As a broad inclusive category, and from a strict constructionist perspective, disability exists only in locally specific relation to Western European notions of medicalization, employment, and welfare (Groce, 1999; Whyte & Ingstad, 1995). Yet, some range of physical and behavioral differences are recognized in all societies and there are often social consequences that follow from this recognition. While it is of paramount importance to elucidate local contexts, knowledge, and responses in the study of these differences (Devlieger, 1999; Groce, 1999; Ingstad, 1999b), anthropology is a comparative discipline and in their research on impairment-disability cross-culturally, anthropologists implicitly or explicitly make comparisons between the local worlds of their informants and their own usually Western European or North American societies. This can prove difficult given the variation in cultural conceptualizations of bodily and behavioral differences.
This brief review uses Mary Douglas's (1966) notion of anomaly, "matter out of place," as a baseline concept to orient a comparative approach. This notion has been widely acknowledged by many anthropologists and cultural theorists as providing a starting point from which to begin to understand the cultural meanings and implications of these kind of differences (see, e.g., Murphy, 1987; Shakespeare, 1994; Shuttleworth, 2000b; Stiker, 1999a, 1999b; Thompson, 1997; Whyte, 1995b). Of a different order than liminality, "matter out of place is a culturally constituted perception" that does not fit within recognized cultural categories "and not a phase in a (ritual) process" (Shuttleworth, 2000b, p. 80). Douglas views anomaly as inherently threatening to the social order. Devlieger (1999) refers to disability as an interstitial category, which adds a structural component to the concept of liminality. This section considers the kinds of bodily and behavioral differences perceived as anomalous in a range of societies and the various social responses to these differences. The question of how to define disability-related terminology will be explicitly addressed in a later section, but for now it is enough to mention that much of the research reported on below does not often sustain an effort to analytically distinguish between anomalous bodily and behavioral differences from impairment and disability.
In terms of body and behavior, any out of the ordinary manifestation may be perceived as anomalous. This does not necessarily mean that people exhibiting certain recognized differences will either be stigmatized or viewed as sacred (Rosing, 1999; see also Douglas, 1966). Ingstad (1999a) makes the observation that in many societies "physical and mental impairment is not necessarily what determines the status and inclusion of a person More important are family and kinship ties, competence in doing useful tasks for the good of the household, and the ability to behave in a socially acceptable manner" (p. 757). For example, Marshall (1996) notes that among societies of the Caroline Islands in Micronesia "individuals impaired from birth defects, accidents, or diseases are not necessarily considered disabled unless the impairment is coupled with an inability to speak and/or hear; that is with an inability to manipulate culture and to participate in the social life of the community" (p. 254). These Micronesian societies appear not to stigmatize people with many kinds of physical impairments, as long as one is personally and culturally competent.
Much depends on the interplay of beliefs, social expectations, and economic imperatives of the particular society as to whether some bodily or behavioral anomaly will be considered a disability (Groce, 1999). For example, in China today the ability to be active and mobile outside the home in terms of public life and also in one's livelihood is highly prized. Combined with ideas about national development and mobility and the Confucian emphasis that transmutes bodily imperfection into social meaning, men who have difficulty walking experience stigma and discrimination (Kohrman, 2000, n.d.). Here cultural beliefs, social and gender expectations, and also economics conspire and contribute to the creation of an identity based on a negatively perceived bodily difference. In some less modernized societies the situation may be entirely different, as alternative tasks and roles are found that contribute to the group. As Scheer and Groce (1988) state, "although specific occupations or trades might be closed to a disabled person because of his or her specific impairment (such as hunting to a mobility impaired man), there seems no single role or group of roles to which most disabled adults are limited" (p. 29).
Negative social consequences can range from mild stigmatization through infanticide. For example, among the Shona of Zimbabwe, Burck (1999) reports that children who get their upper teeth first are considered seriously disabled and this has lifelong consequences. A 1980 survey on leprosy in Nepal found that a majority of persons would separate family members who got leprosy, and a third said they would put them out of the village. Ten years later in 1990, there was little change in expectations (Hyland, 2000). Turmusani (1999a, 1999b) reports widespread negative social attitudes toward physically disabled people in Jordan resulting in charity, the attribution of cognitive impairment, and an asexuality (not unlike some of the attitudes and responses in the United States). The birth of twins constitutes a social disgrace among the
Punan Bah and one of them is usually given away or withers away (Nicolaisen, 1995). Similar data exist from other societies including those in the past. Dasen (1993), for example, states that in Greco-Roman Egypt protection against evil by oracles was sought in the case of multiple births. The extreme exclusionary practice of infanticide occurs in some societies (see, e.g., Devlieger, 2000; Scheer & Groce, 1988). Although not as widespread as previously thought, neglect of impaired infants is usually not included as infantacide (Scheer & Groce, 1988; see also Scheper-Hughes, 1990, 1992). The most common justification across cultures for infanticide, as Scheer and Groce (1988) state, is the "belief in the linkage between evil spirits and/or parental misconduct" (p. 28). Yet, as Talle (1995) notes, integration is not necessarily always the answer. Among the Maasai, children with an impairment are treated the same as other children, given the same food, ritual blessings, ceremonial procedures, and level of support. However, the lack of special treatment often results in early death (p. 67).
