This article is in three parts. Part 1 discusses the meaning, target and sources of stigma with emphasis on physique, social group membership, cognitive and neurological factors and life style preferences. Part 2 looked at the manifestations and effects of stigmatization such as labelling, discrimination, anxiety, with special attention to Ghana specific cases. The final part (3) deliberates on the way forward to stigma reduction through awareness creation and sensitization. Others are community involvement and the role of faith-based institutions as well as work place policies and the critical role of the media.
What is stigma?
Stigma is derived from a Greek word which originally referred to a type of mark or tattoo that was cut or burned into the skin of criminals, slaves, or traitors in order to visibly identify them as blemished and therefore to be avoided. It is a label attached to a person with a set of unwanted and unwelcome characteristics which is socially undesirable, discrediting and must therefore not be entertained. Put differently, stigma or stigmatization is a negative labeling and/or emotional reaction(s) to an individual or a group mainly because ‘something’ about that individual or the group (‘his/her likes’ as the case may be) is perceived to be different or negatively out of the ordinary; and as a result, such individual and/or his/her group members are tagged by a cross-section of society as ‘dangerous’, ‘unusual’, ‘weird’, ‘mystical’, ‘peculiar’, ‘bizarre’, ‘strange’ and ‘odd’.
In some instances, the condition(s) which makes someone looks different and unwelcome seems incomprehensible to those who stigmatize and that in itself may create anxiety and induce fear and other negative emotions towards the stigmatized person(s). These perceptions and their associated emotions are the main reasons why certain individuals and groups are regrettably placed in a different category and labelled in ways that are humiliating and degrading. As a consequence of these perceptions and categorizations, most invariably and automatically, the individual or the group is branded as an outcast and treated differently in ways that embarrass, demean and disadvantage them in many ways.
Who is a target of stigma [tization] in Ghana?
Everyone can be a subject or target of stigma depending on where one finds him/herself. Stigma predominantly applies to humans but it can also be tagged to inanimate objects such as an institution, a house, settlement, and in some cases, a town or a city, a country or a whole continent. Stigma applies to both groups and individuals of all age brackets and sexes/gender, race, and socio-economic background but minorities, the poor and the vulnerable, are more susceptible to stigma than the rich and those highly placed in society. In Ghana, persons with condition of albinism, the physically challenged, persons with squinted eyes, the visually and auditory impaired and those with some form of psychologically challenges popularly referred to as mental illness, are among individuals who are the unfortunate targets of stigmatization.
Others are those with certain levels of cognitive limitations and therefore cannot benefit from formal academic education beyond certain level, persons with Acquired Immunodeficiency Syndrome (AIDS) and in recent times, contact persons who have been quarantined for observation and testing, those tested positive for COVID-19 and even those who have recovered. In addition, persons with conditions of epilepsy, ex-convict and spouses (especially the women) who do not have children or perceived to be unable to give birth even if it is by choice are also target of stigma. Most of the targets listed above are applicable in other societies.
Stigma is ‘contagious’
Stigma tend to be ‘contagious’ in the sense that it does not affect only the person whose ‘condition’ has led to the labelling and emotional reactions, but members of his/her family, friends and even in some instances co-workers, neighbours, community and social group members. Based on the ostensible fear and other negative emotion attached to stigma, the ‘stigmatizers’ tend to extend those perceptions to anyone who is associated with the stigmatized. This is the main reason why families and those close (e.g. friends, co-workers, etc.) to the stigmatized are also sometime stigmatized and avoided. By extension, the stigmatized is usually avoided by others not only because of the perception of ‘possessing undesirable features/characteristics’ but also, the fear of being associated with him/her – the stigmatized person.
By implication, in the minds of ‘stigmatizers’, stigma is an ‘contagious/infectious disease’ hence the source must be avoided to prevent ‘contracting it’’- by analogy with COVID-19 recommended protocols, the avoidance is a form of hand-washing with soup, the use of sanitizers, wearing of face mask or even staying at home to avoid infection. Indeed, it can be argued forcefully that apart from the fear of contracting the covid-19, the fear of potential stigma by association – located in their neighbourhood – is one of the main reasons why some residents in parts of the country have resisted the attempt by the Ministry of Health (MoH) and the Ghana Health Service (GHS) to use certain state facilities in their communities as quarantine centres. The other angle of stigma being contagious is that as others learn (observe, hear, etc.) about how persons with certain features are categorized and treated, there is the tendency for some of those who heard and/or observed the behaviour to also do same given the opportunity – spread by imitating others.
This suggest that stigma is not necessary the result of direct ‘possession of any or some of the apparent undesirable and unwelcome’ physical, social, cognitive, neurological or life style characteristics (to be elaborated later under sources of stigma), but also by association. In effect, depending on one’s place of residence, the environment or society one finds him/herself in, one’s demographic characteristics and many other variables, individually and vicariously, almost every person in one way or the other, is at risk of stigma. On the basis of everyone as a potentially susceptible to one form of stigma or the other, I want you to ask yourself how you would have felt if anything about you or associated with you had been used to stigmatize you. If your response is negative, then make conscious efforts not to stigmatize anyone.
