Challenging the Authority of the Medical Definition of Disability: an analysis of the resistance to the social constructionist paradigm

This article attempts to explain why the social constructionist paradigm has failed to replace the medical model in American disability theory. The social movement led by American disability activists attempted to reframe the definition of disability using a minority group model based on the social constructionist paradigm. This paper argues that the disability movement was unable to successfully advance the social constructionist paradigm because the activists accepted the Americans With Disabilities Act (1990) despite its ideological basis in the medical model of disability, and the social constructionist theory does not adequately account for the importance of structural constraints to redefinition.     

How is disability understood? An examination of sociological approaches

This paper considers sociological understandings of what constitutes disability. Current meanings of disability in both disability studies and medical sociology are examined and compared, using selected articles from leading authors in each discipline as case studies. These disciplines are often represented as offering starkly contrasting approaches to disability, with their differences amounting to a disciplinary 'divide'. It is argued that, on closer inspection, common ground can be found between some writers in disability studies and medical sociology. It is suggested that this situation has arisen because, in disability studies, the social relational understanding of disability developed by Vic Finkelstein and Paul Hunt in the 1970s has been lost over time, overshadowed by the rise to prominence of its offspring: the social model of disability. The paper concludes with some reflections on the need to revive a social relational understanding of disability.     

Disability as a Phenomenon: a discourse of social and biological understanding

This paper addresses conceptualisations of disability and what it constitutes as a category in a social security system. It argues that the conceptualisation of disability involves a discourse about definitions. This means it is an ongoing debate about principles or which determinators to use presenting the 'correct' understanding of disability as a phenomenon. The disability discourse involves a contest between a biological and social understanding of disability. This paper discusses which domains of interest are produced by each of these understandings. They are based on empirical findings when analysing rights of entitlement to a disability programme in the Swedish social security system. The study followed documentation of the public debates for a period of 25 years and extracted what was communicated as constituting disability in these debates. Which definition to give disability by this social security programme appeared as being a continuous contest between medical and social understanding. The paper argues that, rather than approaching the biological understanding as representing an antiquated concept to disability and the social model as a modern conceptualisation, these understandings are competitive. This makes disability into a flexible and heterogeneous concept, a term difficult to give a specified and limited meaning.     

Toward a Holistic View of Health and Health Promotion in Social Work with People with Disabilities

Abstract

The individual medically oriented model of disability suggests that people with disabilities seldom achieve health and wellness because of their impairments and disabilities. This paper provides an alternative to the tendency in social work to focus on the medicalization of disability without a due consideration of the social context. It draws insights from the social model that asserts disability is a form of social restriction encountered by people with disabilities and that social barriers of disability must be removed through collective action. Also, this model posits that people with disabilities can be healthy if the barriers preventing good health are removed. However, medical aspects of a person with a disability should not be forsaken entirely. Therefore, this article proposes a holistic view that converges insights of the individual and social models toward a better understanding of health issues for people with disabilities. It shows the implications for social work that follow from the convergence.     

Patterns of disability and norms of participation through the life course: empirical support for a social model of disability

An attempt has been made in this article to empirically demonstrate the social derivation of disability using quantitative data, framed around the medical model. It would seem that people who are not convinced of the social derivation of disability, are likely to be influenced by findings made in such data. The term 'social derivation' is used to encompass both social construction and creation. The approach taken was to focus on one aspect of the social derivation of disability—investigating how the patterns of 'disabling conditions' vary over the course of life, specifically the schooling, working and retirement age. The observed patterns are not consistent with a medical model of disability that ignores social factors. Instead, the patterns are linked to social forces, both attitudinal and material. Socially-determined norms of participation, which vary between the life phases, seem to be a key determinant of the observed patterns of disability.     

Dimensions of Oppression: theorising the embodied subject

This paper argues that a critical study of disability needs to examine how disability is subjectivity experienced, both at a conscious and an unconscious level, as well as having an appreciation of disabling social policies and structures. I begin by identifying the reasons why many social model theorists have not, in the past, seen the analysis of 'experience' as being relevant to our understanding of disability. I adopt an interdisciplinary approach (that is, one that recognises the importance of biological, social, relational and unconscious levels of analysis) in the study of two specific groups of people; those with learning difficulties and those with sickle cell anaemia. I focus particularly on the role of modern medicine within a disablist society in this attempt to demonstrate that bodily, emotional and social differences are mutually constitutive.     

