An overwhelmed health care system’s triage may discriminate against people with disabilities

The Atlantic states that people with disabilities may face not only “overt discrimination” in hospitals, but “implicit bias” from a prejudice about their quality of life.

As the philosopher Nietzsche remarks below, in times of stress, an eliminationist attitude residing in some of the mainstream rises to the surface.

Elaine Godfrey:

Daniel Florio … was born with spinal muscular atrophy, a genetic disorder that makes him unable to walk or use his arms. His disability makes him more vulnerable to the virus than most people, and he’s afraid of what will happen if he ends up in the hospital with a serious case. Intubated people cannot speak, and Florio would not be able to use gestures or otherwise communicate with his doctors. Given infection-prevention rules, his caregivers would likely not be allowed to accompany him.

She adds:

But Florio is afraid of something else too: the possibility that, if he contracts the virus, he could be denied lifesaving treatment because of his disability. And like other Americans with disabilities, he worries that could happen not just because of overt discrimination in hospitals, but also because of implicit bias. “People overwhelmingly believe that being disabled implies a worse quality of life than it does,” Florio said. If doctors act on those beliefs—wittingly or not—“what that means in practical terms is that people like us will die.”

In some states’ policies it appears that people with disabilities do not have an equal right to life in comparison with the mainstream:

Washington’s guidelines include considerations about a patient’s “baseline functional status,” which involves factors such as physical ability and cognition. … The Washington health department told me it’s updating its guidelines to make sure “its original intent of nondiscrimination” is “unequivocally clear.”

This bears uneasy resemblance to the presuppositions of eugenics advocates, and of proponents of the Will to Power who said that “in a certain state it is indecent to go on living.” The Antichrist declares, “The weak and ill-constituted shall perish: first principle of our philanthropy. And one shall help them to do so.”

A Partial List of the Disabled Among Us

(See analysis of social attitudes toward disabled characters at end.)

Stephen Hawking, first rank physicist, Amyotrophic lateral sclerosis (Lou Gehrig's disease).

Oidipous Tyrannos, mythical star of the greatest drama (Oedipus Rex) of classical antiquity, talipes equinovarus (club foot).

"Nor is that other point to be passed over, that the Sphinx was subdued by a lame man with club feet …" - Sir Francis Bacon, Novum Organum

A reasonable translation of "Oidipous Tyrannos," following Bacon’s interpretation, is "Clubfoot the Ruler." When a drama has a name of this form, as with "The Hunchback of Notre Dame" or even "Beauty and the Beast," there is a certain hint as to how the plot will go.

Franklin Delano Roosevelt, the 32nd President. A polio survivor, he adroitly concealed that he could barely walk.

Michael J. Fox, who continued his acting career after he developed Parkinson's.

Michael Kinsley, founder of Slate Magazine, Parkinson's.

Helen Keller, blind and deaf.

John Nash, mathematician, schizophrenia.

See movie, A Beautiful Mind

Christy Brown, author, Cerebral Palsy.

See movie, My Left Foot

Demosthenes, classical era orator, stammer.

Vincent Van Gogh, painter, psychiatric illness.

Beethoven, composer, deaf.

Ray Charles, singer, blind.

Stevie Wonder, singer, blind.

Marlee Matlin, actress, deaf.

Peter Dinklage, actor, dwarfism.

Joaquin Phoenix, actor, cleft palate.

Jürgen Habermas, philosopher, cleft palate.

Stacy Keach, actor, cleft palate.

Flanner O’Connor, author, lupus.

Robert Pirsig, author, schizophrenia.

Sartre, philosopher, strabismus (exotropia).

Saul of Tarsus (the Biblical Saint Paul), had a “thorn in the flesh,” which was not described.

Sherman Alexie, author, hydrocephalus

Implied fictional disabled characters (other than Oidipous):

Beauty and the Beast

Boo Radley of To Kill a Mockingbird, psychiatric illness.

Of Mice and Men (Lenny Small, limited intelligence)

The Hunchback of Notre Dame

Tiresias in Oidipous, blind.

