Models of Disability Module 4

Models of Disability Module 4

2. Models of Disability

These different understandings of the relationship of impairment to limitation inform two contrasting approaches to disability, often described as opposing models: the medical and social. The medical model understands a disability as a physical or mental impairment of the individual and its personal and social consequences. It regards the limitations faced by people with disabilities as resulting primarily, or solely, from their impairments. In contrast, the social model understands disability as a relation between an individual and his/her social environment: the exclusion of people with certain physical and mental characteristics from major domains of social life. Their exclusion is obvious not only in intentional separation, but in a built environment and organized social activity that disqualify or restrict the participation of people seen or labelled as having disabilities.

In their extreme forms, the medical and social models serve to chart the space of possible relationships between impairment and limitation more than to reflect the actual views of individuals or institutions. (A variety of more formal models, described in Altman, 2001, graphically represent the causal complexity of disability.) The medical model is rarely defended but often adopted unreflectively by health care professionals, bioethicists, and philosophers who ignore or underestimate the contribution of social and other environmental factors to the limitations faced by people with disabilities.

A variety of social models are embraced by disability scholars and activists in and outside of philosophy. The “British social model” associated with the UPIAS (1976) definition quoted above appears to deny any causal role to impairment in disability. As suggested, however, that denial may best be seen as limiting the scope of “disability” to the effects of exclusion and discrimination, or as symbolic, countering the prevailing emphasis on biological causes of disadvantage. More moderate versions of the social model maintain the emphasis on social causes while insisting on the interactive character of disability (e.g., Bickenbach 1993; Altman, 2001). Taking the poor fit between atypical embodiment and standard environments as their starting point, they treat disability as an interaction between biological and social causes, denying causal priority to either.

Implicit in the UPIAS definition of disability are two ways that society imposes limitations on disabled people, corresponding to two distinct strands of the social model. When the UPIAS claims that society “excludes” people with impairments, this suggests the minority group model, which sees people with impairments as a minority subject to stigmatization and exclusion. On this view, the main reason people with disabilities encounter hardship is because they suffer discrimination along the same lines as racial or ethnic minorities. Accordingly, civil rights protections and anti-discrimination laws are the proper responses to disability (e.g., Hahn, 1997 and Oliver, 1990). Perhaps the most familiar expression of the minority-group model is found in the preamble to the Americans with Disabilities Act, which describes people with disabilities as “a discrete and insular minority”—an explicit invocation of the legal characterization of racial minorities.

The UPIAS also asserts that “contemporary social organization” fails to “take into account” people with disabilities. This suggests the human variation model, according to which many of the challenges faced by disabled people do not result from their deliberate exclusion, but from a mismatch between their characteristics and the physical and social environment. On this view, disability is “an extension of the variability in physical and mental attributes beyond the present—but not the potential—ability of social institutions to routinely respond” (Scotch and Schriner, 1997). This view of disabilities as human variations is closely related to the view that disability is a universal human condition (Zola, 1989) or shared human identity (Davis, 2002, Ch. 1). The claim that disability is universal can be taken as nothing more than a prediction that we will all acquire familiar disabilities at some time in our lives. But that claim is better construed as one about the nature of disability; as maintaining that all human beings have physical or mental variations that can become a source of vulnerability or disadvantage in some settings.

These two versions of the social model are not incompatible, differing mainly in emphasis. The discrimination stressed by the minority group model generally leads to, and is expressed in, the societal failure to accommodate people with various differences. In some contexts, it is appropriate to analogize people with disabilities to racial minorities; in others, it is important to reject a difference between disability and normality and treat impairments as permanent variations. If one goal of social policy is to remove discrimination and its enduring disadvantages, another is to encompass the full range of human variation in the design of the physical environment and social practices.

Although the social model, in one variant or another, is now the dominant legislative, social-science, and humanities paradigm for understanding disability, it is not without its critics. Several argue against extreme versions of the social model, contending that an adequate conceptualization of disability requires a recognition of impairments as an objective basis for classification, to distinguish disability discrimination from other types of discrimination (Bickenbach, 1993). Others argue that extreme versions of the model doubtfully deny or understate the role of impairment itself as a source of disadvantage (Terzi, 2009, 2004; Shakespeare, 2006).

Some critics claim that the social model, as well as the medical, is based on a false difference between biological impairments and social limitations. “Impairment,” the argument goes, is no less a socially construction that the barriers faced by people so classified. Claims that there is a stable biomedical basis for classifying a variation as an impairment are called into question by shifting classifications; by the “lexicalization” of some conditions (shyness) and “demedicalization” of others (homosexuality). Moreover, the social environment appears to play a significant role in identifying and, arguably, in creating some impairments (dyslexia) (Shakespeare, 2006; Davis, 2002, Ch 1; Tremain, 2001; Amundson, 2000). What counts as an impairment may depend on which variations appear to be disadvantageous in familiar or salient environments, or on which variations are subject to social prejudice: Less-than-average height may be more readily classified as an impairment than greater-than-average height because the former is more often disadvantageous in environments designed for people of average height, or because it is generally seen as less desirable. For such reasons, it is difficult to establish the objectivity of the impairment classification by appeal to a clear and undisputed biomedical norm. Amundson (2000) goes so far as to deny that there is any biological basis for a concept of functional normality—a claim emphatically rejected by Boorse (2010).

The disputed objectivity of the impairment classification is adduced by Tremain to argue that impairments “must no longer be theorized as essential biological characteristics (attributes) of a ‘real’ body on which recognizably disabling conditions are imposed” (2001, 632). Rather, she argues that being classified as having an impairment is an integral part of the social process of disablement. Such criticism parallels the debate among gender theorists about whether we can distinguish sex from gender on the ground that gender is socially constructed whereas sex is not.

Thus, some critics conclude that it is at best oversimplified, at worst, futile to distinguish biological impairments from social limitations, or to attempt to separate and compare the biological and social contributions to the disadvantages of people with disabilities But even those who believe that the impairment classification can be defended in biomedical terms recognize that impairments are not merely biologically-defined atypical but also markers for discrimination—discrimination that may be reinforced by the conviction that it is a response to objective biological attributes.

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