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Conceptual models of disability: the development of the consideration of non-biomedical aspects.

Graphical Abstract

1. Introduction

2. on models, 3. methodological approach.

• Definitions
• Application Context and Value Assumptions
• Content Validity
• Disease (Biomedical Body)
• Illness (Subjective Individual)
• Sickness (Society)

4. Conceptual Models

4.1. first generation (1965–1994), 4.1.1. the disablement process, 4.1.2. context factors, 4.1.3. quality of life, 4.1.4. evaluation, 4.2. second generation (1996–1997; 2006), 4.2.1. disability relation and context factors, 4.2.2. evaluation, 4.3. third generation (1999–2019), 4.3.1. main components, 4.3.2. context factors, 4.3.3. evaluation, 5. discussion, 6. conclusions, supplementary materials, institutional review board statement, informed consent statement, acknowledgments, conflicts of interest.

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Forstner, M. Conceptual Models of Disability: The Development of the Consideration of Non-Biomedical Aspects. Disabilities 2022 , 2 , 540-563. https://doi.org/10.3390/disabilities2030039

Forstner M. Conceptual Models of Disability: The Development of the Consideration of Non-Biomedical Aspects. Disabilities . 2022; 2(3):540-563. https://doi.org/10.3390/disabilities2030039

Forstner, Matthias. 2022. "Conceptual Models of Disability: The Development of the Consideration of Non-Biomedical Aspects" Disabilities 2, no. 3: 540-563. https://doi.org/10.3390/disabilities2030039

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Disability: Definitions and Models

Philosophers have always lived among, and often as, people who could not see, walk, or hear; who had limited mobility, comprehension or longevity, or chronic illnesses of various sorts. And philosophers have lived in societies that respond to these and other bodily differences in a wide variety of ways. And yet philosophical interest in these conditions and the social response to them was piecemeal and occasional until the past hundred or so years. Some of these conditions were cited in litanies of life’s hardships or evils; some were the vehicle for inquiries into the relationship between human faculties and human knowledge (see entry on Molyneux’s problem ). But the treatment of disability as a subject of philosophical interest in its own right is relatively new.

The lack of attention to “disability” or the related concept of “impairment” may have a simple explanation: there were no such concepts to attend to until nineteenth century scientific thinking put variations in human function and form into categories of abnormality and deviance. Once such categories were established, it became possible to talk, and generalize, about (first) “the disabled”, and (then) “their impairments”, and philosophers have done so for various purposes [Hacking, 1990; L. Davis, 2002: Ch. 4]). The resurgent political philosophy of the second half of the last century, preoccupied with eliminating or reducing unearned disadvantages, tended to treat disability as a primary source of those disadvantages, to be addressed with medical correction or government compensation (Cohen 1993; Sen 1993). Somewhat later, social philosophers began to see disability as a source both of discrimination and oppression, and of group identity, akin to race or gender in these respects. And biomedical and other practical applied’ ethicists have been concerned to help policy-makers construct and interpret new legal and regulatory frameworks making central reference to “disability” and related concepts.

For these reasons and others, philosophers have had much to say, initially in passing and now at length, about what disability is and what “disability” means. This entry will discuss both issues—first, detailing philosophical engagement with longstanding debates over the correct “model” or general framework for understanding disability as a phenomenon; second, asking how philosophers have come to understand the meaning of concepts denoted by words like “disability” and “impairment”, as those have been used in various empirical and normative discourses concerning people with disabilities.

1.1 Medical and Social Models

1.2 an affirmative model, 1.3 models, decisions, and policies, 2.1 philosophical discussion of official definitions of disability, 2.2.1 normal-function views, 2.2.2 the welfarist view, 2.2.3 social constructionisms, 2.2.4 inability views, 2.2.5 skepticism about defining disabilities, other internet resources, related entries, 1. models of disability.

Many different characteristics have been considered disabilities. Paraplegia, deafness, blindness, diabetes, autism, epilepsy, depression, and HIV have all been classified as “disabilities”. The term covers such diverse conditions as the congenital absence or adventitious loss of a limb or a sensory function; progressive neurological conditions like multiple sclerosis; chronic diseases like arteriosclerosis; the inability or limited ability to perform such cognitive functions as remembering faces or calculating sums; and psychiatric disorders like schizophrenia and bipolar disorder.

Disabilities like these have been objects of study in sociology, medicine, and policy debates for much longer than they have been subjects of sustained interest in philosophy. These discourses do not tend to define “disability” by way of the sort of rigorous necessary and sufficient conditions philosophers often prefer. But they have been centrally concerned with broadly definitional issues, often discussed under the heading of “models” of disability—that is, general theoretical perspectives concerned to say what in the world social scientists are investigating when they investigate disability. These models generally pick out, both (1) a set of phenomenon as what needs explaining, when we explain disability, phenomenon typically but not necessarily characterized as disadvantages ; and (2) an explanation of these phenomenon—again, typically, but not solely, an explanation of why disabled people experience the disadvantages they do.

In their extreme forms, the medical and social models serve to chart the space of possible relationships between bodily difference and functional 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 explains disability disadvantage in terms of pathological states of the body and mind themselves. It regards the limitations faced by people with disabilities as resulting primarily from their bodily differences. The medical model is rarely defended explicitly, but aspects of it are often adopted unreflectively, when health care professionals, bioethicists, and philosophers ignore or underestimate the contribution of social and other environmental factors to the limitations faced by people with disabilities.

In contrast, the social model explains the characteristic features of disability in terms of a relation between an individual and her social environment: the exclusion of people with certain physical and mental characteristics, or “impairments”, from major domains of social life. Their exclusion is manifested not only in deliberate segregation, but in a built environment and organized social activity that preclude or restrict the participation of people seen or labeled as having 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 Union of the Physically Impaired against Segregation (UPIAS 1976) appears to deny any causal role to impairment in disability:

In our view, 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 excluded from full participation in society. Disabled people are therefore an oppressed group in society. Disability [is] the disadvantage or restriction of activity caused by a contemporary social organization which takes no or little account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities.

Two features of this influential statement are worth noting, although we will only discuss the second at length. First, it limits itself to physical impairments; second, it contrasts impairments , individual characteristics or conditions, with disabilities , disadvantages imposed by society on those with impairments. The first feature inaugurates a long tradition in disability activism and scholarship of focusing exclusively on “physical” disability, to the neglect, if not the exclusion, of intellectual, psychiatric, and other “mental” disabilities. Both scholars and activists have long criticized, and sought to broaden, this narrow focus, and even those philosophers who continue to focus on physical disability recognize that adequate models and definitions must include mental disabilities as well. In the rest of this entry, we will not distinguish between the two types of disability except when it is relevant to a particular model or definition; we will note when an account is limited to physical disabilities or criticizes other accounts for that limitation.

