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