Critical Analysis of Leprosy Discriminatory Discourses and the Underpinning Social Constructs: The case of some leprosy affected

communities and families in Ethiopia

A Seminar Paper prepared on some selected topics in Applied Linguistics and communication BY DANIEL TAYE FEYISA

Introduction
Leprosy is a bacterial disease which causes damages

on the human body and results in discrimination. Discrimination by leprosy includes the production of various discourse and other mechanisms. Discrimination is an act of excluding members of another group from various social affairs. According to Goffman (1963), discrimination involves exclusion or restriction of members of one group from opportunities that are available to other groups.

It is also defined as an attitude, emotion or behavior towards members of a group which directly or indirectly implies some negativity

Background of the study

This research will be conducted in Ethiopia where

discrimination based on disease and disability is common . In addition, Gender, age, social background, ethnicity, economic status, health, religion, disability, feeding habit, political views, craft and traditional skills among others are sources of discriminations. A variety of discourses are produced, consumed and transmitted across the society in Ethiopia regarding the variables of discrimination mentioned above.

My intention is to uncover discriminatory discourses and the underpinning social constructs about leprosy. CDA researches have demonstrated that discriminatory approaches may be discovered to be embeded in discursive practices in the form of discreet linguistic strategies . These include implicit language contents underlie in structure or functions of language as indicated by Fairclough and Wodak, (1997) Gruber, (1997) Teo, (2000) vanDijks ,(1993 ,1995) and van Dijk and Smitherman-Donaldson, (1988) Wodak et al.,( 1999) .

 The implicit linguistic strategies used as the means of

exclusions have destructive effect on human relations. we should be curious of influence of linguistic and nonlinguistic strategies. Discriminatory discourses of leprosy is operetionalized in terms of social, economic, cultural, religious, power, and space occupied by the people affected by the disease.
According to the World Medical Association (WMA),

Leprosy is widespread public health problem, with approximately 250,000 new cases diagnosed annually worldwide.

 Leprosy is a disease that has been inadequately

addressed from the point of view of investments in research and medical treatment. WMA recommends every people to defend the right of the people affected with leprosy and members of their families.
WMA 62nd General Assembly; October 2011 http://xa.yimg.com/kq/groups name/WMA.pdf

According to Elizabeth (2010) there is a substantial

number of leprosy affected people in Ethiopia, though the country is lowering the new cases. In general, lowering the number of new cases does not mean that avoiding the discriminatory expressions about the disease.

1.2 Statement of the problem

Discriminations by using language expressions seem

reasonably prevalent in almost all societies of Ethiopia based on various discriminatory variables. One among discriminatory variables is disease /disability. Despite the presence of many sources of discrimination, I am interested in discriminatory discourses of leprosy as such discourses are critical to health communication of the victims of leprosy and their families. There are acts and regulations set by the Ethiopian government to address the problems of disabled people even by the application of affirmative actions.

 But the current generation seems sensitive

to adopt and reproduce discreet discriminatory discourses. (JICA), (2002 p. 24), indicated that leprosy accounted for 3.5 percent of the total disability records in the nation. As discriminations provoke social disorder, promote inequalities, cause intolerances and brings about instability , we need to critically deal with communication massages and the way they are used.

 Discourses may be the instruments that are

used for discrimination of leprosy affected individuals/community. People with disabilities may lose confidence due to the social practices and word attacks from their healthy counterparts. Researches on leprosy based discriminations regarding the use of linguistic expression is scant in Ethiopia and even in Africa. However, there are so many research works regarding healing the disease and controlling programs in general. It seems that people with leprosy and their family are discriminated not based on reality.

 As a result of the disabilities, individuals affected by

leprosy are more susceptible to stigmatized discourses. Visibility of wounds and ulcers can aggravate the fear of infection (Jopling, 1991; Seddon et al, 2006). Individuals affected by leprosy have experienced isolation and discrimination as they were rejected even by their families and hassled by community members to leave their villages (Shieh et al, 2006). In some societies, persons affected by leprosy are blamed for their condition, which is thought to be a punishment for something wrong they have done in their previous life. Seddon et al, (2006), considers this kind of perception as stigma that includes a moral judgment.