The second feature, the distinction between impairment and disability, will be more central to our discussion. It is through those terms that the medical and social models have been distinguished, and it is this “anatomy” of disability that several recent philosophical definitions have rejected or significantly modified.

Implicit in the UPIAS understanding of disability are two ways that society imposes limitations on disabled people, corresponding to two distinct strands that might be a part of any 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 population 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 1987 [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 (ADA), 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 & Schriner 1997)

This view of disabilities as the result of human variations is closely related to the view that disability is a universal human condition (Zola 1989) or shared human identity (L. 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 point 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 or other minorities; in others, it is important to reject a dichotomy between disability and normality and treat impairments as continuous 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 version or another, is now the dominant legislative, social-science, and humanities paradigm for understanding disability, stronger versions of it – particularly the British Social Model exemplified by UPIAS – have been subject to extensive criticism. Some argue 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). Several critics argue that extreme versions of the model implausibly deny or understate the role of impairment itself as a source of disadvantage (Anastasiou & Kauffman 2013; Terzi, 2004, 2009; Shakespeare 2006). Others, however, contend that this criticism is misplaced, because the British Social Model does not deny the importance of impairments but rather seeks to restrict the application of the term “disability” to social exclusion and oppression (Beaudry 2016).

Another objection is that the social as well as the medical model both rest on a false dichotomy between biological impairments and social limitations. There are two versions of this objection. One maintains that disability is a complex phenomenon, in which biological impairment and social exclusion are deeply interwoven and difficult to tease apart (Martiny 2015; Anastasiou & Kauffman 2013). The other version of this objection rejects the treatment of impairment as a (strictly) biological phenomenon. “Impairment”, the argument goes, is no less a social construction than the barriers faced by people so classified (more on this below). Claims that there is a stable biomedical basis for classifying a variation as an impairment are called into question by shifting classifications; by the “medicalization” of some conditions (shyness) and “demedicalization” of others (homosexuality). Moreover, the social environment appears to play a significant role in identifying and, arguably, in constituting some impairments (dyslexia) (Cole 2007; Shakespeare 2006; L. Davis 2002: Ch 1; Tremain, 2001, 2017; 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), indeed, 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 debate between the medical and social model about the source of the disadvantages disabled people experience has dominated academic discourse about disability since the 1970s. More recently, however, disability activists and disabled scholars have questioned the apparent shared assumption of both models, that disability is fundamentally a matter of disadvantage, exclusion, or functional limitation. This to take a (partly) different view on what an account of disability should explain; a view consistent in principle with either a more medical or more social view of what does the explaining. The affirmative model of disability and impairment, as articulated by John Swain and Sally French (2000), holds that disability is not in the first instance a problem—not simply or solely a “personal tragedy”, and implicitly, not simply or solely a social injustice either. Rather, disability is a different way of living in and experiencing the world, one not characterized by its disadvantages any more than its advantages.

Note that this is not a claim about what causally explains disability; rather, it is a claim about what aspects of the phenomena of disability should serve as the object of explanation in social scientific theories of disability. As such, the affirmational model is prima facie consistent with either the medical or the social model, and indeed tends to draw on considerations from both. The diverse mix of advantages and disadvantages that characterize life with disability can derive from biological factors, social factors, or interactions between the two. On the side of advantage, a person with a disability like blindness might celebrate the increased attention sightlessness saves for hearing and other senses as well as the solidarity they experience with other disabled people as they fight together against ableism and for social justice. On the side of disadvantage, the affirmational model will point to the considerations some would regard as personal tragedies as, instead, a combination of purely functional challenges to be overcome, and conditions of social exclusion that can make life harder without thereby making it any less valuable or worth living.

Still: though logically independent of claims about the evaluative import of disability, the medical and social models suggest different views about the impact of disability on well-being, and different views about how disability is relevant to reproductive decisions, medical interventions, and social policy. The affirmational model is likely to be more in sympathy with social than medical models here. Those who accept a social model of disability regard the association between disability and well-being as highly contingent, mediated by a variety of environmental and social factors (Campbell & Stramondo 2017). They also tend to question conceptions of well-being that give a central role to the possession or exercise of the standard array of physical and mental functions, as those conceptions imply, or are often taken to imply, that well-being is precluded or diminished merely by the absence or limitation of those functions (see entry disability: health, well-being, and personal relationships ). As a result, they generally see the disadvantages of disability not only as externally caused, but as less formidable than they appear to people who view disability in largely biomedical terms. These differences are reflected in the conflicting assessments of life with disabilities found in the bioethics and public policy literature on the one hand, and disability scholarship on the other (contrast Brock 2005 with Goering 2008).

The different models of disability—and particularly, the medical and social models—have always been interpreted as favoring different responses to disability. The medical model appears to support the correction of the biological condition (or some form of compensation when that is impractical); the minority group model appears to favor measures to eliminate exclusionary practices or at least recognize their injustice; the human variation model appears to favor reconstruction of the physical and social environment to take into account a wider range of differences in human structure and function (measures that could in turn make the social environment less exclusionary).

But claims about the causal explanation of disadvantage do not always yield straightforward prescriptions for their remediation (Wasserman 2001; Samaha 2007; Barclay 2018). In some cases, medical or surgical “correction” may be the most effective way to escape discrimination; if correction is not appropriate, that is because it reinforces discriminatory attitudes and practices, not because it is discriminatory per se . Even an affirmational model does not straightforwardly imply that we should change society rather than disabled bodies: that disabled people have reason to be proud of their disabilities and/or impairments does not immediately entail claims in justice on the rest of us to incur the costs of accommodating these differences. This is to be expected: the proper response to the disadvantages associated with disability depends not only on causal attributions and prudential evaluations, the domains of the three “models”, but also on moral judgments about responsibility, respect, justice.

