Stigma and Disability: Stereotypes

Stigma is a complex issue that affects all people in all strata of society. Stigma works in the following way: There is an acknowledgement in a society that something is undesirable. People with that attribute have the stigma and are stigmatized. An "us" and "them", ingroup/outgroup situation is created. Further, stigma maybe internalized with a "buy in" from a person with the stigma agreeing to be stigmatized. Stigma is a social construct that people can buy into. Something can become stigmatized at any time and someone has the possibility of being stigmatized at any moment.

To put it another way, stereotypes are a way of assessing complex situations rapidly. For example you need to find the way somewhere, who do you ask? That person has a nice smile I bet they are friendly. In this case there is no other basis for the decision. This is an example of a positive stereotype. Or you are sitting on a bus and think: That fat man over there must be really lazy. Again with no basis for the though other than seeing the man on the bus. This is an example of a negative stereotype. Essentially stigma is about receiving a negative stereotype, but a stereotype that wont go away. Like for instance a disabled man seeking employment: That man without legs wont be able to work because he is too disabled is a negative stereotype associated with disability.

Disability has all sorts of negative stereotypes associated with it. This leads to stigmatization. This study from 2013, Stigma, Discrimination & Marginalization: Gateways to Oppression of Persons with Disabilities in Ghana, West Africa describes the situation. It shows the effects of stigmatization of the disabled through all strata of society. It begins by summarizing how stereotyping operates around disability:

Public attitudes and beliefs on disabilities in Africa which are often based on fear and misunderstandings, stereotype individuals with disabilities exposing them to prejudice, discrimination and ultimately to the denial of rights and resources that are afforded to all citizens. The importance of understanding the different ways in which disability is perceived lies in the fact that societies address disability issues based on the ways they conceptualize it. Avoke (2002) reports that in Ghana, the general attitude in many communities in Ghana towards children with intellectual disabilities is that  they are ‘children of the rivers and forest’ and, in the past, they were returned to the forest or to the rivers under the guise of helping them ‘to go back to where they came from’ (p.773). Fefoame (2009) also indicates that in some traditional communities, some creatures like crocodiles and snakes are believed to have supernatural powers, or in some cases, human beings change into such creatures, and therefore any cruelty against them can lead to an individual giving birth to a child with disability. Such beliefs invariably influence societal beliefs and perceptions about disability in Ghanaian traditional society. Although some of the above terms may no longer be used as blatantly as described above in modern Ghanaian society, the labels reflect what the dominant perceptions about persons with intellectual disabilities are.
Avoke (2002) indicates that in many communities in Ghana, pejorative labels and unkind treatment were meted out to people with disabilities. These treatments were considered justifiable due to the strong belief that disability was the result of evil placed on an individual from the gods, for committing offences in the community or to the gods. According to Fefoame (2009), when a woman gives birth to a disabled child, there is only one explanation that is offered: that the gods are annoyed. She further explains that the society does not take into account sicknesses like Rubella and German measles, and other factors such as the woman’s nutritional state and prenatal care conditions. Instead, emphasis is laid on the purported guilt of the family, which element is instrumental in curtailing the promotion and protection of the rights of people with disabilities (Fefoame, 2009).
These public attitudes and perceptions about persons with disabilities in Ghana have created situations that lead to the further isolation and stigmatization of persons with disabilities. It is this stigmatization and marginalization of persons with disabilities and their ramifications that were the basis of this study.

A Disabled child in Uganda

The study, Stigma, Discrimination & Marginalization: Gateways to Oppression of Persons with Disabilities in Ghana, West Africa, details its findings in 6 categories, detailing the negative effect of stigma throughout Ghanaian society. The effects of stigmatization are familiar to studies and reports of disability cited in this blog. They are a good introduction to the subject:

