative emotions manifest and make negative emotions direct away from the original targets, no matter from emotional energy or the essence of emotions, displacement and projection have not alleviated or altered the intensity of negative emotions and transmuted negative emotions into positive emotions. Although negative emotions have been manifested for a while, they have laid the groundwork for the re-manifestation of negative emotions, which may trigger a spiral change of negative emotions and form more intense emotional presentations.

6.2.2 Sublimation and Reaction-Formation Different from displacement and projection, sublimation and reaction-formation both reverse the polarity of negative emotions, that is, they convert negative emotions into positive emotions energy directed at others. Sublimation converts negative emotions, the combined state of repressed emotions such as anger, sadness, fear, shame and guilt, into positive emotional energy directed at corporate units. Reaction-formation converts very intense emotions, particularly anger, into positive emotional energy directed at others and potentially corporate units and categoric units. When individuals (such as infected persons) have experienced sadness, fear, and anger at the same time, they will be more likely to have sense of shame and guilt, and once these negative emotions are repressed, their intensity will increase and be

150

6 Emotional Presentations

transmuted into new emotions, which include fear, sadness, shame, and alienation transmuted into anger directed at corporate units in order to successfully obtain resources and partially compensate for the shame associated with failure (infection). As Collins once pointed out, the lower classes often used their noisy music and deafening conversations to govern public space and force the upper classes to retreat. Collins argues that the series of behaviours are not the result of shame, but that these negative emotions are used strategically to gain temporary power (over the upper classes) and privileges (among their associates) (2004), while thereby gaining the experience of positive emotions. In fact, we do this not just for ourselves, especially the gays. You know, at the end, what can we really fight for homosexuals? Nothing. People are too sensitive to homosexuality in China. Our efforts may end up benefiting all infected people. No matter how people think of us in society, dirty or messy, if we change people’s perception of us through our efforts, it’s a kind of success. We say that we exist to find the power to change. When people’s perceptions of homosexuality change, it’s not necessary for us to suffer from bias. It’s the only way. Is there any way else? One always has to live; to live, one has to accept that reality and change it. As people often say, it’s a day whether you are happy or not; complaining about this or that, like grumblers, can’t change anything. Actually, if we look on the bright side, lots of things will be changed. It won’t be like the current condition. There will be a sense of accomplishment if we change. We need to strive for our rights. (DCYJ26) I’ve tried to commit suicide for a few times. At present, I also wanna die from time to time. I thought that it’s better to jump off a 20 or more storeys building, and everything will be over. I have also been sent to Y hospital several times because of opportunistic infections. Once I was given the Notice of Critical Condition, but eventually I came back to life. Now I recall that condition, it’s called “Being-towards-death”. At that time, my ward was next to the morgue. Every night, I saw that the undertaker put on makeup for the dead; and the cremation was performed before dawn. But I thought, I always have to strive to live, so I survived, and I lived well. I established one ASO. In this process, I felt a sense of accomplishment and felt that I was not alone any more. When I first came to B (the name of a city), I didn’t know anyone. Though many infected people have complaints about the organisation nowadays, I think that not everything is satisfactory. What I can do is to convert the dissatisfaction into the impetus. Only if we take actions, we can change something. For example, with our efforts, the funds are used for infected people, which, at least, have access to minimum guarantee service. (DCYJ27) We suffer from too much discrimination and prejudice. Sometimes we get together, we won’t talk about it. When we talk about it, it will become a complaint meeting: everyone shed tears. Everyone has grievances, sadness, anger, resentment, and all kinds of complaints and suffering. Later, I said that we did suffer from a lot of misunderstandings, and these emotional pains are much more upset than taking medicine; what should we do? If we can’t unite together, and if we can’t transmute the grievances into a joint force, we suffer from the pains and tortures in vain. Therefore, we must hold together and turn grief into strength. Make our voice heard! To change! So, we establish our own organisation, and through some activities, we have also changed people’s ideas about PLWHA to a certain degree, and our own value has also been reflected in it. (DCYJ04)

Therefore, people can also use these diverse negative emotions to indirectly defend more resources, including emotional resources, such as the pride generated by hitting back at the stratification system and institutional domains that produce negative emotions. In fact, emotions such as sadness, fear, anger, shame, alienation, and even guilt can actively function in revealing the injustices in the distribution process, and

6.2 Re-transformation of Negative Emotions

151

can also indirectly change the institutional domains and stratification systems. For example, if anger involved in shame, alienation, and guilt burst out, they may be used by people to promote a fairer distribution of resources. Jack Barbalet and Axel Honneth have put forward unanimous views. Barberlet emphasised that resentment is a moral emotion. When others are perceived to receive resources that they do not deserve, those that lose resources would become resentful of those that gain resources. When the resentment is conscious, it can lead to collective action, whereas when it is repressed, it will manifest itself in “crime, cruelty, deviance, and perversity” (Barbalet, 1998) Honneth draws the same conclusion when he argues that political protests are an outcome of a perceived lack of respect by elites and others in advantaged persons for the rights of dominated segments of a population to form affective bonds, experience a sense of autonomy, and to feel esteem (Honneth, 1995). According to these viewpoints, when infected people believe that their basic rights to establish meaningful interpersonal relationships are deprived by the use of power by others, vengefulness emerges. For infected people, especially those at the bottom of the stratification system, will be more likely to perceive that power has been used to deny them basic rights, leading to violent actions to redress their sense of outrage and change their situation. In my opinion, the generalisation of Barbalet and Honneth can be further transformed into the view that intense and aggressive negative emotions, such as resentment and vengeance, are primarily aroused by the repression of shame (and to a lesser extent, guilt) in interactions over a long period of time among some infected people. The shame arises from the failure to meet expectations and from punishment. When self cannot be verified in roles in corporate units and when exchange payoffs consistently fall below what they perceive as a “just share,” an individual will experience anger. But if fear and sadness are also evoked, then shame may also emerge, especially when expectations of key institutional domains cannot be met and punishment becomes habitual and long term. To protect self, shame is repressed and re-emerges as anger, but usually, the anger is further transmuted by mixing satisfaction-happiness with assertion-anger to form righteous anger and desires for vengeance. Through actual actions, the negative emotion will be converted into positive emotions. After that, the effect on individuals will decrease. Although these defensive strategies are usually temporary and unfold in specific episodes of interpersonal interaction, people’s self-protection does not stop there. Others in encounters may also experience frustration and anger, causing them to be imposed additional punishments (including withdrawal from the interaction). If people’s use of these strategies is chronic, as long as they feel that they have not been duly confirmed every time, that others are punishing themselves, these defensive strategies will be automatically activated, thus marking the individual’s defenses stronger. As a result, continuous misunderstandings, reinterpretations, and habitual activation of defensive strategies evolve into forms of repression that enhance emotions. Others may express anger at this, but this person does not think that this anger is an appropriate punishment for himself. As a result, this repressed emotion is enhanced or indirectly transmuted into a new emotional form, and directed at others and social structures.

152

6 Emotional Presentations

6.3 External Presentation of Emotions Attribution is a process originally highlighted by gestalt psychology; and within psychology proper, this emphasis on the cognitive side is still retained, although the dynamics of attribution and emotions have been explored in great detail by more recent approaches (Weiner, 1986). Within sociology, there are some theories on the attribution dynamic (Kemper & Collins, 1990; Lawler, 2001; Ridgeway, 1994; Ridgeway & Johnson, 1990; Turner, 2002). However, Turner conceptualises attribution processes, which is somewhat different from other scholars and more in line with Edward Lawler’s approach. Edward Lawler has noted that positive emotions arousal reveals a “proximal bias” in that individuals are likely to see self as responsible for rewarding outcomes and, thereby, to make self-attributions, or internal attribution, for these outcomes (Lawler, 2001). Thus, the fulfillment of rewards, needs and expectations is likely to be seen as the result of the person’s own actions, with the result that this individual will direct positive emotional arousal toward self and then give off rewards to others in the encounter which set into motion those ritual processes that increase the flow of positive emotions in the local encounter. In contrast to “positive bias” posed by Lawler, negative emotional arousal reveals a “distal bias,” with individuals making external attributions as to the causes of these outcomes (Lawler, 2001; Turner, 2002). Turner believes that external attributions are defense mechanisms and also a natural cognitive processing process (2002). This characteristic renders this process more complicated. The external attribution may be conscious and correct, or it may be derived from repressed and unconscious emotional energy. In this manner, self avoids blame for failing to meet expectations, for punishment, and for any negative outcome. Once repression becomes organised around external attributions, the emotions aroused are generally transmuted into more intense forms of anger. If individuals cannot leave iterated encounters in which they experience negative emotional arousal, it is likely that attributions will become distorted by repression. Especially when negative emotions are caused by inequality, since the individual cannot break free from encounters and social structures embedded by the encounters, the repression of negative emotion will occur. Individuals usually deny their resent, and only unbalanced resent will erupt suddenly. Individuals may attribute their anger externally. Individuals often blame meso-level corporate units or categoric units, claiming that corporate units or categoric units should be responsible for these negative emotions that orient towards self. Therefore, as Scheff and Retzinger (1991) and other researchers (such as Volkan, 2004) have emphasised, when negative emotions are attributed externally, the aggressive actions against social structures will be beyond the emotions proper.