This is not to say that these causal attributions, much less prudential judgments, are morally irrelevant: to the extent that social causation of disability disadvantage makes social institutions morally responsible for the limitations disabled people face, it may be unfair and disrespectful for society to ask disabled people to change themselves rather than changing itself to be more inclusive (Aas 2020). Moreover, “correcting” disability may (as the affirmational model reminds) us involve destroying valuable forms of life and reducing the vibrant diversity of human embodiment; or it may not do not enough to counterbalance the benefits of uniformity (Garland-Thomson 2012). Contra the sense that the social, medical, and affirmational models each come bundled with obvious policy consequences, it seems clear on reflection that there is much yet to do to understand just what these different explanations of disability imply as to how we should respond to it.

2.Definitions of Disability

Until relatively recently, there was little independent philosophical discussion of definitions of disability. Instead, philosophers focused primarily on developing and interpreting legal and regulatory definition needed to implement disability policy. The legal definitions, in turn, were heavily influenced by the two-part “anatomy”—impairment and social response—of the social model of disability, which was developed by activists seeking to influence legislation and policy.

Thus, two familiar features are shared by most official definitions of disability, such as those in the World Health Organization (1980, 2001), the Disability Discrimination Act (UK), and the Americans with Disabilities Act (United States): (i) a physical or mental characteristic labeled or perceived as an impairment or dysfunction and (ii) some personal or social limitation associated with that impairment. Impairments are generally seen as traits of the individual that he or she cannot readily alter. Just what makes a condition a trait or attribute of an individual is obscure and debatable, but there seems to be agreement on clear cases. Thus, poverty is not seen as an impairment, however disabling it may be, nor is tasteless clothing, even if it is a manifestation of impaired fashion-sense rather than scarce income. On the other hand, diseases are generally classified as impairments, even though they are often neither permanent nor static conditions. Diseases that are especially transient, however, such as the flu and the measles, do not normally count as impairments.

As in early philosophical debates about competing models, the most controversial issue in defining disability is the relationship between these two features. At one extreme are definitions that imply, or are read to imply, that biological impairments are the sole causes of limitation. The definitions in the World Health Organization’s 1980 International Classification of Impairment, Disability, and Handicap, and the Disability Discrimination Act (UK) have been interpreted this way. At the other extreme are definitions that restrict the limitations faced by disabled people (as such) solely to “contemporary social organization”, such as the definition given by the Union of the Physically Impaired Against Segregation (UPIAS 1976). In between are definitions which assert that individual impairment and the social environment are jointly sufficient causes of limitation. Perhaps the best-known example is the WHO’s International Classification of Functioning, Disability and Health (World Health Organization 2001, referred to as ICF), which emphasizes that disability is a “dynamic interaction between health conditions and environmental and personal factors”.

Through much of the first two decades of this century, philosophers were largely content with this definitional approach to disability as a relationship or interaction, disagreeing primarily on the comparative contribution of the two elements and the policy relevance of their contributions. As noted in the last section, dissenters mainly focused on the characterization of one or both elements, as, e.g., on the first as social vs. biological, rather than on the “anatomy” itself. More recently, however, there has been some movement away from reliance on these two-part approaches to defining disability (e.g., Barnes 2016, and much of the literature responding). One reason may be that in most settings, we do not think of or refer to disabilities as relationships or interactions, but as individual somatic or psychic traits, states or conditions (including absences and deficiencies). These commonsense referents are hard to find in, for example, the multifactorial charts by which the ICF illustrates its definition of disability as a complex interaction of health conditions with environmental, social, and personal factors.

Some might argue that ordinary usage is ideological, shaped by false failure to be conscious of the insights of social and interactionist models. But defining “disability” in rough conformity to ordinary usage hardly implies that its referents are selected by biomedical criteria, let alone that the traits selected cause the disadvantages faced by their bearers or dictate the appropriate social response to those disadvantages. Rather, this view on what “disability” and “people with disabilities” refer to is compatible with a wide variety of positions on how those referents are picked out: e.g., by biomedical criteria; by the rules of a civil-rights movement; by the assumptions of the dominant ideology about bodily dysfunction; or by the demands of justice. The extent to which what counts as a disability, or a person with a disability, varies with context will depend on the account adopted; on biomedical accounts, the extension of “disability” will be as stable as human biology; on other accounts, it will change with changing social norms, economic needs, or political developments. Further, on some accounts, the referents will have common features, identifiable by inspection; on others, what they have in common can only be understood in terms of an ideology or a theory of justice.

After discussing several types of accounts, we will address the claim, inspired by the diversity of traits and conditions they pick out, that “disability” has no core meaning, and that it may be futile and distracting to search for one.

2.2 Philosophical Definitions of Disability

Outside of legal and policy interpretation, philosophers have made a number of claims about the definition of “disability”—at first, mostly only in passing, during discussion of other matters, like “disease” and “health”; later as an increasingly important philosophical topic in its own right.

Given the pervasiveness of medical models of disability in the culture, one would think that at least some recent philosophers would defend a view of disability on which it is defined in terms of pathology or departure from normal functioning (see entry on concepts of health and disease ). So far we can tell, however, no one has done so explicitly, in print. Christopher Boorse, perhaps, comes closest, when he says:

at first sight, one expects disability […] to consist of a pathological condition severe enough to have certain morally and legally important effects. (Boorse 2010: 60–61)

Though Boorse only broaches the possibility of such a definition, without defending, his broader views about health and disease may seem to support this approach. If, as Boorse argues there is a good naturalistic sense of “pathology” as (statistically) downward departure from species-typical functioning, then that notion can be inputted into our moral and political thinking to produce a definition of disability on the following pattern:

S is disabled, in a context C , iff

• S has a pathology—that is, some part of their body performs its normal function at statistically subtypical levels,
• In C , that pathology causes effects that make a difference, of kind D , to how S ought legally or morally to be treated

To fully develop this view, of course, one would need to say what sort of moral/legal difference pathology is supposed to make—not just any difference will do, since it would not follow from the fact, say, that everyone has a legal or moral right to treatment for transient injuries or diseases that all these conditions are disabilities. Note also that, though this view mentions the medical concept of pathology, as a definition of disability it does not entail a medical model, or indeed even the denial of the affirmational model. The medical/social debate will turn on the extent to which it is pathology itself that makes a moral difference, rather than pathology in combination with social factors. The affirmational model debate will turn on just which effects are definitive of disability; if these are all negative or harmful, it will be harder to understand disability as something to be proud of. But the bare fact that disability arises from pathology, on this definition, does not necessarily preclude pride in it, given Boorse’s normatively neutral definition of pathology.