On the other hand, some physical and behavioral differences in various societies can be accorded positive significance of a sacred or trans-personal character. For example, Rosing (1999) maintains that among the Quecha-speaking people in the Kallawaya region of the Bolivian Andes, they do not necessarily perceive people who are blind or with crippled hands, among other differences, as disabled. She notes that "there is initially a culturally defined, positively evaluated area of meaning which can be seen as a cultural resource" (p. 38). If other personal, social, internal, and external resources are met, such as reciprocity and exchange, and personal representation by some personal object is fulfilled, then "disabling characteristics" may be perceived not as illness, impairment, and disability but of vocation, sometimes of a trans-personal concept. One example Rosing provides is of a blind man who is ascribed a type of trans-personal vision, which allows him to see the unseen.
Many bodily and behavioral differences recognized as anomalous in other societies, such as the birth of twins and upper teeth coming in first, are not especially important to societies influenced by Western European orientations. In fact, this points to a significant difference noted by some cross-cultural researchers: lack of perceived function seems to be the core negative meaning that characterizes an impairment-disability in the latter societies (Burck, 1999). The extreme version of this, of course, is the biomedical model of impairment-disability. In many societies, however, other ethnophysiological or ethnopsy-chological concepts or indices may be highlighted instead of or in addition to function. For example, among the Shona, "dryness of the affected part" (presumably) within their humoral system, is the essential factor in determining disability (Burck, 1999, p. 203). In addition, in many non-Western societies, interpreting fault often takes precedence over assigning blame to the individual or wanting to improve the individual's condition or situation (Devlieger, 1995). As Devlieger notes, "The idea of rehabilitation as a continuous effort of improving and accommodating the living conditions of persons with disabilities is basically a Western idea that is foreign to Songye thought" (p. 95).
All societies recognize and respond to cognitive differences and erratic behavior. However, Nicolaisen (1995) says the Punan Bah do not hold the mentally impaired responsible for their situation (see also Marshall, 1996). Epilepsy and madness are caused by non-human spirits who invade or partly take over the body, relegating the soul of the body to a secondary position. Effort is made by families to cure madness by way of spirit mediums. Persons so affected are regarded as dangerous only if violent. For the most part, effort is made to include them as part of regular social relationships. On the other hand, for the Hubeer stupidity and madness are viewed as similar to infertility and death and the mentally impaired are often treated with abuse outside of their family (Helander, 1995, p. 89). Talle (1995) states that among the Kenya Maasai mentally retarded or mad persons are regarded not as disabled in a physical sense but as "abnormal" ("fool"). Nicolaisen (1995) echoes an observation made by many cross-cultural researchers that some forms of severe cognitive difference such as severe forms of mental retardation, "... among the Punan Bah. I suspect that children born with such impairments 'wither away' .or die at an early age" (p. 44).
Examining a particular social context within a society can further reveal that those with certain physical and behavioral differences may encounter restricted access. Anthropologists often note in their studies of impairment-disability in other societies that physical and/or cognitive impairment does not necessarily determine status and exclusion, that family and kinship ties are more important (see, e.g., Ingstad, 1999). What are we then to make of the fact that in the context of sexual and/or marriage negotiation and family formation, it has also paradoxically been observed that people with bodily and behavioral differences often encounter difficulties in a range of societies (see, e.g., Ablon, 1984, 1995, 1999; Devlieger, 1995; Fassin, 1991; Guldin, 1999, 2000; Kohrman, n.d.; Nicolaisen, 1995; Sentumbwe, 1995; Shuttleworth, 2000a, 2000b)? This is not to say that impaired people are always excluded from these institutions and activities (see, e.g., Guldin, 1999, 2000; Sentumbwe, 1995; Shakespeare, Gillespie-Sells, & Davies, 1996; Shuttleworth, 2000b; Wolf & Dukepoo, 1969). However, impairment or some other ethnophysio-logical or ethnopsychological indicator interacting with differences of gender, class, etc. will often be significant in determining negative cultural beliefs, social expectations, and responses regarding sexual and/or marriage negotiation and family formation for people with certain bodily and behavioral differences.
Joan Ablon (1996), for example, exploring the differential access to intimacy and sexual experiences for men and women with neurofibromatosis found that two thirds of the women she interviewed were married, as opposed to only one third of the men. The single men in her sample were much less likely to have had sexual experiences than the women. Ablon notes the persistence of women in finding a partner. She hypothesizes that they continue strategizing to connect with a man because in U.S. society women are socialized to be interpersonal communicators. However, the lack of achievement by many of the men, due to early learning disabilities and social failures, negatively impacts their gender identity, which significantly contributes to their social withdrawal. Nayinda Sentumbwe working in Uganda (Sentumbwe, 1995), provides another instance: he found that cultural beliefs that blindness is incapacitating contributed to the fact that sighted men will have sexual relations with blind women and/or keep them as mistresses but rarely marry them because of their desire for a domestically competent wife. This dynamic was missing for blind Ugandan men who would often marry sighted women. Matthew Kohrman's (2000) research on disabled men in China provides a somewhat different example: for men with mobility impairments and their families, during negotiations for a wife, they must continually negotiate downward in terms of the social position of their prospective partner, which indicates to them their diminished social value and disabled identity.
What is interesting to note is that, as alluded to above, exclusion from the primary institutions of marriage and/or family or from effectively negotiating sexual intimacy with others often occurs in many societies for people with certain physical and behavioral differences, despite their being accorded other aspects of personhood. One must question anthropological observers who report that disabled people are well integrated into a society and yet cannot negotiate sex, marry, and/or form a family. Despite the importance of detailed views of how well particular sociocultural contexts do or do not integrate people with culturally recognized physical/behavioral differences, we need this kind of in-depth information for multiple contexts within a society and across many societies in order to perform effective cross-cultural analyses.
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