“Am i disabled?”: disability and identity management among middle-class persons with disability in Ghana

Abstract

Persons with disability experience actual manifestations of stigma (enacted stigma) and imagined or anticipated responses of people to their impairments (felt stigma). These experiences influence their conceptions of their impairments and their behaviour as well. This study examined how 16 middle—class persons with disability in Ghana frame their impairments and how they manage their identities in response to stigma. Data for the study was obtained from in-depth interviews of participants who had been selected purposively. The author used the interpretative phenomenological analysis framework to analyse data. Findings from the study were organised into two themes. These are how the participants frame their impairments and how the participants managed their identities as they confronted disability stigma. The participants engaged in self—denial of disability because they did not regard their impairments as “disabling”. They also employed two related strategies to manage their identities. First, they made use of behavioural strategies to alter the nature and sources of stigma, and second, they devised cognitive strategies to construct positive identities to challenge disability stereotypes. It is important that persons with disability are given the opportunity to obtain adequate formal education in order for them to increase their levels of awareness. This will enable them to improve their cultural and social capitals and also facilitate their entry into mainstream activities in society. furthermore, inclusive spaces have to be expanded so that persons with disability will not have to rearrange themselves and their thoughts for social integration.

Keywords:

• Disability
• middle-class persons with disabilities
• psycho-emotional dimensions of disability
• stigma
• identity management strategies

1. Introduction

This study examines the ways in which middle-class persons with disability in Ghana frame their impairments and manage their identities in response to their experiences of disability stigma. Impairments are construed as attributes that are loathed because of social norms and value systems which govern social relations in societies (Edwards & Imrie, 2003; Meekosha et al., 2013; Nario-Redmond, 2010). The manifestations of stigma are the root causes of the experiences of oppression, discrimination and exclusion which persons with disability face. This is because stigma “spoils the identity” of the individual who carries the attribute that has been stigmatised (Goffman, 1963; Vernon, 1999). For persons with disability, their impairments often violate acceptable standards of human appearance and functionality, as typically defined by social norms and societal values (McLaughlin et al., 2004). The stigma, which is situated in social responses to the impairments they possess, therefore, deprives persons with disability of their dignity and hinders their full participation in mainstream activities in society (Bos et al., 2013; Link et al., 2004).

Persons with disability live their lives knowing very well that their entry into certain social spaces could lead to the manifestation of stigma, marginalisation or outright exclusion. The actual manifestation of stigmatising and discriminatory treatments may be described as “enacted stigma” (Goffman, 1963). This is the overt form of stigma. It is relational and is seen in the actual experiences of marginalisation, exclusion and discrimination that persons with disability have (Scambler, 2009). Enacted stigma is very direct and can significantly alter the thoughts, feelings and behaviour of persons with disability. Persons with disability may also experience “felt stigma”. This is the imagined or perceived response to the impairment from society (Goffman, 1963). It is an assumed, rather than an actual, response of others to the presence of an impairment. Persons with disability may experience felt stigma even when they are not involved in a social interaction. Thus, felt stigma may also be seen as the fear of enacted stigma (Bos et al., 2013; Burris, 2002; Green et al., 2005) and because of that, stigmatised individuals, and in this case persons with disability, may behave in a manner that will make them attempt to avoid enacted stigma (Goffman, 1963; Scambler, 2009).

Like every other person in society, persons with disability have agency. They have the capacity for independent thinking and action, and they are also capable of framing their impairments and constructing identities for themselves even as they experience disability stigma and its ramifications (Bruce & Yearly, 2006; Cobley, 2018). The identities they construct are products of social interaction and these identities are sustained and transformed through the same social interaction (MacRae, 2008). Persons with disability construct identities for themselves as they seek to make sense of their impairments and the world within which they live (Johnstone, 2004). The identity formation processes are influenced by the nuances of the social context that persons with disability find themselves in and perhaps, most importantly, the conduct of the people who may stigmatise persons with disability. The outcomes of the identity formation processes also influence how persons with disability conduct themselves and how they may behave towards others in society (Björnsdóttir, 2010; Frederick, 2017; Johnstone, 2004). Some persons with disability, however, internalise the stigma that they experience, and this affects their emotions, their behaviour and their thoughts, leading to fear, anger, and a sense of embarrassment (Baffoe, 2013; Burris, 2002; Dirth & Branscombe, 2017; Frederick, 2017; Link & Phelan, 2001; Spiritos & Giligan, 2020).

1.1. Middle-class persons with disability

Middle-class, as used in the study, means “non-manual workers who enjoy a wide range of advantages over manual workers but subordinate to people whose wealth means they do not have to work” (Bruce & Yearly, 2006, p. 96). This definition is founded on Weber’s conceptualisation of class since the category of people to which the label “middle-class” may apply have analogous “life chances” in respect of their levels of education, occupation, incomes and their preferences. The middle-class persons with disability who were the subject of the study included skilled professionals, public workers and entrepreneurs. They are people who tend to be of higher repute and have more control over their livelihood as a result of their relatively higher incomes (Leinonen et al., 2012; Vitt, 2007).

Middle-class persons with disability are not impoverished and their social class position means that they are found in social relations and spaces where persons with disability are stereotypically not expected to be. This exposes them to a lot of stigma, prejudice and discrimination. The result is that they are often subjected to undesirable behaviours and attitudes that often involve the questioning of their identities, their aspirations and their sense of worth (Maroto & Pettinicchio, 2014, 2015; McCarthy, 2003; Soldatic & Meekosha, 2012). These experiences may also draw various responses from the middle-class persons with disability in how they see themselves, their impairments and their place in society (Johnstone, 2004; Laganà & Hassija, 2012; Pande & Tewari, 2011).

1.2. Disability stereotypes and stigma in Ghana

The conceptualisation of disability in Ghana and as found in many other countries is profoundly laden with traditional and religious beliefs. These beliefs lead to the formation of stereotypes that influence how persons with disability are perceived and how they are treated (Kassah, 2008; Mensah et al., 2008; Naami et al., 2012). Persons with disability are often subjected to name calling and the use of pejorative labels to describe their impairments (Agbenyega, 2003; Avoke, 2002; Baffoe, 2013; Naami & Hayashi, 2012). These mostly offensive labels reflect the contempt in which persons with disability are held because they possess attributes that are considered undesirable by society. The labels also serve to remind persons with disability of how society disapproves of their involvement in mainstream social, economic and political activities. The stigma that persons with disability carry, as a result of their impairments, leads to as Picton (2011) describes, “a culture of entrenched discrimination” against persons with disability.

The negative stereotypes are indicative of the lack of knowledge and understanding of impairments and disability in general. This is because some people do not know about the nature of particular impairments and they are unable to distinguish between different forms of disabilities (Avoke, 2001; Bayat, 2015; Naami et al., 2012). The ignorance about impairments and disability leads to the development of negative attitudes which culminate in the isolation and marginalisation of persons with disability (Baffoe, 2013). As a result of these, persons with disability tend to have inadequate access to education, housing, employment and healthcare (Mensah et al., 2008; Mfoafo M’carthy et al., 2020; Slikker, 2009).