That said, few philosophers seem inclined to defend this way of defining disability. Many philosophers are skeptical of the analytic division between facts about bodily function and social and ethical norms, arguing that there is no way to define disease or pathology independent of “normative” considerations (Wakefield 1992; Kingma 2007; entry on concepts of health and disease ). Those sympathetic to the claims of the disability may have more specific qualms, as well. Those attracted to the “human variation” version of the social model may be skeptical that all of the bodily difference that make for disability are statistically atypical in the required way, e.g., very common or universal conditions like age-related hearing loss or atherosclerosis. Those who tend more to a “minority group” model will tend to see the bodily differences that matter to disability as perceived or represented difference, rather than actual difference. And anyone with any sympathy to the social model at all will tend to think that, as-so-far stated, this definition puts its philosophical precision in the wrong place: that it is at least as important to understand what social, moral, and legal effects characterize disability as to understand which sorts of causes these effects must have to count as “disabling”.

Kahane and Savulescu (2009; Savulescu & Kahane 2011) propose a reforming definition of disability that promises to avoid potentially problematic references to pathology. Their basic idea is that a disability is a (broadly) bodily condition that makes its bearer worse off. To wit:

“disability” should refer to any stable physical or psychological property of subject S that leads to a significant reduction of S ’s level of wellbeing in circumstances C , excluding the effect that this condition has on wellbeing that is due to prejudice against S by members of S ’s society. (Savulescu & Kahane 2011: 45.)

This view adopts certain insights of the social model: in particular in holding that disability is relative to circumstance and in downplaying the role of pathology or biological abnormality in defining disability (note there is no reference to “impairment”, not even records or appearance of impairment).

In other ways, however, it seems to be significantly out of step with both the letter and the spirit of social models of disability. On this definition, a condition which is only harmful in virtue of social prejudice would not be a disability. Even the softer social model implicit in the Americans with Disabilities Act allows that some people are disabled solely in virtue of being “regarded as” impaired; those in that group who experience discrimination as a result would still not be “disabled” on Kahane and Savulescu’s view. Just how out of step this judgment is with the usual commitments of the social model, may depend on the relative importance it places on prejudice as compared to other factors in producing disability disadvantage. A social model that cleaves closely to a “minority group” understanding of ableist injustice may find that this definition excludes the paradigm cases of disability, people who experience gross or net reductions in advantage due to prejudicial phenomenon like stigma and intentional exclusion. A “human variation” account of most disability disadvantage would see more possibility for people to be disadvantaged by non-prejudicial mismatches between atypical bodies and societies built for typicality, since this account will say that many of the welfare costs experienced by people with atypical bodies are not a result of prejudicial attitudes per se , even if they often reflect structurally unjust failures of inclusion.

It should be even more clear that the affirmational model of disability is in substantial tension with this harm-requiring definition of disability. Granted, affirmation of disability may not be formally inconsistent with defining it in terms of harm, since it is possible in principle to take pride in or otherwise be glad about something that leads to a reduction in our well-being (since there are things in life that matter, besides our own well-being). But affirmational models generally hold that being disabled is not always or in general a cost to our well-being (Swain & French 2000; Barnes 2016). This would be a conceptual falsehood, on the welfarist view: something which is not a cost to well-being in some context is simply not a disability.

Are these decisive problems for defining disability in terms of welfare? Much depends here on what we intend to do with definitions of disability. If the goal is to capture ordinary usage, a welfarist view may be on the right track. It might account, for instance, for the broad appeal of slogans like “deafness is not a disability” and euphemisms like “differently abled”; these expressions, on this view, would be ways of emphasizing some of the substantive evaluative intuitions behind the affirmative model, that most conditions we call disabilities are not so bad absent prejudice. That said, disability scholars and activists have tended to be skeptical of such expressions, on the grounds that they undermine efforts to see disabled people as a politically salient group with similar experience of ableism and strong reason to work together for justice, rather than to simply commiserate. If a definition of disability should advocate in favor of usages that produce a better or more just world, this might be a reason to reject Kahane and Savulescu’s view, in favor of one that allows people to be disabled due to prejudice and/or in the absence of harms to well-being. Or at least, this will be so if the social and/or affirmational models of disability have the moral and political advantages proponents advertise for them.

Most philosophers who have considered the definition of disability in recent years have written in sympathy with either or both of the social or affirmational model of disability.

Elizabeth Barnes’s critique of definitional claims implicit in the social model has been a signal moment in the recent debate. Barnes is concerned that thinking of disability as a stigmatizing, oppressive, and exclusionary response to bodily difference does not distinguish disability from other properties grounded in responses to the body, like (on many accounts) race, gender, and sexual orientation identities.

Barnes develops an alternative view which still defines disability as a social property—but in a way that fits the affirmational model better than the definitions suggested by classic social models, doing away with the distinction between disability and impairment and making no direct reference whatsoever to injustice or disadvantage. Barnes (2016) proposes to define disability in terms of the judgments of disabled people themselves, not society as a whole. To wit, S is (physically) disabled if and only if:

• S is in some bodily state x ; [such that]
• The rules for making judgments about solidarity employed by the disability rights movement classify x in context C as among the physical conditions that they are seeking to promote justice for.

This makes who is disabled a social construction—dependent on the attitudes and commitments of a particular, self-identified group of people in contemporary society, the “disability rights movement”, composed of self-identified disabled and nondisabled members. It thus raises the concern that a disability movement might seek justice for the wrong people. Couldn’t some of those people complain that they should be included in the aims of that movement, precisely, because they are disabled? Barnes responds in two ways. The first is to note that she appeals to the rules for judgment-making, rather than judgments themselves; some people might not actually be included in the disability rights movement—say, because of internal prejudices on the part of those within the movement—but if this is inconsistent with the reasons for including others, then the excluded people will count as disabled too, on Barnes’ account. Still one might ask, what if the rules themselves were bad rules, wrongly but consistently excluding some people form the ambit of the struggle against ableism? Barnes, in response to this, rigidifies, insisting that we judge disability relative to the rules of the actual disability movement, even when we are imagining situations where that movement should use different rules than it actually does.

Some are not convinced by this last reply. For it can seem to give too much weight to judgments of the actual disability rights movement. As Jenkins and Webster point out, “rigidifying” to the actual world in this way means that imagining a world with a different disability rights movement isn’t imagining a world with different disabled people. But what if the disability rights movement is different there because social conditions are different, warranting a different set of rules for determining which people with pathologized bodily difference to seek justice for? And indeed isn’t there a sense in which “there” could be “here”? That is, couldn’t the disability right movement as it actually is, use rules that even when consistently applied lead it to seek justice for the wrong people (Wasserman 2018; Howard & Aas 2018; Lim 2018)?