6.3 External Presentation of Emotions

153

6.3.1 The Departure from Corporate Units In general, when external attributions act as a defense mechanism and are accompanied by the repression of shame and other negative emotions, they enable individuals to protect themselves and to blame others and their embedded corporate units. As analysed above, the repressed shame is often transmuted into intense forms of anger (e.g., rage), especially the first-order combined form of anger. For example, the interviewee labelled DCYJ12 has overtly expresses a sense of righteous anger and vengeance. However, it is the sense of alienation that is most likely to occur, and will be accompanied by anger at the social structures from which it has been alienated. If my employer finds out about my infection, I will lose my job definitely. Even if I’m not fired, I will still be under pressure from my colleagues, which would force me to make new choices for survival. (DCYJ08) But you can’t hide it from the people around you. And, slowly, it gets out. Yet the disease is a touchstone. I used to have a lot of people very close to me, including some of my relatives and friends, but now they have started to distance themselves from me. Every time when I eat with my family, I use disposable bowls and chopsticks. Later, I simply do not go with them because I feel uncomfortable. (DCYJ07)

Sometimes, it’s reasonable for individuals to make external attributions for the unfulfilled transactional needs, unmet expectations, or sanctions they receive in their encounters. Under these conditions, individuals are usually angry at themselves or at the social structure in which encounters are embedded. If the individual cannot break through the obstacles of others or the social structure to attune behaviours to activate and present positive emotions, then the individual may feel anger and fear at others, but also feel sadness for his or her own destiny. Furthermore, if these three primary negative emotions are presented at the same time, the individual will experience a sense of alienation of life and social organisation generated by the second-order mix (secondary emotions) of these emotions. To a certain extent, the features of the objects directed by alienation or anger have an important effect on the presentation of emotions, and the attribution process enters into the general defense mechanism of self-protection. If corporate units are the targets of repressed shame, individuals will feel anger and alienation towards the structure and culture of these units. If corporate units are the target of anger, then the anger will be directed at the members of the corporate units, produce negative stereotypes of the corporate units, and generate prejudice against the members of the corporate units, just as many infected people refuse to accept help from AIDS service organisation. Likewise, when faced with various improper treatment such as excessive examination in the hospital, one of corporate units, many infected people showed negative emotions such as resentment, resisted medical institutions through behaviours such as refusing treatment and refusing to take medicine and developed strong feelings of anger and alienation towards medical institutions. I try not to go to the TC Hospital. If I can get medicine in B (the name of one city), I would rather go there by train every time. It’s not too far away. It’s not a big deal that I spend more money. Because TC Hospital doesn’t care about infected people and protect

154

6 Emotional Presentations

our privacy at all. At the beginning, we didn’t know this. We did as many examinations as we were required. Later, we learned that many examinations were useless. For this matter, we have also reported the problem, but there’s no feedback, no matter how you report it. The hospital completely ignores our advices. Moreover, TC Hospital makes money with advanced equipment. Though medical technique is poor, the equipment is quite advanced. Anyway, we must do examinations every time we go there. And every time we would spend a few thousand Yuan. You know, there are so many big hospitals, why is this one established as the designated hospital? Why doesn’t the government designate more? (DCYJ17)

In the personal experience of PLWHA, the more repressed shame is aroused towards the corporate units such as medical institutions and ASOs, the more distal the initial interaction is to the targets directed by anger, the first-order mix of anger, including just anger and revenge. Negative emotions emerge, accompanied by repression, transformation and enhancement, and the resulting emotions reveal stronger distal bias. Simultaneously, the centrifugal force existing in encounters not only arouses a variety of negative emotions, but also directs these negative emotions to meso-level corporate units. As the interviewee labelled DCYJ17 said: “there are so many big hospitals, why is this one established as the designated hospital? Why doesn’t the government designate more?” It can be seen that there is a further aspect of this distal bias: external attributions will generally jump over local encounters because to vent anger in the local encounter composed of other(s) invites negative punishment which further attack self and force renewed repression and activation of defense mechanisms. As a result, it is generally easier to blame meso-level structures because they are still immediate, but cannot so easily strike back and bring self into focus. Since encounters are embedded in these mesostructures and, hence, are immediate to the person, the targeting of mesostructures provides a sense of efficacy and power, without risking direct negative sanctioning from others. Indeed, there are fewer emotional risks in assigning blame to entities that are not persons and that cannot retaliate in very personal ways. Yet, once anger begins to flow outward, there are conditions under which this anger targets ever more macrostructures such as institutional domains, stratification systems, countries, and even national systems (Turner, 2007).

6.3.2 The Diffuse of Anger in Categoric Units If categoric units are the attribution target of repressed shame of PLWHA, their anger will diffuse. If categoric units are the attribution object of anger, infected individuals will express anger towards, and develop negative prejudice against, members of the targeted categoric units. The negative stereotypes about the members of categoric units have complicated effects on negative emotions. Anger becomes as persistent as the shame that drives this anger. The more shame an individual experiences in daily life, the more diffuse is the anger directed at members of categoric units. Ironically, when members of categoric units are portrayed in negative terms, this

6.3 External Presentation of Emotions

155

portrayal reaffirms reasons for being angry at them. This negative stereotype, especially when fueled by the anger stemming from repressed shame, has a significant negative effect on the meso and macrostructures when individuals collectively vent their anger towards members of categoric units and social structures in which these units are embedded. In fact, it is still very embarrassing for infected people to contract AIDS because of whoring activities. I don’t know if you know, in prison, the rapists are the most despised, and among infected people, drug users and whoremongers are the most despised. In fact, until now, I don’t know by whom or when I was infected. This confirms that statement that “One doesn’t even know why he died.” I once felt very angry with prostitutes, and thought that it was some whore who infected me. It must be some whore. But in fact, it is difficult to find people who contract the virus. We can’t always ask people how they got the infection. Moreover, most members of ASO are homosexuals. They look down on us, and we look down on them. In short, I rarely participate in their activities. (DCYJ02) In fact, members in the homosexual circle also despise those who are promiscuous. XX organisation has a WeChat group for infected persons, and most of members are gay men. I withdrew from the group after two days. They talked nonsense rather than about the disease. What’s the significance of such a group? Anyway, the route of infection always develops bias. For example, everyone looks down on drug users. Not long ago, someone slandered Duan Yi (one person’s name), saying that he took drugs. This is the most despised. And it’s followed by the whoremongers, and promiscuity. (DCYJ30) On December 1st (World AIDS Day) when the leaders visit PLWHA, I can never be the interviewee, because they are afraid that I will speak the truth. Now in the circles people don’t tell the truth. Before being visited, write down what you want to say and hand it in. You can only say it after the review is passed. You can’t say what you wanna say. Or a few people who have been infected by blood transfusion or blood selling were selected because they always feel themselves innocent. In fact, it’s all the same, regardless of the infection route. No one cares how you are infected. It’s useless to assume an expression as if others owe you money. There’s no place for you to express your desperation. You talk about this in the circle, which is regarded as to threaten the unity. In the meeting, they behave well. But the fact is not so. There are more people playing tricks. And there’s no place for us to speak out. I can’t attend the meeting, either. (DCYJ22) Discrimination and fear are different. I can understand that people are afraid of us, for example, relatives and friends. What about discrimination? What does this have to do with them? If the media does not discredit infected people, how can the public have such attitudes? I think the media deliberately means that. In order to prevent the spread of AIDS, we are described as demons. You know, we are the most painful. Whether being infected by blood transfusion or because of retribution, anyway, we’ve been infected and we must suffer from the disease. I think, it is our own business, whether it is torturous or painful. I did not deliberately spread it. I can understand that family members are worried and afraid. After all, there’s no cure for the disease. After all, this disease is related to our behaviour. Homosexuality, whoring activities, and taking drugs are all bad behaviours. Family members are angry and evicted us from the house. We deserve the punishment. We made mistakes. But I don’t understand the discrimination against us. What does this matter to others? When we go to hospital, we are disregarded and charged high. When we attend some group, we are used to earn money; when we find a job, the health is harmful due to working overtime every day. But we can’t tell the truth of being infected. It will threaten others. Why? All this is caused by discrimination. The media, or hospitals, etc. said that AIDS is so scary, and people who get AIDS are not good people, and so on. What did we ever do to others? (DCYJ25)