Forrest Gump (Crooked spine, I.Q 75)

Cyclops ("Circle Eye," i.e., One Eye)

Captain Hook (Missing hand)

Tiny Tim (possibly renal tubular acidosis (type 1), or rickets)

... And many more.

-*--

Apposite comments from the National Council of Teachers of English:
Are disabled people “pitiable, helpless, evil, super human, magically cured at the end, or dead?” Or are they complex individuals who enjoy their lives and have the same values, hopes, and aspirations as the mainstream?

Patricia Dunn:

Whether students are disabled or non-disabled themselves, they absorb impressions about characters like or unlike themselves from the books they read for school. So when they read books that feature characters with disabilities, what messages are they getting about disability? Does the story reinforce negative stereotypes (that disabled people are pitiable, helpless, evil, super human, magically cured at the end, or dead)?  Or does the text challenge negative stereotypes in its depiction of characters with impairments by showing that they are complex individuals, that they enjoy their lives and are as “normal” as non-disabled people, and that they have agency and voice?

She adds:

Works such  Johnson’s Accidents of Nature, Orr’s Peeling the Onion, and Alexie’s True Diary, written by authors with disabilities similar to those of their protagonists, depict these characters as fully developed individuals with agency, voice, and a critical attitude toward  their ableist societies.

Disabled people are America's largest minority, according to the Department of Labor and the website of the Americans with Disabilities Act. As well, a significant number of mainstream people will be disabled in later years, such as former President George H. W. Bush, wheelchair-bound in his last years. Disabled people are widely distributed among us; are powerful symbolic themes in some of our greatest works of literature; and are, in the final analysis, us.

A casebook on disability: Facial disfiguration

The first selection notes that in discussions of those whose civil rights are commonly violated, disabled people or often left out.
Jonathan Allen, on the deep divisions exposed by the fight over Rep. Ilhan Omar, in the form of “the list of groups targeted by hatred”: “Rep. Doug Collins, R-Ga., [noted] that Wiccans, Mormons and disabled people had been left out.” (Emphasis added)

Neil Steinberg, on the human discomfort occasioned by disfigured faces:

Disfigured faces can provoke a fear reaction, leading to bullying and other social tyranny:

Fear of people with facial disfigurements is a common phobia, yet, unlike other fears -- of height, of water, of the dark -- it is seldom discussed, perhaps because so much popular culture, from The Iliad to Saw V, pivots upon this fear. Perhaps it is assumed: of course you are afraid of the man without a face. Who wouldn't be?

Or perhaps because, unlike fear of high places, water or the dark, teratophobia -- fear of disfigured people or of giving birth to a disfigured baby, literally 'fear of monsters' -- has a living object: the injured, burnt, unusual-looking people themselves. Drawing attention to the flinching reaction they often receive, the stares and mockery that are a routine part of their daily lives, can seem an additional cruelty, the sort of vileness enjoyed by schoolyard bullies.

Identifying friend and foe has been a survival skill. A disfigured face, perhaps not seeming human at all, can trigger an instinctive fear:

Why are distorted faces so frightening? Freud classified certain objects as 'unheimlich,' a difficult-to-translate word akin to 'uncanny': strange, weird, unfamiliar. Waxwork dummies, dolls, mannequins can frighten us because we aren't immediately sure what we're looking at, whether it's human or not, and that causes anxiety. A surprisingly large part of the human brain is used to process faces. Identifying friend from foe at a distance was an essential survival skill on the savannah, and a damaged face is thought to somehow rattle this system. ...

The psychologist Irvin Rock demonstrated this in his landmark 1974 paper 'The perception of disoriented figures.' Rock showed that even photos of familiar faces -- famous people like Franklin D Roosevelt, for instance -- will look unsettling when flipped upside down. Just as, if you tip a square enough it stops being a square and starts becoming a diamond, so rotating a face makes it seem less like a face. The mind can't make immediate sense of the inverted features, and reacts with alarm. A bigger change, such as taking away the nose, transforms the face severely enough that it teeters on no longer seeming a human face at all, but something else.

The author himself, who thought he was prepared, experiences “horror”:

That isn't a theoretical example picked out of the air. On another visit to the Craniofacial Center, I enter Seelaus's examination room to be introduced to a patient. He turns in the chair, and is missing the middle part of his face. There are four magnetic posts where his nose will go, and below it, a void revealing smooth yellow plastic. My eyes lock on his eyes, I shake his hand and say some words.

