MANAGING COMMUNICATION SURROUNDING TUNGIASIS STIGMA IN KENYA

Stephen Kimotho:  United States International University
Ann Neville Miller: University of Central Florida, Orlando, USA
Peter Ngure: African Population and Health Research Centre

DOI: 10.108  0/02500167.2015.1100646     Communicatio Volume 41 | Number 4 | 2015pp.523–542

Abstract

Tungiasis is a neglected parasitic skin disease widespread in resource-poor communities in sub-Saharan Africa, South America and the Caribbean. Stigmatisation of tungiasis sufferers has been identified as a key reason why tungiasis frequently progresses untreated in many parts of the world, however little research has investigated the specifics of tungiasis stigma or the communication strategies sufferers use to manage stigmatization. This article reports results of focus group and in-depth interviews regarding strategies used to manage tungiasis stigma from the perspective of persons living with tungiasis in Murang'a County, Kenya. Most frequently mentioned were withdrawal tactics. Participants also engaged in refutation strategies to deny responsibility for their condition. Implications for stigma management communication theory are discussed.

Introduction 

Tungiasis is a neglected parasitic skin disease common in resource-poor communities in sub-Saharan Africa, South America and the Caribbean. It is caused by a small reddish-brown sand flea, Tunga  penetrans  (T.  penetrans), which burrows into the host’s skin and lays up to a thousand fertilised eggs (Heukelbach and Ogbomoiko 2007; Heukelbach, De Oliveira and Hesse et al. 2001). In most cases T. penetrans infests the folds of the toes, inter-digital spaces, soles, heels, hands and knees (Chen, Thong and Jee 2011). In extreme infestations it can infect almost the entire body, leading to crippling disfigurement and ultimately death.  Besides physical suffering, individuals and family members of persons with tungiasis suffer from stigma and are often isolated by their societies (Heukelbach and Ugbomoiko, 2007; Njau, Wanzala and Mutugi et al. 2012). Although research has investigated the pathology and control of T. penetrans (Feldmeier and Heukelbach 2003;  Ugbomoiko, Ariza  and  Ofoezie  et  al.  2007),  few  studies  have  addressed characteristics of stigma in areas where the disease is endemic, or how infected persons communicate to manage that stigma. This research applied the tenets of stigma management communication theory (SMC – Meisenbach 2010) to explore these issues in Murang’a County, site of the highest tungiasis prevalence in Kenya. SMC predicts communicative coping mechanisms of stigmatised persons on the basis of their attitudes toward public perceptions of the stigmatised mark and its applicability to themselves, and provides a broad framework within which to analyse a range of communicative behaviours 

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Understanding the Nature of Stigma Communication Associated with Mental Illness in Africa

By Stephen Gichuhi Kimotho

United States International University – Africa, Kenya
DOI: 10.4018/978-1-5225-3808-0.ch002

Abstract 

Besides health and social costs, mentally ill, often, are also victims of stigma and discrimination, among many communities in Africa. Cultural beliefs, stereotypes are some of the social constructions used to perpetuate mental illness stigma. The purpose of this study was to describe the nature of stigma communication associated with mental illness, beliefs and stereotypes underpinning mental illness stigma. Generally, the findings indicate nature of mental illness stigma communication is an intersection of stigma messages, cultural beliefs, and stereotypes associated with mental illness. Cultural beliefs associated with mental illness are inextricably intertwined with the perceived causes of mental illness (which include curses, witchcraft, cultural misdemeanor, and possession by spirits or demons). Symptoms of mental illness (mainly aggression and nudity) mark the mentally ill as different and expose them to labeling by the rest of the community. Generally, the mentally ill are stereotyped as aggressive, symbol of shame, and unpredictable.

INTRODUCTION

Mental disorder places immense financial, psychological and social burden on family members of the persons with mental illnesses and ultimately have a significant impact on the family’s quality of life. WHO estimates that as many as 450 million people suffer from a mental disorder and nearly one million people commit suicide every year around the world. In addition, one in four families has at least one member with a mental disorder (World Health Organization, 2001).

Besides health and social costs, those suffering from mental illnesses, often, are also victims of human rights violations, stigma and discrimination, both inside and outside psychiatric institutions. Such stigmatization manifest through stereotyping, fear, embarrassment, anger, and rejection or avoidance. Among many communities, stigmatization of mentally ill is highly entrenched in the language and communication of the people and in various social interaction contexts. Understanding this, is important because this study is founded on the philosophical assumption that stigma and stigma communication are social constructions through language. Some of these social constructions used to perpetuate stigma associated with mental illness, among the members of different communities include: myths, cultural beliefs, stereotypes and misconceptions associated with mental illness.

Stigma and stigma communication associated with mental illnesses negatively affect the day-to-day lives of persons affected, leading to discrimination and the denial of even the most basic human rights. All over the world, people with mental disorders face unfair denial of employment and educational opportunities, and discrimination in health insurance and housing policies (Lasalvia, et al., 2013). Though a significant amount of research has been done on mental health, many studies have focused on measurement of mental illness (Van Brakel, 2006); coping strategies (Corrigan, & Miller, 2004) and others psychological outcomes. Despite these extensive research on mental health, mental illnesses continue to financially and socially torment millions of people in Africa because of the stigma, beliefs and stereotypes associated with mental illnesses. Nevertheless, little scholarly work has gone into analyzing the nature of stigma communication associated with mental illness or cultural beliefs and stereotypes underpinning such stigma in Africa. This study set out to fill this gap.

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WHAT IS STIGMA

Definition of Stigma. 
Stigma is a fairly elusive concept; scholars from various disciplines have defined and used the term in varied ways and for different purposes. Although there are some clear indicators of the social origins of stigmatisation and the factors that perpetuate it, a generally accepted unitary theory of stigma remains unavailable to date. Stigma, according to Goffman, refers to an attribute that is profoundly degrading, reducing the individual that possesses a particular trait from a whole to an aspersed and discredited one (Goffman, 1963), and consequently the person is socially disregarded. 

source: www.pbs.org

The gist of this approach is the understanding that stigma arises during a social interaction. By defining stigma as a spoiled identity, which means that a person is somehow not normal or accepted by society because of a physical disability, sign of immoral or nonconforming behaviour, or membership to a particular group, Goffman cast stigma as a social construction in which society determines which statuses deserve to be stigmatized (Smith, 2009).

Stigma Communication Associated With Mental Illness in Africa

Understanding the Nature of Stigma Communication Associated With Mental Illness in Africa: A Focus on Cultural Beliefsand Stereotypes

source www.pbs.org

Besides health and social costs, mentally ill, often, are also victims of stigma and discrimination, among many communities in Africa. Cultural beliefs, stereotypes are some of the social constructions used to perpetuate mental illness stigma.

The purpose of this study was to describe the nature of stigma communication associated with mental illness, beliefs and stereotypes underpinning mental illness stigma. Generally, the findings indicate nature of mental illness stigma communication is an intersection of stigma messages, cultural beliefs, and stereotypes associated with mental illness.

Cultural beliefs associated with mental illness are inextricably intertwined with the perceived causes of mental illness (which include curses, witchcraft, cultural misdemeanor, and possession by spirits or demons). Symptoms of mental illness (mainly aggression and nudity) mark the mentally ill as different and expose them to labeling by the rest of the community.

Generally, the mentally ill are stereotyped as aggressive, symbol of shame, and unpredictable.

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