156

6 Emotional Presentations

People often denounce social structures in which they are embedded. According to distinction proposed by Hawley (1986), they can blame corporate units (or any social structure related to the labour division, such as universities or commercial enterprises) or categoric units (such as gender, infection route and social attributes such as rich and poor). If they fail to achieve their expectations in a corporate unit, they will blame the unit and express their anger, and their motivation to stay in the units will be reduced; or even if they cannot withdraw, their enthusiasm for role-making will be reduced. If they blame a categoric unit, they will vent their anger towards, or be more likely to develop prejudice against, other members in the categoric unit. If negative emotions, especially anger, fear, sadness, shame and guilt, linger for a long period of time, and if these negative emotions are continuously not recognised, the intensity of these emotions is likely to increase and interfere the balance of social relations. If there are enough people experiencing and denying these emotions, people probably engage in violent activities that change social structures, and demonstration on social organisation.

6.3.3 Persistent Deterioration of Macrostructures If negative emotions direct at more macro social structures, especially at institutional domains or stratification systems, then the association with mesostructures that initially generates shame must be deteriorated by the activation of defense mechanisms, or the anger of actors direct outwards through transmutation. Shame arises from local encounters, which are embedded in mesostructures and then embedded in the macro-level of the institutional domains and stratification systems. Consequently, the anger generated by the repressed shame directs the object further away from the initial micro-social structure. Otherwise, people will direct at the ultimate goal of shame: arousing emotional encounters at the meso level. Repression can also accelerate the rupture of the connection between negative emotion and its source. In addition, people also experience positive emotions in micro-interactions (such as family, neighbors, friends), but the high pressure of such emotions deflects the movement trajectory of negative emotions, which directs at the external macrostructures. In fact, we will deal with them privately, including doctors and staff of CDC. They are very kind and sincerely help us, but these are their personal behaviour after all. You can’t expect CDC staff to go to work on Saturdays and Sundays or work during non-working hours at nights. It’s unrealistic. The same goes for doctors. There are only a few free drugs. There are more than 20 antiviral drugs in the world, but there are only 8 drugs for us. Why? Because our pharmaceutical plants can only produce them, all of which are first-line drugs. We are given the drugs for free, but in fact, the drugs have significant side effects. Once the drug is resistant, there’s no drug to change. As a result, if you want to live, you can take second-line drugs at your own expense, or, you face death. This is the policy. We shouldn’t infect others. (DCYJ29) It seems that infected people are treated well, due to the policy of “Four Frees and One Care”. But it’s not the truth. Although the medicine is free, the examination before taking medicine requires 1,000 yuan and sometimes a few thousand yuan. As a result, the examinations are

6.3 External Presentation of Emotions

157

useless. Not only we spend a lot of money, there are also risks of disclosure. It’s nonsense to say that AIDS, like diabetes, is a chronic disease. What about the result of taking medicine? There are currently 25 kinds of antiviral drugs in foreign countries, and only 8 kinds in our country, and they are basically first-line drugs. Only Kelizi (lopinavir ritonavir tablets) is a second-line drug. You know, we are usually prescribed three kinds of drugs once, thus there are few drugs left that can be changed. Finally, you have to pay for medicines. If you don’t pay for the medicines, you’ll die. There are also the side effects of the drug. Many people around me stop taking the drug because they can’t stand the side effects. Once the drug is stopped, drug resistance will develop. Therefore, the “Four Frees and One Care” policy is to allow you to take the medicine first, and not to infect others. When you take medicines, you can’t live without them. What if there are side effects? Who cares? You may have heard of liver damage after taking free medicine. Does anyone take care? What should I do if I have drug resistance? Sorry, there are only a few first-line free drugs in our country. You can buy second and third-line drugs at your own expense. So, the only way for us is to die slowly. (DCYJ03) I think that if someone told me that the act of male-to-male sex would transmit AIDS, I would definitely not contract it. No one told me, including the propaganda. The propaganda only involves sexual transmission, not male-to-male sex. Therefore, this is the root of the problem. (DCYJ20) Infected people should have human rights, right? However, we cannot claim the rights, nor can ASOs. Once we are infected, we cannot enjoy such rights as medical insurance, subsistence allowances, and so on. This is unfair. Because we need money for examinations and medical treatments, and many infected people are relatively poor. Many people can’t see a doctor or get medicines because they cannot afford medical examinations. Now there’s no medicine like penicillin in the hospitals. For example, if someone gets gonorrhea, penicillin works best, but there’s none in the hospitals. Why? Because penicillin is cheap, there is no profit for the hospitals. The cephalosporin is much more expensive. Why? You can’t say that the hospital is just for money, and the root cause is the materialisation of the culture. If the society even exploits the money of infected people, how to reassure infected people and prevent the spread of AIDS? (DCYJ27)

In this process, the conditions for generating emotions are contained in the structure of corporate units and categoric units. The meso level social structures are not only the background in which micro encounters are directly embedded, but also the platform that the macro social organisation act on micro encounters. People can maintain a high emotional state locally through communication rituals, and at the same time direct their anger at the interactive objects, others, and mesostructures, and indirectly at the more distal macrostructures. To sum up, under the effect of attribution, although the emotional presentation mechanisms vary, it is particularly important that different mechanisms will lead to the transmutation of negative emotions into different types of new emotions and direct at others. Therefore, the target of emotional direction is expanded to other interactive objects, corporate units, categoric units, institutional domains, stratification systems, countries and even national systems. In other words, people’s hostility towards their social structure and culture and their feelings of anger and alienation, are usually the result of attribution and counter-attack in the process of face-to-face interpersonal interaction. The external presentation of negative emotions closely correlates with social events and psychological dynamics.

158

6 Emotional Presentations

Therefore, attribution is very important in sociological analysis, because people perform causal attribution to find the root of the consequences. Once people exclude self from causal calculations, or partly because of the pursuit of cognitive consistency, people will accuse others, interacting targets and meso level and macro level social organisation, which are regarded as being responsible for negative emotions. As a result, attribution becomes the primary approach for individuals to establish connections between their emotional responses to others, social organisation and the consequences of events, and social organisation thus indirectly become the target of repressed emotions (such as anger, sadness, shame, and guilt). Guided by the external attribution mechanism, negative emotions become a heat source-oriented missile. The attribution process is an important issue in sociological research. This is because the manifestation of social structure and culture requires a long-term process, requiring people to form positive emotions toward social organisation and culture, and at the same time weaken negative emotions that direct at social organisation.