Sources of stigma [Why stigmatization?]: Physique
Stigmatization may arise from several sources including physique – one’s body types, physical appearance -, social group membership, cognitive and neurological impairment, health condition – illness or disease and personal choices and preferences. Unfortunately in many societies including Ghana, physical looks or appearance which deviates from the known and the expected range of ‘standards” whether as a result of congenital disease or otherwise is one of the attributes or characteristics use to stigmatize individuals and groups. In essence, persons who are physically challenged, visually impaired, have squinted eye(s), certain facial marks, of different skin colour such as condition of albinism, black, yellow, etc., persons who are very ‘fleshy’/’flabby’/’plump’, those who are very ‘lanky’/’skinny’, women with masculine body type or physique and excess hair on the face (beard-like and side facial hair), men with feminine body type or physique such as bigger than average male breast or stomach, lager than average male buttocks, or have any visible physical feature perceived to be ‘undesirable’ in one way or the other, are unfortunately, the main basis for perceiving others differently and consequently stigmatized and treated in ways that tend to dehumanize them. It must be emphasized that some of these features or sources tend to attract more stigma than others.
Social group membership, cognitive and neurological
Another set of features/characteristics used as reference point when it comes to stigma are social group membership, certain health condition and personal preferences. Social group membership includes race, ethnicity, religion, socio-economic status and profession. In the context of social groups, minorities of all categories tend to suffer most. Skin colour and other more visible features as in clothing as well as hair style, Islamic head gear – Hijab – are typical examples of outward appearances used to identify group membership for the purpose of stigma and other social categorizations. The social group membership which are not very conspicuous are mostly used by persons who are close to, know the target of stigma or find out through other means such public records.
Cognitive, neurological and related impairments include psychological ones usually referred to as mental illness; others are epileptic condition, hearing impairment, learning difficulties and the associated challenges and the inability to derived maximum benefits from formal education beyond certain academic level are other instances which are sources of stigma. Stuttering which is popularly referred to stammering and other speech difficulties also fall under characteristics which are sometimes used as a source of stigma. The above are some of the reasons which account for why some parents and families keep their children who suffer from certain conditions away from the public eye – an attempt to avoid stigmatization over one or more of the above sources.
Other health conditions and personal preferences
Traditionally, among almost all the sub-cultures in Ghana (especially among the Akans which I am reasonable well vest in), frowns upon the use a person’s health condition (especially the ones that arise from natural causes and accident) to degrade him/her under any situation and for any reason either directly or in a subtle way. Ironically, illness such as leprosy, Acquired Immunodeficiency Syndrome (AIDS) and in recent times, the novel coronavirus or COVID-19 are unfortunately perceived negatively and frown upon by a significant number of persons in many societies as sources of stigma. The interesting issue is that society does not even seem to draw a fine line between illness that may be associated with an apparent reckless life style and those that the individual may have very little or no control over. In effect, the moment an illness is tagged as dangerous, strange and therefore unwelcome, whoever becomes a victim automatically suffers the accompanying stigma and all the negativities associated with it.
Personal preferences and life style
Another interesting feature which is a target of stigma is personal choices in terms of lifestyles, manifested in personal appearances and other preference such as visible body tattoos, multiple piecing of the ears, males who plait their hair or wear dreadlocks, women who deliberately exposure their under-pant and beads are among those who are usually stigmatized. In Ghana persons of certain age bracket who are not married either by choice or otherwise are also sometimes stigmatized. Certain type of apparel and the way they are worn are also part of the category. Until recently females who prefer to dress like men and men who dress as women were all frown upon and indeed stigmatized. One other issue which is very sensitive and controversial in Ghana but seen as personal or individual choices and life style preferences in other countries is sexual orientation. Put differently, whereas any known gay or lesbian may be a subject of stigmatization in the country, that may not be the case in other countries especially where the practice has been legalized and also perceived as individuals choice. Indeed, it will be against the law is such jurisdictions to stigmatize any person on the basis of his/her sexual preferences. In other words, whereas there are some commonalities in the sources of stigma across the globe, there are also differences from one society or country to the other and sometimes variations within the same country.
Purposive stigmatization
In addition to these major categories, stigma may also emerge as a result of a deliberate attempt by an individual or a group to tag others with negativities and convert the stigmatized into special purpose vehicles. For instance, it has been argued forcefully that the tagging of blacks during the slave trade and colonization periods as lazy, unintelligent, backward looking and many other derogatory terms and phrases were all deliberately orchestrated by the slave beneficiaries and the colonizers to consign our great grandparents into slavery and menial jobs. In order to do so successfully, convince others and themselves and save their conscience, they constant catchphrase were ‘blacks are lazy’, ‘blacks are not good intellectually’, they do not have the ability for ‘academic and intellectually related program and professions’.
That is, through the lens of stigma the merchants, slave owners and colonial government were able to shrewdly kept blacks in certain socio-economic positions for a very long time. Similar arguments are sometimes advanced to justify the treatment meted out to some domestic assistants popularly referred to as house helps. Ironically, as is the case with the slaves and colonization, domestic assistants are very much ‘used’ to achieve a lot for those they work for, but some of them are despised – their end product is liked and cherished but not their person – a form of approach-avoidance.
Wiafe-Akenten, C. Brenya, PhD
Social Psychologist and a Senior Lecturer
Dept. of Psychology, Univ. of Ghana.