3. The Generation of Negative Attitudes
3.1. The social construction of disability
Accepted ways of thinking, reacting and doing business become firmly embedded in society and can be remarkably resistant to change. Negative attitudes can become institutionalised: "We often see the impact of negative attitudes in how one person treats another. But negative attitudes are also the foundation stone on which disabling policies and services are built. Harmful attitudes that limit and restrict are institutionalised in policies and services and so maintain the historic disadvantage that disabled people have faced" (Massie, 2006).
A major reason proposed for negative social attitudes, resulting in the denial of basic values and rights/conditions, is the way disability is portrayed and interpreted in society. Biklen (1987) and Taylor et al (1993) identified social construction of disability as a barrier to social inclusion. At community level negative attitudes can become structured into social patterns of segregation and discrimination. The theory of social construction attempts to explain the process by which knowledge is created and assumed as reality (Douglas, 1970 cited by Devine, 1997).The theory asserts that meanings are created, learned and shared by people and then reflected in their behaviour, attitudes and language (Devine 1997 citing Berger et al, 1966).
Particular social constructions of disability portray people with disabilities as "other" and not as an integral part of the 'normal' world. Negative attitudes and behaviours develop from this 'worldview'. In the last two decades disability rights activists and academics have highlighted cultural and environmental factors that marginalise people with disabilities, denying them basic values and the accompanying basic rights/conditions. This social model of disability places a person's impairment in the context of social and environmental factors, which create disabling barriers to participation (Oliver, 1990). This social model of disability approach suggests that the root of disability lies in a failure of the environment to allow someone to function to his/her full capacity as much as in any functional impairment that the person may have.
Highlighting the marginalisation of people with disabilities through cultural and environmental factors does not mean that impairment is denied. Impairment is an objective concept and means that aspects of a person's body do not function or function with difficulty (Crow, 1996). However, when impairment is taken a step further to imply that a person's body, the person and the person's worth is inferior to that of others, then there is an interpretation that is socially created and is therefore not fixed or inevitable (Crow, 1996). Crow argues that one can think of impairment in three, related, ways. First there is the objective concept of impairment. Second, there is the individual interpretation of the subjective experience of impairment. Finally, there is the impact of the wider social context upon impairment, in which misrepresentation, exclusion and discrimination combine to disable people with impairments. It is this third aspect of impairment which is not inevitable. Such socially constructed interpretations and meanings are not fixed or inevitable and can therefore be replaced with alternative interpretations (Crow, 1996).
Gleeson (2006) has attempted to de-construct 'discourses of what is considered normal i.e."normalcy". In the NDA Research Conference in Dublin in 2006 she describes how a powerful but narrow and rigid set of thinking called 'normal' arises and how structures and systems are then organised around this thinking. Reviewing research carried out by people with disabilities Gleeson found that
- Fear and power under-gird relationships with disability
- Vulnerability to illness and death are feared and unconsciously that fear is projected onto people with disability
- Fear turns in to power in that unconsciously people with disabilities are treated as not normal and our projection is reflected in social structures which further isolate and marginalize them
- From an early age we are socialised into thinking about 'normal' and 'not normal' categories of people and consider those categories to be true or natural
- As soon as we begin to see as small children we become aware that we can also be seen by others and, accompanying this realisation, is the 'pressure' of conforming to social expectations (Gleeson citing Berger, 1972)
- Bodies are pressured to conform to an 'ideal', for example, the size zero dynamic
- Everyday visual imagery consolidates a narrow category of normal particularly in relations to how bodies should look and behave (Gleeson, 2006)
The social construction of disability represents a basis from which barriers to inclusion of people with disabilities are created (Devine, 1997 citing Olkin et al, 1994).As a result of the social construction of disability, people with disabilities experience decreased expectations by people without disabilities and limited inclusion in society (Devine, 1997 citing Bogdan et al, 1992; Safilios Rothschild, 1976). Understanding social constructions can help to explain why people with disabilities have been sidelined and discriminated against and also can draw attention to what needs to be done to eliminate negative attitudes. New interpretations of impairment and disability can be informed by the experience of impairment of people with disabilities; by facilitating their rightful participation in mainstream activities and by the recognition and defence of the common values of autonomy/self-determination, equality, dignity, social justice and diversity that are rooted in every person and of the rights that flow from them.