 People who do not have any signs of leprosy are still

stigmatized as they make contact with the victims and the impact weighs heavily on their lives. (Seddon et al, 2006). Discriminations are apparent through various discourses and social behaviors and inbuilt attitudes. This research is devoted to uncover linguistically and socially produced discriminatory discourses of disease and disability. I also hear some offensive expressions which belittle leprosy affected individuals. These noticeable actions of the society in general have motivated me to undertake this research

 Health communication education about leprosy

discriminatory discourses seem scant and consequently, prejudicial expressions may exist throughout. Here, little is known about the impact of discriminatory expressions and communications. Thus, this research will fill the gaps which are observed currently concerning social attitudes and prejudgments of leprosy affected families and communities in Ethiopia.

1.3 Justification of the study

There are several rationales to undertake this study. At the outset, the problems of disability discriminations has become natural and implicit. we innocently or deliberately use various mechanisms to discriminate other people with disabilities. Leprosy is the most open to stigmatizing discourses nationwide. Broad areas of leprosy discriminatory communication are unexplored . Segregation variables are either fabricated or exaggerated which this research is meant to uncover.

 The problems of a curable disease with

incurable stigmas require clarification and great social behavioral changes. Recovering from disease is not normally recovering from discrimination; the reason of that should be uncovered Health policy issues seem fail to recognize reduction of disease related talks, texts, funny narrations and other important concerns of ill health in general and disability in particular.

Objectives of the study

The research is aimed at uncovering the use of particular discourses , and socially inbuilt values to discriminate individuals affected by leprosy in general. It has the following specific objectives. To find out talks and texts used for disease &disability discrimination and critically analyze them To describe linguistic and non-linguistic strategies reflected to prejudge leprosy affected people To asses attitudes of lepers towards the social discourse attached to them

 To explore social practices which inculcate leprosy

discriminatory discourses via social semiotics To describe Styles and procedures of discriminatory discourses To explicate the implication of discriminatory discourses and social constructs about leprosy To examine preconditions for operationalizations of discriminatory discourses of leprosy.

1.5 Basic research questions

This research will answer the following basic research questions . 1. What are the beliefs inbuilt by the society about different types diseases? 2. How are diseases and disabilities perceived and represented? 3. What discourses are attached to leprosy? 4. Why have the discourses of leprosy continued to influence the mind of people? 5. What are social constructs attached to leprosy discourses?

6) How are/were discriminatory discourses produced and reproduced? 7) What are the historical narrations that encourage discriminatory discourses of leprosy? 8) How do the children and family of leprosy victims feel regarding the existing discriminatory expressions? 9) How do healthy counterparts perceive leprosy victims and their families? 10) What policy and initiatives are on the ground currently and what is the reality like?

1.7

Significance of the study

This research through its findings, will greatly contribute to

create appropriate communication strategies about diseases and disabilities. It is also significant to aware the societies about the harm of discriminatory expressions concerning leprosy and consequences of discriminatory discourses. When we speak or write, we have to design what we have to say to fit the situation in which we communicate James, P 2005 p-10). Discourses of disabilities need to fit to the situation of the individuals with disabilities. Discriminatory languages about infectious diseases are

 This research is a contribution to struggle

against discriminatory discourses, particularly disability discriminations of leprosy

Since critical discourse analysis method will be employed,

there is possibility of investigating social problems about leprosy. The stakeholders of health interventions would use the finding of the research for program or policy concern in their areas of involvement. This enables communication specialists or any person in communication to avoid harmful discourses. Studies were not conducted on discriminatory discourses of leprosy in Ethiopia.