Stigmatization of disabilities: The first major finding from the study concerned societal stigmatization of persons with disabilities in Ghanaian society. Stigma is the single most difficult barrier to living “normal” and productive lives by persons with disabilities. Stigma refers to the negative and prejudicial ways in which people living with disabilities are labeled (Agbenyega, 2003). Stigma arises from a number of factors. Some of these are: superstition/ignorance, lack of knowledge and empathy, old belief systems and a tendency to fear and exclude people who are perceived as different, (Avoke, 2002).
Effects of Stigmatization: Stigma results in stereotyping, fear, embarrassment, anger, and avoidant behaviors, among others. Selfstigma can also occur when persons with disabilities and their families internalize society’s negative attitudes towards them, leading to self-blame and low self-esteem (Dhar, 2009). Aside from being personally painful, stigma is dangerous in a number of ways: It can prevent people from seeking help; can lead to feelings of hopelessness when in fact, persons with disabilities can function “normally” when societal barriers are removed. It can impede individuals from advocating for services that may ultimately have an impact on social policies and laws. Discrimination against persons with Disabilities: Participants in the study constantly alluded to the blatant discrimination that are directed against persons with disability in Ghanaian society. Discrimination refers to the way persons with disabilities are treated, intentionally or unintentionally, due to stigma (Goreczny, et. al, 2011). Persons with disabilities are often treated with disrespect. This show of disrespect and discrimination may lead to societal exclusion, bullying, aggression, ridicule and devaluation of the self-worth of the person. Such discrimination meted against persons with disabilities results in oppression against them in all areas of life including their ability to obtain housing, maintaining regular employment, access education, engage in meaningful relationships and enjoy quality of life afforded to all citizens.
Goreczny et. al (2011) have noted that, “negative attitudes toward individuals with disabilities can be ‘invisible barriers’ as persons with disabilities pursue community involvement and community resources” (p. 1596), geared towards achieving good quality of life. The participants in this study, especially those with disabilities were overwhelmingly appalled and concerned about the labels and stigmas that are attached to persons with disabilities in Ghanaian society. Some examples of disability stigmas in Ghanaian society are the following: Persons with disabilities are generally referred to in Ghanaian society as "ayarefuo" (sick people). Persons with Autism and Down's Syndrome are labeled as "Kwasea, kwasea", "Gyimi, gyimi" (stupid person, imbecile). Persons with hearing impairment are referred to as, “Mumu” (dumb). A person with any form or level of mental illness is referred to as “Obodamfuo” (Mad Person).
These stigmatizations that reflect on the belief systems, myths and superstitions of the general Ghanaian society have had the effect on creating barriers for persons with disabilities in many areas of life in Ghana. This situation can therefore be likened to a situation of systemic societal barriers that lead to the oppression of persons with disability in Ghanaian society (Mulally, 2002). A comment by a participant sums up this feeling of oppression felt by persons with disabilities: "We have no respect in Ghana. People don’t regard us as human beings. Is this not sad? Ghana and its resources are for all its citizens. Does that not include us? We cannot get work; we cannot take a bus, we cannot go to government offices that have all these long steps. Even if we go to hospital we are not treated with any respect. Life is really hard for us."
Educational exclusion of persons with disabilities: Education is widely recognized as a means to developing human capital, improving economic performance, and enhancing people’s capabilities and choices (OECD, 2011). Thus, governments owe it to their citizens to make the necessary investments in education, in order to provide the best standards possible (Porter, 2001). It is well documented that disabilities present certain challenges that influence the learning modes of persons especially children. Available research does not support the fact that persons with disabilities, including children, are ‘non-educable’ (Culham & Nind, 2003; Reiter & Vitani, 2007; Porter & Smith, 2011; Maul & Singer, 2009). The United Nations estimates that the school enrolment rates of children with disabilities in developing countries are as low as 1 to 3 per cent; implying that approximately 98 per cent of children with disabilities do not go to school and are therefore illiterate (United Nations, 2007). Meanwhile, research shows that there is a greater likelihood that children, including those with significant disabilities, who are included in regular education, will finish school, acquire further education and training, get jobs, earn good incomes, and become active members of their communities (United Nations, 2007).