References Barbalet, J. M.(1998). Emotion, social theory, and social structure: A macrosociological approach. Cambridge University Press. Burke, P. J. (1980). The self: Measurement implications from a symbolic interactionist perspective. Social Psychology Quarterly, 43, 18–29. Burke, P. J. (1991). Identity processes and social stress. American Sociological Review, 56(6), 836–849. Burke, P. J. (1996). Social identities and psychosocial stress. In H. B. Kaplan (Ed.), Psychosocial stress: Perspectives on structure, theory, life course, and methods (pp. 141–174). Academic Press. Burke, P. J., & Stets, J. E. (1999). Trust and commitment through self-verification. Social Psychology Quarterly, 62, 347–366. Collins, R. (2004). Interaction ritual chains. Princeton University Press. Hawley, A. (1986). Human ecology: A theoretical essay. University of Chicago Press. Heise, D. R. (1979). Understanding events: Affect and the construction of social action. Cambridge University Press. Honneth, A. (1995). The struggle for recognition: The moral grammar of social struggles. Polity Press. Kemper, T. D., & Collins, R. (1990). Dimensions of microinteraction. American Journal of Sociology, 96, 32–68. Lawler, E. J. (2001). An affect theory of social exchange. American Journal of Sociology, 107, 321–352. Lewis, H. (1971). Shame and guilt in neurosis. International Universities Press. Powers, W. T. (1973). Behaviour: The control of perception. Aldine Publishing. Ridgeway, C. L. (1994). Affect. In M. Foschi & E. J. Lawler (Eds.), Group processes: Sociological analyses. Nelson-Hall. Ridgeway, C. L., & Johnson, C. (1990). What is the relationship between socioemotional behaviour and status in task groups? American Journal of Sociology, 95, 1189–1212. Scheff, T. J. (1979). Catharsis in healing, ritual, and drama. University of California Press. Scheff, T. J. (1988). Shame and conformity: The deference-emotion system. American Sociological Review, 53, 395–406. Scheff, T. J. (1990a). Microsociology: Discourse and social structure. University of Chicago Press.

References

159

Scheff, T. J. (1990b). Socialization of emotion: Pride and shame as causal agents. In T. D. Kemper (Ed.), Research agendas in the sociology of emotions. SUNY Press. Scheff, T. J. (1997). Emotions, the social bond, and human reality. Cambridge University Press. Scheff, T. J., & Retzinger, S. M. (1991). Emotions and violence: Shame and rage in destructive conflicts. Lexington Books. Smith-Lovin, L., & Heise, D. R. (1988). Analysing social interaction: Advances in affect control theory. Gordon and Breach. Tangney, J. P., & Dearing, R. L. (2002). Shame and guilt. Guilford Press. Turner, J. H. (1999). Toward a general sociological theory of emotions. Journal for the Theory of Social Behaviour, 29, 132–162. Turner, J. H. (2002). Face-to-face: Toward a theory of interpersonal behavior. Stanford University Press. Turner, J. H. (2006). Psychoanalytic sociological theories of emotions. In J. E. Stets & J. H. Turner (Eds.), Handbook of the sociology of emotions (pp. 276–294). Springer. Turner, J. H. (2007). Human emotions: A sociological theory. Routledge. Volkan, V. (2004). Blind trust: Large groups and their leaders in times of crisis and terror. Pitchstone Press. Weiner, B. (1986). An attributional theory of motivation and emotion. Springer.

Chapter 7

Emotional Attunement: The Dynamic Mechanism of Being and Manifestation

7.1 Emotional Being and Manifestation Emotions are one of the most critical micro-level social forces because they are what hold social reality together at micro, meso and macro levels or, in the end, breach encounters or break mesostructures and macrostructures apart. Emotions are, of course, not the only force that has these effects, but they are the most important social force that has not been fully theorised until recent decades. One of the most distinctive biological characteristics of human beings is that we can generate emotions and apply emotions to construct social relations and social structures. Emotions are not referred to simple or individual biological changes, but are restricted by factors such as cultural traditions, institutional norms, and social structure. More importantly, emotional being and manifestation are also subject to the reconstruction, which reflects the interaction of thinking and consciousness. Similarly, the management and control of emotions not only involves individual interaction, but also affects social control and social integration. As Turner said, if humans have no capacity to arouse emotions, human culture and social structure will no longer exist (2007). It can be said that human emotions, the corollary of active choices and creations in interpersonal interaction, are expressed, conveyed and displayed through specific behaviours and symbols. Therefore, emotions are actually the carrier and bearer of social significance and values of various symbols. Emotions constitute not only the basis for interpersonal interaction, but also the tools for communication and symbols. In this sense, emotional being becomes one of the motivations of human behaviour, and emotional manifestation is presented in the form of human behaviour to realise the motivations. The two compose “motive” discussed in this book. Furthermore, emotional being of some kind does not necessarily lead to a particular or a single emotional presentation, but contains various potential possibilities. In other words, there is no linear causal relationship between being and manifestation, nor is there a simply one-way effect, but rather a kind of joint forces in an operating © Huazhong University of Science and Technology Press 2021 R. Hou, A Sociological Study on Emotion Regulation in People Living with HIV/AIDS in China, A Sociological View of AIDS, https://doi.org/10.1007/978-981-16-1494-1_7

161

162

7 Emotional Attunement: The Dynamic Mechanism …

mechanism. The conclusion of this book is to analyse and summarise such emotional dynamic mechanism. In previous sociological studies, although many literatures have discussed the dynamic mechanism of human behaviour from many perspectives, the few studies on “emotional dynamics” have tended to be influenced by psychology and have mainly focused on the micro level (Collins, 2009; Hochschild, 1983; Stryker, 2004), or overemphasised on specific factors such as gender, group, and sociobiology that generate emotions, at the expenses of a sociological examination of emotions. Few scholars have studied “emotional dynamics” at the meso and macro levels, and Scheff and Turner have established a link between the micro and macro levels, but none of these theorists, except for Scheff, have collected data to argue for the link between the emotions of the levels or for dynamic mechanisms. Through the study of the dynamic mechanism of emotional being and manifestation, this book not only illustrates emotional arousal, enhancement and transformation, but more importantly, illustrates how emotions, as a kind of “adhesive”, prompt commitment to social and cultural structure in a broad sense. In terms of conflicts and games, emotional arousal, elaboration and transmutation can be clarified; in terms of structure and function, individuals can grasp the characteristics of social structure and the trend of social changes and generate commitment to social and cultural structure in a broad sense; in terms of interaction and systems, the comprehension of social interaction and social relations can be deepened, and the reliance of complex social relations and systems on emotions can be constructed and forged. Furthermore, this book more comprehensively integrates the social unity of the micro, meso and macro levels, studies the dynamic mechanism of emotional being and manifestation from the three perspectives of conflict and game, structure and function, and system and interaction, and, through placing emotions in a certain context, explores how emotions shape us and are shaped by us. Meanwhile, emotions lead to alienation between people, prompt people to breach the social structure, correlate experience, behaviour, interaction, organisation and emotional movement and expression, and challenge social and cultural traditions. In essence, emotions maintain the relations, carry macro social structure and cultural generation, and produce a splitting force on micro social relations (Turner, 2007). Therefore, with regard to the range from encounters at the micro level to large-scale social systems, emotions are the key force that drives social reality of all levels.

7.1.1 Conflict and Game Emotion may be a private issue, but it is not irrelevant to public issues in a broad sense. As Elias proposes, emotional control and attunement is the core of the entire cultural process (1994). Thus, emotional being and manifestation can not only be determined by social conflict, but also be constructed or altered by individuals during the game. Therefore, this section discusses the dynamic mechanism of emotional being and manifestation from the perspective of conflict and game, and analyses the

