Social vs Medical Model Evolved

This article was originally posted on Yahoo! Accessibility.

Models Of Disability

Disability activists and advocates have been trying to frame disability and surrounding issues using a social model of disability since at least the 1980s in an effort to distance discourse from the (still) predominant medical model that rules many of our lives. This switch in models was to frame disability in a way that made it clear where many people face barriers and how those barriers can be addressed. However, the vast majority of people have still never heard these terms or understand the implications of these thought frameworks. Of those who have, even within the disability community, there is a sense of division between those who embrace the social model and those who don’t feel it is an accurate description of their reality. So, what are these models and how can we bridge the gap?

Medical Model

The medical model of disability focuses on the impairment (physical/health/mental/etc.) as a person’s barrier to a “normal” level of functioning in their daily lives and in society. This model focuses on curing the cause of the impairment or correcting that impairment through use of equipment, medication, etc. in order to enhance the individual’s quality of life. This has long been the most commonly used model by the medical field, as well as many other organizations. It is by far the one that most people are familiar with and are used to working within. (For more information, see the table below.)

Social Model

The social model of disability focuses on a broader view of the existence of barriers as mainly stemming from a social construct of disability by society in general. In this model, people with disabilities would largely have no barriers if people took into consideration the vast diversity that exists within humans. If we did not use stairs in architecture, people in wheelchairs would no longer have the barrier (and the same could be true for someone pushing a stroller or a dolly stacked with heavy boxes). If government and society supported adequate support services such as funding for caregivers and medical coverage, our individual impairments would no longer be a barrier to engaging in society and our lives. This model has roots back to the 1960s civil rights movement, but has been largely used by disability activists since at least the 1980s. (For more information, see the table below.)

After reviewing the definitions of these two models on the Spina Bifida Support website (see definitions), our community members began a discussion on how they felt about these models and how it applied to their lives. The following is one outcome of that discussion: Ricky Buchanan’s opinion on how these models could be integrated to more accurately describe her experience. Many other members felt this perspective was worth sharing.

The Integrated Model: An Individual’s Perspective (section by Ricky Buchanan)

There is no denying that the creation of the social model of disability has helped a lot for changing/raising disability awareness in the past. At the time we needed a polar opposite to persuade people to move away from the purely medical definition of disability. However I believe its job is done (to the extent it can be done) and we can now most usefully look at models which integrate the best and most relevant aspects of both the social and medical models.

I see the social model and the medical model of disability as ends of a spectrum – the medical model pretty much said “everything about disability is intrinsically negative” and the social model contradicted that with “nothing about disability is intrinsically negative”. I think that the truth, as usual, is somewhere between the two extremes – as a person with a disability, I do believe that some things about my disability are intrinsically negative to me and no amount of environmental adjustment will help with them. I find that things like pain and excessive fatigue come under that category – these things affect me even when I am not doing anything at all and it is very hard to find any environmental changes that help with them.

So although I believe in the social model as a whole, some aspects of my disability really do fit best under a medical model. I believe very strongly that each individual must decide for themselves which aspects, if any, of their self they would prefer to view under that medical model.

MEDICAL MODEL SOCIAL MODEL INTEGRATED MODEL
Disability is a deficiency or abnormality. Disability is a difference. Disability is a difference.
Being disabled is negative. Being disabled, in itself, is neutral. Being disabled, in itself, is neutral. Specific attributes of a disability may be viewed as negative by the vast majority of people who deal with them (e.g. pain, fatigue, depression) but this distinction can only be made by those living with the attributes.
Disability resides in the individual. Disability derives from interaction between the individual and society. Disability derives primarily from interaction between the individual and society but also from negative attributes of disability present within the individual.
The remedy for disability-related problems is cure or normalization of the individual. The remedy for disability related problems are a change in the interaction between the individual and society. The remedies for disability related problems include (a) a change in the interaction between the individual and society, (b) neutralizing or ameliorating negative attributes as far as possible.
The agent of remedy is the professional. The agent of remedy can be the individual, an advocate, or anyone who affects the arrangements between the individual and society. The agent of remedy can be the individual, an advocate, a professional, or anyone who affects the arrangements between the individual and society or who is able to neutralize or ameliorate negative attributes of disability.

Origins of an Integrated Model

This concept of integrating models of disability is hardly new, but most of this work seems to have been done by academics in various fields, and has unfortunately not trickled down to individuals even within the disabled community.

Carol Thomas, a professor/writer in the UK who specializes in disability studies and sociology of health and illness, wrote about a “social relational model” that defines “disability” as a result of people with impairments being restricted by society from participating in an activity (2004). However she also mentions a concept that she calls “impairment effects.” For example, if an activity we wished to do had provisions in place to enable access for us, effects of our impairment, such as emotional and physical pain, still have the potential to prevent us from taking part in activity.

If this kind of social relational understanding of disability could be adhered to within disability studies, that is, if the commonplace view that disability equates with restrictions of activity could be broken away from, then there would be no need for futile and time-wasting disputes about whether or not impairment or chronic illness cause some restrictions of activity. We can say, ‘Yes, of course impairment causes some restrictions of activity—but these are not what is of interest in studying and combating disability’. Disability is a form of social oppression on a par with other forms of oppression in our society associated with gender, race, class, and sexuality. (Thomas, 2004)

Tom Shakespeare, a geneticist and sociologist from the University of Newcastle, and Nicholas Watson, from the University of Edinburgh, also write about using a “critical realism” framework to view barriers:

Experiential, impairment is salient to many. As disabled feminists have argued, impairment is part of our daily personal experience, and cannot be ignored in our social theory or our political strategy. Politically, if our analysis does not include impairment, disabled people may be reluctant to identify with the disability movement, and commentators may reject our arguments as being ‘idealistic’ and ungrounded. We are not just disabled people, we are also people with impairments, and to pretend otherwise is to ignore a major part of our biographies. (2002)

Shakespeare and Watson ask: “Where does impairment end and disability start? … Impairment is part of our daily personal experience, and cannot be ignored in our social theory or our political strategy.” (2002)

Conclusion

This debate is definitely not new, and has been at times contentious among those feverishly working to further disability rights and access. Often, those outside academic and activist circles are largely unaware of this debate. However, in order to come together to further disability rights and awareness, some believe we need to change the discourse.

What do you think? How can we take these models of disability and make them more accessible to the common person? How can we involve more people in affecting rights and access? Please comment below!

Sources:

Shakespeare, T. & Watson, N. (2002) The social model of disability: an outdated ideology? In: Research in social science and disability, volume 2, pp. 9–28.

Thomas, C (2004) How is disability understood? An examination of sociological approaches. In Disability & Society, Vol. 19, No. 6, October 2004 pp. 569-83. Taylor & Frances Ltd