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  1.  James I. Charlton, Nothing About Us Without Us: Disability, Oppression and Empowerment. (Berkeley: U of California 

Press, 2000), p. 8. See also Lennard Davis, Enforcing Normalcy: Disability, Deafness, and the Body (London: Verso, 1995), 

p. 7.

  2. World 

Health 


fi gures quoted in Dying for Growth: Global Inequality and the Health of the Poor, ed. Jim Young Kim et al, 

(Monroe, Maine: Common Courage Press, 2000), p 4.

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127

Universal Design



  3.  Paul Farmer, “Introduction.” Global AIDS: Myths and Facts.(Cambridge: South End Press, 2003), p. xvii.

  4.  Dying for Growth, p. 25.

  5. Louise 

Bourgault, 

Playing for Life: Performance in Africa in the Age of AIDS. (Durham: Carolina Academic Press, 2003), 

p. 261.


  6.  James Charlton, “Th

  e Disability Rights Movement as a Counter-Hegemonic Popular Social Movement.” Unpublished 

MS, p. 5. See also David Levi Strauss, “Broken Wings,” in Between the Eyes: Essays on Photography and Politics (New York: 

Aperture, 2003), pp. 56–64.



  7. Nayan 

Shah, 


Contagious Divides: Epidemics and Race in San Francisco’s Chinatown (Berkeley: U of California Press, 

2001).


  8.  Chris Holden and Peter Beresford, “Globalization and Disability,” Disability Studies Today, ed. Colin Barnes, Mike Oliver, 

and Len Barton (London: Polity Press, 2002), p. 194.



  9.  On “structural violence,” see Johan Galtung, “Violence, Peace and Peace Research.” Journal of Peace Research 3 (1969), 

p. 171. See also Dying for Growth (pp. 102-4) and Paul Farmer, Pathologies of Power: Health, Human Rights, and the New 

War on the Poor (Berkeley: U of California Press, 2003), pp. 29–50.

 10. Th

  is ad appeared in Scientifi c American 231:1 (July 1974), p. 9.



 11.  See, for example, Lennard Davis, Bending Over Backwards: Disability, Dismodernism and Other Diffi

  cult Positions (New 

York: New York U Press, 2002), p. 25.

 12.  For discussions of global disability from a social science perspective see the following: Brigitte Holzer, Arthur Vreede, 

Gabriele Weight, ed. Disability in Diff erent Cultures: Refl ections on Local Concepts (New Brunswick: Transaction Publishers, 

1999); Benedicte Ingstad and Susan Reynolds Whyte, ed. Disability and Culture (Berkeley: U of California Press, 1995); 

Mark Priestley, ed. Disability and the Life Course: Global Perspectives (Cambridge: Cambridge U Press, 2001). 



 13.  J. Hanks quoted in Colin Barnes and Geof Mercer, Disability (London: Polity Press, 2003), p. 135.

 14. Arjun 

Appadurai, 

Modernity at Large: Cultural Dimensions of Globalization (Minneapolis: U of Minnesota Press 1996), 

p. 33.


 15. Keith 

Wailoo, 


Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill: U of North 

Carolina Press, 2001), p. 6. On the “space” of disease, see Keith Wailoo, “Inventing the Heterozygote: Molecular Biology, 

Racial Identity, and the Narratives of Sickle Cell Disease, Tay-Sachs, and Cystic Fibrosis.” Race, Nature, and the Politics 

of Diff erence, ed. Donald S. Moore, Jake Kosek, and Anand Pandian (Durham: Duke U Press, 2004), pp. 236-53. Charles 

Rosenberg and Janet Golden, eds. Framing Disease: Studies in Cultural History (New Brunswick: Rutgers U Press, 1992).