The marginalisation and exclusion of persons with disability mean that persons with disability are often unable to participate equally to access resources and opportunities in society. This results in persons in disability often ending up as destitute who are forced to depend on the benevolence of others, particularly non-disabled people, for their sustenance. They are required, by virtue of the traditional beliefs and negative stereotypes, to live and operate on the fringes of society and accept social roles such as begging, but this is considered to be relatively unproductive (Kassah, 2008; Naami & Hayashi, 2011; Naami et al., 2012). Consequently, persons with disability are perceived to be lazy, poor, weak, ignorant, stupid and incapable of helping themselves (Attafuah, 2000; Naami et al., 2012) and social expectation of them are often lowered (Kassah, 2005; Ocran, 2022a). This is compounded by the fact that numerous persons with disability are seen begging on the streets and various commercial centres. The government, non-governmental agencies and several donors have worked to address the poverty that such persons with disability experience (Kassah, 1998, 2008; Baffoe, 2013; Naami & Mikey-Iddrisu, 2013; Roosta et al., 2013). The support given to persons with disability is often taken as proof that they are incapable of an independent and assertive life. These factors reinforce the negative stereotypes about the functional incapacitation and the exaggerated vulnerability of persons with disability and hence, persons with disability are exposed to various forms of oppression.

Research on persons with disability in Ghana has largely emphasised the economic and social deprivations that persons with disability experience. While the experiences of persons with disability in Ghana have been studied extensively, the emphasis has largely been on inequalities in health (Abodey et al., 2020; Abraham et al., 2018; Howard, 2018; Senayah et al., 2019), employment (Kassah, 1998; Acheampong et al., 2016; Naami, 2015), education (Kassah et al., 2018; Braun & Naami, 2021), political participation (Kyei & Dogbe, 2020; Sackey, 2015), barriers in the built environment (Ackah-Jnr & Danso, 2019; Tudzi et al., 2020; Yarfi et al., 2017), social protection (Adamtey et al., 2018; Opoku et al., 2019), lived experiences of stigma (Kassah, 1998; Baffoe, 2013; Ocran, 2022b; Sottie & Darkey, 2019), as well as the coping strategies of family and carers of children with disability (Dako-Gyeke, 2018; Lamptey, 2019; Nyante & Carpenter, 2019; Okyere et al., 2019; Zuurmond et al., 2019). Consequently, the lived experiences of persons with disability from the middle-class has not been well explored. The experiences of persons with disability who have had higher formal education, those who are employed in professional occupations and those with higher repute in society have not been theorised adequately. Not much is, therefore, known about how these middle-class persons with disability respond to their experiences of stigma and its consequences, and how they make sense of their impairments as they contend with the stigma and marginalisation that the disability identity tends to elicit.

This study is, therefore, an attempt to contribute to the literature on the intersection between class and disability and the identity management strategies that middle-class persons with disability in Ghana use to respond to stigma, both enacted and felt. Furthermore, the study addresses the paucity of research on disability identity formation in Ghana and also assesses how the middle-class status influences the disability identity formation process in the presence of disability stereotypes and disability stigma.

1.3. Theoretical framework

1.3.1. Psycho-emotional dimension of disability

This study drew from the theoretical foundations of the psycho-emotional dimension of disability which emanated from the writings of Carol Thomas (1999, 2004a, 2004b). The psycho-emotional dimension of disability comprises the emotional responses to social exclusion and physical barriers which produce the hurtful feelings, shame, anger and frustrations that occur in reaction to the actions and inactions of others in society. It also includes the feelings of inferiority, worthlessness and unattractiveness which emerge out of the stigma that their impairment carries (Reeve, 2002; Thomas, 2006). The psycho-emotional dimension of disability has subsequently been extended by Hernandez-Saca and Cannon (2016), Reeve (2002), Reindal (2008) and Watermeyer and Swartz (2008).

Thomas (1999, p. 60) defined disability as “a form of social oppression involving the social imposition of restrictions of activity on people with impairments and the socially engendered undermining of their psycho-emotional wellbeing.” This definition draws attention to the dual nature of disability oppression. In the first, persons with disability are exposed to social restrictions that inhibit their ability to participate in mainstream activities of society. In the second, the psycho-emotional well-being of persons with disability is undermined within their social relations. Thomas, by this approach, emphasises the fact that disability is a relational phenomenon, one that has an individual/subjective dimension as well as a structural dimension. The structural dimension is found in the oppressive combination of social barriers, value systems and normative restrictions that persons with disability are exposed to on a daily basis. The individual dimension exists in the micro-politics of the individual and how the social impositions and restrictions affect the thoughts and feelings of the persons with disability. The individual dimension also deals with the specification of what may or may not be allowed of the persons with the disability in their social relations (Hernandez-Saca & Cannon, 2016; Reeve, 2004; Thomas, 1999, 2004a). The psycho-emotional dimension of disability, thus, recognises the role of social forces of oppression (external factors), and the role of individual or subjective factors (internal factors) as having the power to marginalise and exclude persons with disability (Hernandez-Saca & Cannon, 2016; Reeve, 2006; Thomas, 2004a; Watermeyer, 2009). This is because the social forces of oppression are not universal but rather particularistic since the social forces that shape the intricacies of normative systems vary from one society to another. The individual influences are, likewise, unique because of individual differences and contextual factors which give rise to varying experiences for different people.

The individual influences can be conceptualised as internalised oppression as it focuses on the feelings and thoughts of persons with disability (Hernandez-Saca & Cannon, 2016; Reeve, 2002). Internalised oppression is explained by Pheterson (1986) as the:

incorporation and acceptance by individuals within an oppressed group of the prejudices against them within the dominant society … [and] the mechanism within an oppressive system for perpetuating domination not only by external control but also by building subservience in to the minds of the oppressed groups. (p. 148)

Morris (1991) extends this by positing that persons with disability are not only oppressed by the real and tangible experiences of stigma, exclusion and discrimination. They are also oppressed by the knowledge that entry into particular social spaces could invite public scrutiny, scorn, contempt, condescension, pity, and hostility. Internalised oppression can also emanate from the frustrations, sense of worthlessness and unattractiveness, and the feelings of anger, pain and hurt that persons with disability have as a result of stigma (Reeve, 2002; Thomas, 2006). Persons with disability are, thus, compelled to respond to the conduct of other people to their impairments in ways similar to how they may respond to actual physical and structural barriers which exclude persons with disability (Reeve, 2004; Thomas, 1999).

It is worth noting that the social forces and the individual influences do not exist independently of each other. They may combine or oppose each other in the oppression of persons with disabilities. This is because they are embedded in cultural representations and elements of culture such as language, symbols, values and norms that are typical of the society within which the person with disability lives (Hernandez-Saca & Cannon, 2016; Reeve, 2004). These elements of culture are contextual, and they determine the standards according to which disability may be conceptualised. This occurs through interactive processes that determine which persons ought to be perceived as persons with disability and who may be excluded from such a classification. The same cultural elements that give rise to the oppressive social relations also shape how persons with disability conceptualise their own disability identities. As a result of these factors, the conceptualisation and experience of disability have to include the psycho-emotional dimensions of disability (Hernandez-Saca & Cannon, 2016; Reeve, 2004).