 Hence, this work will be the first of its kind as

empirical research in the area of leprosy discrimination discourses. It will be helpful contribution to the field of health communication. It also reminds the concerned people that intervention of disease and disability need critical analysis of harmful discourses. The study will show the harms of discriminatory discourses of leprosy. People who engaged in using such discourse may abstain themselves from employing discriminatory discourses. Finally, the study is used to close the gap of knowledge about the discriminatory discourses related to diseases and disabilities. The health Communication gaps due to leprosy

1.8

Scope of the study

It would be important to include all leprosy affected areas across the globe to show the intensity of disease burden related to leprosy. However, due to time, financial and other restrictions, I would like to delimit the scope of my study to selected areas in Ethiopia. Some selected leper prevalent areas ; mainly : Zenebework memorial hospital ,in Addis Ababa, Kuyera around Shashmane ,Lalibela in Wollo and Bisdimo around Harar and other newlydiscovered areas (if available) will be under focus . Inclusiveness of all leprosy affected communities and families will be highly regarded to make the samples of the study representative.

 There are vast areas of discriminatory discourses

related to health and disability problems. This research deals with discriminatory discourses of leprosy in detail. Though the problem of discrimination and prejudicial discourses are global concern, I will cover selected areas in Ethiopia for previously mentioned reasons. This research will stick only to prejudiced expressions, societal attitudes, economic, and social discourse of the disease and disability. The medication of leprosy is not the concern of this study ,as health organizations and respective partners are doing a lot in the medications of leprosy.

1.9

Limitation of the study

Researches may not be devoid of drawbacks and obstacles that stand in the ways of researchers. Investigators must be curious and systematic to withstand limitations in order to conduct dependable research using limited recourses at hand. Some victims may be reluctant to offer information or it maybe difficult to get them in one place . The area of this study is new; as a result, there could be shortage of empirical researches to support it by rich literature. However, I will try to organize the literature from divers field of studies in order to make it comprehensive. Generalizing the result of the finding to every

2. Review of Related literatures

The reviews of related literatures for this study will be

about disease and disability discriminatory discourses. There are different theoretical perspectives that inform this study as CDA research depends on eclectic methodology . Related literature to this study will be organized from three view points: health discourse of leprosy, social discourses which are discriminatory and apparent through language expressions.

2.1. Leprosy related discriminations and their impacts

Discriminatory communications have impacts on patients in various ways. At the outset, it is an obstacle to good social relation. Secondly, the victims of such a disease might be hurt psychologically since they need love and affection from their healthy counterparts. In addition, they might also develop negative attitude towards those who discriminate them. Bainson et al (1998) and White, (2007) cited by Hagens (2007: p11) confirms the power of prejudice as: some patients identified with leprosy may hide their illness out of fear of rejection and exclusion from society.

 This may result in different problems of self isolation.

Firstly, the societies may develop antisocial behaviors as a result of self alienation done by the patients. Secondly, Patients may stop their treatment hastily out of fear for prejudice. Thirdly, they experience extreme physical changes due to side effects of medication. These physical changes may attract production of new discourse to describe individuals affected by leprosy. Here, the Emerging discourses about physical changes in the patients can be discriminatory. Discriminations due to the visible body changes have an impact on disease control programs.

 This is because, there might be conditions in

which people report the disease late due to stigma and because of that the opportunity for the transmission of the disease increases. It has impact on control efforts that it will have economic consequences. The living conditions of the person affected by leprosy might be complicated.

2.2 Why critical discourse analysis?

According to (Chouliaraki & Fairclough, 1999) the

typical vocabularies of many scholars in CDA reveal such notions of 'power, dominance, hegemony, ideology, class, gender, race, discrimination, interests, reproduction, institutions, social structure, and social order, in addition to the more familiar discourse analytical notions.' My interest in particular will be about social constructs and discriminatory discourses of diseases and disabilities.

CDA
Discourses and social semiotics are used to influence the

minds of people with disabilities. There are various ways in which power and dominance are involved in mind control. First, recipients tend to accept beliefs, knowledge, and opinions through discourse from what they see as convincing, truthful, or plausible sources in their social environment (Nesler et al. 1993). This affects the social behavior in general. Second, in some situations participants are obliged to be recipients of discourse, in socializing institutions.

CDA
Thirdly, in many situations there are no pubic

discourses or media that may provide information from which alternative beliefs maybe derived (Downing 1984). Addressees may not have the knowledge and beliefs required to challenge the discourses or information they are exposed to, (Wodak 1987).