This last concern can be generalized. Chong-min Lim, responding to Barnes, questions why the disability movement alone should have the authority to constitute disability. Where, we might ask, does this leave the experience of disabled people not part of the movement, or of those caregivers and/or non-disabled loved ones who advocate for them? And couldn’t the disability movement be overinclusive too, in principle, attempting to expand solidarity beyond what makes sense morally or politically. To address this problem (and in the process, expand the account to cover cognitive and other “non-physical” disabilities), Lim proposes that we make the following modification to Barnes’ account:

S , is disabled in context, C , if and only if:

• S is in some state, x ;
• x is constitutive, in C , of some constraint on S ’s legitimate interests;
• x is regarded, in C , as the subject of legitimate medical interest;
• the rules employed by the disability rights movement classify x in C as among the traits that they are seeking to promote progress and change for. (Lim 2018: 987)

Relative to Barnes, II and III are new restrictions, while IV is a substantially broadened version of the main clause of Barnes’ approach—in effect, broadening the relevant goals to include any improvement in the lives of putatively disabled people, whether that comes from social change or bodily transformation. Relatedly, III seems to bring back in medicalization—though now constrained by the requirement that the medical interest in question be “legitimate”, meaning, not apt in the traditional sense (not, concerned with pathology ) but rather just or right ; morally legitimate in light of whatever morally appropriate role medicine has to play in our society. Lim introduces these conditions to reflect the fact that expert communities outside of the disability rights movement have expertise relevant to constituting the disability population; parents or caregivers, even those not part of the movement itself, may have insight into whether and how a condition affects legitimate interests, while physicians will have important (though not exclusive) knowledge of which limitations on function are legitimately subject to medical interest.

The (intended) effect of Lim’s modifications, then, would be to limit the authority of the particular political judgments of the actual disability rights movement in determining who is disabled. This points to what may be a deeper problem for Barnes’ account, and the parts of Lim’s that follow her in making recognition by the rules that guide the disability movement determinative of disability. If the disability movement ought to adopt rules that pick out a certain group, isn’t that precisely because that group shares some other property, that makes that choice reasonable? That is, isn’t there something that those the disability rights movement share, that explains why they ought to seek justice in solidarity together? Wouldn’t that thing, whatever it is, make a better candidate definition of disability? To put the question for Lim’s account in particular: why would we want to deny that a condition is a disability, it if were a medically interesting constraint on legitimate interests, but not recognized as such by the rules of the disability rights movement?

Howard and Aas (2018) respond to Barnes in a different way, developing a definition that harkens back to the classic social model of disability. Building on the work of Sally Haslanger (2000) on gender and race, they define disability classically as a certain sort of social response to impairment. On their view, person S is disabled in a context C , iff

• S is in some bodily or psychological state x [such that]
• x is regularly assumed in the ideology in C to involve an impairment: a dysfunctional bodily state that limits a major life activity, and
• in the dominant ideology of C , that someone in x has an impairment explains why they can be appropriately pitied, stigmatized, and excluded from socially valued activities and statuses.
• The fact that S is in this state plays a role in S ’s systemic disadvantage: that is, (i)–(iii) actually explains why S is involuntarily excluded from certain valued activities or relegated to a marginal status along some significant social dimension. (2018: 1128–1129)

Impairment is critical on this analysis. Disability is distinct from other bodily-based social categories on this definition precisely because it is a response, of a certain distinctive sort, to social perception about bodily properties, namely impairment . Race, gender, and orientation identity would be different (thought possibly overlapping) responses to different (again, possibly overlapping) bodily properties. Howard and Aas do not, however, defend the biological reality of impairment; it suffices for their account that society itself employs some notion of biological abnormality or insufficiency, saying with the classic social model that disability is a matter of being classified as impaired, and excluded on that basis.

Barnes (2018) responds that, because of this last feature, this account does not after all give sufficiently central place to bodily difference. In particular, she thinks it makes it hard to see how the bodily differences characteristic of disability could be, as the affirmation model has it, something to be proud of. They are, after all, picked out negatively, by reference to disadvantage and social exclusion. Bodily features picked out for their role in the struggle for disability justice seem to be a better candidate source of joy, identification, and pride. The success of Barnes’ response depends on how exactly disability pride is supposed to work, and on how exactly definitions like these are supposed to serve the interests of the struggle against injustice. Among other things, reflection on related cases involving racialized body features suggests that it is possible to take pride in something that others respond to in oppressive and stigmatizing ways. On this understanding, the pride is not in the oppression, but in the oppression-triggering feature itself or in a skillful or solidaristic response to oppression.

Jenkins and Webster (2021) propose a different sort of social-construct definition of disability—or actually, three different but closely related definitions. Like Barnes, Howard, and Aas, they are interested in understanding what bodily differences are centrally relevant to disability. But they cleave closer to the human variation model than the minority group model in understanding these differences. Their key notion is what they call marginalized functioning : having a body that does not work in the way that our socially constructed world expects. Each of their three definitions of disability presuppose this notion; to wit:

MF1 : A subject S is [physically] disabled if they have marginalized functioning relative to a context, C , where this is the case iff:

• there is a set of social norms N , comprising \(n_1,\) \(n_2,\) …\(n_n,\) each of which serves as a default for the purposes of constructing common social environments and structuring common social interactions in C ; and
• there is some norm in N , \(n_x,\) such that S cannot physically function in a way that satisfies it. (2021: 8)

It might seem that this account, and indeed Howard and Aas’s, implies that there could be no disability in a just society. Though this is a classic claim of the traditional British social model of disability (UPIAS 1976), some find it implausible. Note, however, that neither of these views in fact implies the impossibility of disability in a just society (even if their language sometimes suggests it). For neither view, in itself, implies that the social responses that constitute most disabled people as such are necessarily unjust (though surely all four authors would agree that in the actual world, they usually are). If it is morally legitimate to set society up in a way that is designed for the functioning of most but not all its members—and it may well be, given how costly it would be to get anywhere near complete and comprehensive inclusion (Barclay 2018)—then some forms of functioning could be marginalized or be a source of disadvantage, even in a just society. And, thus, those that function in those marginalized ways, could be disabled.

