What forces influence cultural standards of beauty? How do discipline, punishment, and torture reflect our attitudes about the human body? In this challenging new book, Jean Bethke Elshtain, a nationally recognized scholar in political science and philosophy, and J. Timothy Cloyd, a strong new voice in social and political science, have assembled a collection of thought-provoking essays on these issues written by some of the finest minds of our day.
Read more Read less. From the Back Cover In this challenging book, Jean Bethke Elshtain, a nationally recognized scholar in political science and philosophy, and J. About the Author Jean Bethke Elshtain has written extensively on political philosophy, feminism, reproductive technology, the family, and the ethics of political and social thought and action. No customer reviews. Share your thoughts with other customers. Write a customer review. Discover the best of shopping and entertainment with Amazon Prime.
Prime members enjoy FREE Delivery on millions of eligible domestic and international items, in addition to exclusive access to movies, TV shows, and more. Encounters are more likely to result in dignity promotion when the relationship between the actors is one of solidarity ; that is, when the relationship is characterized by qualities like reciprocity, rapport, empathy, and trust. Dignity promoting settings are those that feature humane circumstances —characteristics like accessibility, transparency, friendliness, beauty, and calm. Finally, dignity promotion is more likely to occur under an order of justice , a social order that sees the provision of adequate income and housing, access to education and healthcare, and other societal investment in public goods.
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Participants' accounts suggested these are the ideal conditions for violation and promotion, but that in actuality their dignity encounters often take place in mixed conditions. That is, one may find settings meeting the description of humane circumstances even under broader orders of inequality or relationships characterized by solidarity even when one actor is in a position of vulnerability. Thus, neither dignity violation nor dignity promotion requires the simultaneous presence of all of the conditions described.
Conditions at one level can influence conditions at other levels, however. In an order of inequality, the relationship between actors in a given dignity encounter is more likely to be characterized by asymmetry and individual and collective actors more often find themselves in positions of vulnerability. Conditions may be temporally related. Past dignity encounters help to establish the conditions for present and future encounters.
An actor whose dignity has been violated in previous encounters is more likely to be in a position of vulnerability in a new encounter, for example. The conditions described should be conceptualized as risk factors for dignity violation or promotion: their presence does not fully determine violation or promotion, but makes such outcomes more likely.
In a dignity encounter, individual or collective actors engage in a cyclical interaction that involves reading each other's physical and social markers e. It is such social processes that violate dignity. Analysis of participants' accounts found that the main social processes involved in their experiences of violation were:. These processes exhibit a number of properties, including temporal properties like duration or frequency; properties of scope, like whether they involve individual or collective actors; properties of visibility, like whether they can be attributed to named actors or whether the actors are anonymous; and properties of intentionality, like whether they are acts of omission or commission.
They occur at the micro, meso, and macro levels. For example, a process like deprivation may describe both a child's experience of receiving her siblings' skimpy hand-me-downs and a government's habitual failure to provide adequate health and social services for a segment of its population.
Certain processes of violation seem more likely to occur in some settings than in others. Closed environments like jails or family households see some of the more violent processes, like assault. For a social process to become a dignity violation requires not only the occurrence of word or deed, but also an act of interpretation. The individual or collective actors involved in the encounter, including any observers who might be implicated, must perceive what transpires and attribute meaning to it.
Interpretation itself is a social process structured by the multiple levels of conditions in a given dignity encounter.
The actor who exists in a position of vulnerability, for example, may be more likely to read a relatively minor social slight as a dignity violation. In a setting characterized by harsh circumstances, actors may be so worn down from the constant state of arousal that any questioning or refusal of cooperation is interpreted as an attack on dignity. Thus far, this analysis has presented the social processes of violation as distinct and separate mechanisms. In participants' accounts of violation, however, the social processes of violation tend to cluster.
Grouping, labeling, vilification, and discrimination often co-occur, for example, forming social order-level phenomena known as racism, when directed at individuals or groups of color, or stigma, when directed at individuals or groups whose identities have been "spoiled" by a discrediting difference [ 39 , 40 ]. The participants in this study were quick to focus on dignity violation in their lives, but had to be prompted to think about times when they experienced an enhancement in their dignity.
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When they did so, however, it emerged that dignity promotion is a distinct activity—a kind of work, performed by individual and collective agents with the aim of promoting either their own dignity or the dignity of others. This dignity work shares with violation its embeddedness in interaction and in conditions pertaining to the actors, the setting, and the social order.
It too is constituted by a number of social processes. The social processes of dignity work described by participants as being conducted by individuals or collectives in order to promote their own dignity are:. Participants spoke of the following social processes as dignity work that individuals or collectives perform in order to promote the dignity of others:. Depending on the nature of the dignity encounter, these micro, meso, and macro level social processes become ways to create dignity where it is lacking, to maintain dignity that may be fragile, to defend dignity that is under threat, or to reclaim dignity that has been lost.