CDA
Critical discourse analysis also focuses on how

discourse structures influence mental representations. Context based power derives from the fact that people understand and represent not only discourses, but also the whole communicative situation. to Martin Rojo and van Dijk (1997) ,Critical discourse analysis also focuses on how discourse structures influence mental representations.

CDA Though the societies are charitable to disabled and sick people, they have at least certain aversion of the individual with disabilities. This is because of the fact the social opinions are underpinning in its implicit premises and thus taken for granted by the recipients of discriminations ( Wodak and van Dijk 2000) .

CDA
As several discourses are produced, practiced,

represented regarding leprosy discrimination, we need to critically analyze the formation of discriminatory discourses and their power of mind control. Here, Leprosy related discriminations are reflected in various forms of discriminatory expressions in: social, cultural, religious , semiotics other social practices.

2.3 Experiences of some nations about leprosy

Various stories are told to describe leprosy and

leprosy affected people. Narratives of leprosy are prevalent in every nation where leprosy is common. Some countries approve rules that support isolation of individuals affected by leprosy. There are also situation in which people with leprosy are alienated from social institutions by the rules and acts leading to discrimination and productions of narrations and stories.

 For instance, section 19 (2) (B) of the Andhra Pradesh

Panchayati Raj Act 1994 of India prohibits dumb and deaf people, along with leprosy patients, from becoming candidates in panchayat elections. Here, inequality of opportunity is manifested through discrimination of disease and disability. Section 13 (1) (IV) of the Hindu Marriage Act 1955 states: Any marriage solemnized, whether before or after the commencement of this Act, may, on an appeal presented by either the husband or the wife, be dissolved by a decree of divorce on the ground that the other party has, for a period of not less than three years immediately preceding the presentation of the petition, been suffering from a virulent and incurable form of leprosy. www.leprosy review

 Deliberate discriminatory practices and inhuman

acts were committed in Korea sometimes in history. For instance, discrimination against people with leprosy has been recorded since the Joeson Dynasty 1910-1945 in Korea. History of leprosy issues revealed that, during the Japanese occupation of Korea, medical reasons were used to spread institutional discrimination and exclusion nationwide. In addition, social prejudice about the disease became more widespread and gained legitimacy through medical authorities.

 It can be reasoned that these policies were

substantial in influencing the mass murder of leprosy patients throughout Korea by civilians in the 1950s. Between 1945 and 1957, over 300 leprosy patients were murdered by hospital workers, police, army and civilians over 11 incidents. Sterilization and abortion practices from the Japanese occupation were persisted after liberation and they were huge inhumane acts on leprosy patients. According to an annual report by the Sorok Island Hospital in 1958, eleven hundreds and ninety-one leprosy patients received sterilization procedures from 1949 to 1958.

 The medical and institutional issues around leprosy have

been largely resolved these days. But the prejudice and discrimination in common society is deeply rooted. However, there has been a continuing effort to alter the terminology, and in December 1999, at a general meeting of the Korean National Assembly, a matter was passed to use the term Hansens Disease instead of the term leprosy (IDEA Korea; Jan, 2008:p14-43.) Some language expressions are discriminatory in their nature. Thus, distasteful figures of speeches employed as discriminatory discourses should be investigated and avoided. Otherwise, they should be changed to the pleasant and integrating discourses.

 In Ethiopia, discrimination is not clearly supported by law

and acts in the nations history. The segregations are still underlying in social practices. Ethiopians are kindhearted for any sick individuals or people with disability. Richard Pankhurst in Medical History (1984:28, 55) explained about leprosy discriminations as follows:

Legends and beliefs, helped to mould the

Ethiopian attitude to leprosy. Perhaps this is because of belief in the possibility of miraculous cures.

 Acts in the Fetaha Negest (Law of Kings) in the medieval period

prohibits the leper from being a priest due to the consideration that he would cause priests to be despised, presumably on account of the opprobrium with which the disease was popularly regarded. A leper was likewise excluded from being a patriarch, not, we are left to assume, by reason of any uncleanliness on his part, but because his complaint would prevent him from "associating with people under his jurisdiction. This act also works for one who was to be Judge. It was stated that a judge had to be free of leprosy, but, again, only because the infection would "keep away many people who have [to come] to see him".