The situation in Ghana unearthed from then study paints a disturbing picture. A colonial relic or throwback from the colonial structures in Ghana is the establishment and continuous existence of segregated or “special” schools for persons with disabilities. There are a number of “Schools for the Blind”, Unit Schools for the Deaf” and vocational institutions for persons with physical disabilities. These schools and institutions “train” persons with disabilities who end up with some form of graduating diplomas that fit them no-where in the mainstream economic system (Turnbull, et al, 2007). The following narrative from a visually-impaired teacher at one of the Schools for the Blind underscores this point: "I graduated from the University of Education in Winneba where I studied alongside students who had sight, but since I graduated with my Education Degree, no “regular” educational institution will employ me because I am blind. I have therefore ended up here at the School for the Blind where I started my secondary school education. It is as if those of us with disabilities belong only to the disability schools. This is segregation that does nothing to assist us to access the same employment and economic opportunities in Ghana."
Another student with visual impairment at Ghana’s premier university, the University of Ghana at Legon lamented as follows: "All the roads on this campus have open gutters beside them. There are no pavements by the roadside so it is very difficult for those of us that are blind to walk safely around the campus. Another difficulty I have is the stairs to climb to some of the lecture halls that are on the second and third floors. There is no lift (elevator) in the building so sometimes I get some friends to carry me upstairs. But this is difficult. When I don’t get any people to carry me upstairs to the lecture hall, I don’t go to class. It is as if the university is only for ablebodied persons."
Social exclusion of persons with disabilities: From interactions with the persons with disabilities and other participants in this study, it emerged that the myths, superstitions and negative labels attached to disabilities in Ghana contribute significantly to the social exclusion of persons with disabilities. This exclusion results in their inability and difficulty in participating meaningfully in activities in society that will earn or ensure them a good quality of life. Most of the study’s participants’ who had various forms of disabilities recounted with pain and anger, how they are tagged with negative labels in Ghanaian society. These labels are mostly negative and derogatory. They portray persons with disabilities in very negative light, as second class citizens, as persons who should be pitied, at best, and ignored and shunned at worse. The following narratives from some of the participants attest to their situation: "People make fun of me with very ugly words when they see me begging on the streets. I cannot work because I was not allowed to go to school. Because I didn’t go to school I have no skills to look for a descent job. So I come to the car station or sometimes the streets to beg. I don’t cause trouble to anybody. Because I am begging for help, some people insult me all the time. They say all kinds of dirty things about me as if I am not a human being."
Another had this to say: "Sometimes when you go to a public place or a public event, people look at you in such a way that make you feel that you are not wanted. They question why you are there. Why can people not accept us for who we are as human beings. We are also human being except that we happen to have a problem of disability."
Parental and community responses: The responses from parents, family members and community members who participated in this study were equally disturbing and compelling. A number of parents with children with disabilities admitted hiding their children from public view. This was particularly widespread among parents of children with Autism and Down’s syndrome. They talked about how such children, and by extension, their families are shunned by society because of the still prevailing myths and superstitions about children with Autism and Down’s syndrome in Ghanaian society as being children of evil spirits and gods. The following narrative from a parent was really disturbing: "When my child was born with this illness (Down’s syndrome), everybody told me that my family may have done something wrong for the gods to send me this child. I have never brought him outside the house. Then only time I bring him out of the room to the open compound is when everyone in the neighbourhood has gone to the farm. Life has really been tough for us. I don’t know what to do."
Public/government responses: In the international scene, there are various laws and legislations that have been designed to correct misconceptions about disability as well as to protect the rights of persons with disabilities. One of the major international instruments working toward these objectives is the United Nations Convention on the Rights of People with Disabilities (CRPD, United Nations, 2006).Ghana has also made some significant official moves in addressing the plight of persons with disabilities. The Persons with Disability Act (Act 715), which seeks to protect the rights of people with disabilities in the country was passed in 2006. A National Council on Persons with Disability (NCPD) was established in 2009 to coordinate the activities of organizations working with and for persons with disabilities. It is also charged with the mandate to monitor the implementation of the provisions of the Persons with Disability Act (Act 715). Although this is a significant official step, much needs to be done by the government to address current problems and issues that affect the rights of persons with disabilities including their access to resources and opportunities especially in education and employment. Service provisions to persons with disabilities in Ghana are run mainly by nongovernmental organizations with limited resources. Participants in this study from such organizations complained that not much progress has been made in the last six years since the Persons with Disability Act (Act 715), was passed.