A half-hour later, standing on the elevated train platform, I still feel ... what? 'Harrowed' is the word that eventually comes to mind. Why? There was no surprise. I'm no longer a child but an adult, a newspaper reporter who has spent hours watching autopsies, operations, dissections in gross pathology labs. I was expecting this; it's what I came here for. What about his face was so unsettling?

Maybe seeing injured faces compels an observer to confront the random cruelty of life in a raw form. Maybe it's like peeling back the skin and seeing the skull underneath. Like glimpsing death. Maybe it touches some nameless atavistic horror. ...

Randall H James was born in Ohio in 1956. His first surgeries were done over the next couple of years at Cincinnati Children's Hospital by Dr Jacob Longacre, a pioneer in modern plastic surgery.

The teachers assumed I must be stupid.

Randy James, doctor

Our instincts often betray us into making an “automatic connection between inner person and outer appearance”:  “A disfigured person is a retard”:

"He was like a second father to me because I saw him so much," says James, who didn't celebrate a Christmas at home between the ages of 3 and 13. School holidays were for operations. Summers too.

When little Randy began school, his teachers in the city of Hamilton made a common mistake, the sort of automatic connection between inner person and outer appearance that has been the default assumption since history began.

"The teachers assumed I must be stupid," says James, who was put in a class with children who had learning disabilities -- until teachers realized that he was actually very bright, only shy, and missing an ear, which made it harder for him to hear. He was allowed to sit in the front of the room, where he could hear the teacher, and his grades soared. ...

The disability version of the Heckler's Veto: “You might make the students nervous”:

As a student at the University of Kentucky, James applied to be a residence hall adviser, someone who assists other students in navigating dorm life. The supervisor who rejected him candidly told him that his odd-looking ear could put others off.

"'You might make the students nervous,'" James recalls him saying, then paused, the pain still obvious after 40 years. "These were my classmates."

In the past, disfigured people were often subject to genocide: “A couple hundred years ago, people born with craniofacial conditions, they were just putting them in a bucket of water”:

We are a society where people thrive or fail -- in part, in large part -- because of appearance. The arrangement of your features goes far in deciding who you are attractive to, what jobs you get. Study after study shows that people associate good looks with good qualities, and impugn those who aren't attractive. Even babies do this, favoring large eyes, full lips, smooth skin. Billions of dollars are spent on plastic surgery by people who are in no way disfigured, just for that little extra boost they feel it gives to them, gilding the lilies of their attractiveness.

How do people with unusual appearances fit into such a world? For most of recorded history, children born with disfigurements were wonders, portents or punishments. If they were allowed to live. "A couple hundred years ago, people born with craniofacial conditions, they were just putting them in a bucket of water," said Dr David Reisberg, an oral plastic surgeon at the Craniofacial Center.

“Those that we call monsters are not so to God”:

But even then, astute observers saw beyond externalities. Michel de Montaigne in 1595 encountered a child conjoined to the half-torso, arms and legs of an undeveloped twin (what we would now call a parasitic twin), displayed by its father for money. Montaigne noted: "Those that we call monsters are not so to God, who sees in the immensity of His work the infinite forms that He has comprehended therein."

“With malice toward none, with charity for all,” said our kindest president.

A Recent Book on the Civil Rights of the Disabled

This is a collection of notes, with comments, from What We Have Done: An Oral History of the Disability Rights Movement - Fred Pelka, 2012

In the first post of this weblog, we wrote:

A reciprocity principle: If a remark or an action or an attitude would be seen as discriminatory if directed toward a minority, it is discriminatory for us. We have exactly the same civil rights, even if the justice system does not act as if we do. 

