Disability – Medical Fact or Social Construct?

Disability is a term widely used for the social condition recognised as resulting from any type of physical or mental impairment mainly identified through medical procedures. Some are present at birth while other impairments occur at various stages of an individual’s life either as manifestations of genetic conditions or as the result of conflicts (e.g. war), and accidents. Examples are varying degrees of blindness, deafness, speech impairments (dumbness) and loss of limbs. Chronic illnesses too should be added to this list. Usually prosthetic devices such as magnifying glasses, Braille, hearing aids, sign language, crutches, wheelchairs and other similar aids have been designed to ameliorate handicaps in living, experienced by disabled people.

Constitution of Disabled Peoples’ International (1981) defines Impairment as ‘the loss or limitation of physical, mental or sensory function on a long-term or permanent basis’, with Disablement defined as ‘the loss or limitation of opportunities to take part in the normal life of the community on an equal level with others due to physical and social barriers’

Since all serious impairments giving rise to disability appear to stem from a recognised medical condition, historically, disability studies relied on a medical model centred almost solely on the individual. Following the medical model the disabled were segregated from ‘normal’ people and seen as deficient, lacking in self-efficacy, needing care. The disabled were defined by their deficiencies, in what they could not do, and not by what they could do. Society at large made no attempt to adjust to the requirements of the disabled, to integrate them, instead tending to isolate them in institutions or at home. Impairment was seen as the problem, and the disabled were restricted to being passive receivers of medication, care, and targeted assistance through state intervention or charity. Even today, as befitting the medical model, disabled people are regarded as requiring rehabilitation. They are subject to negative stereotyping and prejudice by the rest of society. Further, the ubiquitous built environment imposes restrictions on their mobility, access to employment and recreation.

Mike Oliver (1996), an academic with first-hand experience of disability and what it entails, calls the medical model an ‘individual model’ making a binary distinction between it and the social models which followed the Disabled People’s Movement in the 1970s. Vic Finkelstein, another academic and Paul Hunt, an activist, were also involved in helping to form the Union of the Physically Impaired against Segregation (UPIAS). Oliver fought against the ‘medicalisation’ of disability denying that there never was a ‘medical model’ of disability. Oliver believed that problems attendant on disability should not be regarded exclusively as the responsibility of the medical profession and other similar ‘experts’ who, from a position of power, see the problem as entirely located within the individual. For Oliver and others working in the disability field around the 1970s disability was a social state and not a medical condition. These pioneers were influenced by Marxist rhetoric much in evidence at the time.

The individual discourse on disability is allied to World Health Organisation pronouncements, as for example, by the International Classification of Functioning, Disability and Health. It owed its existence to advances in science and medicine which placed disabled individuals into medical categories for the convenience of medical practitioners and other health professionals. This, though eminently practical and appropriate at the time, was later experienced by the disabled population as an oppressive situation. They felt themselves labelled, manipulated, and powerless vis-a-vis their own bodies and personhood.

There is inherently nothing wrong with impairments being initially identified and treated as a medical condition. Indeed, this is a necessary first step, especially when individuals require continuing, lifetime medical care. It is when such treatment excludes or disregards the social environment, which to a large extent defines the parameters within which the disabled are expected to function, that problems arise. It inevitably invites social exclusion and disadvantage, segregation and stigmatisation, which is the fundamental criticism against the narrow medical model.

Still, there are apologists for the medical model of disability. They regard as questionable Mike Oliver’s denial that impairment has any causal correlation with the societal notion of disability. For them this is an ‘oversocialized’ and overly politicized view. Although he accepts that disability is both biologically and socially caused, he places ‘more significant causal weight’ on the former. They recognise the sociological significance of the body, but complain hat the social model suffers from ‘somatophobia’ due to an over-emphasis on the social context. Other researchers are keen to emphaise that there is social oppression at play in the field of disability.

Shakespeare and Watson (2002) stress that ’embodied states are relevant to being disabled’. They believe that social model advocates ‘over-egg the pudding’ by stating that disability is entirely a creation of society instead of accepting that ‘disability is a complex dialectic of biological, psychological, cultural and socio-political factors, which cannot be extricated’ to any great extent. However, Carol Thomas (2004) is critical of anyone not recognising the importance of disabilism in their discussion of disability. She thinks they confine themselves to a ‘commonplace meaning of disability’ ignoring the much larger significance allied to similar concepts like racism, sexism and homophobia.

Vic Finkelstein, a pioneering academic and activist in the field of disability, himself disabled, was a refugee from apartheid South Africa where he had been in prison for five years. Having been active in the civil and human rights movement in South Africa, he was immediately sensitised to the ghetto-like experience of the disabled in the UK. He saw that they were denied participation in the mainstream social and political life of the country. One of Finkelstein’s collaborators Paul Hunt, had been living in residential institutions (Cheshire Homes) from childhood and campaigned with other residents for a role in the management of such Homes. Following the medical model Cheshire Homes believed it had provided compensatory measures to meet the needs of the disabled, but disabled activists like Finkelstein and Hunt saw it as oppression of a minority by society at large.

These activists saw the medical model as the default position of the disability ‘industry’ staffed by care managers, social workers, physiotherapists, occupational therapists, clinical psychologists and doctors. Disabled persons’ powerless and socially inferior position was reinforced in such circumstances, however sympathetic and dedicated these professionals were in carrying out their duties. It was only after the establishment of UPIAS that the political landscape changed. UPIAS (1976) concluded that ‘… it is society which disables physically impaired people. Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and exclude from full participation in society. Disabled people are therefore an oppressed group in society’.