For example, a woman hospitalized with a terminal disease defends her dignity by attempting to conceal the markers of her illness, disdaining a hospital gown and putting on full make-up each day. Health and social care providers working with homeless individuals describe how they use processes like presence, advocacy, and empowerment to help create and maintain dignity for their clients. Such uses of dignity promotion also may be instrumental—helping to keep clients engaged and linked to services.
When participants spoke about situations in which their dignity was violated or promoted, what is it they understood to have been harmed or enhanced? What are the objects of violation or promotion? Violation and promotion are experienced as causing injury or benefit at two levels: the collective and the individual. At the collective level, participants described how the social processes of violation and promotion, even when enacted in an encounter between individuals, may also offend or benefit a people a group or organization joined by common identification or humanity in general.
At the individual level, there are two types of harms and benefits. In the first, people spoke of injuries or benefits to the self identity, self respect, self esteem, individuality, self concept, intelligence, character, self determination, confidence, a sense of one's self as valuable, worthy, or good ; violations of or respect for the body bodily integrity ; injuries or benefits to moral agency belief, standards, or aesthetics ; and offenses to or enhancement of personhood humanness.
In the second, participants described how violation and promotion of dignity infringed upon or served autonomy privacy, freedom of choice or movement, "adulthood" ; status stature, social standing, role, reputation, visibility ; and citizenship the relationship between an actor and the state. These objects correspond to human dignity the people and humanity , dignity-of-self the self, the body, moral agency, and personhood , and dignity-in-relation autonomy, status, and citizenship. Many of the social processes of violation and promotion are linked to specific objects.
For example, at the individual level, aspects of the self are injured by multiple social processes, including rudeness, contempt, bullying, and suspicion, and benefited by others, including authenticity and creativity. The body is violated by intrusion, assault, deprivation, and revulsion. Moral agency is offended by trickery and abjection, but may be enhanced through enrichment and empowerment. Citizenship is degraded by deprivation, exclusion, restriction, and discrimination, and may be advanced through contribution, leveling, or advocacy. Similarly, collective objects like a people may be harmed through processes like vilification, discrimination, exclusion, or exploitation, and greater humanity may be promoted through recognition, acceptance, and courtesy.
Often participants referenced the golden rule, noting that when people treat others as they themselves would wish to be treated the dignity of all is enhanced. Investigators in the social determinants of health have begun to theorize about the pathways through which dignity violation may affect health status [ 12 , 41 , 42 ].
A taxonomic element that will be important to understanding those pathways, one this paper has not yet discussed, is that of consequences. Participants used strong language and vivid examples to speak about the consequences of violation: Violation begins a "dwindling spiral" of damage and loss.
When a violation occurs, the individual may experience many emotions, including shock, fear, disbelief, hurt, mortification or embarrassment, discomfort or pain, indignation, frustration, or anger. Initial emotions evolve into a range of longer term experiences of "being wounded": degradation feeling "worthless," feeling that "you don't deserve anything better," feeling "worn down," feeling "like a failure," feeling "an inch high" or "like a criminal" , humiliation shame and guilt , anger resentment and hostility , isolation no sense of belonging, feeling different from everyone else , insecurity distrust, dread , disempowerment, and apathy and depression feeling "like a cork in the water," lack of belief in or valuing anything, feeling suicidal.
The individual experiences a series of losses: loss of respect, loss of self worth, ego, sense of self, and soul, loss of status, social standing, and moral standing, loss of confidence and determination. Longer term, the consequences of dignity violation are understood to be social isolation or marginalization, a reluctance to seek help or access resources, passivity or "learned helplessness," a "small" life of constrained choices, chronically poor physical and mental health, and a cycle of victimization and abuse, in which the violated individual turns to violating others.
Dignity violation has similar consequences for collectives and whole societies: a group "traumatization," resulting in a lack of balance and the development of a "culture of disrespect" and a subsequent loss of collective dignity "we all feel less human". In order to expand our understanding of how dignity violation affects individual and collective health status, it will be important for future research to describe and classify these consequences and to link them to specific conditions, social processes, and objects.
The taxonomy of dignity presented in this paper has identified two main forms of dignity—human dignity and social dignity—and has described and classified several elements of these forms, including the social processes that violate or promote them, the conditions under which such violations and promotions occur, the objects of violation and promotion, and the consequences of dignity violation. The companion grounded theory of dignity to emerge from this research sets the static components of the taxonomy in motion, showing how dignity is constituted through social processes of interaction and interpretation that are structured by conditions pertaining to the actors involved, their relationships, the settings, and the broader social order.
Several limitations of this taxonomy should be noted. In presenting the taxonomy in an abstract and generic form, context is lost and, with it, the active interplay among specific social processes and conditions. A more nuanced, and animated, representation would require thick description of particular dignity encounters situated in time and place. Through such close examination, the explanatory depth of the theory would be enhanced, although some of its breadth would be lost. The taxonomy may or may not be exhaustive and universal in its forms and elements.
As noted, there is a long history of defining and explicating dignity in disciplines like philosophy and law. The empirically-based taxonomy described here shows some concordance with the technical meanings of dignity derived through analysis and argument in those fields, but also some divergence.