 As Pelka writes, "People with disabilities are an oppressed minority with protected rights." (p. 3) He continues:

Robert Funk . . . has recounted the history of what he calls "the humanization of disabled people" in America as the journey of individuals with disabilities from "objects of pity and fear . . . who are incapable and neither expected nor willing to participate in or contribute to society" to a "disability rights movement" which maintains that "disabled people have the constitutional and human right to equal citizenship, that is, the right to be treated as a person worthy of dignity and respect." (p. 4)

Our first post continued:

People with cleft palates bear two stigmas: the stigma of disability; and the stigma of birth condition, which is considered guilt by many. An example of the latter from the 1st Century: Paraphrasing John 9:2, "Master, did this man sin . . . that he was born thus?"

Pelka:

Americans with disabilities have generally found themselves, as the activist Justin Dart Jr. put it, the nation's "poorest, most oppressed group." ...

"The persistent thread within the Christian tradition," writes theologian and sociologist Nancy Eiesland, "has been that disability is either divinely blessed or damned: the defiled evildoer or the spiritual superhero." ... [In parts of the third world] religious tradition regards disability as a form of "divine punishment" for alleged sinfuless. (p. 5)

Social attitudes can render the disabled the scapegoats of our society:

Rosemarie Garland-Thomson: "According to [Melvin] Lerner, the human need for order and predictability gives rise to the belief that people get what they deserve or that the way things are is the way they should be....if something 'bad'—like having a disability—happens to someone, then there must be some 'good' reason—like divine or moral justice, for its occurrence." ... it results in victim-blaming and scapegoating of those who are different. (p. 6)

In This is the Son of Kings, we suggested that the classic tragedy Oedipus the King paralleled the traditional treatment of a baby with a club foot disability in some Greek city-states. Pelka:

According to [Henri-Jacques] Stiker, the religious systems of Graeco-Roman antiquity were even less tolerant . . . In both ancient Athens and Sparta infants with disabilities were "exposed," taken "outside to an unknown location and [left to]...expire in a hole in the ground or drown in a course of water." The birth of disabled infants was believed to "signal the possibility of misfortunes and are [sic] explained by the anger of the gods. Deformed infants are exposed because they are harmful, maleficent. They implicate the group." (pp. 6-7)

In Internalized Discrimination: You're Not Supposed to SAY That, we suggested a powerful social pressure to remain silent. Pelka:

Robert Garland: "[The disabled were generally held in disdain] both by their families and by society at large. ... The disabled themselves were encouraged to feel a certain shame for their own physical condition." Disability rights activists today would call this "internalized oppression"—the absorption by oppressed people of the judgments and assumptions of the majority culture. p. 7

In the last note taken so far from Pelka's book:

Tim Cook: "Persons with disabilities were believed to simply not have the 'rights and liberties of normal people.'" (p. 11)

In a post November 26, 2014 we wrote:

“Spoiled Identity”: When the Disabled Are Not In “A State of Society” - In Pauline Maier's American Scripture we find:

In June 1776 the Virginia Convention ... amended the ... draft so it said that "all men are by nature equally free and independent" and had "certain inherent rights" ... "when they enter into a state of society." The statement ... freed the state of Virginia from an obligation to recognize and protect the inherent rights of slaves since ... slaves had never entered Virginia's society, which was confined to whites. - Pauline Maier, American Scripture: Making the Declaration of Independence, p. 193 (Emphasis added)

The post continues:
What is significant here is that the basic human rights—normal human rights—are not guaranteed simply because a person is human, but only if society accepts the person. The "spoiled identity" which sociologists recognize in such stigmatized people as the disabled, and especially those with birth defects, often means a specific lifetime exclusion from society. The results, as implied by the following defamatory passage from the Time Magazine web site, can be devastating:

Another six months of Monica, have mercy; I don't care if it harelips the Governor. - Molly Ivins, Time.com

The sociologist notes that the effect is reduced "life chances": 

Goffman [says] “The term stigma, then, will be used to refer to ... a special kind of relationship between attribute and stereotype” (2). [1] Observing that “the person with stigma is not quite human” (3), Goffman explains that the our unconscious assumptions lead us to “exercise varieties of discrimination, through which we effectively, if often unthinkingly, reduce his life chances.”

Reflecting on the Purposes of this Blog

A revision of a post from September, 2013:

One purpose is to give a report from inside on one of the fronts in the battle against prejudicial discrimination.