Even though the psycho-emotional dimension of disability permeates all aspects of social relations of disability, it is possible for some persons with disability to resist the oppression by “transforming themselves and ‘coming out’ as a disabled person—reclaiming disability as a positive identity” (Reeve, 2002, p. 494). Reeve (2004), in explaining this further, states that:

Not all disabled people will experience this form of disability and it will change in intensity with time and place; whether or not it is more or less disabling than their experience of structural disability will vary and sometimes the two dimensions reinforce each other. (p. 86)

The ability to resist the oppression comes when persons with disability possess the capacity and the resources needed to challenge the stigma or when the norms regulating the social relations of that social context are acquiescent to the social influence of the person with disability. In the attempt not to internalise and accept the negative social reactions to their impairments, persons with disabilities may rationalise their impairments and their stigmatising experiences by deflecting the thoughts of what constitutes disability away from themselves and their impairments (Watermeyer, 2009). This process of rationalisation takes place because the psycho-emotional dimension of disability is situated within the social relations and interactions that persons with disability have with their families, friends, work colleagues, members of religious fellowships as well as strangers in their homes, schools, places of work and sites of religious congregation (Reeve, 2004). These are the sites within which persons with disability use various cultural and interpersonal relational processes to confront the oppression from disability stigma and manage the negative social responses that their disability identities elicit (Thomas, 2006).

The focus of this study is on the ways by which some selected persons with disability confront and resist the oppression of the psycho-emotional dimension and how they recreate their disability identities to reclaim and lay emphasis on the positive aspects of their social identities. Being able to respond to disability stigma and oppression require what Reeve (2002) calls “emancipatory forces” which include personal experiences and counter identities besides the individual’s impairment. The ability to resist the psycho-emotional dimension of disability is in itself a political action and is founded on the common emancipatory phrase – “the personal is political” (Hernandez-Saca & Cannon, 2016; Thomas, 2006).

2. Methods

2.1. Research approach

This study was conducted using the phenomenological research design. It is part of a larger qualitative research that examined the lived experiences of disability stigma among middle-class persons with disability (Bryman, 2016; Heidegger, 1962; Poth & Creswell, 2017). The design also allowed for the interrogation of how the participants conceptualised their impairments and how they managed their identities in light of their relational experiences.

Data for the study were gathered from 16 middle-class persons with disability who had been purposively selected for the study. Six (6) of the participants were my acquaintances. Six (6) were recruited through my social network. Three (3) participants were contacted after they had made appearances on TV and one (1) was recruited at a disability advocacy event that I attended. All the participants acknowledged their impairments and identified as persons with disability. They shared stories of their lived experiences as they have been experienced from different parts of Ghana. Since Ghana has several ethnic groups and diverse cultural beliefs, practices and norms, it was important that such diversity was taken into consideration in the assessment of how people from different cultural backgrounds evaluate their impairments and how they manage their disability identities.

The participants consisted of 11 males and five females. They had sensory and/or physical impairments such as visual impairment (2), hearing impairment (3), speech impairment (1), kyphosis (1), physical impairments (6), achondroplasia (1) and both visual impairment and physical impairments (2). The purposive selection of the participants was also informed by the ages at which the participants acquired their impairments, their religion, ethnicity, geographical location and for those who acquired their impairments in their childhood or were born with them, the social class of the families into which they were born. Thirteen (13) out the 16 participants had had tertiary education and three had attained secondary education or its equivalent. The participants included two (2) health professionals, three (3) journalists, two (2) civil society workers, one (1) insurance broker, one (1) para-athlete, one (1) IT administrator, four (4) educators and two (2) civil servants, one of whom had retired after reaching the compulsory retirement age. The demographic details of the participants have been given in Table 1.

Table 1. Profiles of participants for the study

No.	Name*	Age	Gender	Type of disability	Occupation	Level of Education
1	Louisa	30	Female	Speech Impairment	Health Professional	Tertiary
2	Isaac	38	Male	Visual impairment	IT Administrator	Tertiary
3	Ruth	55	Female	Visual impairment & Physical Impairment	Journalist/Civil Society Advocate	Tertiary
4	Sylvia	55	Female	Kyphosis	Civil Servant	MSLC
5	Felix	59	Male	Visual impairment & Physical Impairment	Academic/Real Estate Owner	Tertiary
6	Ernest	37	Male	Visual impairment	Journalist	Tertiary
7	Hamza	71	Male	Physical Impairment	Retired Civil Servant	Tertiary
8	Desmond	33	Male	Physical impairment	Civil Society Advocate	Tertiary
9	Henry	27	Male	Physical impairment	Teaching Assistant	Tertiary
10	Abena	46	Female	Physical impairment	Journalist	Tertiary
11	Rose	33	Female	Hearing Impairment	Teacher	Secondary
12	Richard	32	Male	Hearing Impaired	Civil Society Advocate	Tertiary
13	Abel	37	Male	Physical Impairment	Civil Society Advocate	NVTI
14	Nicholas	53	Male	Hearing Impaired	Tutor	Tertiary
15	Yaw	29	Male	Achondroplasia	Insurance Broker	Tertiary
16	Noah	38	Male	Physical Impairment	Health Professional/Teacher	Tertiary

*Pseudonyms used for the purpose of anonymity

The author conducted the in-depth interviews using a semi-structured interview guide in order to hear the participants’ stories about their experiences of disability to better understand the realities of their experiences at home, in schools, places of work and at religious spaces. The participants consented to the audio recording of the interviews. Thirteen (13) of out the 16 interviews were conducted in English. One interview was conducted in Asante Twi (Akan). Two were conducted in both Asante Twi and English. The author speaks both languages fluently and so had no difficulty interpreting what had been said in Asante Twi into English. The interviews were transcribed soon after the interviews had been concluded. Data collection for the study and analysis of the data were done contemporaneously. The author analysed the data using the Interpretative Phenomenological Analysis (IPA) framework (Larkin et al., 2006; Smith & Osborn, 2015). Close reading of the interview transcripts led to the generation of codes that showed similarities and differences of experiences, as well as patterns of relevant experiences and identity management strategies. The codes were constituted into themes which have been presented as the findings of the study. These codes and themes were generated inductively through an iterative process that involved the constant evaluation of the interview guide and the responses of the participants and the adoption of better approaches to obtain the required data.

The author kept audit trails that enabled him to keep track of all the activities that were undertaken at various stages of the research to ensure reliability and to improve rigour in the data analyses (Creswell & Miller, 2000; Golafshani, 2003; Miller, 2008; Rodgers, 2008). The author also listened to the interviews repeatedly and compared them with the transcripts to ensure that the transcripts did not have any errors in them (Brinkmann & Kvale, 2015). In addition to these, the author constantly went back to the definition of the codes to make sure that their meanings had remained the same across different transcripts over the course of data gathering and data analysis (Poth & Creswell, 2017).

Ethical clearance for the study was given by the Ethics Committee for the Humanities (ECH), University of Ghana, Legon (ECH 053/15–16). Consent documents that spelt out the nature and purpose of the study and also provided them the necessary assurances of privacy, confidentiality and anonymity were made available to the participants. All but two of the participants provided written consent to participate in the study. One gave oral consent, and one asked a family relation to sign the consent document on his behalf. All the participants participated in the study voluntarily.

3. Findings

The findings of the study are presented in two broad themes. The first theme deals with how the participants framed their impairments. The participants’ framing of their impairments was based on their self-denial of “disability” and how they embraced their disability identities. The second theme presents how the participants engaged in identity management as they confronted enacted stigma and felt stigma. The identity management strategies have been categorised into two subthemes. These are social response strategies and cognitive response strategies (Boehmer, 2007; Bos et al., 2013; Cox et al., 2003). The social response strategies involve behavioural responses or an alteration or management of the source of tension. The cognitive response strategies involve the regulation of one’s negative emotions.