It will be important for future work to subject the taxonomy to interdisciplinary and cross-cultural comparison, allowing for the addition or modification of conditions, social processes, and objects. In some of its emphases, the taxonomy certainly reflects particularities of the environment in which it was developed. For example, the notion of citizenship as an object of violation was very strong in these data, which may be a reflection of specific historical circumstances in Toronto: the city is a major center for arriving immigrants and still feels the effects of a neo-liberal provincial government that, after being elected in the mids, embarked on a series of budget cuts that left lasting holes in the social safety net and a lasting sense of betrayal among the populace.
This taxonomy has several implications for work in health and human rights. It serves as a reminder that dignity pertains to both individuals and collective entities and that there is a connection between the two; that is, threats to the dignity of one threaten the dignity of all, and vice versa. Thus, one might expect to see individual and collective health impacts resulting from injuries to dignity that are both very broad and very narrow in scope. The mechanisms of dignity violation described as part of the taxonomy help to elucidate the meso and micro processes embedded in the macro processes of "structural violence" that have been the focus of much attention in the health and human rights movement [ 43 ].
Such elucidation can help to explain the connections between societal conditions and health status in individuals and communities. In addition to its focus on the health impact of human rights violation, the health and human rights approach is concerned with the effects of health policy and health services on human rights [ 13 ]. Analyses that look at dignity in healthcare can use this taxonomy to shed light on the nature and consequences of dignity violation in these settings and eventually may provide knowledge that can be used to develop "dignity screens" for health policy development, health program planning, and health services delivery.
Mann's original call did not focus on dignity promotion. However, this study, along with other empirical research, has made it clear that individuals and collectives do act to create, maintain, defend, and reclaim their own dignity and that of others, even in the most difficult situations [ 1 , 32 , 44 ]. An understanding of dignity work can be extremely useful to advocates and practitioners in health and human rights—who are themselves engaged in a kind of dignity work—allowing them to harness the social processes and conditions of dignity promotion in order to improve health and promote the attainment of human rights goals.
This taxonomy can be of value to them in providing both a map to possible points of intervention and a language in which to talk about dignity. NJ developed the study design, collected and analyzed the data, and wrote the paper. She will act as guarantor for the paper. My thanks to the interview participants and to Vanessa Oliver and Andrew Koch, who helped to plan and conduct the interviews.
National Center for Biotechnology Information , U. Published online Feb Nora Jacobson 1, 2. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Nora Jacobson: ten. Received Oct 28; Accepted Feb This article has been cited by other articles in PMC. Abstract Background This paper has its origins in Jonathan Mann's insight that the experience of dignity may explain the reciprocal relationships between health and human rights. Methods Grounded theory procedures were use to analyze literature pertaining to dignity and to conduct and analyze 64 semi-structured interviews with persons marginalized by their health or social status, individuals who provide health or social services to these populations, and people working in the field of health and human rights.
Results The taxonomy presented identifies two main forms of dignity—human dignity and social dignity—and describes several elements of these forms, including the social processes that violate or promote them, the conditions under which such violations and promotions occur, the objects of violation and promotion, and the consequences of dignity violation. Conclusion The taxonomy has several implications for work in health and human rights. Background Dignity has long been prominent in the discourses of both health and human rights.
Methods Grounded theory is an interpretive research approach with theoretical roots in symbolic interactionism and methodological roots in Chicago School sociology [ 14 , 15 ]. Results Forms of Dignity A short history of dignity has three main episodes.
Elements of Dignity Dignity Encounters Every human interaction holds the potential to be a dignity encounter—an interaction in which dignity comes to the fore and may be either violated or promoted. Open in a separate window. Figure 1. Conditions of the dignity dimension of an interaction. Figure 2. Figure 3. Dignity Violation In a dignity encounter, individual or collective actors engage in a cyclical interaction that involves reading each other's physical and social markers e.
Dignity Promotion The participants in this study were quick to focus on dignity violation in their lives, but had to be prompted to think about times when they experienced an enhancement in their dignity. Objects of Violation and Promotion When participants spoke about situations in which their dignity was violated or promoted, what is it they understood to have been harmed or enhanced?
The Consequences of Dignity Violation Investigators in the social determinants of health have begun to theorize about the pathways through which dignity violation may affect health status [ 12 , 41 , 42 ]. Discussion The taxonomy of dignity presented in this paper has identified two main forms of dignity—human dignity and social dignity—and has described and classified several elements of these forms, including the social processes that violate or promote them, the conditions under which such violations and promotions occur, the objects of violation and promotion, and the consequences of dignity violation.
Conclusion This taxonomy has several implications for work in health and human rights. Competing interests The author declares that she has no competing interests. Authors' contributions NJ developed the study design, collected and analyzed the data, and wrote the paper. Acknowledgements My thanks to the interview participants and to Vanessa Oliver and Andrew Koch, who helped to plan and conduct the interviews. References Chochinov HM.
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