A more significant prima facie concern for MF1 is that it seems to include amongst the disabled people with merely transitory mismatch between body and society—say, someone who broke one or both arms, and therefore cannot open doors or otherwise do what society expects people to be, physically, able to do. These people do not normally identify and are not normally identified as disabled. To capture this, Jenkins and Webster propose that we might move, simply, to:

MF2: someone is disabled in a context if and only if they have lasting marginalized functioning in that context; OR

MF3: someone is disabled in a context if and only if they experience disability-characteristic oppression because they have marginalized functioning in that context

MF2 solves the problem of temporary conditions by stipulation. This may or may not be good enough here, depending on whether we think temporary conditions (e.g., post-concussion syndrome or pregnancy) can be disabilities. MF3 faces some of the same problems as other social-model-inspired definitions—particularly, that it seems to define disability in terms of a kind of oppression, and therefore in terms of something bad, something that is therefore (arguably) difficult to be proud of or happy about. Further, by requiring that oppression be caused by functioning that actually fails to fit going norms and expectations, it does not clearly classify as disabled people who are disadvantaged by false perceptions regarding their bodily differences—again, failing to follow the ADA in its well-considered inclusion of people “regarded as”, but not, impaired, in its definition of disability (Francis 2018). It remains to be seen whether the advantages of this definition are great enough to justify excluding such “regarded” as people as disabled.

In their influential book From Chance to Choice , Buchanan, Brock, Daniels, and Wikler (2000) propose the following definition, meant as an explication of the legal and policy decisions considered above.

To have a disability is to be unable to perform some significant range of tasks or functions that individuals in someone’s reference group (e.g., adults) are ordinarily able to do, at least under favorable conditions, where the inability is not due to simple and easily corrigible ignorance or to lack of the tools or means ordinarily available for performing such tasks or functions. (2000: 286)

This defines disability colloquially, in terms of ability; disability is, roughly, an unusual inability. Barnes and others object, however, that this definition is too broad. It seems to make it the case, for instance, that someone who cannot “roll their tongue” or do mental subtraction is disabled; since most people can do this under favorable conditions. Conversely, this sort of view also seems to undergenerate disabilities, since some (fibromyalgia or depression for instance), only make it more difficult to do things, without making any particular task or function straightforwardly unachievable. And it is not entirely clear how this account avoids the obviously problematic implication that identity categories like race, gender, and sexual orientation imply disability; someone subject to social prejudice in virtue of their gender or the color of their skin might be, for that reason, unable to do things others can do.

Alex Gregory (2020) takes a different approach to defining disability in terms of inability:

The Inability Theory: To be disabled is to be less able to do something than is typical, where this degree of inability is partly explained by features of your body that are atypical. (2020: 26)

This definition of disability brings the body into the definition, but it is meant to be neutral between more-medical and more-social ways of seeing disability. “Atypical” features need not be “abnormal” in a medicalizing sense; they are simply different, not necessarily worse. To say that an inability that comes to disability must be at least partly explained by bodily features is consistent, both, with saying that it is entirely explained by them (a la the medical model) and that it is also partly explained by social factors. This in itself rejects the medical model as a general claim, as well as the less nuanced statements of the social model, that would definitionally exclude non-social inabilities from the ambit of “disability”.

The initial statement of the Inability Theory would still seem to be overinclusive; someone who cannot get a good job because of the color of their skin, or marry the person they love because of their sexual orientation, has an atypical inability explained by an atypical bodily feature. To rule these cases out, Gregory moves to:

The Final Inability Theory: To be disabled is to be less able to do something than is typical, where this degree of inability (1) is partly explained by features of your body that are atypical, and (2) is not explained by anyone’s attitudes toward those bodily features. (2020: 33)

This does plausibly avoid the problem of classifying sexual and racialized minorities at least as disabled; any inability engendered by color of skin is explained entirely by prejudicial attitudes. (Or so it may seem; more below). But in the process it also raises a recurring problem—where an atypical feature is only inability-generating because of attitudes specifically about whether it is inability-generating . If people think that people with, say, Down syndrome, cannot benefit from education, they will not be educated; when they do not develop the skills they could have developed, that lack of skill is, then, explained by a combination of atypical bodily features and attitudes towards those features. It can seem plausible to say, with the ADA, that discrimination rooted in a pathologized understanding of a trait is a kind of disability discrimination.

Moreover, this analysis also raises some of the same concerns as those Barnes and others pressed against Buchanan et alia ’s explication of disability as biologically abnormal limitation. For here even more than there it seemed like not every limitation on ability, not even every one explained by atypicality or abnormality, is a disability properly-so-called. Gregory, however, has a novel response here—insisting that these are, really, disabilities, but just not normally worth calling attention to as “disabilities”, since the aptness of this ascription in conversational context depends on the significance of the abilities at issue.

This proposal raises other problems, however.. Recall race and sexual orientation. A person with light-colored skin cannot work in even relatively moderate sun all day without getting a sunburn. Someone with exclusively same-sex orientation cannot have procreative sex with someone for whom they have romantic and sexual feelings. These are inabilities explained by bodily difference, not by attitudes, and they are not insignificant or trivial ones: yet it seems they are not disabilities, not even a little bit.

Why not? The social constructionist views considered above would give one kind of answer—pointing to the facts that (depending on the view):

• the disability rights movement is rationally unconcerned with properties like race and orientation; or
• that race and orientation are not targeted by ableist ideology for exclusion and stigmatization; or
• that our actual social norms do not marginalize these configurations of bodily function, in the way they marginalize paradigm impairments.

An alternative, more positive approach, which remains focused squarely on ability, would hold that these inabilities, like the minor inabilities considered above, are not relevant to disability because their absence does not place claims on others, in justice. To wit, Jessica Begon (2021)

Thus, I define disability as the restriction in the ability to perform those tasks human beings are entitled to be able to perform as a matter of justice, as the result of the interaction between an individual’s impairment, their social and political context, and the resources they have available to them. (2021: 936–937)

It turns out that by impairment Begon simply means “atypical or unusual functioning”, not pathological or life-limiting functioning; so, this account is actually structurally more similar to Gregory’s than to Buchanan et alia. The difference is that the specific absence of ability that constitutes a disability is the atypicality-caused absence of abilities we ought to have , or anyway that our societies ought to provide for us.