3.1. Framing the impairments

3.1.1. Self-denial of disability

Eight out of the 16 participants acknowledged their impairments, but they did not necessarily recognise their impairments as “disabling” to them. These participants did not define disability in terms of the functional limitations that it placed on persons with disability, neither did they do so because of the presence of an impairment. Their position was founded on two factors. One was their ability to work and function at what they perceived to be optimal levels, and the second was that they believed that their impairments did not exclude them from participating in their preferred mainstream activities of society. For these reasons, they were hesitant in accepting “disability” as a descriptive label. They considered themselves to be persons with disability, but they also rejected “disability” as a label because to them, their impairments had not “disabled” them. They have taken this position because they are aware of the stereotypes about persons with disability being functionally incapacitated and being incapable of full social participation. Henry, a participant who had physical impairment preferred to recognise his impairment as a “challenge” and “a hurdle in life”, because, as he indicated, “…sometimes I even forget that I have lost an arm because I do everything that anybody else does.” Likewise, Sylvia said that she did not regard herself as “disabled” and that she did not worry about her “disability” as was the case in her past. She indicated that she did not call herself “disabled” since she is able to “walk up and down.” She added that she does not “address [her] mind to that.” She noted:

I don’t call it disability because what every normal human can do, I can also do the same and so I don‘t call myself a disabled person. I don’t even want to say that because, there are things I do that able-bodied people cannot do. I go to work, I come back. I am able to do what everyone else does. (Sylvia, kyphosis)

The denial of disability also stems from some of the labels that are used for persons with disability in Ghana. A very common label that is used in Akan, a language that is widely spoken in Ghana, is “yarefoɔ” which literally means “sick person”. A number of participants reported that they had been described as such in the past. These participants do not accept the “yarefoɔ - sick person” label because they do not consider themselves to be sick. Disability, to them, is not equal to sickness. For these participants, the admission of disability is akin to accepting incapacitation and, hence, the inability to match the aspirations and successes of non-disabled people. Desmond acknowledged his impairment, but he did not accept that it had inhibited his aspirations. He stated that he had “limited use of [his] leg but that doesn’t mean [he is] disabled”. He added:

We are not disabled. We are persons with disabilities. The disability is there alright but it doesn’t make me inadequate. When you disable computer application, it cannot be used but in Ghana, when you talk about persons with disability, people really think that of beggars. (Desmond, physical impairment)

The point he made about beggars was in reference to some persons with disability who are usually unkempt and line the streets and other places ostensibly to beg for alms. It was also because for him and other middle-class persons with disability, the use of disability as a metaphor for functional limitation does not apply to them. Abena made a similar point when she said “I didn’t want people seeing my disability thing as a hindrance or telling myself that I can’t do it. When you think I can’t do it, I will tell you I can do it and I will prove to you that I can do it.” Yaw also remarked that he did not pay attention to discussions on disability because he did not consider himself as a “disabled” person. He explained:

I have a perception that disability is not inability. It’s your mind. You can do everything. It’s the perception. Society has made you like that. As you see me sit here, am I disabled? It’s the society. If you listen to the society, even if you are tall and you listen to the society, they will make you disabled. So why should I allow you? (Yaw, achondroplasia)

The participants emphasised their abilities and their achievements in the face of the impairments as they compared themselves with non-disabled persons and also refuted the notion that they were “disabled”. Abel said that:

The things I will say I’m unable to do are things that I should do with my legs, but there is something I always say, that you will be more disabled if you accept the disability in your mind, because it is when you accept in in your mind that it affects your physical body. If you don’t accept in your mind, you can overcome everything. (Abel, physical impairment)

Sometimes, the ability to rationalise the impairment and to reject the disability identity is inculcated in the persons with disability by their non-disabled associates. Hamza, who had physical impairment, indicated that his doctor challenged him and “put in [his] head that he should not consider himself as disabled.” He believed that this advice gave him the audacity in order that he “ … would not get stuck, lie down and ask for help and sympathy.” These are attributes that are stereotypically ascribed to persons with disability. He held the view that “denying” the disability had allowed him to take control of his life because, as he explained, he requests for help from his family on his terms, not when another person assumes that he needs it.

3.1.2. Embracing disability identities

Eight participants gave responses that emphasised how they embraced their impairments and the disability identities. They indicated how their perceptions about their impairments had changed and how they had learnt to ignore the disapprovals associated with their impairments. The impairments and the stereotypes used to bother them, but they explained that they had better responses to it now. Rose showed this when she said:

Before I became deaf, I was forced to use it [the cochlea implant] and I accepted it because I was shy to be called a deaf person so always, I was using it but when I grew up, I realised that no, I’m a deaf person. Why should I be shy about it? So, I decided to throw it away to be at peace with myself. (Rose, hearing impairment)

Richard took a similar position about his impairment and his response. He noted:

Apart from me being a person with disability, I can do so many things. I’m not bothered because I’m a person with disability. I focus more on the positive side of life. I enjoy life, I’m not bothered. There are many things that I can do which a number of hearing people cannot do. (Richard, hearing impairment)

Richard’s statement about not being bothered is similar to Rose’s response that she was “at peace with herself”. They have learnt to overlook the challenges that come their way as a result of their impairments. These comments are an admission by the participants that persons with disability experience stigma but that they have learnt how to remain positive despite the obvious challenges. Richard said that he was focused on “the positive side of life”. Rose said she was no longer shy about having the impairment. She believed that her attitude towards her impairment had freed her from the internalised oppression that disability stigma sometimes causes. Abena said she “enjoys life” because she participates in recreational activities against all social and biological odds. She stated:

It is just that these days … unless I didn’t hear that there is a concert there … That’s me. I have told myself I don’t want to pity myself. No, I won’t. If I can’t do it, I will tell you, this one I can’t do it. (Abena, physical impairment)

Abena said that she had slowed down on recreational activities as a result of her busy work schedule. Otherwise, she would have participated in them as had been the case previously. She believed that being able to come to terms with her impairment and not letting it affect her for the worse was a sign of strength. Louisa had a similar position when she said “I do my work normally because now my decision is, what have I done wrong? I’ve not done anything wrong so why should I hide? I should live like a normal person.”

The participants who embraced their impairments exhibited a conscious effort to suppress the constraints that the impairments had on their full participation in mainstream activities of society. They perceived their abilities to participate in mainstream activities of society as evidence of their liberation from their impairments and from disability stigma. This, to them, showed how empowered they are. Louisa, in expressing this position, said that “I would want to say that my [impairment] is a blessing in disguise. It has made me a better person and it has made me a very strong person.”

