Health Psychology. Michael Murray
area of Guatemala with two groups of women who had suffered from violence. It used a psychosocial and participatory approach to develop the use of sports and games as educational and therapeutic tools. The methods of movement, games and sports used in the project included physical (e.g., progressively increased physical activity of middle–low intensity, stretching and relaxation exercises) and psychosocial and educative activities (e.g., cooperative games, modified sports, role-play, verbalization of experiences and perceptions). A mixed method approach was used combining questionnaires, participatory observation and interviews to examine the effectiveness of the programme in promoting health.
Findings
Quantitative findings reflected improvements in a sense of coherence and self-esteem among participants. Results suggest that the programme provided opportunities for women who suffered from violence to socialize and offer mutual support. Modified sport, games and participatory group activities that were conducted in an active and enjoyable way also facilitated group interaction. By enabling participants to share their experiences of violence and domestic conflicts in a safe and protective space, they were able to express their feelings and to explore potential solutions with others. This process contributed to mutual learning and enabled participants to reconstruct their perceptions of the world and to reflect on how their circumstances could be improved.
Conclusion
Using a psychosocial and culturally grounded use of games and sports as participatory tools may be useful in promoting health in the context of violence and conflict.
Source: Ley and Rato Barrio (2013)
People with poor health may also suffer from an increased vulnerability to human rights violations due to their fragile state. The stigma associated with their condition may increase their vulnerability to discrimination and maltreatment, as discussed below.
Stigma
Stigma refers to unfavourable reactions towards people when they are perceived to possess attributes that are denigrated. Stigmatization is universal; it is found in all cultures throughout history. The majority of people will experience it at some time, as both the young and the elderly are stigmatized groups. In addition, people can be multiply stigmatized, as in the case of HIV infection and AIDS, which is associated with certain highly stigmatized groups (e.g., homosexuals, sex workers, intravenous drug users) and adds a further source of stigma as well as intensifying existing stigma(s) (see Chapter 22). Stigma involves a pattern of discrediting, discounting, degradation and discrimination, directed at stigmatized people and extending to their significant others, close associates and social groups. Link and Phelan (2014) used the term ‘stigma power’ to refer to instances whereby exploitation, control and exclusion of others enable people to obtain what they want. They argued that stigmatization is most effective in achieving its prejudiced aims when it is hidden or ‘misrecognized’.
Stigmatization devalues the whole person, ascribing them a negative identity that persists (Miles, 1981) even when the basis of the stigma disappears (e.g., when someone recovers from mental illness they remain characterized forever as a person who had mental health problems). It is a form of social oppression and operates to disqualify and marginalize stigmatized individuals from full social acceptance and participation. Health care professionals are as likely to stigmatize as any other group, influencing their behaviour and decision-making in the provision of health care. The consequences of stigma include physical and psychological abuse, denial of economic and employment opportunities, non-seeking or restricted access to services, and social ostracism. It is not surprising, then, that individuals frequently expend considerable effort to combat stigmatization and manage their identities, including passing (acting as if they do not have the stigmatized attribute), covering (de-emphasizing difference), resistance (e.g., speaking out against discrimination) and withdrawal. They may also internalize the stigmatization, feeling considerable guilt and shame and devaluing themselves. Kadianaki (2014) argued that coping with stigma could be seen as a meaning-making effort to enable those who are being stigmatized to transform the way they see themselves and to orient themselves in society.
The pervasive Western idealization of physical perfection, independence and beauty may play an important role in the constant devaluation of disabled people and people who are ill. Particular characteristics of illness or disablement increase stigmatization, including perceptions that the condition is the person’s own fault (e.g., obesity), is incurable and/or degenerative (e.g., Alzheimer’s disease), is intrusive, compromises mobility, is contagious (e.g., HIV infection and AIDS) and is highly visible.
The lower value placed on the lives of disabled people can be seen in the way disabled people are segregated from the general population, including in education, housing, employment and transportation. It is also apparent in the way crimes against disabled people are minimized (e.g., discourses of abuse rather than theft/fraud/rape; acquittals and light sentences in cases of ‘acceptable’ euthanasia). For both disabled people and those with severe or terminal illness, stigma may be central to debates around suicide/euthanasia and abortion (see below). Stigma is a powerful determinant of social control and exclusion. By devaluing certain individuals and groups, society can excuse itself for making decisions about the rationing of resources (e.g., HIV antiretroviral drugs), services (e.g., health insurance exclusions), research funding/efforts and care (e.g., denying operations to individuals who are obese) to these groups. In terms of the social model of disablement, stigmatization may be the main issue concerning disablement.
Multidisciplinary research is needed to further explore how stigma is related to health, disablement and social justice. Why is recognition of the similarities between stigmatized and non-stigmatized individuals overridden and obscured by perceived differences that are devalued? How do different stigmas, particularly health-related stigmas, interact? How is stigma manifested by health care professionals and what interventions might mitigate the negative effects of stigma?
Lives Worth Living versus the Right to die
The pervasive devaluation of people with disabilities, and the negative assumptions about their lower quality of life, are central to the current debates about the abortion of impaired foetuses and the legalization of assisted suicide/euthanasia or the right to die. Disablement rights organizations champion the argument that abortion decisions should not be made on the basis of foetal impairment indicators, whereas they challenge the ‘right-to-die’ rhetoric on the basis of disablement.
The disablement movement argues against abortion on the grounds of potential impairment due to the eugenic implications of such a practice (Sharpe and Earle, 2002). The reason for their concern is encapsulated in Singer’s quote: ‘the killing of a defective infant is not morally equivalent to the killing of a person; very often it is not morally wrong at all’ (Singer, 1993: 184). The new genetic testing and selection technologies allow the identification of suspected foetal impairment during pregnancy and subsequent foetal termination. Shakespeare (1998: 669) argues that such technologies operate as a weak form of eugenics ‘via non-coercive individual choices’ based on the assumed unacceptable quality of life of disabled people. The rationales for screening and termination include assumptions that people with disabilities are more costly to society, that the lives of children with disabilities are harmful to their families, and that some impairments involve a level of suffering and misery that makes life not worth living.
The way professionals describe test results and the influence of the advice they give is also a concern. There is substantial evidence that the advice given, while often subtle, most frequently encourages termination in response to potential impairment results, and most testing takes place within a plan-to-abort context. There is a tension between this argument and the feminist position that women have a categorical right to make decisions about their own bodies, including the decision to terminate an unwanted pregnancy. However, the disablement movement position is not against abortion itself; rather, it revolves around the basis upon which the decision is made. Aborting a specific foetus on the basis of a devalued attribute is different from aborting any foetus on the