7.1 Emotional Being and Manifestation

163

mutual penetration between emotional arousal, expression and transformation and social structures. Emotional arousal occurs to us, and is aroused by our behaviours (Goffman, 1959). Therefore, we will analyse the dynamic mechanism of emotional being and manifestation from the perspective of conflict and game. Emotions are not only physiological behaviours or psychological reactions to pleasure and pain (Gane, 2005), but also a complex process of social conflict and game between two or more people. Emotions are influenced not only by the interplay between an individual’s values, attitudes, habits, perceptions, needs, desires, and behaviours (Layder, 2004), but more importantly by the interactions between individuals at the micro, meso, and macro levels. Actually, individuals assign specific identities to themselves and others, engage in undertakings through physical and mental efforts and poses solutions to various conflicts. And these solutions are to maintain their identities attached to them and the process of game of other action categories (the behaviours, contexts, and feelings involved). There has long been an academic debate over whether emotions are biologically constructed or socially and culturally constructed, and it will continue to exist that is unlikely to be fully resolved in the near future. But this debate does not deny that emotional ups and downs not only rely on the activation of the body system, but also are subject to many constraints imposed by social structure and culture. As Turner argues, the appropriate solution to the debate on the emotional hardwiring and social cultural construction is to adopt a moderate method, which recognises the biological attributes of these emotions, such as the physiological structure of the nervous system during emotional arousal, and emotional arousal, expression and elaboration are typically constrained by social culture, and the social situation in which the individual is located will also have an impact on people’s emotional arousal and expression (2007). In addition, traditional research on emotions has shown that the emotional ups and downs will eventually achieve mutual congruence between identity, identity norms, behavioural output, and reflective evaluation by attuning behaviour, identity norms, and identity. Emotional attunement contributes to the consistency of perception, which composes negative emotions. In general, the process is illustrated in Fig. 7.1, i.e., from hardwiring, emotional ups and downs to emotional composure. However, the research on the dynamic mechanism of emotions mentioned above does not take intense negative emotions and defense mechanisms into account. Therefore, from the perspective of conflict and game, this section, based on subject construction, analyses dynamic mechanism of intense emotional being and presentation, enriching the traditional research on dynamic mechanism of emotions. As shown in Fig. 7.1, an individual generates intense negative emotions under the influence of hardwiring, social structure and culture; meanwhile, the emotions are impacted by social environment at the micro, meso and macro level, the expression of negative emotions is often temporal, situational and subjective. Firstly, the negative emotions aroused by conflicts may not be expressed immediately; individuals may repress negative emotional arousal because there’s a lag in the expression of emotions for them or they are affected by the defense mechanism. Secondly, individuals’ emotional presentation responded to their environment they are in is a makeshift, not

164

7 Emotional Attunement: The Dynamic Mechanism …

Fig. 7.1 The dynamic mechanism of emotional being and presentation

a true expression. Thirdly, the presentation of negative emotions is the consequence of subject construction and game. Therefore, emotional being does not refer to the opposition between hardwiring and social construction, but a moderate state that is rationalised and chosen by the subject according to time, place and the object. It is termed as emotional being because negative emotions, on the one hand, are actually aroused and activated; on the other hand, emotional expression and presentation reflect the individual’s consideration of the conflict and game process. Negative emotions evolve into emotional presentation through defense mechanisms. In terms of emotional presentation, the repression of negative emotions may trigger a cyclical process after emotional being is repressed. In other words, after the arousal of emotional being, the defense mechanism is activated and represses the negative emotions. When the cortical censors are negligent, the repressed emotions will be expressed in an intense form and directed at others. As shown in Fig. 7.1, there are two pathways through which repressed negative emotions can be transmuted after negative emotions are aroused at the micro, meso, and macro levels. The first one is that negative emotions, through transmutation and projection, will be re-directed at micro encounters, meso corporate units and categoric units, and further at macro social structures and culture. Negative emotions after transmutation and projection will be intensified, thereby forming a cyclical process. The second one is that if negative emotions experienced by individuals activate the sublimation and reaction-formation in the defense mechanism, then individuals will present positive emotions in response to repressed negative emotions. Similarly, the intensity and target of these new positive emotions have also changed, and the emotions will eventually be composed. When negative emotions are repressed, different defense mechanisms will be activated and different conflict and game pathways will be formed. Different forms of emotional being and target of emotions from repressed negative emotions during the course of conflict and game are listed in Table 7.1.

7.1 Emotional Being and Manifestation

165

Table 7.1 Repression, defense, transmutation and the target of new emotions Defense mechanism

Transmuted emotions

Targets of emotions

Displacement

Anger

Corporate units and categoric units, macro social structures

Projection

Anger of low intensity

Anger, sadness for the blamed target, shame for other’s feelings

Sublimation

Positive emotions

Task of corporate units and categoric units

Reaction-formation

Positive emotions

Corporate units and categoric units, macro social structures

Note The repressed emotions are anger, sadness, fear, shame, and guilt

The defense mechanism of negative emotions involves external presentation caused by external attribution. Because the external attribution of emotions has “distal bias”, negative emotions by the operation of defense mechanisms of attribution are directed at the meso and macro social structures and culture, so as to realise emotional composure. In addition, negative emotions achieve emotional adjustment through cognition and behavioural adjustments, so as to realise the process of emotional composure without activating the defense mechanism. Individuals always attune their emotions to the norms of interactive emotions. There will be a kind of pressure when the interactive situation conflicts with the various requirements put forward by the individual. Individuals may feel “sad” or “happy” because a particular social situation requires them to act in this way, but emotions require them to act in a different way. The combination of these two opposing motives renders people ambivalent and hesitant (Layder, 2004), which requires a better resolution to resolve the conflict. To sum up, the dynamic mechanism of emotional being and presentation, from the perspective of conflict and game, is the process of selective game and construction by the subject under the influence of hardwiring, social structure and culture. What’s more, it’s a process of transmutation and expression of higher-intensity negative emotions under conflict, as well as a process of emotional energy intensification and transmutation.

7.1.2 Structure and Function The relationship between human actions and social structure must be considered. From the perspective of emphasis on social structure, emotions are presented in a social structure within a specific context, and this emotion makes it possible for people to perceive that structure and the social consequences of actions. It can be seen that emotions and social cultural phenomena are interpenetrated. This emphasis on social structure and function is also reflected in the fact that one expresses emotions to another, indicating his or her subjective approval/disapproval, which implies that

166

7 Emotional Attunement: The Dynamic Mechanism …

they share a set of social structure and promotes people to implement rational actions in a group and be full of emotions. Thus, from a structural and functional perspective, although emotions are important forces at the micro level and emotional being is mainly reflected in the satisfaction of transactional needs at the micro level, it is indisputable that emotional being arises from the micro, meso and macro level. When transactional needs are not satisfied at the micro level, there may be arousal of one or more negative emotions. The intensity of these negative emotions depends on the level of satisfaction of the five transactional needs, with the highest intensity of negative emotions occurring when the need for self-realisation is unmet and the lowest intensity of negative emotions occurring when the need for facticity is unmet. The arousal of negative emotions is not only at the micro level, but also at the meso level and macro level of social organisation in which encounters are embedded. At the meso level, when the five transactional needs of encounters cannot meet an individual’s expectations within corporate and categoric units in which encounters are embedded, or the encounters cannot be embedded in the meso corporate and categoric units, the individual will experience unfulfilled expectations and arouse negative emotions. At the macro level, if an individual experiences enough punishment in the macro institutional domains and stratification systems or if the micro encounters and meso structures cannot be embedded in the macro level social organisation, the individual will also arouse ore or more negative emotions, as shown in Fig. 7.2. When individuals continually experience negative emotions such as sadness, fear, anger, as well as the first and second order elaborations of these negative emotions (e.g., distress, sadness, jealousy, bitterness, depression, shame, guilt, and alienation, etc.), their defense mechanisms will be activated in response to these painful emotions to seek self-protection. The consequence is that the negative emotions they continually experience, once presented, develop into diffuse anger, which is disturbed by sadness and fear from time to time. Thus, individuals experience more anger, sadness, fear, shame and alienation, and these emotions are often accompanied by a lower level of commitment to the meso-level and macro-level structures, which may not only lead to aggressive behaviours, but may also induce incidents of collective violence.