This account has a natural response to the problems of non-disability inabilities. No one is entitled to roll their tongue (at least in any social environment remotely like our own); thus, nobody is disabled because they cannot do so. Nor, in most circumstances, are we entitled to sit unprotected all day in the sun without paying the consequences. We might be entitled to protection by sunscreen, or to the opportunity to escape the sun, but we are not entitled to have the ability to withstand the sun if we choose to forgo these protections. Similarly, it seems plausible to deny that anyone is entitled to procreate sexually with their romantic partner; there may be entitlements to become a parent, perhaps even a genetic parent, but they need not be realized in this way. Thus, Begon’s account appears at first glance not to overgenerate disabilities, as other inability-based accounts seem to.

That said, the account still faces some of the problems we see with other ability-limitation-based accounts. The non-pathologizing sense of impairment as “functional difference” may not in the end be specific enough to distinguish disability from other kinds of unjust absence of ability. Begon addresses this in the case of sex difference, arguing—in effect, with Boorse—that differences in the “reference class” or appropriate functional norms applying to males and females of the species make for differences in what counts as an impairment between males and females. So, for instance, an inability to get a good-paying job resulting from possession of the capacity to menstruate is not a disability, because that capacity is not atypical for female human beings . Such a way to address the problem may not cover all forms of oppression since much oppression seems to be evoked by differences that are functional in some sense—sexual orientation relates to the function of our dispositions to sexual attraction; absence of athletic ability (within the normal range) to the function of the musculature; even pigmentation, to the function of the epidermis in protecting the organism from the environment.

Begon’s view could avoid classifying inabilities down to these differences by further multiplication of “reference class”, so that, say, being unable to get a job because you are gay is not a disability because gay people function typically “for gay people”. But as Elselijn Kingma has argued, in response to similar maneuvers in the health literature, this kind of specificity seems problematically arbitrary—in the limit, threatening to trivialize the relevant notion of “functional typicality” (Kingma 2007). These concerns seem to press back in the direction of Lim’s restriction of disability to responses to “medically significant interests”, or Howard and Aas’s definition in terms of traits perceived or represented as functional deficits in the reigning biomedical ideology.

There are also questions about how we are to understand the set of entitlements relevant to determining when the absence of ability is unjust. Begon discusses these issues only briefly (2021: 954, n30); a more fully developed version of the view would have to do more. It seems important to abstract from resource constraints, since we would not want to say that someone is only disabled if habilitating them is cost-effective relative to other priorities justice gives us, given what resources we happen to have. But this abstraction threatens to make too many of us disabled, since justice might, absent resource constraints, give us powerful reasons to enable one another to do all sorts of things—to give those of below-average height the ability to dunk a basketball, say; or to give women well-past childbearing age the ability to conceive and gestate children. Perhaps we should do these things in response to these functional atypicalities; that does not make people disabled, until we are rich enough to do them.

Two sorts of skeptical responses have greeted the effort to define disabilities as individual traits, conditions, or functions, selected by some set of rules or criteria. The first critique is inspired by the work of Michael Foucault on biopower as a form of control exercised by modern states over the bodies of their populations (Tremain 2017). This critique argues that to focus on individual characteristics in defining disability is to miss the forest for the trees. “Disability” refers not to a set of individual characteristics, or to a concept that encompasses such a set, but to a mechanism that identifies various types of individual characteristics for the purpose of social control. Notably, Shelley Tremain analyzes disability as a mechanism constructed and maintained by laws, informal norms, cultural understandings and other exercises of biopower. Impairments and disabilities only exist within this culturally and historically contingent apparatus that arose in part as a means for people who saw themselves as “normal” to regulate those they labeled as “deviants”.

[D]isability is not a metaphysical substrate, a natural, biological category, or a characteristic that only certain individuals embody or possess, but rather is a historically contingent network of force relations in which everyone is implicated and entangled and in relation to which everyone occupies a position. That is, to be disabled or non-disabled is to occupy a certain subject position within the productive constraints of the apparatus of disability…. (2017: 22).

At first glance, Tremain’s Foucauldian claim can seem to be talking past the interlocutors considered above; no more a distinctive analysis of disability to compete with the foregoing than was Foucault’s famous claim that “knowledge is power” a competitor to Plato’s or Goldman’s or Sosa’s analytic definitions of knowledge (see entry on the analysis of knowledge ). As in that case, however, a recognition of the role the concept of disability plays in reproducing unjust social conditions can cast doubt on reliability of the commonsense judgments and linguistic intuitions appealed to by rival analytic definitions. Such judgments and intuitions are, so the Foucauldian could argue, products of the apparatus, not an independent basis for assessing or understanding its assignment of positions. However, several of the analytic accounts discussed in the preceding action were developed with awareness of and due skepticism towards the ideological roots of prevailing convictions about disability and do not explain disability as a natural, biological category. It is unclear then, if a Foucauldian challenge could undermine the evidence used to develop these accounts.

The second critique, rather than dismiss the value of philosophical definitions, emphasizes their multiplicity, maintaining that different definitions are appropriate in different contexts and for different purposes. On this view, the problem with these definitions is that they see themselves as competitors in pursuing a goal that is both unattainable and undesirable: a single unified or core definition of disability:

Many philosophical disagreements about disability simply overlook the fact that the disputants are talking about different phenomena (impairment vs. oppression; care vs. justice; legal vs. extra-legal obligations, etc.). Some of those disagreements are more productively articulated as disagreements on how to handle the polysemy of disability. (Beaudry 2020: 5; see also Beaudry 2016).

Though certain ethical or political contexts might call for specifying or stipulating a definition, this view holds that we have little reason to think we can find, or should seek, a definition of “disability” as a general matter. We are unlikely to find one because these different definitions will have conceptual and practical advantages in different contexts; we should not seek one because adopting a canonical definition would foreclose our recognition of other characteristics and phenomena with moral and practical affinities to what we have decided to call “disabilities”. An open-ended approach, in contrast, “can create avenues for new kinds of emancipatory self-understandings” (Beaudry 2020: 13).

Beaudry acknowledges that even open-ended approaches have evidentiary constraints, but these constraints are far looser than any which a single definition, however nuanced and complex, would impose:

Disability remains a term that at least denotes or connotes “abnormal embodiments”, including phenomena entirely external to the bodies of “disabled persons” (such as prejudices directed at imagined abnormal embodiments or strictly cultural artifacts). It is a useful commonality between a constellation of discourses that relate to objects that are at least united by this family resemblance and may overlap or interact with each other, even though it is unlikely that a “master theory” would neatly choreograph all such interactions. (Beaudry 2020: 17)

This deflationary pluralism, however, arguably overlooks the value of continuing to seek a single unified or core definition of disability, however unlikely we are to agree on one. Most philosophers who have taken this tack do so not on the supposition that “disability” or even “impairment” are natural kinds—objective properties that legal and regulatory definitions ought to track. Rather, they are largely motivated by a belief that there is a set of personal experiences and social responses that people with disabilities have in common, and that ways of precisifying the meaning of “disability” and “impairment” are likely to work better than others for purposes of framing policies and building political movements to address the needs and claims of individuals those sharing such personal experiences and aimed at addressing the moral and political of this group.