 16.  Howard Frumkin, Mauricio Hernandez-Avila, Felipe Espinsoa Torres, “Maquiladoras: A Case Study of Free Trade Zones.” 

Occupational and Environmental Health 1.2 (April/June, 1995): 96-109. See also Joel Brenner, Jennifer Ross, Janie Sim-

mons, and Sarah Zaidi, “Neoliberal Trade and Investment and the Health of Maquiladora Workers on the U.S.-Mexico 

Border.” Dying for Growth, pp. 261–90.



 17. Keith 

Wailoo, 


Dying in the City of the Blues, 10–11.

 18.  David T. Mitchell and Sharon L. Snyder, Narrative Prosthesis: Disability and the Dependencies of Discourse (Ann Arbor: 

U of Michigan Press, 2001).



 19. Ato 

Quayson, 

Calibrations, p. 117.

 20.   See, for example, David Held and Anthony McGrew, ed. Th

  e Global Transformations Reader: An Introduction to the 

Globalization Debate (Cambridge: Polity, 2000); Jim Young Kim, et al, Dying for Growth; Rob Wilson and Wimal Dis-

sanayake, ed. Global/Local: Cultural Production and the Transnational Imaginary (Durham: Duke U Press, 1996; Amitava 

Kumar, ed. World Bank Literature (Minneapolis: U of Minnesota Press, 2003); Fredric Jameson and Masao Miyoshi, ed. 

Th

  e Cultures of Globalization (Durham: Duke U Press, 1999; Joseph E. Stiglitz, Globalization and its Discontents (New 



York: Norton, 2003).

 21. Gillian 

Hart, 


Disabling Globalization: Places of Power in Post-Apartheid South Africa (Berkeley: U of California Press, 

2002).


 22. Richard 

Wolff , “World Bank / Class Blindness,” World Bank Literature, ed. Amitava Kumar (Minneapolis: U of Minnesota 

Press, 2003), pp. 174–83.

 23.  Walt Bogdanich and Eric Koli, “2 Paths of Bayer Drug in 80’s: Riskier Type Went Overseas.” New York Times (May 22, 

2003), C5.



 24.  In contrast, Cuba initiated an HIV screening program early, once it was suspected that HIV was blood borne. According 

to Paul Farmer, in 1983 Cuba “banned the importation of factor VIII and other hemo-derivatives, and the Ministry of 

Public Health ordered the destruction of twenty thousand units of blood product.” Th

  ese actions have resulted in Cuba’s 

having one of the lowest incidence of HIV infection in the western hemisphere. Farmer, Pathologies of Power, 70.

 25.  Nuria Homedes, “Th

  e Disability-Adjusted Life Year (DALY) Defi nition, Measurement and Potential Use.” Human Capital 

Development and Operations Policy Working Papers available at http://www.worldbank.org/html/extdr/hnp/hddfl ash/

workp/wp_00068.html, 3. See also David Wasserman et al. eds. Quality of Life and Human Diff erence (Cambridge: Cam-

bridge U Press, 2005).

 26. Homedes, 

8.

 27.  Nirmala Erevelles, “Disability in the New World Order: Th

  e Political Economy of World Bank Intervention in (Post/

Neo)colonial Context.” (Unpublished manuscript, p. 5)

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Michael Davidson

128


 28. Th

  is aspect of globalization is developed in Lisa Lowe, “Th

  e Metaphoricity of Globalization.” Unpublished MS, p. 3. I am 

grateful to Professor Lowe for allowing me to see this unpublished manuscript.



 29.  On the 1994 devaluation, see Manthia Diawara, “Toward a Regional Imaginary in Africa.” World Bank Literature, p. 

65.


 30.  On the cultural function of West African markets, see Diawara, pp. 73–80.

 31.  Nancy Sheper-Hughes, “Th

  e End of the Body: Th

  e Global Traffi

  c in Organs for Transplant Surgery,” available at http://

www.sunsite.berkeley.edu/biotech/organsswatch/pages/cadraft .html

 32.  Lawrence Cohen, “Where it Hurts: Indian Material for an Ethics of Organ Transplantation.” Daedalus 128:4 (Fall, 1999), 

pp. 4–5.


