Notes

Disability - Medical Fact or Social Construct?
Disability is a term trusted for the social condition recognised as resulting from any type of physical or mental impairment mainly identified through surgical procedure. Some can be found at birth while other impairments occur at various stages of a person's life either as manifestations of genetic conditions or because the consequence of conflicts (e.g. war), and accidents. https://click4r.com/posts/g/9380437/ are varying examples of blindness, deafness, speech impairments (dumbness) and lack of limbs. Chronic illnesses too ought to be put into 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 be a part of the standard life of the community on the same level with others because of physical and social barriers'

Since all serious impairments giving rise to disability appear to stem from a recognised condition, historically, disability studies relied on a medical model centred almost solely on the average person. Following medical model the disabled were segregated from 'normal' people and viewed as deficient, without self-efficacy, needing care. The disabled were defined by their deficiencies, in what they might not do, and not by what they could do. Society at large made no attempt to adjust to certain 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 folks are regarded as requiring rehabilitation. They're subject to negative stereotyping and prejudice by the others 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 with assisting 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 shouldn't be regarded exclusively because the responsibility of the medical profession and other similar 'experts' who, from a position of power, see the problem as entirely located within the average person. For Oliver and others working in the disability field round the 1970s disability was a social state rather than a 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, 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 capability of medical practitioners along with other health professionals. This, though eminently practical and appropriate at that time, was later experienced by the disabled population as an oppressive situation. They felt themselves labelled, manipulated, and powerless vis-a-vis their very own bodies and personhood.

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

Still, you can find apologists for the medical style 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 neuro-scientific 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 really a complex dialectic of biological, psychological, cultural and socio-political factors, which can't be extricated' to any great extent. However, Carol Thomas (2004) is crucial of anyone not recognising the significance 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 neuro-scientific disability, himself disabled, was a refugee from apartheid South Africa where he had experienced prison for five years. Having been mixed up in Ethereal Paradox and human rights movement in South Africa, he was immediately sensitised to the ghetto-like connection with the disabled in the UK. He saw that they were denied participation in the mainstream social and political life of the united states. One of Finkelstein's collaborators Paul Hunt, had been surviving 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 because 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 such circumstances, however sympathetic and dedicated these professionals were in carrying out their duties. It had been 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 along with our impairments by the way we have been unnecessarily isolated and exclude from full participation in society. Disabled people are therefore an oppressed group in society'.

In addition to 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 america. Known as the Willowbrook Experiment, in 1956 disabled children were deliberately infected with viral hepatitis to monitor progress of the disease over a lengthy amount of 14 years. Parents have been under pressure to accede to it. It had been also approved by the brand new York STATE DEPT. of Mental Hygiene. To a large extent such extreme measures are no longer evident, but you can see how disability had been a custodial discourse.

Among a drastic change in the medical model is that no more than 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 the few extreme right politicians and religious fanatics, it is now accepted as a standard 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 time is demonstrated by the example of Lord Nelson and President Roosevelt. With an arm amputated and blind in a single 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 created into a modern culture where having an 'impairment' was likely to directly 'disable' a person. Therefore, a 'public statue of Roosevelt sitting in a wheel chair was unthinkable' So now we have been offered a statue to a significant USA public figure that takes care to cover any proof his impairment. There might 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 wouldn't normally be considered 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 style of disability. As in the united kingdom, 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 effect a result of needed changes through legislation, it locks people into an identity thought as being members of a minority community. This way the conceptual barrier between 'normal' and 'abnormal' is maintained. There are also new challenges once the latest genetic and reproductive technologies add a larger proportion of the populace as carriers of 'bad' genes and unwittingly placed in the disabled category inviting discrimination and avoidance.

Four decades after the Cheshire Homes incident, we've 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 season the Coalition government has made a decision to close 36 Remploy factories making 1700 workers redundant (press reports). It is unlikely that UPIAS would accuse Remploy to be in the business of segregating the disabled, but at some early point in a disabled person's life that kind of provision was always more 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 for example 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 really a 'post-modern concept, since it is indeed complex, so variable, so contingent, so situated. It is at the intersection of biology and of agency and structure. Disability can't be reduced to one identity: this 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 recognize themselves as disabled. They wished to see themselves as normal though different. Many people with learning difficulties won't 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 not any 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 method of 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 in fact 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. However, researchers in the field have accepted the idea that all human beings are impaired in a single way or another. Disability is the normal condition of all humanity; it isn't limited to a small minority of people.

The refusal to acknowledge that disablement or impairment is not only limited by those very obviously disabled but is really a 'normal condition of most humanity' is clearly the reason behind the historical oppression and exclusion of ostensibly impaired people by nearly all so-called normal people. This is said to be because of need for denial of their own vulnerability, frailty and mortality, projecting them 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, however in a time-limited and contingent manner.

The above is really 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 idea 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.

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