Fig. 7.2 Mechanism of negative emotions (repression)

7.1 Emotional Being and Manifestation

167

The more negative emotions an individual arouses, the greater the intensity and energy of negative emotions will be, and the more likely it is that defense mechanisms will be activated and that one or more negative emotions, or a combination of them, will be presented. As shown in Fig. 7.2, after an individual arouses negative emotions at the micro, meso, and macro levels, the negative emotions are transmuted by repression, resulting in two pathways of emotional presentation. One is the selfintensification of negative emotions, that is, if these negative emotions are directed at self, then the emotional energy will continually be intensified, thus affecting micro encounters and the satisfaction of transactional needs. The negative emotions that have been self-intensified include emotions such as disappointment, sadness, shame, and guilt, etc., but may also direct at a sense of alienation from micro encounters. Simultaneously, this impact includes not only the individual’s relationship with self, but also the satisfaction of transactional needs between individuals. If these negative emotions direct at others, corresponding defense mechanisms such as displacement, projection, sublimation, and reaction-formation will be activated. If emotional being is a product of the combination of external socio-cultural stimuli and individual hardwiring, defense mechanisms based on repression and attribution, revealing the effect of an individual’s thinking and consciousness on emotional presentation, more reflects the subject’s reconstruction of negative emotions. When individuals experience positive or negative emotions, they will make an attribution for emotional arousal. While making an attribution, self, the structure of interpersonal interaction, corporate units and cultures, members of categoric units, institutional domains, stratification systems, whole societies and systems of societies will be involved, as shown in Fig. 7.3. Because the presentation of negative emotions reveals a distal bias, that is, individuals make an external attribution for failure, unsatisfied expectations, and punishments. Meanwhile, the external attribution will generally jump over encounters and directly direct at corporate units and culture, categoric units and their members, and social organisation at the macro level. As shown in Fig. 7.3, if corporate units in which encounters are embedded are the target of negative emotions, people will show anger and express anger at corporate units, thereby reducing their commitment to culture

Fig. 7.3 Mechanism of negative emotions (attribution)

168

7 Emotional Attunement: The Dynamic Mechanism …

and structure of corporate units. If shame is repressed and the lower intensity of guilt presented by individuals fuels anger, thus anger is more likely to transmute into alienation from the culture and structure of corporate units, and the sense of alienation will indirectly direct at the structure and culture of the institutional domains in which corporate units are embedded. Similarly, if the categoric units in which encounters are embedded are target of negative emotion, individuals will show anger, express anger at categoric units, and develop negative prejudices against the members of the categoric units, and indirectly develop negative prejudices against institutional domains and stratification systems of categoric units. If negative emotions target the macro social structures, especially the institutional domains or stratification systems, the link between macro-level social structures and meso-level structures that initially generate shame definitely deteriorate due to the activation of the defense mechanism, or due to the fact that the actor transmutes anger and direct the anger outward. Shame arises from local encounters, which are embedded in the meso-level structures and further in the institutional domains and stratification systems. Therefore, the target of anger generated by the repressed shame is far away from the initial micro social structures, thereby obscuring or dissolving the connection between the initial local structures and shame. Repression can accelerate the breach of the connection between the emotion and its initial source of generation. In addition, individuals experience positive emotions within micro encounters (such as family members, neighbors, and friends). Affected by the great power of positive emotions, negative emotions take many turns and direct at the external macrostructure. To sum up, from the perspective of structure and function, negative emotions arousal cannot be separated from the micro, meso and macro social organisation, and the presentation of negative emotions conversely have an effect on the micro, meso and macro social organisation, which is more likely to bring forth the changes of social organisation.

7.1.3 Interaction and System The system interaction theory highlights the interactions and inter-relationships between systems, thus giving a great insight into understanding the world. S. Williams argues that, in terms of social theory, a more specific way is required to reassess and study emotions. He argues that emotions have a kind of “deep sociality” because they are embedded in, and constitutive of, social interactions (Williams, 2000). There are also scholars linking emotional states with system needs, as well as with environmental issues (Luhmann, 1989). It seems to me that exploring the dynamic mechanism of emotional being and presentation should also be reflected in the perspective of interaction and system. As we have seen above, emotions act on the micro, meso and macro levels, similar to acting in an ecosystem. In terms of negative emotional being, when interactions are

7.1 Emotional Being and Manifestation

169

not embedded in the corporate units and categoric units at the meso level, and thus in institutional domains and stratification systems at the macro level, and when those who interact do not use the same emotional language and discourse, individuals will experience unsatisfied needs at the micro level, unfulfilled expectations at the meso level, and corresponding punishment at the macro level, thereby arousing negative emotional being. When more negative emotions are aroused, after the effect of defense mechanisms such as repression and attribution, the negative emotions will be presented with a great intensity, and negative emotions repressed and transmuted will form a spiral change. For example, if repressed and transmuted shame manifests itself in the form of intense anger and hinders interaction, people will experience more intense shame. If the shame generated is repressed, more intense anger will eventually manifest. The resulting shame-anger-shame cycle (Lewis, 1971; Scheff, 1988) initiates the next round of situations that trigger the repression of shame. As this cycle proceeds, the intensity of the emotions involved usually increases and spirals upward with anger. However, in order to avoid obstruction of the interaction, negative emotions, especially those of higher intensity (e.g., anger), are repressed during the interaction or even expelled from the microstructure and into safer meso- and macrostructures. In this manner, the individual is able to maintain positive emotions at the micro level, while meanwhile regarding the more distant social organisation as the vent of negative emotions. More importantly, this reduces not only the solidarity between interpersonal interactions, but also the level of commitment to the meso- and macrosocial structures (and relative cultures) within which micro-interpersonal interactions are embedded. The more iterated encounters embedded within the corporate and categoric units lead to consistent negative emotional arousal among their participants, the less likely are individuals to develop commitments to the structure and culture of these units. The more individuals experience consistent negative emotional arousal across iterated encounters within diverse corporate and categoric units within clearly differentiated institutional domains and within clearly differentiated classes and class factions of the stratification system, the less will be their commitments to the structure and culture of macrostructures, and the more likely will their cumulative negative emotional arousal be mobilised in efforts to change the culture and structure of macrostructures. The more negative primary emotions, such as fear, anger, and sadness, are aroused by the mesostructure of institutional domains, the more likely are individuals to experience the second-order elaborations of negative primary emotions, especially shame and alienation. If moral codes are invoked to evaluate failures in these areas, people may also experience guilt. The more shame people experience in the mesostructure of institutional domains, the more likely are they to repress the shame, especially when they fail to verify self in roles or obtain a fair distribution of resources, and the more are shame and the second-order elaborations of the emotions (such as guilt and alienation) repressed. The anger of these emotions will be externalised, and based on external attribution, the intensity of anger directed at the meso-structure and macro-structure will increase.

170

7 Emotional Attunement: The Dynamic Mechanism …

Fig. 7.4 Negative being and presentation from the perspective of interaction and system

The more individuals have experienced diffuse anger, especially anger stemming from repressed second-order elaborations of negative primary emotions, the more likely will they make external attributions to macrostructures; and the more likely will they begin to experience intense first-order elaborations of anger (such as righteous anger and vengeance at targets of external attribution). The more the connection between negative emotional arousal and the structures and persons causing this arousal become obscured, the more distal will the targets of external attributions become, and the more intense will the emotions accompanying these attributions be, as shown in Fig. 7.4. I hold the view that external attribution as a defense mechanism and cognitive processing process makes this attribution process more complicated. External attribution can be conscious and accurate, or it can emerge from repression and unconscious emotional forces. When used as a defense mechanism and when coupled with repression of shame and other negative emotions, external attribution allows an individual to protect self and blame others or social structures. Thus, as people persistently cannot verify self in roles and must accept exchange payoffs below their sense of what is fair, their feeling may be a complex mix of anger, shame, sadness, indignation, guilt (if moral codes are invoked), and alienation. This negative emotional cocktail form may not all remain conscious, nor need it be accurate, but it is likely that some portion of this emotional cocktail form may be repressed, particularly that part which could harm self. The result is that righteous anger may be fuelled by a person’s conscious indignation at unfair payoffs in encounters, coupled with repressed, intensified, and transmuted anger from repressed shame and guilt. In the end, the more repressed are the emotions that attack self, the more volatile will the emotional cocktail form that fuels righteous anger and vengeance

7.1 Emotional Being and Manifestation

171

become; and the more these emotions will lead to external attributions that target not just other people but also larger-scale social structures that are perceived to cause persistent negative emotional arousal in those institutional domains distributing valued resources. And, the more classes and class factions have persistently experienced negative emotions and performed moral work, the more likely will the system of emotional stratification in a society be an impetus to social change.

7.2 Social Effects of Emotional Attunement Emotions are one of the most critical micro-level social forces because they are what hold all levels of social reality together or, in the end, breach encounters or break mesostructures and macrostructures apart. Emotions are, of course, not the only force that has these effects. Although a lot of human energy emerges from transactional needs of biological foundation and at micro-level, emotions are not only involved in the process, but more importantly, emotion is an independent source of motivational energy. It goes beyond these biological foundations and social transactional needs, and has a very important effect on social structures and culture. Therefore, we need to summarise the emotional energy at the micro level, and under certain conditions, what kind of energy can be presented to stabilise or change meso and macro structure and culture, thereby forming an impetus to social change.

