‘Just because I’m smiling doesn’t mean I’m not in pain’: navigating the layered stigma of chronic pain and suicidality in social worlds

This article aims to provide an illustrated account of layered stigmatisation processes and consequences for those who experience chronic pain and accompanying suicidality. Using constructivist grounded theory, I draw from 20 in-depth interviews conducted from 2022 to 2023 to explore how chronic pain and suicidality operate within people's social worlds. Findings demonstrate how layered stigmatising processes, occurring based on chronic pain and suicidality, operate consistently across multiple social arenas to create interactional troubles, which result in enduring negative social, emotional, and financial impacts. Three themes were constructed, including (1) self-stigma and the multiple roles of the family, (2) missed connections, and (3) anticipated stigma and workplace discrimination. Taken together, themes support the overarching category, 'interactional troubles'. Findings suggest a need for attunement to stigmatising processes' omnipresence and the depth of their consequences. Clinical interventions may benefit from emphasizing participants' social worlds and incorporating the complexity of navigating social arenas given layered stigmatisation. Moreover, policies that support those with chronic pain and mental illness could offset the long-term negative economic consequences of discrimination.