3.2. Low expectations
Morris (2005) considers two common attitudes that create enormous barriers to participation. Firstly, that people with disabilities are commonly considered to be in need of care and this undermines peoples' ability to see people with disabilities as autonomous people." We are not recognised as actors in community participation but as recipients of other peoples community participation". Secondly, people with disabilities are often treated as not belonging to the communities in which they live. These attitudes stem from particular social constructions.
Devine (1997) cites Funk (1987) who said that the social construction of disability is responsible for creating images of people with disabilities as "pathetic figures in need of pity, charity and caretaking" (p.25). Society prescribes a set of standards for functional independence, capabilities and social reciprocity. When people's functioning or biological composition does not fall within these standards, they are assumed to be inferior and are subject to a decrease in inclusion in society (Devine, 1997 citing Allen et al, 1995; Bogdan et al, 1987 and Hahn, 1988). Devine (1997) cite Hey et al (1984) who believe that the social construction of disability is at the root of the stereotype that all people with disabilities are helpless.
In the Department of Work and Pensions, UK, 'Disabled for Life': attitudes towards, and experiences of, disability in Britain Survey (Grewal et al, 2002), 1 in 3 people believe that disabled people cannot lead a full life due to their health problems; 1 in 5 people believe that in general disabled people cannot be as effective at work as their non-disabled colleagues; more than 1 in 4 people admitted they would feel uncomfortable and embarrassed in an encounter with a deaf person using British Sign Language; and 1 in 4 people confessed they would go out of their way to avoid an encounter with someone experiencing mental illness.
"Possibly the most damaging consistent response to disability is simply the low expectations that we have of disabled people and for them and, as a consequence, that many have for themselves. We don't expect that people with significant levels of impairment will work, so when such people present themselves for a job, the experience is novel and employers naturally worry about their productivity, the likelihood of lots of sick leave, whether they will disrupt normal working practices, or put the customers off. Of course the expectation creates the reality - the apparent absence of disabled people from boardrooms and public life fosters low aspirations and expectations.' How could I ever climb that high?' This is both because people who have obvious visible impairments often aren't there and because people with invisible impairments have the rather dubious luxury of hushing it up... but at what personal cost? (Massie, 2006)"
Genesi (2007) cites Van Der Klift et al (1994) "When disability is seen as the largest component of a person, much of what is unique and "human" about him or her will be obscured. When needs and deficits are what we see, we only see what that person cannot do" (p. 339). Genesi also cites Marks (1997) who states the following regarding inclusive education, "A major shift in how we think about disabilities is necessary for we cannot truly include all children until we value all people" (p. 126). Singer (2001) cites Lown (1996) who uses Mann's classical quote: that we must behave as if the world was created for all human beings. Lown argues for the importance of adequate human etiquette in relationships where people meet as equals. McConkey et al (1983) suggest that people must first change their beliefs about themselves before they change their attitudes to others.
3.3. Lack of visibility, ignorance and fear
In research commissioned by the NDA, Strategic Options for influencing public attitudes towards people with disabilities (NDA, 2004), both focus groups conducted in the research (one focus group composed of people with disabilities and the second composed of their friends and family) considered that, historically, the primary reason for negative attitudes and perceptions to disability in Ireland was the lack of visibility and integration of people with a disability in mainstream society. This lack of integration resulted in a marginalisation of those with a disability and an ignorance and fear on the part of people stemming from their inexperience of learning, living or working alongside people with disabilities.
In the quantitative element of the UK survey, 'Disabled for Life': attitudes towards, and experiences of, disability in Britain (Grewal et al, 2002), 2064 respondents were surveyed of which 47% had a disability. The majority surveyed, both those with and without a disability, thought that the primary reasons for prejudice against people with disability, which they considered common, were fear of difference, lack of awareness and ignorance.
The Social Exclusion Unit's inquiry (2004) into the experiences of people with mental health problems found rejection, or fear of rejection by the community to the most important cause of this group's social exclusion.
Negative attitudes structured into discrimination and exclusion at the community level mean that people with disabilities and particularly those with mental health problems can be marginalized economically, segregated and be prone to further mental health problems due to this exclusion and rejection (Singer 2001 citing Carling 1995).
Discrimination and exclusion are rooted in fear and stereotyping, reinforced by a lack of personal contact (http://www.realising-potential.org).