Apart from the horrors of the Holocaust which enabled doctors to experiment on disabled victims, there is at least one documented case of clinical abuse of disabled children in the USA. Referred to as the Willowbrook Experiment, in 1956 disabled children were deliberately infected with viral hepatitis to monitor progress of the disease over a lengthy period of 14 years. Parents had been under pressure to accede to it. It was also approved by the New York State Department of Mental Hygiene. To a large extent such extreme measures are no longer evident, but one can see how disability had been a custodial discourse.

A good example of a drastic change in the medical model is that only about four decades ago, the universally acclaimed and used Diagnostic and Statistical Manual of Mental Disorders (DSM) listed homosexuality as a mental illness. Psychiatrists and clinical psychologists practised aversion therapy (among others) to ‘cure’ these ‘unfortunates’. In spite of objections from a few extreme right politicians and religious fanatics, it is now accepted as a normal and positive variation of human sexuality. Indeed equal opportunity and human rights legislation have recognised the ‘gay’ community as a minority group. Some states even allow civil union and even marriage between same sex couples.

How the society’s views and treatment of the disabled have changed over the years is demonstrated by the example of Lord Nelson and President Roosevelt. With an arm amputated and blind in one eye, ‘the statue of Horatio Nelson defies modern infatuation with physical perfection by flouting his impairments.’ He contrasts Admiral Nelson with the wheel-chair using wartime US president Franklin Delano Roosevelt. Unlike Nelson, he was born into a modern culture where having an ‘impairment’ was supposed to directly ‘disable’ a person. Therefore, a ‘public statue of Roosevelt sitting in a wheel chair was unthinkable’ So now we are presented with a statue to a major USA public figure that takes care to hide any evidence of his impairment. There may not be a call to erect a statue to an even more modern celebrity like Prof. Stephen Hawking, but one must grant that without the medical advances that recognise his impairments making it possible for him to receive the right medical treatment and continue living and working as he does, there would not be a social or academic role for him to fill with such distinction.

In Australia, a variation of the social model was referred to as the rights-based model of disability. As in the UK, disabled people as a group there sought a political voice. Such activism and advocacy has brought gains, but they admit that there are also limitations. Although as a political strategy it helped to bring about needed changes through legislation, it locks people into an identity defined as being members of a minority community. This way the conceptual barrier between ‘normal’ and ‘abnormal’ is maintained. There are also new challenges when the latest genetic and reproductive technologies include a larger proportion of the population as carriers of ‘bad’ genes and unwittingly placed in the disabled category inviting discrimination and avoidance.

Four decades after the Cheshire Homes incident, we now have the spectre of Remploy Ltd. a government owned factory network across the UK established in 1945 offering both employment, and employment placement services, to the disabled, being dismantled. Remploy had been producing or assembling a vast range of products in its 54 factories spread across the country. Towards the end of the last century it even moved into service sector work. In 2009/10 Remploy placed 10,500 disabled people in jobs in a range of sectors. This year the Coalition government has decided to close 36 Remploy factories making 1700 workers redundant (press reports). It is unlikely that UPIAS would accuse Remploy as being in the business of segregating the disabled, but at some early point in a disabled person’s life that type of provision was always likely to have been necessary.

On doctrinaire grounds alone neither the medical model nor the social model would be privileged in explaining changes in circumstances such as those occurring now in the UK as exemplified by the fate of Remploy Ltd.

Others in the field take somewhat of a middle ground. For them disability is a ‘post-modern concept, because it is so complex, so variable, so contingent, so situated. It is at the intersection of biology and of agency and structure. Disability cannot be reduced to a singular identity: it is a multiplicity a plurality.’ They assert that any social theory ought to include ‘all the dimensions of disabled people’s experiences: bodily, psychological, cultural, social, political, rather than claiming disability is either medical or social’. They found people unwilling to identify themselves as disabled. They wanted to see themselves as normal though different. Many people with learning difficulties refuse to be referred to as disabled.

People have many different identities. Those who do not accept being labelled disabled may own up to various other identities as more salient. For example, gender, ethnicity, sexuality, class or marital status. The social model developed in the 1970s is no longer useful or valid. There needs to be a paradigm shift.

Today’s academics argue against a ‘crude determinism’ in favour of a more sophisticated approach to disability. For them, disability is not just a medical condition. Neither should it be reduced to being the result of social oppression, ‘overlaid with negative cultural meanings’. The disability literature has been plagued with overgeneralisations and it is now time to admit that it cannot speak for over six million people with impairments in Britain alone, and over half a billion across the planet. On the other hand, researchers in the field have accepted the notion that all human beings are impaired in one way or another. Disability is the normal condition of all humanity; it is not limited to a small minority of people.

The refusal to acknowledge that disablement or impairment is not just limited to those very obviously disabled but is a ‘normal condition of all humanity’ is clearly the reason for the historical oppression and exclusion of ostensibly impaired people by the majority of so-called normal people. This is said to be due to a need for denial of their own vulnerability, frailty and mortality, projecting them on to others less able to defend themselves. The far-reaching insight that we are all impaired should alert us to the fact that simplistic models may serve their purpose, but in a time-limited and contingent manner.

The above is a wide ranging exploration of academic discourse comparing and contrasting the concepts of the medical model and the social model of disability. Exploration of the advantages and disadvantages of either model as situated in historical context gave rise to the notion of disability as a universal human condition that neither model could explain comprehensively. Researchers and commentators today need to acknowledge that no one model could comprehensively encompass such a continually shifting paradigm.

This entry was posted in Uncategorized and tagged . Bookmark the permalink.