Another purpose is a sociological perspective. Social identity is what makes ordinary human life work. For a person to have what Erving Goffman called a "spoiled identity"* may be to "reduce his life chances."**

A third purpose is to argue that all prejudice is the same prejudice and all discrimination is the same discrimination. The enormous harm of prejudicial discrimination throughout the ages is the history of man's inhumanity to man. Prejudice is too monstrous to be a tool for any honorable purpose.

A fourth purpose is to argue that middle-class values were favorable to the stigmatized. These include:

• The idea of a common humanity.
• The idea of a connection with the past and the future and of a responsibility to our ancestors and our descendants.
• The idea of civility and of respect, so far as possible, for all people regardless of what group they are thought to belong to.
• The belief in uplift.
• The idea that political freedom comes when "we the people," all of us with one spirit work together for the public good.

The contrary values of the counterculture, in particular the tendency to frame solutions in terms of group identity, have been harmful to those with a spoiled identity.

A fifth purpose is to draw attention to a pervasive double standard in discrimination. For example, the term "harelip" is as ugly and defamatory as the n-word, yet even when it clearly is being used to marginalize and disenfranchise those with cleft lips and palates, as in the phrase "if it harelips the governor,"*** progressives stand calmly silent.

A sixth purpose is to argue that "harelip" is the symbolic birth defect, the one which William Shakespeare**** and Mark Twain***** cite, and that those so stigmatized have a corresponding classic symbolic role, the scapegoat, the "sin eater," as Patrick O'Brien says in Master and Commander: in Wikipedia, "one who is blamed for misfortunes, often as a way of distracting attention from the real causes."

A seventh purpose is to draw attention to widespread prejudices, some with impressive scholarly pedigrees, which could contribute to the double standard mentioned above, which serve as the unspoken and unexamined rationale for targeting the stigmatized: "In a certain state it is indecent to go on living," the influential philosopher Friedrich Nietzsche wrote. "To vegetate on in cowardly dependence on physicians and medicaments after the meaning of life, the right to life, has been lost ought to entail the profound contempt of society."(#)

An eighth purpose is to ask you to imagine the life of the stigmatized. Would a complete stranger attack you as soon as he sees you? What would be the cumulative effect, if you went through each day never knowing who would turn on you? If you came to realize that in many cases where for others the answer is "yes," for you it is "no," would you have the same hopes, the same aspirations, the same goals, the same confidence as you do now? Imagine an existence characterized by reduced life chances.

A ninth purpose is to draw attention to the dual nature of identity. There is the identity we have by ascription, which Goffman describes as spoiled. But other sociologists, such as John Murray Cuddihy, have argued that a feature of liberal modernity is that individuals have their character by achievement and not by ascription.(##) Randall Kennedy, in "My Race Problem -- And Ours," argued that "a brute fact does not dictate the proper human response to it." For the stigmatized, there are terrible consequences attendant on accepting the way many persons see them. A difficult choice is forced on them: To accept the "profound contempt" as their due; or to reject it at the possible cost of being accused of failing to know their place. When a disabled person was asked, "As an outsider, what do you think of the human race?" he answered, "It gives me a valuable perspective."

/**************************************/

(*) In Stigma: Notes on the Management of Spoiled Identity

(**) The sociologist notes that the effect is reduced "life chances"

(***) Another six months of Monica, have mercy; I don't care if it harelips the Governor. - Molly Ivins, Time.com

(****) This is the foul fiend Flibbertigibbet: he begins at curfew, and walks till the first cock; he gives the web and the pin, squints the eye, and makes the harelip; mildews the white wheat, and hurts the poor creature of earth. - Lear, Act III, Scene iv
Never mole, hare-lip, nor scar, Nor mark prodigious such as are, Despised in nativity, Shall upon their children be. - A Midsummer-Night's Dream. Act V, Scene ii

(*****) Mary Jane's nineteen, Susan's fifteen, and Joanna's about fourteen -­ that's the one that gives herself to good works and has a hare-lip. - Huckleberry Finn

(#) “The invalid is a parasite on society. In a certain state it is indecent to go on living. To vegetate on in cowardly dependence on physicians and medicaments after the meaning of life, the right to life, has been lost ought to entail the profound contempt of society.” - Nietzsche
 