Laws, constitutional acts and conventional agreement documents can make discourses of disease and disability known to the public. The current Ethiopian constitution article 41(5) encourages the equal treatment of people with disabilities and affirmative actions are implemented. The reality and possibility for treating each type of disability concept and social behaviors about the disabilities will be assessed and analyzed

2.4 Economic segregation of leprosy Victims

People affected by leprosy are also affected by economic problems. The common problems of leprosy are deformity and disability. These limit the participation of the victims in productions of items which contribute to support their livelihoods. For instance in Brazilpoverty, inequality, urbanization, low educational level and food shortage are known risk factors in Cear State, stigmas influence is unknown. Qualitatively, the Portuguese word lepra (leprosy) is synonymous with grotesque deformities.

 In So Paulo, women with leprosy, when compared with

men, are more often single, separated or divorced, live with family and children rather than husbands or partners, work in domestic occupations without benefits, have less education and attend religious cults ; 37.1% reject multi-drug therapy. Leprosy, by all accounts, is a demoralizing disease. People in general, might recognize disability as the source of poverty.

Dimensions and strategies of discrimination

Dimensions that match different types of stigmas: Concealable- level to which others can distinguish the stigma. Course of the mark- whether the indignity becomes more well-known over time. Disruptiveness- the degree to which the indignity gets in the way of social relations. Aesthetics others reactions to the indignity Origin- whether others think the stigma is present at birth, accidental, or deliberate. Peril- the apparent danger of the stigma to others. Jones, et al., (1984) and Jacoby (2005)

Discriminatory discourse strategies Below are lists of strategies with explanations: Scare tactics: the use of exaggerated figures and extensive attention to the alleged threat to the interests and privileges of the dominant group as a way to create panic and discredit the powerless group; Categorical generalization: generalized ascription to the minority group which is stereotyping or cognitively prejudiced; Positive self-presentation, as opposed to negative otherpresentation; Positive discrimination/self-justification: accusing the minority group for creating a burden of social resources as a way of justifying the majority groups discriminatory attitude;

 Problematization: to problematize issues concerning the

minority group such as immigration, residence, cultural conflicts, etc.; Blaming the victim: that the minority in question are to blame for causing conflicts or problems; Disclaimers: verbal denial of discrimination; and Mitigation: downtoning, minimizing or using euphemisms when describing the negative actions of the dominant group. Van Dijk cited in Flowerdew,etal (2002:325-9)

2.6 Semiotic representation of leprosy

Leprosy is signified by different expressions including

cultural items, connotations, denotations, myths and other mental representations.

According to Jewitt (2001:134) the social semiotics involves the

description of semiotic resources, what can be said and done with metaphors (and other visual means of communication). Semiotic resources in here qualify any symbol, indication, representation, or motto as something that is potentially meaningful. Representation embeded in language is also indicated by Kamler (2001:25) mentioning Hallidays theory of language as social semiotics. And said that language is seen as a mode of representation which constructs social realities, social identities and social relations as well as being constructed by them . Concerning CDA, social semiotics views language as a social practice.

3. Theoretical foundations
Theories are built in order to clarify, envisage and master

observable fact such as relationships, events, or the behavior. In several instances we build models of realities. This study employs diverse approaches; such as CDA, sociological theories of prejudice and discrimination ,grounded emergent theory , and theories which provide models of the conditions, unforeseen events and limit of human perception . General social theories that try to conceptualize the relations between social structure and social action in general are used as theoretical frameworks.