Sometimes, those who engage in self-denial of the “disability” also embrace their impairments, especially when doing so offers them some an advantage in some social situations. When Desmond stood in an election for a political position, his impairment was used by his opponents as a sign of his weakness to campaign against him. When Desmond was given the opportunity to address the electorate, in his own words, he had to “play smart on their emotions”:

I gave them an Ewe proverb … It is translated as I am a tree, I may not bear fruit but for sure I will provide a shade for my family. So, when I said that most of the people felt emotionally attached and people got up and declared their votes for me right there in the auditorium. They said they will vote for me. (Desmond, physical impairment)

Louisa said that when she had not asked to be pitied and you proceeded to offer pity, she would refuse it and “make you feel bad”, and in the end “[make] you regret” pitying her. Like Desmond in the election scenario, she admitted to using pity and embracing her impairment when it suited her. In these two scenarios, the participants chose when they wanted to accept pity and embrace the disability identity. These same participants reject pity and the disability identity in other situations when doing so makes them feel weak and helpless. This means that the participants are able to make a deliberate attempt to utilise their disability as a means of gaining an advantage, when some definite gains are at stake. Embracing the disability identities and self-denial of disability are, thus, used at different times by some persons depending on the nature of the social encounter and what the consequences of that encounter may be. When Henry was in a position to use his impairment to his advantage, he rejected it because the alternative to not using his impairment to his advantage was equally acceptable to him, compared to what he was forgoing. In the case of Desmond and Louisa, the alternative would have been what they perceived to be a greater loss, hence their decision to move between the two conceptualisations.

Self-denial of disability and being able to accept and embrace their disability identities allows the participants to focus on their unique strengths and the resources that allow them to challenge the effects of disability stigma. These strategies are used by different people at different times for similar purposes. In either case, the objective of the participants is to engage in self-empowerment in the face of disability stereotypes and stigma. These middle-class persons with disability showed through their words and their reported actions and inactions that they were primed to accept and embrace their disability identities but also to reject the disability label whenever possible. They have, through these strategies, communicated their defiance of disability stereotypes and stigma, and their agency in taking control over their social encounters.

3.2. Identity management strategies

3.2.1. Strategies for dealing with enacted stigma – social response strategies

3.2.1.1. Avoidance of mixed contact

Middle-class persons with disability are in constant touch with non-disabled people at their places of work, schools, religious meetings and at home. Goffman (1963) refers to this interaction between stigmatised individuals and non-stigmatised persons as “mixed contact”. The stigmatised identities of persons with disability are often drawn into focus in such situations. Persons with disability may be subjected to scrutiny, curiosity and pity. For these reasons, four participants reported that they sometimes avoid or intend to avoid certain spaces and encounters when they believe that their impairments could expose them to stigma and condescending scrutiny. They are selective about their social contacts and social participation. Isaac said that he avoided people when he had reason to believe that they would not treat him properly because of his impairment. His unwillingness to interact with such persons means that he has awareness of his stigmatised identity. It also means that he abhorred the negative treatment he had been subjected to in the past. Louisa took a similar position when she said:

… it would be difficult to communicate with people who were not used to the way I talk so to save myself from the problem … the trouble of having to explain myself to the curious people, or having to repeat myself, or having to clarify or explain, I would rather keep quiet to save myself from a lot of explanations … from those who are curious and those who can’t hear you. Someone would even laugh at you or something so to save myself from all that, I was more quiet outside. (Louisa, speech impairment)

The avoidance of mixed contact situations enables middle-class persons with disability to temporarily escape from disability stigma. Louisa’s use of the word “trouble” to describe an aspect of her mixed contact situations showed her discomfort from previous mixed contact encounters. She further added that:

I don’t want to draw attention to myself, and I don’t want any drama as … what did you say? What did she say? How come she is talking like this? I don’t want to go through that drama. (Louisa, speech impairment)

Felix, in commenting about his visual impairment said “I don’t tell anybody. I knew my own problems.” He was not willing and ready to disclose his impairment in his conversations and only did so when it was absolutely essential that he spoke about it. When asked why he had taken that position, his response was this:

… but if you hadn’t asked me, why should I tell you I can’t see with one eye? Except where there is a challenge which requires that I have to use the other eye, then I can say that it is not working. Sometimes, when there is an eye test or something, I close the other eye, test the proper one and if I close this one and I’m testing, I tell you I can’t see properly with it from the word go so that you don’t continue doing. So, for me it has been something I have kept to myself unless someone asks and finds out because I can read. It was something I didn’t tell people because you can see it is squinted but that is enough. (Felix, physical impairment & visual impairment)

The impairments of Felix and Louisa remain hidden because the impairments are not readily noticeable. Both of them act in ways that would not draw attention to their impairments. This shows the awareness they have that they have attributes that could be stigmatised in their mixed contact situations. For middle-class persons with disability, the uncertainty about mixed contact encounters, the fear and distress of disrespect and the sense of insecurity that these breed, particular from persons with whom they are not already acquainted, sometimes compel them to adjust their behaviour to avoid disability stigma.

3.2.1.2. Confrontation and resistance

Some of the participants confronted people who abused them as a way of resisting the stigmatising treatment that they are often subjected to. The ability to confront people and defy situations that may be stigmatising depends on how much power and control that the person with disability has in that social encounter and also, what failure to resist the stigma would mean. Seven participants were involved in formal disability advocacy through their association with disability organisations. Two participants indicated that they had engaged in advocacy informally. All of these participants used the confrontational approach to challenge disability stereotypes and stigma. Ruth, who uses a wheelchair, indicated that she “will scream and kick if [she goes] somewhere and they don’t have a ramp. I won’t turn round and say I am being discriminated against. I will point it out to you that you should have a ramp.” Ruth found a lot of satisfaction in her disability advocacy work which to her, allowed her to confront disability stigma. She stated:

I think at the moment, I’m comfortable in that I have a voice and that my opinion is sought because I’m a member of GFD [Ghana Federation of Disability Organisations]. I’m talking of (disability NGO). I’m a member of (disability organisation). I can do a letter to parliament anytime. Whether they will act is another thing but at the moment, I don’t think people will shut any door because I have a disability, or anybody I want to talk to will say oh no. I think I have access to people. If I want to see them, I can get to see them. (Ruth, physical impairment & visual impairment)

Abel narrated the struggles he engaged in together with his colleagues who also had physical impairments after a specialised vehicle that had been donated to their disability organisation by a philanthropist was almost appropriated by some persons in authority. The process of taking possession of the vehicle became unusually difficult and efforts towards the repossession of the vehicle involved numerous visits to some government offices. Abel says at some point, he and his colleagues threatened the state officers with a full-scale public and media exposure of their seemingly dishonest actions. It was then that the vehicle was released to them. He remarked, concerning one of the officers who had earlier treated them with contempt, that:

The man whose office we went to has now seen different persons with disabilities, courage and boldness in depth. We were three and we went to the office to fight. It wasn’t easy. These are some of the things our disability has turned us into. It has given us some boldness and courage to do things. The country has added some courage to us. In this country, if you are not strong, you cannot survive. It’s like a jungle. (Abel, physical impairment)

Desmond spoke about how he went to confront the head of a disability advocacy organisation about what he believed was the organisation’s misplaced focus in their work. He believed that the organisation was not doing enough to protect persons with disability. He said that even though he was not looking for a job at that organisation, the organisation later offered him a position which he accepted.

Ernest, a participant who had visual impairment, had not been on the frontline of disability advocacy but he indicated that he never let go of an opportunity to educate people who mistreat him because of his visual impairment. He has challenged people on buses, roadsides and in many other places. Isaac also had visual impairment and had been involved in disability advocacy since his days in secondary school. He said that he has participated in capacity building workshops and conferences to enable him take up disability advocacy roles at both organisational and national levels. For all of these participants, their involvement in advocacy and resistance allowed them to construct a defiant and positive image about themselves. This gives them the leverage to persist in their advocacy and further resistance of disability stereotypes and stigma.