7.2.1 Negative Emotions and Social Changes The more intense negative emotions arousal is, the more explosive does the emotional energy present and the more destructive emotions are to social structures and culture. It follows from the above analysis that if other resources, such as ideologies, generalised symbolic media, various capitals including money and emotions, as well as corporate units and categoric units become the target of these negative emotions, then the possibility of collective action caused by the accumulation of these negative emotions will increase. The energy carried by negative emotions spreads through the population like a fuel that is ready to explode, while negative emotions such as shame, guilt, grief, sadness and even alienation may be the primary forces that initiate social change and lead to larger-scale participation in social movements. This is particularly true for PLWHA, for whom the negative emotions they experience are directed at ideologies in various institutional domains, at the unequal distribution of capital, at rejection, exclusion and stigmatisation from the corporate and categoric units, then the large number of negative emotions they have and emotional cocktail may be concentrated, leading to widespread anger and alienation among PLWHA. If anger sufficiently penetrates PLWHA, and the sense of injustice among infected people increases through the accumulation of ideologies, diffuse anger can trigger

172

7 Emotional Attunement: The Dynamic Mechanism …

movements against power-centered society, which poses great hazards. For example, the issue of equal access to medical care for PLWHA may initially lead to resentment against medical staff. Once the resentment (especially anger that is transmuted from repressed shame) spreads, it develops like a giant vortex that sucks in PLWHA that are drenched in anger. Initially, these angers are mobilised against the meso-level social organisation that are perceived to trigger negative emotions in people, but after the conflict takes shape, meso-structures in the polity, economic, educational, and healthcare system domains will be involved into the conflict, such as the communities, the workplace, the schools, and the hospitals, etc. Once these meso-structures are defined as representatives of most institutional domains, or these meso-structures are considered to be responsible for the unequal distribution of resources in the stratification systems, the conflict will focus on changing the macro-structures, not just the meso-structures in which people experience negative emotions. Of course, there is also the possibility that such anger can be repressed, especially if the capital possessed by the corporate units is sufficient to maintain the equilibrium of such conflicts, even if the anger is quite intense and widely spread among the population, it is not capable of generating social movements. When anger is repressed and the power center has sufficient resources to control the collective movement, the shame from which anger emerges is typically transmuted into alienation. In a sense, these dynamics can be regarded as collective displacement of anger, i.e., the displacement of anger from a meso-level unit in the institutional domains to a safe object, so that it cannot effectively “fight back”. As this process unfolds gradually, the connection between anger and its primary source (the meso-structure of resource distribution in institutional domains) will disappear or be distorted, so that the “macro social structure” is regarded as the source of negative emotions. If the structure and culture of the corporate units are perceived to impose unrealistic expectations, negative emotions will readily be directed at the corporate unit; there is a built-in distal bias for negative emotions, but this bias is facilitated by the structure of the corporate units in which encounters are embedded. When the structure and culture of the corporate units operate to assure that individuals will fail at meeting expectations, the presentation of negative emotions is promoted. For example, if PLWHA are unable to take roles of ordinary patients in medical institutions, and are unable to gain support and status within an organisation, they will often show resentment towards the meso corporate units and develop a sense of alienation under the influence of defense mechanisms. Just as is the case with corporate units, in categoric units, these processes can erode commitments. When members of categoric units are perceived (whether or not accurately) to have frustrated meeting expectations or to have been directly or indirectly responsible for negative sanctions, then negative prejudices towards members of these categoric units will emerge, and PLWHA will express anger towards their members. At the macro level, because negative emotions have a distal bias, thus they are more likely to be beyond the meso structure, direct at the macro structure (regardless of institutional domains or stratification systems), or indirectly at the entire country

7.2 Social Effects of Emotional Attunement

173

or national system. Due to the penetration effect, emotions in a certain institutional domain or a certain position in a stratification system may affect positions in other institutional domains or classes. For example, PLWHA may initially be discriminated against and unfairly treated only in the field of medicine, but this situation usually infiltrates the economic, political, and even family and education domains, causing many infected people to be unemployed, deprived of rights, suspended from school, and evicted from home. It also caused many infected people to face the loss of economic capital, social capital, cultural capital, and symbolic capital, which exacerbated the lack of emotional capital.

7.2.2 Positive Emotions and Social Structure As it has been stated that the presentation of negative emotions may bring about changes in social organisation at the micro, meso and even macro level, it is necessary for us to stimulate the presentation of positive emotions. Although there are many forces that can bring about social changes, we cannot regard emotions as the only driving force for social transformation; however, emotions are still one of the most important forces leading to social changes. Contrary to the destructive nature of negative emotions, the presentation of positive emotions usually transforms into a commitment to corporate units and categoric units, and then this commitment extends to institutional domains and stratification systems. For this, positive emotions maintain individuals’ expectations of status. Therefore, even if the goals of corporate units may indirectly change the macro structure, the attachment of members to the corporate units is still sufficient to maintain the goals of these corporate units. The commitment of the members at the meso-level social organisation arises when they perceive the penalty boundaries and their role-making leads to self-verification, and the exchange of benefits is promoted. If these mesostructures can store other capitals (such as economic capital, social capital, cultural capital, symbolic capital, and emotional capital), these mesostructures are more likely to become the backbone of macrostructural and cultural change. There are two types of structures at the meso level of social organisation: corporate and categoric units. In terms of positive emotions developing the commitment to corporate units, although positive emotions emerging from fulfillment of needs, satisfaction of expectations, and acquisition of rewards tend to be in the cycle of iterated encounters, individuals may make an external attribution of their positive emotions and express their gratitude to those who have helped them meet their needs, achieve expectations, and receive rewards. And they will express gratitude to mesostructures. If people perceive that a certain corporate unit facilitates the satisfaction of their needs, the fulfilment of their expectations and the attainment of rewards, then some positive emotional energy directed at self and others will be diffused into these corporate units. Another way to increase commitment to structure and culture at the meso level is the capacity to fulfill expectations by status-verification and role-making in these

174

7 Emotional Attunement: The Dynamic Mechanism …

institutions. When expectations are defined by the culture and structure of the corporate units, fulfilling expectations automatically makes the corporate units highly salient and thus more likely to be the target of positive emotions. Likewise, when the corporate units center on fulfilling individual expectations, people tend to perceive the fulfillment of expectations as coming from the structure and culture of mesostructures as well as from specific individuals, which makes it easier to form a commitment to mesostructures. In terms of the commitment of positive emotions presentation to categoric units, if the membership of a categoric unit is perceived to facilitate the fulfillment of need, satisfaction of expectation, or achieving rewards, then the proximal bias of positive emotions can more easily be extended to the social identity of a person as one member of the particular category. For example, if male is considered as partly responsible for positive emotions arousal, then commitments to this social category increase as a natural matter of course. The same process can work in developing commitments to other categoric units. When a person perceives that members of another distinctive categoric unit have been responsible for positive emotional arousal, this person will develop positive stereotypes about members of this categoric unit, giving them a high evaluation and developing commitments to members in this categoric unit. For instance, people who are infected through iatrogenic approach (especially those who were infected due to illegal blood collection and supply in the Central Plains) are often considered to be “well-born”, and are given the role of innocents during interactions, thus being more likely to satisfy needs, fulfill expectations, and stimulate presentation of positive emotions. More intriguing than commitments to meso units are commitments to macrostructures and their cultures. In many ways, commitments to the culture and structure of macro-level structures are an extension of the processes generating attachments to mesostructures. If expectations have been realised and positive sanctions received across many encounters embedded in diverse corporate units and categoric units of macrostructures, the positive emotions aroused will move outward towards these macrostructures. For example, if an infected person has been successful in coping with the HIV virus, that person is first successful in taking antiviral medication and self-care. Secondly, he has been successful in medical treatment in the medical domain of the corporate units, or he has been successful in accessing support and care within ASO, then this person will develop commitments to structure and culture of health care as institutional domains, ideology and stratification systems and will regard health as a condition for access to certain resources for others. Just as I can always hear about those who have fought against HIV for more than two decades, “I am more focused on my health now than ever before.” Thus, the key dynamic mechanism here revolves around the consistent activation of positive emotions in meso-level units over a longer time frame. When institutional domains and stratification systems are built from these meso units, the positive emotions aroused will target macrostructures. Consistent reinforcement arouses positive emotions towards self and others in the encounter, but this pattern of reinforcement also generates a sufficient surplus of positive emotions that moves out of the meso-level units and moves to macrostructures. And, this external attribution