 Diverse theoretical approaches are employed to conduct studies

under CDA. Robyn Henderson (2005:p7) quoting (Fairclough 1989, 1992a, 2001b) presents the concepts as follows: CDA draws from post structuralism the view that discourse functions imaginatively on the whole local institutional sites and those texts have a constructive function in forming up and shaping human identities and actions. CDA also originates from the assumption that actual textual practices and interactions with texts become materialized forms of social capital with exchange value in particular social fields. Finally, it comes from neo-Marxist cultural theory with the assumption that discourses are produced and used that they thus produce and articulate broader ideological interests, social formations and movements

Research methods and design

Qualitative research methodology will be

employed in order to collect reliable and valid data to understand the social constructs that underpin discourse of leprosy stigma and prejudice, to critically analyze how stigma and discrimination manifest through language expressions, to study how the discriminatory discourses are produced, transformed oprationalized and consumed, to explore how discriminatory discourses of leprosy change through time and to investigate government policy on disease and disability discrimination

 qualitative research methodology will be employed

to undertake this study. However, it is difficult in general, to give a single definition of critical discourse analysis as a research method. It is eclectic that, it takes divers methodological developments. In this sense, discourse analysis is neither a qualitative nor a quantitative research method, but a manner of questioning the basic assumptions that determines the type of methodology ; according to some scholars like : (TUNE VAN DIJK 2007, Ruth Wodak 2008, Jorgensen and Louise ,Phillips, Fairclough and others) .

 These scholars also assure that, CDA enables us to

make assumptions explicit; discourse analysis aims at allowing us to view social problems from a higher position and to gain an inclusive view of others and ourselves in relation to those problems. For example, Van Dijk (2001) supports a theoretical discourse-cognition-society triangle in which societal discourses are contextually manipulated to deal with social problems.

 CDA looks at the discursive constructions that are found

in texts in relation to their contexts. Reisigl and Wodak (2001) assert this , as critical discourse analysts, we assume a dialectical relationship between particular discursive practices and the specific fields of action in which they are embedded. In my analysis of the implied discriminatory discourses , I am going to apply a CDA approach that is informed by social semiotics used in (Kress & van Leeuwen, 1996)

Reisigl and Wodak (2001), state that the discursive construction of us and them is the underpinning of prejudiced and racist perceptions and discourses. This discursive construction starts with the labeling of the social actors, proceeds to the generalization of negative attributions and then elaborates arguments to justify the exclusion of many and inclusion of some.

4.2 Population and sample of the study

The target population of this study is leprosy affected

people and their family in general and some selected areas mentioned in the scope of the study in particular. The total numbers of registered ex-leprosy patients will be drawn from valid sources that it enables me determine sample size to make it representative of the population. The communities adjacent to leper settlements will also be source of informationto respond to the survey questionnaires for attitude rating. Some selected public figures from social institutions: like religious organizations, health institutions and

4.3. Sampling techniques To gather data for this research, different sampling techniques will be employed based on the situation of data types required. The essential ones will be: availability (purposive) for patients, random sampling for survey questionnaires and the best sampling method will be determined accordingly in other cases. Number of respondents will also be determined based on the availability of willing leprosy patients and their families. However, the sample size of this study will be surely large to increase representativeness.

A. Data sources Both secondary and primary sources of data will be consulted to undertake this research. Primary sources like leprosy victims and their family, community in the adjacent areas, health institutions, and religious institutions and; secondary sources including story books on

B. Data collection tools

In-depth interview, focus group discussion, close ended survey questionnaires and informal talk will be the possible instruments. Dependability of information will be tested through by piloting the data collection instruments. C. Method of data analysis Data collected by various instruments will be analyzed qualitatively using the CDA method. Description, interpretation and explanation of social /personal experiences, social semiotics, labeling of physical objects, narrations of leprosy and etc, will be examined accordingly. The data will be sorted out (grouped), organized, coded,

4.3 Ethical review

Critical Discourse Analysis (CDA) is a highly context-sensitive, democratic approach which takes an ethical stance on social issues with the aim of improving society (Thomas N. Huckin 2002). Thus, it will be essential for those who involve in this research, to recognize their ethical consideration to prevent any harm to the participants, especially as the topic of research is of a sensitive area. Consent to take part will be gained from all participants and all participants will be assured of their anonymity and be free to withdraw from participation before the data is organized for writeup. Concerned bodies will also be asked for permission where necessary. Anything offensive to the leprosy affected respondents will not be expressed as standard expression (agreed upon) but will be said in pleasant manner as much as possible

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