Stigmatization: Consequential issues and the way forward. Part 2

Part 1 of this article discussed the meaning, target and sources of stigma with emphasis on physique, social group membership, cognitive and neurological factors and life style preferences. This part takes a look at the manifestations and effects of stigmatization with particular reference to labelling, discrimination, anxiety and emotions with special emphasis on Ghana specific cases.

Manifestation and effects of stigma: Labelling, discrimination and social exclusion

The adverse effects of stigma [tization] are numerous and go beyond the stigmatized individual to include his/her family, friends, co-workers and many others. The effect may be transient, short or long term or permanent depending on family and/or professional support, the individual’s personality, resilience and other factors. One of the unfortunate manifestations of stigmatization is labelling, name-calling, finger-pointing and taunting. Either explicitly or in a subtle way, individuals who are stigmatized experience this on regular basis in their daily lives some of which are sometime very hostile and aggressive. This in turn often leads to differential treatment in the form of restrictions, avoiding, scorn, ignoring and even abandonment. In some instances, the stigmatized may be denied services that are readily available to others. If these continue for some time it may lead to socio-phobia and subsequent withdrawal from social settings and social engagements and may even result in self-isolation. This is because the stigmatized may be emotionally uncomfortable and psychologically apprehensive in interaction with others even if they are accepted within that circle or environment. Indirectly the above may lead to self-imposed restriction on one’s right of freedom of movement, association and choice.

Anxiety, depression, suicidal thoughts and denial of rights

When name calling, avoidance and other forms of discrimination mentioned above increases, the level of anxiety of stigmatized persons are also likely to increase and if they do not get help or are not able to manage, it could lead to depression. High levels of anxiety or depression can also affect one’s ability to perform at the optimal level hence stigmatization could lead to lower than expected work out put – declined performance. Furthermore, a link has been found between suicidal ideation/thoughts/plans and levels of anxiety hence as the stigmatized experience more anxiety, it predisposes them not only to the contemplating of suicide, but the act of suicide itself. The other resultant effect of stigmatization is the potential refusal of landlords/ladies to rent their rooms and/or apartments/houses to individuals who fall into any of the stigmatized categories.

Furthermore, when the source(s) of the stigma comes up when one is already a tenant some landlords/landladies and even some tenants may put pressure on the individual to leave the house. Indeed, there have been instances where landlords/ladies have adapted unorthodox means to get a person affected by stigma out of their house. Stigmatization may also lead to denial of job/employment, other economic opportunities, education, health and other entitled services. Some stigmatized persons are sometimes refused the right to marriage from certain families. The apparent rejection, spite and discrimination on the basis of stigma also have the tendency to lower the self-worth, self-esteem and self-efficacy of the individual and may lead to inferiority complex.

Differential opportunities, self-fulfilling prophesy and internalization

Depending on the nature and the source of stigma, it sometimes leads to segregated institution for the stigmatized and another for the ‘normal’ mainly of the basis of the perceived or contrived difference. In the case of children it deprives them of the opportunity to interact, learn from and grow up within the context of their peers leading to differential experiences and opportunities from the onset. Stigma also predispose individual and groups to a psychological concept known as self-fulfilling prophesy – the tendency for individuals to act in line with what they are tagged with. Essentially, the more the negativity, the more likely that some of the stigmatized will act as such to fulfil what you and I (society) have predicted for and expected of them. Though some persons may take negative tagging as a challenge and work hard to proof the contrary, a good number of such persons end up as expected by society.

In the light of this, parents, teacher and other child care providers in particular should be extremely careful about negatively tagging children as the latter tend to easily and quickly internalize labels adult assign to them – usually accept as factual, imbibe and sometime act out.. Internalized stigma is thus a related concept which reinforces self-fulfilling prophesy. When internalization sets in, the individual gets to a point where he/she accepts them as his/her fate. When this happens, the individual blames him/herself for all the negativities. Whenever you hear someone says, ‘haven’t you heard everyone saying that I am so so and so, I will proof to you that indeed I am’. Such person is most likely exhibiting a combined effects of self-fulfilling prophesy and internalized stigma, tagged racism as the case may be.