3.4. Stigma, stereotyping and prejudice
Stigma as a concept is imprecise. It involves attitudes, feelings and behaviours (Morgan et al, 2002 as cited by Nolan et al, 2006).
Nolan et al (2006) cite a number of definitions of stigma including the following:
- "A sign of disgrace or discredit which sets a person apart from others" (Byrne 2000 p.65)
- "A societal reaction which singles out certain attributes, evaluates them as undesirable and devalues the person who possess them" (Miles, 1981, p. 70)
- "Some attribute or characteristic, that conveys a social identity that is devalued in a particular social context" (Crocker et al, 1998, p505)
- The co-occurrence of its components - labelling, stereotyping, separation, status loss and discrimination - further indicate that for stigmatisation to occur, power must be exercised (Link et al, 2001, p. 363)
- A special kind of relationship between attribute and stereotype... attribute that is deeply discrediting...Reduces the bearer... from a whole and usual person to a tainted, discounted one... We believe that a person with a stigma is not quite human ..." (Goffman, 1963, pp 14-16)
Stigma can leave people marginalized and excluded from their own community. It can stop people with ability getting the jobs that are qualified to do leaving them dependent on state benefits (McKeever, 2006). Stigma can cause individuals with mental illnesses to be discriminated against and to be mistreated and may even contribute to some people with mental disorders to refuse to seek help for their disorder, which prevents them for receiving necessary treatments.
Stigma against people with disabilities often includes stereotyping based on misperceptions. A stereotype is a form of social typing, which has the potential to be misleading, as it does not acknowledge variability (Nolan et al, 2006). Misperceptions of people with mental illness e.g., include that it is shameful to be mentally ill, that people with mental illnesses are violent and dangerous, or that people with mental illnesses cannot live with the rest of society. "When we say that a person is stigmatised because they have mental illness, we mean that others make harsh judgements about them based on their beliefs about the nature of mental illness and not about the person's abilities, personality or unique traits" (McKeever, 2006).
Stigmatisation has internal and external consequences. It impacts on peoples' quality of life and social and psychological well-being. It causes stress, anxiety and further stigma. It causes reduced acceptance, discrimination, rejection and social exclusion. It causes label avoidance and makes it difficult to pursue employment or access to services. It can result in a lowering of self-esteem and self-efficacy (Nolan et al, 2006). People who perceive themselves as stigmatised may internalise stigmatising ideas (Graham et al, 2003 cited by Nolan et al, 2006). Stigma coping mechanisms include 1) avoidance-withdrawal, 2) education and 3) secrecy (Goffman, 1963 and Link et al, 1991 as cited by Nolan et al, 2006). Social embarrassment can result in people isolating themselves. Denial and pretence can be a means of self-protection but can also lead to reduced supports as help may not be sought or offered (Nolan et al, 2006).
"The British Social Attitudes Survey of 2000 found that 35 per cent of the respondents think there is 'a lot' of prejudice against disabled people; 51 per cent think there is 'a little' and only 3 per cent think there is 'no' prejudice in the society. Yet, few people are willing to admit that they themselves are prejudiced and so it is difficult to measure. Evidence from different scenarios, however, from the classroom to the bus stop, illustrate a wide range of unhelpful or aggressive attitudes towards disabled people, which often vary according to type of impairment or health condition, and according to ethnic origin, age and gender" (Massie, 2006).
Pettigrew et al (2000, 2003), cited by Hewstone (2003), aggregated the effects of contact over 516 studies and reported a highly significant relationship between contact and prejudice - the more contact the less prejudice. Affective ties including forming close friendships appear to be the most effective in reducing prejudice (Hewstone 2003 citing Hamberger et al, 1997 and Pettigrew, 1997). Approximately 21% of the effect of contact reducing prejudice is mediated by contact also reducing anxiety (Hewstone, 2003 citing research by Pettigrew et al, 2003).
Old stereotypes and misunderstandings of disability need to be replaced by new social constructions. Until this happens it is difficult to establish societies where public representatives and ordinary citizens alike systematically take diversity into account and welcome and cater for differences so that people with disabilities are supported as required to access the basic conditions required to live as free and responsible citizens. A range of activities and interventions can promote the reformulation of meanings and these are explored in section 4 and 5 of this literature review.