Postmodern synergistic knowledge creation: extending the boundaries of disability studies

The tensions between the competing discourses of the medical and the social models of disability have traditionally provided a platform for discussion and research in the fields of disability studies and special needs education. Over the last 30 years a wealth of literature has consolidated the debate and produced particular knowledge of impairment and disability. In this paper we argue that by privileging notions of ‘deficit’ within these medical or social model perspectives the richness of the lived experience of people with impairments is denied. The individual becomes lost within a framework of medical symptoms or social inequalities. This paper considers alternative approaches which reveal a fuller picture of the lives of people with impairments. The authors conducted two separate empirical studies, one employing a Deleuzo‐Guattarian perspective, the other a Bourdieusian perspective. In this paper we illustrate how these theories of practice can reveal situated understandings of the individual with impairments and his/her daily life. By embracing new understandings and different theoretical perspectives we show how new knowledge can emerge to illuminate the fluid and ever‐changing notions of ‘disability’, ‘inclusion’ and ‘exclusion’, which form elements of the individual lived experience of the research participants.     

The Social Model of Disability: What does it mean for practice in services for people with learning difficulties?

Does the social model of disability currently inform the delivery of services for people labelled as having profound and complex learning difficulties? What distinguishes practice which draws on the social model from that which is influenced by an individual model or a medical model of disability? This paper draws on the findings of a small scale interpretive research study and some of the current debates within disability studies to illuminate these questions. It concludes that the social model can and does positively impact on some practice and that it should be taught to all providers of services for this group. It further concludes that to include discussion about individual experience of impairment in such training may have negative consequences.     

Navigating the ethical maze in disability research: ethical contestations in an African context

Despite changes in how disability is viewed, ethical requirements for disability research have hardly changed. Some ethical clearance procedures, processes and practices still consider persons with disabilities as not able, creating unease among researchers and research participants with disabilities themselves. This paper considers five ethical contestations arising from research in the area of disability in an African context: positionality, vulnerability, signed consent, anonymity, and research committee composition. We argue that ethical requirements in practice are still largely based on a medical model of disability and propose that culturally sensitive social and human rights models should influence disability research ethics.     

Disability activisms: social model stalwarts and biological citizens

The Disabled People’s Movement (DPM) in the UK rejects the view that disability is an illness. For the DPM it is the social processes of discrimination and oppression that create the material circumstances out of which solidarity and politicisation arise. The DPM has also been shy about impairment, arguing that it is generally irrelevant to the issue of disability and that a clear distinction between impairment and disability is necessary if disability is to be understood as a basis for identity politics. The biological citizens that support embodied health movements use impairment, genetic status, biomedical diagnosis and classification as calling cards that signal their claims to identity. Whilst the DPM has challenged medical hegemony and scientific ideas, many ‘biosocial’ groups embrace the specialised medical and scientific knowledge associated with their ‘condition’, particularly where it might be used to enhance their claims to citizenship. This paper argues that disability activism in the UK is bifurcating. It addresses the difference in perspective and action between the ‘social model stalwarts’ of the DPM and biological citizens that organise politically around particular diagnostic labels.     

Disability and the League of Nations: the Crippled Child’s Bill of Rights and a call for an International Bureau of Information, 1931

In Disability Studies the evolution of conceptual models is often portrayed as linear, with a nineteenth-century charity model shifting to the medical model that dominated disability discourse in the twentieth century. This is then assumed to be largely unchallenged until the 1970s, when an emergent Disability Rights Movement re-framed issues into the social model, from which evolved a rights-based model. This paper documents two early efforts to address disability issues submitted to the League of Nations: the Crippled Child’s Bill of Rights in 1931 and a ‘Memorial’ requesting the establishment of an International Bureau of Information on Crippled Children in 1929. Neither submission achieved its stated goals, yet both reflect early attempts to place disability within wider social contexts.     

'What Matters to Me is not What You're Talking About' - Maintaining the Social Model of Disability in 'Public and Private' Negotiations

Moving from a medical to a social model of individual disability is a political process of change with implications for understanding of and relationship to borders between individual, social life and political participation. This process has echoes in the conceptual experience of change through movement for women's liberation and gay liberation. Conceptualisation of a public/private divide has been identified in both these movements, and can also be used productively to further the use of a social model of disability. In this way, public change in status and participation can be linked to private defeat of barriers to public and political participation. This article identifies some uses of conceptualising public and private as a way of locating service provision within a social model of disability.     

Deconstructing Disability and Neurodiversity: Controversial Issues for Autism and Implications for Social Work

Disability is a socially constructed concept that can be viewed from either a medical or a social perspective. Autism, a developmental disability, can be viewed from the medical model of disability or through a new perspective brought forth by the autistic community and aligning with the social model termed neurodiversity. Using the medical model and a lens of neurodiversity, we can deconstruct the controversial issues surrounding autism and provide insights for social workers and other professionals working with the community of the disabled.     