3.2.2. Strategies for dealing with felt stigma – cognitive response strategies

3.2.2.1. Elevation of self-perception from social comparison

One of the means by which middle-class persons with disability manage their identities is through the elevation of self-perception from social comparison. They do so by comparing themselves with non-disabled people and to prove to themselves and others that they have similar and sometimes better accomplishments than their non-disabled peers. The satisfaction that comes from the comparison limits the effect of the stigma they face. Eight participants described their satisfaction with their accomplishments and how superior their accomplishments were when they compared themselves with some non-disabled people within and outside their social circles. Nicholas stated:

I have a house I have built myself and there is a man who has bought land close to mine, but he doesn’t have the resources to build the house. So, when people see me, they really congratulate me … deaf person with a deaf wife and you have been able to put up a house.(Nicholas, hearing impairment)

The favourable comparison Nicholas made suggested that he sought to show that his impairment had not weakened his financial ability to accomplish what some non-disabled people were labouring to achieve. Desmond had a part-time teaching position and spoke about his excitement at being able to “work on the minds of able-bodied people.” He stated that it made him “feel good” and that he was willing to take up a permanent teaching position even if it meant he would take a salary 10 times less than what he was taking at his current job as an administrator in a disability organisation. The satisfaction from the part-time teaching position emanated from the control he exercised over non-disabled people since his impairment had not “disabled” him. His excitement can also be attributed to the opportunity he had to challenge the disability stereotypes in order for him to “leave a legacy”, as he worked to dispel the notion of persons with disability’s perceived incapacitation.

The favourable comparison can also come from the mastery of certain skills. Abena said she spoke about 10 Ghanaian languages. Her response to my expression of surprise at her comment was that “God will not make me like you. He has given you your legs.” She accepted that she had the impairment, but she believed that there was something she possessed that I did not have, as a compensation for her impairment. To her, I have my legs, but I cannot match her linguistic prowess, but she had the latter even if she did not have the former. Ultimately, we both had an attribute regarded as “strength” and one that may be seen as a “weakness” which makes us “equal”. Abel made a similar allusion to an encounter he had with a certain woman when he was going to church in the company of his wife and their children. Abel and his wife are both wheelchair users and according to him, the woman remarked that “she would prefer to be disabled and have a peaceful marriage and a wonderful marriage.” Abel’s comment on the interaction was that “a lot of people are disabled in their rooms.” What he meant was that some non-disabled people have challenges in their lives that made it difficult for them live their lives to the fullest. His comment is founded on the idea that while disability may be a “weakness”, there are other “weaknesses” which are not like their impairments but are equally “disabling” to whoever has them. Some middle-class persons with disability use this approach to characterise non-disabled people as vulnerable people whose “disabilities” and “impairments” may not be visible as the impairments of persons with disability are. Richard, in comparing himself with his schoolmates, noted:

I have done my Masters, you know, I can even say some of my hearing friends were not able to complete SSS [Senior Secondary School]. At times when I meet my hearing friends, they [think] they speak and hear unlike me. I don’t feel disappointed because after all, I can say I have reached a very high level in terms of my qualifications. When we go for meetings, I have interpreters who sign for me, so I do a lot of contributions, so it is a plus because I am able to contribute to discussions through my interpreters. (Richard, hearing impairment)

Richard believed that his friends had been “disabled” by their inability to complete their secondary education. He was not “disabled” in that aspect. Middle-class persons with disability, by this means, equate physical or sensory impairment with social accomplishments. Ruth made an interesting comparison between herself and other women. She suggested that her impairments had “freed” her from reproductive labour at home. She stated:

I think on the whole, I am a lot more liberated than a lot of other women … the disability has kind of freed me because I don’t have to cook for any man … I’ve never wanted to depend on somebody … in a way I do, yes, now I can’t do things for myself but even with my husband when we are going out, I tell him oh, you can’t transfer me so wait for my driver to come because he knows how to transfer me … and that, I think a lot of women … I don’t know but they don’t have that freedom. They wait for a man to tell them what to do. They depend on men. Me, I find that a little hard. (Ruth, physical impairment & visual impairment)

Ruth believed that her impairments had allowed her to escape the constraints of social norms which require women to perform reproductive labour roles in their households. She believed that even though her impairments had limited her physical abilities, she decided on what happened in her life. She had control over her life and affairs in ways that some non-disabled women may not have. She said that she “controls” the men in her life—her husband and her driver, instead of the usual normative scenario of men exercising dominance over women. Again, Ruth in comparing her situation to non-disabled women remarked that:

… some people, they are able bodied, but they are more disabled than I am. Some people can’t even take decisions. So, I thank God that at least I can take decisions even if it means physically, I cannot go about to see it through, but in my mind, I am very clear. I am very clear, like this is what I would like to do but if i can’t do it now, it’s there, it’s all laid out. (Ruth, physical impairment & visual impairment)

Abel used comparison as a tool to place himself at par with the non-disabled parents of his children’s schoolmates. He did so by referring to his financial ability. He noted:

My children started that school from the nursery, so the teachers and the pupils know them, and they know us, and they know people who started the school with my kids, and they have dropped from that school because of school fees, so the proprietor doesn’t joke with my kids in the school. There are times we pay their school fees ahead of the term so the teachers and administrators in the school know that we are very capable. (Abel, physical impairment)

Abel was aware of the stigma he faced and the courtesy stigma that his children had to deal with since both he and his wife had physical impairments. He said that he had oriented his children with a defence mechanism that is founded on his financial strength and the several trips abroad he have had with his wife. He said:

I’ve tuned up my kids’ mind that sometimes if you say something to them, the reply they will give to you will make you go and cry. I’ve told them that if someone says your parents are in a wheelchair, the first thing [they] should say is ‘and so what?’ and secondly, they should tell them that my mum and dad take care of me. I’m still in the same school with you, and my mum and dad are disabled but they have travelled outside before, have your parents ever travelled outside? I give them so many statements that they can use. (Abel, physical impairment)

Abel’s statement about having “travelled outside” was in reference to the higher social status of persons who have travelled “outside” in Ghana. It is a status symbol that only the elite in the Ghanaian society are able to lay claim to. He used his travel experience as a standard by which he elevated himself against people who may stigmatise his children because of his impairment.