 33.  On rumor and organ traffi

  cking see Scheper-Hughes, “Th

 eft  of Life: Th

  e Globalization of Organ Stealing Rumours.” An-

thropology Today, vol. 12, no. 3 (June, 1996), pp. 3–11; Claudia Castaneda, Figurations: Child, Bodies, Worlds (Durham: 

Duke U Press, 2002)..



 34. Manjula 

Padmanabhan, 

Harvest. Postcolonial Plays: An Anthology, Ed. Helen Gilbert (London: Routledge, 2001), pp. 

214–49.


 35. Stephen 

Frears, 


Dirty Pretty Th

 ings (Miramax and BBC Films, 2003).



 36. On 

Th

  eatre for Development, see African Th



  eatre in Development, ed. Martin Banham, James Gibbs, Femi Osofi san, 

ed.(Bloomington, U of Indiana Press, 1999); Politics and Performance: Th

  eatre, Poetry and Song in Southern Africa, ed. 

Liz Gunner (Johannesburg: Witwatersrand U Press, 2001); Louise M. Bourgault, Playing for Life: Performance in Africa 

in the Age of AIDS (Durham: Caroline Academic Press, 2003). 

 37.  “Yiriba” is discussed in Louise Bourgault, Playing for Life: Performance in Africa in the Age of AIDS, pp. 132–38. A CD-

ROM accompanies the book that includes clips of plays, dances, songs, and “edutainment” performances.



 38.  Bourgault, p. 137.

 39. James 

Cliff ord, Routes: Travel and Translation in the Late Twentieth-Century (Cambridge: Harvard U Press, 1997).



 40.  Documentation of judicial responses to the ADA can be seen in Backlash Against the ADA: Reinterpreting Disability 

Rights, Linda Hamilton Kriger, ed. (Ann Arbor: U of Michigan Press, 2003).



 41. Nancy 

Fraser, 


Justice Interruptus: Critical Refl ections on the ‘Postsocialist’ Condition (New York: Routledge, 1997), p. 12.

 42.  Michael Berube, “Citizenship and Disability.” Dissent (Spring, 2003), p. 3.

 43.  Berube, p. 3.

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Part III

Stigma and Illness

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131

10

Selections from Stigma



Erving Goffman

Stigma and Social Identity

Th

  e Greeks, who were apparently strong on visual aids, originated the term stigma to refer to bodily 



signs designed to expose something unusual and bad about the moral status of the signifi er. Th

 e signs 

were cut or burnt into the body and advertised that the bearer was a slave, a criminal, or a traitor—a 

blemished person, ritually polluted, to be avoided, especially in public places. Later, in Christian 

times, two layers of metaphor were added to the term: the fi rst referred to bodily signs of holy grace 

that took the form of eruptive blossoms on the skin; the second, a medical allusion to this religious 

allusion, referred to bodily signs of physical disorder. Today the term is widely used in something 

like the original literal sense, but is applied more to the disgrace itself than to the bodily evidence of 

it. Furthermore, shift s have occurred in the kinds of disgrace that arouse concern. Students, however, 

have made little eff ort to describe the structural preconditions of stigma, or even to provide a defi ni-

tion of the concept itself. It seems necessary, therefore, to try at the beginning to sketch in some very 

general assumptions and defi nitions.



Preliminary Conceptions

Society establishes the means of categorizing persons and the complement of attributes felt to be or-

dinary and natural for members of each of these categories. Social settings establish the categories of 

persons likely to be encountered there. Th

  e routines of social intercourse in established settings allow 

us to deal with anticipated others without special attention or thought. When a stranger comes into 

our presence, then, fi rst appearances are likely to enable us to anticipate hxs category and attributes, 

his “social identity”—to use a term that is better than “social status” because personal attributes such 

as “honesty” are involved, as well as structural ones, like “occupation.” We lean on these anticipations 

that we have, transforming them into normative expectations, into righteously presented demands. 