(##) from particularism to universalism, from ascription to achievement, ... - The Ordeal of Civility

This is the Son of Kings

The dramatic irony of Oedipus is that he doesn't know who he is. The reason receives somewhat less attention than expected: Oedipus' parents tried to have him murdered as a baby:

This is the Son of Kings

"Nor is that other point to be passed over, that the Sphinx was subdued by a lame man with club feet . . ." - Sir Francis Bacon

It was night in Thebes and the cry of a newborn echoed in the halls of the king. He waited, as custom prescribed, for the midwife's announcement. But when she arrived, she stared boldly at him for awhile. Finally she said, "Somethin's wrong with 'is foot."

The king hastened to the royal bed, where he found the queen lying with her back to the naked infant. "Do what you have to do," she murmured.

"I'll have Shepherd take it to the Grove," he said.

It was not yet dawn when Shepherd arrived at the Grove of the Lost. Unseen predators coughed beyond the lamp as he laid the tiny bundle on the bloodstained rock.

 

The story would have ended there, but as Shepherd made to depart he heard the infant sobbing quietly, hopelessly to itself. He took the child forthwith to his parents' home in a mountain village.

"Take care," he told them. "This is the son of kings."

"What shall we call him?" his father asked. But just then Shepherd's mother, having unwrapped the child, exclaimed, "Oh, the poor baby, his poor foot's all swollen."

"Very well," his father decided, "we'll call him Haltfoot."

When he was become a man, Haltfoot set off for Thebes with his most trusted companions, for he would look upon the faces of his parents. As they entered a crossroads, with the towers of the city gleaming in the distance, a mounted nobleman ordered them to step aside. But Haltfoot, having recognized the king from his likeness on a coin, said "It is written, A commoner shall pass, and none shall deny him."

At this the king made to run him through with his spear. But Haltfoot, stepping aside, seized the spear as it passed and threw the king into the road.

"Take him home," he instructed his companions. "Let him know the village where a prince spent his youth."

Whereupon the king asked, "Who are you?"

"I am your son, whom you sent to the Grove."

In the cool of the evening Haltfoot passed through the gates of Thebes and found the restless queen pacing the byways of the market.

Dawn was brightening the eastern horizon when Haltfoot rose from the royal bed. But the queen detained him, asking "Why did old Shepherd start when he saw you last night?" Haltfoot instead replied, "Do you know where the king is?"

"He rides to the royal estates.

"You are very like him in form," she added. "Who are you?"

But Haltfoot commanded, "Look upon me."

Now it was full day, and an unpitying sun blazed on the cold stones.

"I too am of royal blood," said Haltfoot. "Look upon me and know who I am."

The queen stared wildly at him. "Say no more," she cried. "By the Merciless, say no more."

Unpublished Remarks from a Disabled Person on the West Coast, Part 2

Another six months of Monica, have mercy; I don't care if it harelips the Governor. - Molly Ivins, Time.com

Stigma: Notes on the Management of Spoiled Identity - Erving Goffman

There's case law out there regarding people commenting and gesturing against race and religion. But ... there's nothing out there regarding disabilities. - Assistant City Prosecutor Jennifer Fitsimmons

Take off your hat to nothing known or unknown or to any man or number of men, ... re-examine all you have been told at school or church or in any book, dismiss whatever insults your own soul - Walt Whitman, Preface to first edition of Leaves of Grass

To be decent, every person has to make their own ethical decisions. . . . If you are conformist, you almost certainly violate universal ethical standards of decency.

Then they would ... thrust him out of the house, spitting on him and throwing stones as he ran away. ... He let it out and they all turned against him immediately. - A "sin-eater," described in Master and Commander: (vide infra)

She is looking straight at me with a grim, angry expression, so that I almost recoil. You should be ashamed, it seems to say. Unpublished Remarks from a Disabled Person on the West Coast, Part 1 

The following were conveyed to the authors of this blog by one of the stigmatized disabled:

From the first article in this series, hopefully it is beginning to be apparent what the purposes of the series are.

One purpose is to give a report from inside on one of the fronts in the battle against prejudicial discrimination.