3.2.2.2. Deflection to religion

Some of the participants accepted their disability identities through the adoption of religious rationalisation of their impairments. Nine out of the 16 participants showed willingness to ignore the constraints of disability stigma. These participants rather focussed on what they described as their divine circumstances. The other seven participants who seemed not to actively rely on religion as a means of responding to disability stigma gave responses that suggested that religion was still a significant aspect of their lives. The participants’ devotion to the religious deities provided them with a means of deflecting the discomfort of disability stigma away from themselves. Sylvia noted:

I am very happy that I know Jesus Christ because if I had known Him earlier, I wouldn’t have gone through all the troubles I told you about. I know that if this life doesn’t go down well with me, I still have a good future and reward in Heaven. I used to cry so much but since I got to know of Christ, I have stopped all that. (Sylvia, kyphosis)

Sylvia was referring to some misguided choices and decisions she believes she made in her past as a result of disability stigma when she “did not know Christ.” She believed that she would not have made those bad choices because her faith would have limited the effects of the stigma she faced. Yaw also referred to some inappropriate choices he made in his past. He indicated that the frustrations that came from how his family, friends and strangers behaved towards him made him feel excluded and unhappy. He consequently took to deviant acts under the influence of his peers as he sought social acceptance and validation. When asked about what or who the biggest influence on his life has been, Yaw spoke about his superior at work but also acknowledged the impact that religious devotion has had on him. He said that “[he] did not love himself” but that changed after he became serious with his faith and church services. He explained:

… when you get an encounter with God, it’s in the Bible, everything changes. I was drinking because I didn’t know myself, maybe I was smoking because I wanted to be like [other] people…I was going to the club because I didn’t know myself but after my encounter with God, that is when I realised [that] I have some strength, that is why I did away with those things, and I started loving myself back. Since then, all my plans have fallen in their rightful place and now I’m here … (Yaw, achondroplasia)

The belief and reliance on God are seen again when Louisa suggested that her speech impairment was a sign that she was meant to be different, that she was meant to be a better person. She believed that God gave her enough resources to handle the stigma and the constraints that her impairments presented to her. She believed that she had dealt with her impairment and the stigma well. She explained:

I believe in God, and I trust in God, and I have relied on God so much so there is the God factor in my life. I believe in God, and I believe in divine orchestrations and interventions, and I believe that God made me special and there is a special purpose for me so God will see me through. (Louisa, speech impairment)

Ernest also spoke about the social support he received from his family and friends, but he also added the religious dimension when he noted that “Life [was] good with Christ and having the right resources such as having at least enough to take care of the things you need”. Abena and Henry said that they did not address their minds to how their lives would have been without their impairments. Henry, in responding to a question about whether he thought he would have been in a better standing in society without his impairment responded that:

I would have died yesterday. It could have also been a possibility. So, if I had my right arm … those ‘ifs’ that will make you feel inconvenient. I don’t think about them. Once, somebody got up and was like ‘ah, so you, I always see you bubbly and always excited doing what you do, don’t you sometimes sit down and regret that you don’t have your arm?’ I’m thankful to God that I even have life in the first place. (Henry, physical impairment)

Abena did not attribute her current middle-class status to her own effort. She ascribed it to “grace” and “mercy” from God. She stated:

I don’t want to say that I am too good to be enjoying the things that I am enjoying. It is favour. It is mercy, whichever way. That‘s about it. I‘m not sure, what I can say is maybe had it not be for the disability, I would have been worse off spiritually … just last week at church, Bible Studies, I was telling them that when we talk about the grace of God, I need not look far to see the grace of God. I look at myself, because but for His grace I wouldn’t have been able to do a lot of things. There are people like me on the streets begging. So why am I where I am? It is grace. (Abena, physical impairment)

The participants found comfort and security in their faith because of the assurances they had in their beliefs. Some of them believed that they could have ended up worse than their current social standing. They were aware of the impairments and the significant constraints that persons with disability faced. They, however, perceived their emancipation as an exceptional situation rather than the usual condition of persons with disability. In constructing a divinely inspired emancipation for themselves, the participants were able to focus on the positives of their middle-class social status and ignored some of the challenges of disability stigma.

4. Discussion

The experience of disability stigma influences how individuals respond to their impairments and their overall experience of disability (Rafael et al., 2010). Middle-class persons with disability are able to use their responses to stigma to alter the nature of their social relations. At other times, they use the responses to control their negative emotions which are stirred by their stigmatising experiences (Bos et al., 2013; Laganà & Hassija, 2012). The former approach is regarded as “problem-focused”, and the latter is “emotion-focused” (Bos et al., 2013). Emotion-focused strategies have also been described as cognitive strategies (Boehmer, 2007; Cox et al., 2003; Montel et al., 2009). The findings of the study indicate that middle-class persons with disability frame their impairments in two ways. While some of them deny the disability identity because of what they perceived to be its denigrative nature, others embrace the disability identity because they have been able to overcome the negative effect it once had on them. Middle-class persons with disability also utilise two response strategies to respond to disability stigma. The social response strategies include the avoidance of some mixed contact encounters and confronting people who attempt to denigrate them because of their impairments. The cognitive response strategies include elevation of self-perception from social comparison and deflection to religion.

The denial of disability by some of the participants reverberates with the position of Reeve (2004) that the presence of the impairment does not necessarily lead to the identification with the disability. Similar to the findings of Jammaers et al. (2016), the participants in this study stressed their agency and productivity with their creation of positive identities which challenged disability stereotypes about functional incapacitation. Some of the participants saw the “disability” label as a metaphor for functional limitation and since they did not consider themselves to be functionally limited or sick, it was easy for them to reject the label (Grewal et al., 2002; Grue, 2011; Johnstone, 2004; Lusli et al., 2015; Spiritos & Giligan, 2020) and distance themselves from it (Kusow, 2007). Kusow (2007, p. 4787) posits that distancing is “where stigmatized individuals or groups disassociate themselves from those roles, associations, and institutions that may be considered as stigmatizing.” Some of the participants used this approach to indicate their reluctance to conform to and enact disability roles. Some of them were also not inclined to associate with disability institutions and groups because of their quest to avoid the disability label. This has been described by Goffman (1961) as “role distancing”. Middle-class persons with disability utilise their social class status as a leverage to distance themselves from the disability as an identity, even if the “distancing” serves emotional and cognitive purposes only. The participants who avoid mixed contacts do so as a result of felt stigma because there exists in their minds a fear of being treated with contempt, as the case may be with enacted stigma (Frederick, 2017; Goffman, 1963; Gray, 2002; Lekas et al., 2011).

For the participants who embrace their impairments and the disability identity, doing so is a means of self-empowerment in the pursuit of full social participation (Frederick, 2017; Johnstone, 2004; Lusli et al., 2015). Another means of self-empowerment is by the use of social comparison. By comparing themselves with non-disabled people and emphasising their similarity and sometimes superiority, middle-class persons with disability are able to subdue the negative consequences of stigma by the construction of better social identities over their personal identities (MacRae, 2008; Read et al., 2015). The comparison made by the participants can also be explained by Festinger (1954) Social Comparison theory where he posits that people have the motivation to engage in self-evaluation and that, if the evaluation cannot be done using an objective measure, other people may be used as the standard for the evaluation. In this regard, the participants created their own indices and standards as the bases for the comparison.

According to Burris (2002) and Hale (2010), the strength and inspiration that aids persons with disability to confront disability stigma often lead them into advocacy. Their position is consistent with the findings of the study as seven participants have served in various roles in disability activism in Ghana. Some of them have founded disability organisations and others have worked with disability organisations. A few of them have also appeared on television and on radio to educate the public on disability rights and inclusion. Their desire and ability to engage in disability activism is linked to their middle-class statuses which gives them the strength, the cultural and social capitals needed to advocate not just for themselves but also for others (Hale, 2010).