Typically, we do not become aware that we have made these demands or aware of what they are until 

an active question arises as to whether or not they will be fulfi lled. It is then that we are likely to realize 

that all along we had been making certain assumptions as to what the individual before us ought to 

be. Th


  us, the demands we make might better be called demands made “in eff ect” and the character 

we impute to the individual might better be seen as an imputation made in potential retrospect—a 

characterization “in eff ect,” a virtual social identity. Th

  e category and attributes he could in fact be 

proved to possess will be called his actual social identity.

While the stranger is present before us, evidence can arise of his possessing an attribute that makes 

him diff erent from others in the category of persons available for him to be, and of a less desirable 

kind—in the extreme, a person who is quite thoroughly bad, or dangerous, or weak. He is thus re-

duced in our minds from a whole and usual person to a tainted, discounted one. Such an attribute 

is a stigma, especially when its discrediting eff ect is very extensive; sometimes it is also called a fail-

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Erving Goffman

132


ing, a shortcoming, a handicap. It constitutes a special discrepancy between virtual and actual social 

identity. Note that there are other types of discrepancy between virtual and actual social identity, for 

example the kind that causes us to reclassify an individual from one socially anticipated category to 

a diff erent but equally well-anticipated one, and the kind that causes us to alter our estimation of the 

individual upward. Note, too, that not all undesirable attributes are at issue, but only those which are 

incongruous with our stereotype of what a given type of individual should be.

Th

  e term stigma, then, will be used to refer to an attribute that is deeply discrediting, but it should 



be seen that a language of relationships, not attributes, is really needed. An attribute that stigmatizes 

one type of possessor can confi rm the usualness of another, and therefore is neither creditable nor 

discreditable as a thing in itself. For example, some jobs in America cause holders without the expected 

college education to conceal this fact; other jobs, however, can lead the few of their holders who have 

a higher education to keep this a secret, lest they be marked as failures and outsiders. Similarly, a 

middle class boy may feel no compunction in being seen going to the library; a professional criminal

however, writes:

I can remember before now on more than one occasion, for instance, going into a public library near 

where I was living, and looking over my shoulder a couple of times before I actually went in just to 

make sure no one who knew me was standing about and seeing me do it.

1

So, too, an individual who desires to fi ght for his country may conceal a physical defect, lest his 



claimed physical status be discredited; later, the same individual, embittered and trying to get out of 

the army, may succeed in gaining admission to the army hospital, where he would be discredited if 

discovered in not really having an acute sickness.

2

 A stigma, then, is really a special kind of relation-



ship between attribute and stereotype, although I don’t propose to continue to say so, in part because 

there are important attributes that almost everywhere in our society are discrediting.

Th

  e term stigma and its synonyms conceal a double perspective: does the stigmatized individual 



assume his diff erentness is known about already or is evident on the spot, or does he assume it is nei-

ther known about by those present nor immediately perceivable by them? In the fi rst case one deals 

with the plight of the discredited, in the second with that of the discreditable. Th

  is is an important 

diff erence, even though a particular stigmatized individual is likely to have experience with both 

situations. I will begin with the situation of the discredited and move on to the discreditable but not 

always separate the two.

Th

  ree grossly diff erent types of stigma may be mentioned. First there are abominations of the 



body—the various physical deformities. Next there are blemishes of individual character perceived 

as weak will, domineering or unnatural passions, treacherous and rigid beliefs, and dishonesty, these 

being inferred from a known record of, for example, mental disorder, imprisonment, addiction, 

alcoholism, homosexuality, unemployment, suicidal attempts, and radical political behavior. Finally 

there are the tribal stigma of race, nation, and religion, these being stigma that can be transmitted 

through lineages and equally contaminate all members of a family.