Another purpose is a sociological perspective. Social identity is what makes ordinary human life work. For a person to have what Erving Goffman called a "spoiled identity" may be to "reduce his life chances."
 
  A third purpose is to argue that all prejudice is the same prejudice and all discrimination is the same discrimination. The enormous harm of prejudicial discrimination throughout the ages is the history of man's inhumanity to man. Prejudice is too monstrous to be a tool for any honorable purpose.

  A fourth purpose is to argue that such middle-class values as the idea of a common humanity; the idea of a connection with the past and the future and of a responsibility to our ancestors and our descendants; the idea of civility and of respect, so far as possible, for all people regardless of what group they are thought to belong to; the belief in uplift; and the idea that political freedom comes when "we the people," all of us with one spirit work together for the public good--to argue that these were favorable to the stigmatized. The contrary values of the sixties, in particular the tendency to frame solutions in terms of group identity, have been harmful to those with a spoiled identity.
 
  A fifth purpose is to draw attention to a pervasive double standard in discrimination. For example, the term "harelip" is as ugly and defamatory as the n-word, yet even when it clearly is being used to marginalize and disenfranchise those with cleft lips and palates, as in the phrase "if it harelips the governor," progressives stand calmly silent.
 
  A sixth purpose is to argue that "harelip" is the symbolic birth defect, the one which William Shakespeare and Mark Twain cite, and that those so stigmatized have a corresponding classic symbolic role, the scapegoat, the "sin eater,"* as Patrick O'Brien says in Master and Commander: in Wikipedia, "one who is blamed for misfortunes, often as a way of distracting attention from the real causes." [Ed. Note: The current Wikipedia no longer says this. It does say:

The biblical Jesus has been interpreted as a universal archetype for sin-eaters, offering his life to purify all of humanity of their sins.

 For the Disabled Archetype in myth, see the following post, This is the Son of Kings.]

 A seventh purpose is to draw attention to widespread prejudices, some with impressive scholarly pedigrees, which could contribute to the double standard mentioned above, which serve as the unspoken and unexamined rationale for targeting the stigmatized: "In a certain state it is indecent to go on living," the influential philosopher Friedrich Nietzsche wrote. "To vegetate on in cowardly dependence on physicians and medicaments after the meaning of life, the right to life, has been lost ought to entail the profound contempt of society."
 
  An eighth purpose is to ask you to imagine the life of the stigmatized. Would a complete stranger attack you as soon as he sees you? Three such cases (out of many) are described in the first article, and as seen above no less a personage than Nietzsche argues that this is legitimate. What would be the cumulative effect, if you went through each day never knowing who would turn on you? If you came to realize that in many cases where for others the answer is "yes," for you it is "no," would you have the same hopes, the same aspirations, the same goals, the same confidence as you do now? Imagine an existence characterized by reduced life chances.
 
  A ninth purpose is to draw attention to the dual nature of identity. There is the identity we have by ascription, which Goffman describes as "spoiled." But other sociologists, such as John Murray Cuddihy, have argued that a feature of liberal modernity is that individuals have their character by achievement and not by ascription. Randall Kennedy, in "My Race Problem -- And Ours," [see Defining Liberalism: Randall Kennedy's 'My Race Problem—And Ours', My "Liberalism" Problem—And Ours] argued that "a brute fact does not dictate the proper human response to it." For the stigmatized, there are terrible consequences attendant on accepting the way many persons see them. A difficult choice is forced on them: To accept the "profound contempt" as their due; or to reject it at the possible cost of being accused of failing to know their place. As a friend once told me, when someone once asked him, "As an outsider, what do you think of the human race?" he answered, "It gives me a valuable perspective."

(*)From Master and Commander: "I have a curious case ..."

What is his name?
Cheslin: he has a hare lip. ...
Yet he has been of singular service to men and women, in his time.
In what way?
He was a sin-eater. ...
Will you tell me about him? ...
When a man died Cheslin would be sent for; there would be a piece of bread on the dead man's breast; he would eat it, taking the sins upon himself. Then they would push a silver piece into his hand and thrust him out of the house, spitting on him and throwing stones as he ran away. ... He let it out and they all turned against him immediately.