Emotional reactions

Stigma evokes emotional responses such as righteous anger – a justifiable anger from the point of view of the stigmatized and ironically a similar justifiable anger from the stigmatizer. In this instance, the stigmatized has reason to believe that there is no reasonable cause for him/her to be unfairly treated and become a target of ridicule. – ‘I am human as you so why treat me this way?’ On the other hand, the stigmatizer may also find it difficult to understand why the stigmatized feels disturbed or angry for the former’s reaction to him/her. ‘You are not accepted and welcome here so why come around?’ ‘Don’t you see/understand that you are different and dangerous?’ Each of the two parties has reason to believe that they are right and this can lead to confrontation. Closely related to the above is the issue of objectification – the tendency to perceive a person, in this case the stigmatized, as an object rather than as a fellow human being to be treated with decorum as we would expect or require from others.

Another adverse effect of stigma is that because of the rejection, it may act as a source of inhibition which may prevent individuals from seeking medical or psychological help when they really need it. In the specific case of COVID-19, some persons who are experiencing the symptoms may not only hide it from others, but may also not seek professional help. If this happens it has a high potential of increasing spread and lead to more pressure on the health system and may also lead to high fatality rate. Depending on the individual’s resilience and other factors, the psycho-social, emotional and other effects of stigma may be experienced briefly but for others it may have long term effects including those that can last for the rest of one’s life time.  Either way, stigma can lead to psychological challenges in addition to negatively affecting the fight against COVI-19 or as the case may be.

Ghana specific cases of COVID-19 stigmatization

Among the reported cases of stigmatization in Ghana in relating to COVID-19 are those from Accra, Tema, Gomua and Bolgatanga. It is likely that several others have happened elsewhere within the country unreported. In almost all these instances, all the unfortunate adverse effects discussed earlier in this piece have manifested – rejection by relatives and friends, neighbours and the larger community; avoidance, name calling and varied forms of discrimination. It could be inferred from the interviews the affected persons granted and played by multimedia outlets in particular, 3FM and other media houses that the stigmatized have also experienced and continue to experience some level of anxiety and apprehension. In these Ghana specific cases, there are also about four issues that seem to be somewhat peculiar and must be given more attention. These are; boycott or avoidance of businesses of the affected persons, Face book post, stoning and the nature of some of the calls received. The first issue is that all the recovered persons interviewed who are self-employed have reported that their customers/clients/patrons and others who get to know of their status with regard to COVID-19 have refused to patronise their wares and services. Very unfortunate! Imagine yourself in their position or shoe – to use the popular Ghanaian parlance.

Face book post and atoning

This is not only unfortunate but could also lead to the collapse of their businesses if the situation does not change sooner or they do not relocate to another town or city – a completely new environment. Those who are in the formal sector employment also feel very uncomfortable going to work as they are not sure what type of reception awaits them.The second issue is the report by the marriage couple from Bolgatanga that someone posted on Face book that they have been tested positive for COVID-19. Though it was factual it was unethical and an unacceptable invasion of privacy and propagation of other person’s misfortune. If this action is criminal or against the law then, the person who posted it must be tracked by the cybercrime unit of the Ghana Police Service, arraign before the law court and if found guilty, made to face the prescribed sanctions to serve as deterrent to others. That is how callous some people can be. The third issue is the most unfortunate report of stoning (or attempted stoning) of the daughter of the couple who were tested positive to COVID-19. Even though the child herself had not been tested positive, but by extension and association (as alluded to earlier) with the two – husband and wife, her parents, – she has also suffered from almost all the worst forms and dimensions (physical, psycho-social and emotional) of stigmatization.

Discouraging calls and rejection by friends

Finally, according to the lady in Bolgatanga, some family, friends and others whose identity she did not know, called and instead of wishing her speedy recovery as per our tradition, they rather ridiculed and taunted her for testing positive to the virus. This unfortunate incident goes to reinforce a joke in our dear country which indicates that a typical Ghanaian’s happiest moment is when someone gets into trouble. This is wickedness at its peak – more than the devil. The husband also reported that he could not go to their popular spot where his friends meet because he was not welcome there. Yes, not welcome at where he has all along met with friends to play and have fun. These are some of the stuck realities on the ground for those who are known to have tested positive to COVID-19 and/or recovered hence the Ministry of Information (MoI), National Emergency Respond Team, (NERT) and other relevant state institutions especially the National Commission for Civic Education (NCCE) as well as Non-governmental organizations must act swiftly to prevent the situation from escalating. These persons need psychological support as well as some financial assistance in the face of boycott of their businesses and for that matter, their means of livelihood.

Wiafe-Akenten, C. Brenya, PhD

Social Psychologist and a Senior Lecturer

Dept. of Psychology, Univ. of Ghana.