7.2 Social Effects of Emotional Attunement

175

process becomes even more likely when individuals define “self” in terms of the roles that can be successfully played in a range of encounters within corporate and categoric units. Confirmation of role-identities adds extra levels of positive emotional energy because self-verification is the most important transactional need. Also, when individuals receive positive sanctions and meet expectations, they also will receive profitable exchange payoffs and meet other transactional needs, thereby adding extra layers of positive emotional energy that will migrate outward to macrostructures. The structure of corporate and categoric units also influences the degree to which emotions will move outward to macrostructures. If expectations and sanctions in a corporate unit are clearly specified by the culture, positive emotional arousal will increase commitments to this unit. Moreover, if this unit is embedded in a clearly differentiated institutional domain with a distinctive generalised medium of exchange, clear ideologies, and explicit institutional norms, this close coupling between the culture and structure of a corporate unit and an institutional domain leads individuals to see not only the meso unit as facilitating success, but also, if this success is consistently repeated across a number of corporate units within this domain, the positive emotions will increasingly be directed outward to the culture and structure of the institutional domain. The converse of this process is also important: a lack of clear embedding of a corporate unit in an institutional domain works to localise the positive emotions aroused at the level of the encounter or at corporate structure rather than moving outward towards macrostructures. The same coupling processes also operate with categoric units. If a categoric unit is discrete and commands a clear level of evaluation in terms of class or class faction within a lineal stratification system, success in meeting expectations and receiving positive sanctions in encounters where categoric unit membership is salient will increase not only commitments to this unit but also to the macrostructural stratification system in which this categoric unit is embedded. The same is true for a categoric unit that is also discrete and embedded in an institutional domain. For example, those who have been successful, especially those in charge of many HIV organisations, have not only succeeded in responding to AIDS in the medical domain, and have gained health, but they are also often more successful in the economic domain and have a relatively high level of education. It is possible for them to get the support and care of the family and the presentation of positive emotional energy. The counter-effects of this process are also very important, because if other infected persons do not experience positive emotions in their interactions with the “successful members”, then the negative emotional energy will generate anger towards the “successful members” and diminish commitment to the institutional domains or stratification systems containing these categoric units. For example, if PLWHA do not meet expectations (as in most cases) or must endure punishment from various domains, then their commitment (whether in the institutional domains or the stratification systems) will be lower. In fact, the anger of PLWHA is more likely to trigger changes in social structures and culture. In the long run, those who do well in a society develop higher levels of commitments to the structure and culture of a society than those who do not. Perhaps it’s a wide open, general viewpoint. Actually, the process is more nuanced than that this

176

7 Emotional Attunement: The Dynamic Mechanism …

broad generalisation would indicate. If we are to understand the level of commitments to specific institutional domains or to the class system in a society or, potentially, a system of societies, we need to understand how expectations and punishments have been tied consistently to the structure of corporate and categoric units and how these mesostructures are embedded in the culture and structure of institutional domains and stratification systems. In addition, we must also know the degree to which the culture and structure of meso units increases or decreases the likelihood that individuals will be positively sanctioned and will meet expectations. The expectations are defined by the culture of the meso unit and the macro-level unit in which they are embedded. What’s more, we need to know the degree of success they have had across diverse meso units embedded in different institutional domains and in the classes and classfactions of the stratification system. When positive emotions are consistently aroused among many individuals across many diverse mesostructures and numerous people experience positive emotions, commitments to institutional domains and the existing stratification systems are generated, reducing change generated by emotional arousal less probable.

7.3 Research Reflection This book, with PLWHA as the research subject, aims to explore the influence and commitment of emotional being and presentation on social structures from the perspective of subject construction. This process requires not only learning and thinking, but also the integration of learning and practice. However, any kind of research has its limitations and focus when solving problems. This book is no exception. First, this book, through the analysis of negative emotional being at micro, meso and macro level, elaborates dynamic mechanisms of emotional being and presentation, proposes its influence mechanisms, as well as enriches the horizon of problem solving and expands research field. However, in terms of actual implementation, this book cannot yet propose clear practical steps on how to achieve emotional being and presentation. Second, although the book emphasises the research and analysis frameworks ranging from the micro, meso to macro level, it lacks a macro level of exploration of the influence mechanism of the state and the state system on emotional being and presentation. For example, this book doesn’t provide a detailed analysis of the role of international and institutional forces in the dramatic turnaround of China’s HIV/AIDS prevention and treatment, especially the impact on the emotions of PLWHA, and further research is needed. Thirdly, although social organisation, in this book, are categorised into three discrete parts, micro, meso and macro level, and the embedding relations of the three are emphasised, there is a lack of analysis of the interplay between these three

7.3 Research Reflection

177

levels and between the internal components, such as the interaction between corporate units and the categoric units, institutional domains and stratification systems. This is another one that requires further research. Finally, in line with social science research, the mechanisms of influence and motivation proposed in this study should be tested in practice to seek consistency between knowledge and action. After all, “Practice is the only criterion to test the truth.” If the present study is found wanting, it is incumbent upon me to test the theoretical model in the future, so as to complete the feasible process from induction to practice. There are, of course, issues that need to be discussed further in the future, as many people living with HIV/AIDS have stated that it is a special “gift” that has rendered them ill, but it has also caused them to re-examine the relations between health, social relationships and emotions. The interaction between emotions and “traditional Chinese relationships” (rather than just social capital) deserves further discussion. In addition, I argue that AIDS research and treatment should reflect the guiding ideology of de-specialisation, rather than the current situation of talking about AIDS in a discriminating manner. Among people living with AIDS I have come into contact with, they have a goal and belief to “live to see the success of the development of antiviral drug”. If one day AIDS can be cured, maybe there will be no AIDS problems, just like smallpox and plague in history. The process of fighting against AIDS, the factors affecting emotional being and presentation, as well as the study on emotions of the AIDS population, are what I would like to continue to work for. Therefore, the study is not the end, but a new beginning. For my academic career and my life, I will pursue academic goal with the spirit which is just as Mr. Wang Guowei1 said, “A thousand times I search for her in the crowd/And, suddenly turning my head, /Discover her where the lantern lights are dim”, and just as PLWHA need a lifetime to fight against HIV virus.

References Collins, R. (2009). The micro-sociology of violence. British Journal of Sociology, 60(3), 566–576. Elias, N. (1994). The civilizing process. Wiley-Blackwell. Gane, N. (2005). What is ‘human society’?: A response to Davetian. Sociological Research Online, 10(3), 145–149. Goffman, E. (1959). The presentation of self in everyday life. Anchor Books. Hochschild, A. R. (1983). The managed heart: Commercialization of human feeling. University of California Press. 1 Wang

Guowei applied some poetic lines to illustrate three stages of research. The first stage: Last night the west breeze/Blew withered leaves off trees. /I mount the tower high/And strain my longing eye; the second stage: I won’t regret/even if the belt on my robe grows looser;/For you/it’s worth being wan and haggard; the third stage: A thousand times I search for her in the crowd/And, suddenly turning my head, /Discover her where the lantern lights are dim (supplemented by the translators).

178

7 Emotional Attunement: The Dynamic Mechanism …

Layder, D. (2004). Emotion in social life: The lost heart of society. Sage. Lewis, H. (1971). Shame and guilt in neurosis. International Universities Press. Luhmann, N. (1989). Ecological communication. University of Chicago Press. Scheff, T. J. (1988). Shame and conformity: The deference-emotion system. American Sociological Review, 53, 395–406. Stryker, S. (2004). Integrating emotion into identity theory. In J. H. Turner (Ed.) Theory and Research on Human Emotions. Emerald Group Publishing Limited. Turner, J. H. (2007). Human emotions: A sociological theory. Routledge. Williams, S. (2000). Chronic illness as biographical disruption or biographical disruption as chronic illness? Reflections on a core concept. Sociology of Health & Illness, 22, 40–67.