Dignity and Health PDF
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& Dignity He a lth N O R A J ACO B S O N Dignity anD HEaLtH Dign i t y and H E a Lt H Nora Jacobson Vanderbilt University Press nashville © 2012 by Nora Jacobson Published by Vanderbilt University Press Nashville, Tennessee 37235 All rights reserved First printing 2012 This book is printed on acid-free paper. Manufactured in the United States of America Library of Congress Cataloging-in-Publication Data on file LC control number 2012003426 Dewey class number 174.2—dc23 ISBN 978-0-8265-1861-3 (cloth) ISBN 978-0-8265-1862-0 (paperback) ISBN 978-0-8265-1863-7 (e-book) ContEnts Acknowledgments vii Introduction: A Conceptual, Practical, and Moral Inquiry 1 1 Dignity Violation: A Universe of Human Suffering 21 2 The Structures That Deny Dignity 51 3 An Epidemiology of Damage 87 4 Dignity Promotion: The Ordinary Language of Respect 119 5 The Demands of Dignity 157 References 199 Index 215 aCknowLEDgmEnts It has been a privilege to have had time over the last seven years to think and to write about dignity. I greatly appreciate the re- search funding I received from the Social Sciences and Humanities Research Council of Canada and the sabbatical support provided by the Mary Beck Professional Development Fund at the Centre for Ad- diction and Mental Health in Toronto. I thank Paula Goering for fa- cilitating a leave I took during the first eight months of 2010 to write this book. I am lucky to have shared this undertaking with a number of talented students: Michael Chan gathered literature right at the begin- ning. Diego Silva wrote a paper with me close to the end. Andrew Koch made important contributions to the design and conduct of interviews and to the early stages of analysis. Vanessa Oliver, whose engagement was the most sustained, extending over a period of several years, was an indispensable partner throughout the project’s data collection, initial analysis, and early dissemination phases. I hope Michael, Diego, An- drew, and Vanessa find some of their own intellectual enthusiasm and their compassion reflected in these pages. I am grateful to the people who assisted with study recruitment—for example, the agency man- agers who allowed us to post flyers or to use their spaces to conduct interviews. Many researchers and scholars have asked important ques- tions or offered me good opportunities, and in these ways spurred me to do more careful and comprehensive work. I am thinking especially of Vanessa Johnston and Claire Hooker in Australia and Janecke Thesen and Kirsti Malterud in Norway. I thank all the people who attended conference presentations or seminars or my talks to service providers. I’m sure their observations and questions taught me more than I ever conveyed to them. vii viii Dignity and Health I have also valued the contributions of family, friends, and col- leagues. I would like to single out for special acknowledgment my mother, Dolly Jacobson, who saw from the beginning just how compel- ling a topic dignity is; Suzanne Ross, who listened so attentively to a synopsis of this book during a long, snowy training run we took in Feb- ruary 2010, and continued to ask about it even after race day; and Dale Butterill, whose question during an early presentation of my work in progress helped open up a whole new area for analysis. My association with Carrie Clark and the other members of the dignity working group at the Centre for Addiction and Mental Health showed me some of the ways in which my conceptual thinking might begin to be made prac- tical. For their work during the publication process, I thank Michael Ames and his staff at Vanderbilt University Press, including managing editor Ed Huddleston, freelance copy editor and indexer Peg Duthie, design and production manager Dariel Mayer, and the two anonymous reviewers whose comments did much to improve my presentation of the material in this book. Finally, I would know very little about dig- nity without the generosity of the men and women who agreed to speak about it. This book will have been successful if it goes some way toward portraying the resonant complexity of dignity in their lives. introDuCtion a ConCEptuaL, praCtiCaL, anD moraL inquiry Dignity exists in a state of some peril. It can be “taken away.” Men and women can be “deprived” of their dignity. The verbs people used when they spoke to us about dignity indicate that these threats come in many different forms. Dignity may be “challenged” or “compromised” or “offended.” It can be “upset” or “undermined.” It can be “stolen,” “crushed,” “punctured,” “eroded,” “stripped,” “assaulted,” or “snuffed out.” In some circumstances, it may be “given away.” People may “posture,” putting on a dignified face to hide a felt lack of dig- nity. Yet dignity is also malleable in positive ways. It can be “achieved” (from within) and “cultivated” or “fostered” (from without). Individuals or groups may act and interact in ways that “dignify” themselves and others. Dignity is a “human characteristic” equated with “real worth as a human being” and the “value” of “being a person.” Dignity is “the posi- tive feelings I have for myself,” “self-respect, self-esteem, pride,” and “confidence and self-assurance.” One “has” dignity naturally. Dignity is “inborn,” “inherent in everyone,” and “something that everybody has inside of them.” However, dignity also is something “fluid”: it exists in “levels” or “stages,” serving as an ever-shifting indicator of “your place in the world.” The word “dignified” refers to the outward manifestations of this human characteristic. Dignity is demonstrated in “poise”—“the way somebody carries their self, their speech.” One woman I interviewed described “an image of the person as a whole being . . . standing up- right and, and intact.” A man offered Audrey Hepburn as the picture 1
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