3

 In all of these various instances 



of stigma, however, including those the Greeks had in mind, the same sociological features are found: 

an individual who might have been received easily in ordinary social intercourse possesses a trait that 

can obtrude itself upon attention and turn those of us whom he meets away from him, breaking the 

claim that his other attributes have on us. He possesses a stigma, an undesired diff erentness from what 

we had anticipated. We and those who do not depart negatively from the particular expectations at 

issue I shall call the normals.

Th

  e attitudes we normals have toward a person with a stigma and the actions we take in regard to 



him, are well known, since these responses are what benevolent social action is designed to soft en and 

ameliorate. By defi nition, of course, we believe the person with a stigma is not quite human. On this 

assumption we exercise varieties of discrimination, through which we eff ectively, if oft en unthinkingly, 

reduce his life chances. We construct a stigma-theory, an ideology to explain his inferiority and ac-

count for the danger he represents, sometimes rationalizing an animosity based on other diff erences, 

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133

Selections from Stigma

such as those of social class.

4

 We use specifi c stigma terms such as cripple, bastard, moron in our 



daily discourse as a source of metaphor and imagery, typically without giving thought to the original 

meaning.


5

 We tend to impute a wide range of imperfections on the basis of the original one,

6

 and at 


the same time to impute some desirable but undesired attributes, oft en of a supernatural cast, such 

as “sixth sense,” or “understanding”:

7

For some, there may be a hesitancy about touching or steering the blind, while for others, the perceived 



failure to see may be generalized into a gestalt of disability, so that the individual shouts at the blind 

as if they were deaf or attempts to lift  them as if they were crippled. Th

  ose confronting the blind may 

have a whole range of belief that is anchored in the stereotype. For instance, they think they are sub-

ject to unique judgment, assuming the blinded individual draws on special channels of information 

unavailable to others.

8

Further, we may perceive his defensive response to his situation as a direct expression of his defect, 



and then see both defect and response as just retribution for something he or his parents or his tribe 

did, and hence a justifi cation of the way we treat him.

9

Now turn from the normal to the person he is normal against. It seems generally true that members 



of a social category may strongly support a standard of judgment that they and others agree does not 

directly apply to them. Th

  us it is that a businessman may demand womanly behavior from females 

or ascetic behavior from monks, and not construe himself as someone who ought to realize either 

of these styles of conduct. Th

  e distinction is between realizing a norm and merely supporting it. Th

 e 

issue of stigma does not arise here, but only where there is some expectation on all sides that those in 



a given category should not only support a particular norm but also realize it.

Also, it seems possible for an individual to fail to live up to what we eff ectively demand of him, 

and yet be relatively untouched by this failure; insulated by his alienation, protected by identity beliefs 

of his own, he feels that he is a full-fl edged normal human being, and that we are the ones who are 

not quite human. He bears a stigma but does not seem to be impressed or repentant about doing so. 

Th

  is possibility is celebrated in exemplary tales about Mennonites, Gypsies, shameless scoundrels, 



and very orthodox Jews.

In America at present, however, separate systems of honor seem to be on the decline. Th

 e stig-

matized individual tends to hold the same beliefs about identity that we do; this is a pivotal fact. His 

deepest feelings about what he is may be his sense of being a “normal person,” a human being like 

anyone else, a person, therefore, who deserves a fair chance and a fair break.

10

 (Actually, however 



phrased, he bases his claims not on what he thinks is due everyone, but only everyone of a selected 

social category into which he unquestionably fi ts, for example, anyone of his age, sex, profession, and 

so forth.) Yet he may perceive, usually quite correctly, that whatever others profess, they do not really 

“accept” him and are not ready to make contact with him on “equal grounds.”

11

 Further, the standards 



he has incorporated from the wider society equip him to be intimately alive to what others see as his 

failing, inevitably causing him, if only for moments, to agree that he does indeed fall short of what 


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