The study concludes:

Disability is understood as an unequal relationship within a society in which the needs of people with impairments are often given little or no consideration. The fact that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis with others implies that disability is not an attribute of the person (WHO, 2011). The disability may be a social construct resulting from societal structures erected sometimes unintentionally due to entrenched attitudes. Removing such barriers that hinder the day-to-day lives of people with disabilities is therefore critical to improving their social participation (UNDP, 2007).
Regardless of the areas where we live or work, it is very likely that at some point, we will come into contact with persons with some forms of disability. In order to overcome or avoid stigma and discrimination faced by our neighbors, friends, family and co-workers with disabilities, we must take action, challenge and provide a voice for those affected by stigma in their quest for wellness and quality of life free from stigmas and discrimination. More importantly, we must change the way we perceive, and the way we speak about our clients who have disabilities. Stigmatizing labels and client behavior descriptors must be avoided.
In summary, social workers can play diverse roles to foster social and educational inclusion for persons with disabilities in Ghanaian society (Teasley, 2004). They can also be good advocates for helping to design policy and practice frameworks that guide the whole Ghanaian society as it strives towards inclusion of persons with disabilities.

The study also offers the following recommendations for removing stigma:

Mobilizing Communities for Action: To make a positive difference in the lives of persons with disabilities in Ghana, there is the need effective country-wide community education campaigns aimed at eliminating the myths, negative perceptions, stereotyping, superstitions and their resultant discrimination and marginalization of persons with disabilities. There is also the need for mobilization and community support for services directed at persons with disabilities. These public education and community mobilization campaigns should be aimed at getting people to recognize and accept persons with disabilities as people first. They should not be tagged with their disabilities as illness that needs to be cured: the clarion call should be that: a person is a person, with a physical or psychiatric problem. These will hopefully lead to eventual public support and acceptance and the inclusion of persons with disabilities as normal, important and productive members of society.
Social work practices with persons with disabilities: Bigby and Frawley (2010) state that just like in any other field of social work practice, there are a number of ways to work, both at the individual and structural levels, to redress disadvantages, improve quality of life, and bring about social change to reduce discrimination and oppression that result from the unfortunate situations that persons with disabilities find themselves in Ghanaian society. The situation is even more critical in the field of education where children with disabilities are still segregated to special schools. All children are capable of learning and becoming recipients of quality education if the right atmosphere of inclusion and acceptance are created (Mittler, et al. 2002).
The fields of mental health and social services have a long history of focusing on the deficits, problem behaviors, and pathologies of clients. This is known as the deficit-based approach. There is however new approaches in the field of social work towards clients including Social Work Practice with clients with disabilities. Rather than focusing on the disability and perceived weaknesses or deficits of the individual, there is a new push for social services to discover and work with individual and family functioning and strengths. This is known as the Strength-Based Approach (Bertolino, 2010). At the foundation of the strength-based approach is the belief that clients (service users) have unique talents, skills, and life events, in addition to specific unmet needs. These clients with unique talents, certainly, nclude persons with disabilities.
Strengths-Based Practice uses peoples' personal strengths to aid in recovery and empowerment (Bertolino, et al. 2009). It avoids the use of stigmatizing language or terminology which clients sometimes use on themselves and eventually accept as their situation. Persons with disabilities in Ghanaian society have strengths like other citizens that can be utilized and built upon to help them achieve and enjoy good quality of life. There is increasing emphasis on quality of life as a leading concept regarding services for persons with disabilities, and social workers can facilitate this development by ensuring that public facilities and resources are equally available to persons with disabilities to give them the same opportunities to experience meaningful social lives (Reiter & Vitani, 2007).

This study paints a disturbing picture of the impact of the stigma of disability in Ghanaian society. It shows how the stigmatization of disability affects all disabled people through all strata of society. It illustrates clearly the frustration and hopelessness felt by disabled people. It further points to the necessity of good education to counteract the negative stereotypes that create stigma and fuel discrimination.