The reliance of the participants on religion as a means of mitigating disability stigma is seemingly a contradiction. This is because the core of disability stereotypes and disability stigma emanate from religious beliefs (Kassah, 2008; Mensah et al., 2008; Naami et al., 2012; Slikker, 2009). Religious beliefs influence how persons with disability are perceived and how they are treated. Therefore, for the participants, religion is both a cause and a cure for disability stigma and internalised oppression. The ability of persons with disability to use religion for their benefit comes from their utilisation of aspects of their religious beliefs that liberate them from the internalised oppression, rather than focusing on the dominant ideas and beliefs about disability that tend to confine persons with disability in society. They have their personal affirmation in their religious beliefs that they rely on. The point of variation, however, is that, while the participants alluded to their Christian faith as a means of deflecting the disability oppression, the religious beliefs that are seen to be most exclusionary tend to be steeped in traditional religious beliefs (Agbenyega, 2003; Avoke, 2002). That is not to say that the Christian faith has not been used to justify the marginalisation of persons with disability. Some Christians have also been observed to be using their beliefs to oppress persons with disability (Botts & Evans, 2010; Ocran, 2022b).

A significant feature of the participants’ framing of their impairments and their identity management strategies was that, when their impairments and the idea of disability were being discussed nominally, they acknowledged their impairments and their “disability” experience. However, in ways similar to the findings of Lyons et al. (2018), middle-class persons with disabilities emphasise their ability to use their strengths and functional capacities to limit the effect of disability stigma on them, even if disability stigma used to be a challenge for them in their past. They are, thus, able to move between “claiming” the positive aspects of their identities and at the same time “downplaying” the negative aspects of their identities (Lyons et al., 2018). The identity management strategies used by the participants in this study, therefore, enables them to “move in and out of a disabled status” (Riach & Loretto, 2009, p. 109). These parallel social identities are empowering and liberating (Baldridge & Kulkarni, 2017). This, according to Riach and Loretto (2009), means that disability may be compartmentalised so that it does not remain as a fixed classification of the social identities of people. The process of rationalising the disability identity and the functional limitation stereotypes away from themselves draws on a cognitive ability to temporarily discount the impairment and the social consequences of the existence of the impairment. This enables them to maintain their positive identities even when they experience disability stigma. The ability to temporarily disconnect themselves from the disability identity and the social meanings it comes with also come from their regard of their middle-class social statuses as respectable in their social contexts.

As explained by Reeve (2004), internalised oppression has the tendency of sustaining the negative stereotypes faced by persons with disability. When persons with disability accept and conform to these negative disability stereotypes, they could become what society thinks of them and expect them to be. For middle-class persons with disability, that is what they, through their agency, actively seek to avoid. This is because they are aware of their rights and they also make full use of the social opportunities obtained through their education and employment (Lusli et al., 2015). An obvious aspect of the experiences of middle-class persons with disability is that the high social class status offers some redemption from disability stigma and the overall experience of disability. This is because middle-class persons with disability have some form of emancipation by virtue of their economic independence, high intellect, political activism and social integration and as a result, they are not seen as a nuisance in society. Some persons with disability in Ghana who have had education, acquired the right functional competencies and are in desirable employment with decent incomes are able to use these as leverage to challenge the disability stereotypes and take up activities that may be ordinarily proscribed for persons with disability (Asamoah et al., 2018; Naami & Hayashi, 2011; Naami & Mikey-Iddrisu, 2013; Odame et al., 2019). For middle-class persons with disability, their middle-class status could become their master status under the right conditions, and they may, on that basis escape some, if not all aspects of disability stigma. When the agency with which middle-class persons with disability assess their impairments is considered, together with the strategies they use to respond to their experiences of felt and enacted stigma, they attest to notable emancipatory phrase—the personal is political.

5. Limitations

The sample for the study was made up of only middle-class persons with disability. For this reason, the findings of the study may not be applicable to all social class categories of persons with disability. This limitation notwithstanding, the study has shed light on how some persons with disability respond to disability stigma and some of the processes by which they manage their identities. The heterogeneity in the sample has also made it possible for a wide range of experiences shared by people from distinct cultural backgrounds to be explored. The shared experiences have come from people who have diverse impairments and have lived in different parts of Ghana. The study, is therefore, a worthy addition to the literature on disability stigma and identity management strategies of persons with disability in Ghana and beyond.

6. Implications for policy and research

The study was conducted in Ghana and the narratives that the participants of the study shared are all from their experiences in various Ghanaian communities and social spaces. The role that social class, and in this case, the middle-class status plays in identity formation for persons with disability has relevance across diverse societies since disability stigma has a far-reaching occurrence. It is, therefore, important that disability stigma and the internalised oppression that it sometimes breeds are curtailed. It will not be easy to achieve that objective, but something has to be done. This includes ensuring that persons with disability in Ghana (and elsewhere) are given adequate formal education to increase their level of awareness. This will also empower them build their cultural and social capitals to enable them to integrate into mainstream societal activities. The education they are given will most likely improve their employability or their ability to create jobs for themselves. These will improve their livelihoods and their ability to respond adequately to internalised oppression. An important factor that will facilitate these developments will be the strengthening of the legal protection of the rights of persons with disability to their peace of mind and full social participation. Above all, there has to be a deliberate effort backed by the appropriate legal and policy frameworks that should be intended to create and expand inclusive spaces within which persons with disability will neither encounter enacted stigma nor experience felt stigma.

Research on the experiences of persons with disability does not have to be focused on just enacted stigma (manifest experiences of abuse, exclusion and discrimination) since felt stigma (the anticipation of abuse, exclusion and discrimination) can be equally disturbing. This is because the extent of felt stigma is also dependent on the influence of structures such as social class status, gender, spatial considerations, social contacts and the nature of social interactions. These are all very instrumental in the lives of persons with disability and could be explored further to understand and eliminate their constraining effect on persons with disability.

7. Conclusion

This study examined how middle-class persons with disability in Ghana frame their impairments and how they manage their identities and respond to disability stigma. Persistent experiences of stigma, assumptions of incompetence and inadequate acceptance lead to resistance and the pursuit of ways of responding to the vulnerabilities and the humiliation brought by the disability identity. These strategies are a response to middle-class persons with disability being treated differently and being made to feel “handicapped” and inadequate. These negative experiences occur because of stereotypical notions that disability is a problem for oppressed, marginalised and excluded people whose place in society is on the fringes. For the participants of the study, their conceptualisation of their impairments and the “disability” identity was influenced by normative understandings of what constitutes disability and how persons with disability are expected to behave in society. The identity management strategies emanated from middle-class persons with disability’s rationalisation of what disability was and their responses to these conceptualisations of disability. The participants who rejected the “disability” label and the stereotypes that it carries were able to do so because they had cognitive abilities that are founded on their middle-class social status which allows them to form better identities for themselves. The participants who embraced the disability identity also did so because they were able to construct empowering identities for themselves that emphasised their middle-class social status, their roles in disability activism and their ability to participate in some mainstream social activities. The importance of identity management strategies in the lives of participants cannot be overemphasised. Without these, they would be overcome by internalised oppression from the felt stigma of disability. Given the importance of the social class status in the lives of the participants in their ability to respond to disability stigma, it will be useful to build the capacities of persons with disability and equip them with adequate social and cognitive resources that they can rely on to repel the negative consequences of disability stigma. It is through these that they will be able to challenge disability stereotypes, stigma, exclusion and discrimination brought on by society’s response to disability.

Data availability statement

The data are not publicly available due to their containing information that could compromise the privacy of research participants. However, aspects of the data that do not identify the participants are available from the author on reasonable request.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

This study was supported by funding from the UG-Carnegie Next Generation Academics in Africa (NGAA) Project.