The evolving construction and conceptualisation of ‘disability’ in Bhutan

This study – a year-long ethnographic exploration of disability and education in Bhutan – finds that two dominant discourses around ‘disability’ are entering Bhutan simultaneously: the discourse of the medical model of disability and the discourse of the social or human rights model of disability. In this paper, I argue that these two discourses are especially exposed in the Bhutanese context to be opposing forces in shaping local conceptualisation and construction of ‘disability’. By examining the Bhutan case, it can be seen that these kinds of disparate and contentious exogenous constructions of ‘disability’ occur everywhere in the world and negotiate with local constructions of ‘disability’ uneasily. Understanding the interactions of disability discourses in the Bhutanese context can help to understand the interactions of disability discourses writ large.     

Disabled People,Health Professionals and the Social Model of Disability: Can there be a research relationship?

The social model of disability is proposed as an alternative to models that have viewed disability as an individual, rather than a socio-political issue. The use of this model to guide both research theory and practice is proposed in order to equalise research power relationships, and involve and empower disabled people. Health professionals have traditionally reinforced the medical model of disability in both research and practice, and this has been seen as contributing to the oppression and marginalisation of disabled people. If the social model is to achieve wider dissemination, it would appear important to develop a dialogue between disabled people and health professionals. However, because of negative perceptions it can be difficult for health professionals to find an appropriate position in relation to disabled people, research and the social model of disability. While not denying the past, it appears essential to look at ways in which disabled people and health professionals can work together to overcome the oppression and marginalisation that has been linked to the provision of health services.     

Radicalising ‘disability’ in conflict and post-conflict situations

In this article, a radical social model of disability lens is taken to illustrate what counts as ‘disability’ within a neoliberal mindset. The South African and disabled activist Vic Finkelstein describes both an ‘outside-in approach’ that looks at the material conditions of how ‘disability’ is constructed and an ‘idealist’ ‘inside-out’ approach, or how people describe experiences of inequality and disablement. The ‘outside-in’ approach is where the focus of a social model of disability should be in terms of trying to understand how global capitalism or neoliberalism is (dis)ablest and creating impairment. The ‘inside-out’ approach is ‘idealist’ and where the other ‘components’ of the model such as ‘rights’ are located. This article begins with an overview of the relationship between disability and conflict. The article then moves to an inside-out framework to examine how disability is still viewed and created through a medical humanitarianism. Using an outside-in framework, I illustrate how states become disabled through neoliberalism. Lastly, I discuss how ensuring greater participation and rethinking neoliberalism in terms of sustainability may provide us with a way forward in a humanitarian setting and rethinking of disability.     

The Use and Abuse of Models of Disability

Throughout history, theorists have made use of the technology of the day to provide explanatory models of the behaviour they observe in order to provide an improved understanding of human behaviour. Bax (1998) describes the use of models of disability as not particularly helpful in relation to the treatment of children with physical disabilities. It is the purpose of this paper to show that models do have their place within disability research and the implications of using the medical and social models of disability, together with two models from developmental psychology, namely the transactional model and systems theory, will be discussed. It is argued by the authors that the usage of these models can aid understanding of disability in both research and clinical settings.     

Research on physical disability in sociological social psychology: The state of the field and future directions

We discuss the state of the research literature on physical disability in sociology, focusing particularly on social psychology. We first trace the history of treatments of disability in the field, noting a movement from a medical model that located disability in the individual to a social model that recognizes physical disability as an important social characteristic that is both produced by and has important consequences for social interactions. We then summarize contemporary research, identifying areas in which sociological research tends to be located, particularly in critical approaches, health‐related outcomes, and stigma. Finally, we discuss areas in which more research on physical disability would be fruitful. We believe that research on group processes, intersectionality, and identity would each especially benefit from greater attention to physical disability.     

Constructions and Creations: idealism, materialism and disability theory

This paper suggests that a proper understanding of disability theory requires more than a distinction between individual and social model approaches. It is also helpful to distinguish between materialist and idealist explanations. These two dimensions are used to generate a four-fold typology which highlights important differences between the main approaches. Social models are distinguished as those premised upon commonality. However, it is argued that recent discourses of 'difference' do not detract from social model theory. Social model approaches are examined in more detail and the paper concludes that although social constructionist accounts have been useful they do not provide a sufficient level of explanation. Disabling social values reflect material relations of power and may be better explained as 'ideology'.