Whether and to what extent the practical aims these various models of disability seek to serve are best accomplished by many separate contextual definitions, or one sophisticated one is, in the final analysis itself likely to be a difficult ethical, even political, question. Proponents of social constructionist, ameliorative views of disability, like proponents of similar views of race and gender, have tended to think that there are good practical reasons to define these notions broadly, to draw attention to forms of injustice that many experience, together, as a means for building larger and thus more powerful coalition to push for positive change. And they have, or anyway could, argue that the flexibility and inclusiveness pluralist call for can be accommodated by an open-minded and sensitive debate over just what this one solidaristic definition should or should not include. They might be right, or they might be wrong, but if they are wrong, it is not because the philosophical and political project of offering a unifying definition is a priori misguided.

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disability: and health care rationing | disability: and justice | disability: health, well-being, personal relationships | feminist philosophy, topics: perspectives on disability | feminist philosophy, topics: perspectives on sex and gender | health | knowledge: analysis of | Molyneux’s problem | self-knowledge

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An Essay on Modeling: The Social Model of Disability

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From its first exposition almost half a century ago, the social model of disability has been aimed at altering both theory and practice, bringing about profound changes in people’s understanding of disability, and in the daily lives of disabled people as well. The social model’s foil, and on some accounts its antithesis, is the medical model of disability. Both models treat disability as a locus of difficulties. While the medical model takes disability to be a problem requiring medical intervention—and as both the prerogative and the responsibility of medical professionals to fix—the social model understands disability as a political problem calling for corrective action by citizen activists who alter other people’s attitudes and reform the practices of the state. These two conceptualizations of disability have been treated as competitors, as if one must prevail over and eradicate the other in thinking about who disabled people are and what should be said and done in regard to them.

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Silvers, A. (2009). An Essay on Modeling: The Social Model of Disability. In: Ralston, D., Ho, J. (eds) Philosophical Reflections on Disability. Philosophy and Medicine, vol 104. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-2477-0_2

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Conceptualizing disability: Three models of disability

The author explains different perspectives for understanding disability.

• Disabilities
• Schools and Classrooms

How people think about disability affects how they feel about disability. Although people have various individual perspectives on disability, these viewpoints can be categorized into three overarching models of disability—moral, medical, and social (Olkin, 2002). Each model addresses the perceived causes of disability, appropriate responses, and deeper meanings.

Moral model

In the moral model, disability is seen as having meaning about the person’s or the family’s character, deeds, thoughts, and karma. From this perspective, disability can carry stigma, shame and blame, particularly if the disability is seen as a mark of wrongdoing. Alternatively, disability can be seen as a sign of honor, faith or strength. For example, someone who is religious may believe they (or their family member) were chosen to have a disability due to God’s faith in them. Disability may also be perceived as a positive reminder of having survived a life challenge (e.g., a polio epidemic, or stepping on a land mine). The moral model is very prevalent worldwide and is often depicted in the media. For example, some movies use a physical disability to show evil. In contrast some movies portray the disabled person as one who goes beyond usual human levels to achieve unique goals, such as a wheelchair user who climbs El Capitan in Yosemite.

Medical model

In the medical model, disability is perceived as an impairment in a body system or function that is inherently pathological. From this perspective, the goal is to return the system or function to as close to “normal” as possible. The medical model suggests that professionals with specialized training are the “experts” in disability. Persons with disability are expected to follow the advice of these “experts.” The language of the medical model is clinical and medical (e.g., left hemiplegia; partial lesion at the T4 level). This view is one that can sometimes be seen within the fields of health, mental health, and education.

The medical model of disability often is depicted in movies through a plot in which a disabled person is depressed and hopeless, but through friendship with an able-bodied person the disabled person learns to embrace life. A reverse twist on this is the idea that disabled people show able-bodied characters how to be better people.

Social model

In the social model, disability is seen as one aspect of a person’s identity, much like race/ethnicity, gender, etc. From this perspective, disability is believed to result from a mismatch between the disabled person and the environment (both physical and social). It is this environment that creates the handicaps and barriers, not the disability. From this perspective, the way to address disability is to change the environment and society, rather than people with disabilities. Negative stereotypes, discrimination and oppression serve as barriers to environmental change and full inclusion.

Movies depicting disability from a social model are more apt to have multiple disabled characters who form bonds, learn, and grow, without dependence on an able-bodied character. Other films show disabled characters more realistically: in the context of loving families who are not ‘burdened’ by the disability; in a society that discriminates; as activist trying to change laws.

What is your model?

Although students have a tendency to see one model as superior to the others, there are some potential benefits and costs to all of these perspectives. The moral model can bring shame, but also renewed faith. The medical model has spurred tremendous advances in rehabilitation but is paternalistic. The social model fosters community, but systemic ableism can be overwhelming. Probably most people have beliefs in more than one model. But it is hard to know, since currently there is not a well-established measure of the models. More data are needed from disabled persons to get their perspective on the costs and benefits of their particular model of disability.

Find a movie with one or more disabled characters, then answer a few questions: (a) Which model(s) did the disabled character hold? (b) What was the director’s perspective on disability? (c) What was the main message about disability in the movie?

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Olkin, R. (2002). Could you hold the door for me? Including disability in diversity. Cultural Diversity and Ethnic Minority Psychology, 8 , 130-137.

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Social and medical models of disability and mental health: evolution and renewal

Over the last 6 decades, many published commentaries, from both within and outside the medical community, have criticized medicine’s characterization and management of mental illness and disability. These critiques have often referenced the “medical model,” a term that has multiple meanings but has almost always been used pejoratively. Prominent critics have included disability scholars and self-advocates, who attacked the so-called “medical model” and espoused an alternative “social model,” which characterizes disability as the product of an unaccommodating and oppressive society, rather than an individual and medical problem.

The terms “social model” and “medical model” have frequently been used to highlight opposing views of disability, but there has been little historical examination of their origins and evolving meanings. 1 As a result, clinicians have had limited access to information about what these concepts mean to patients, making it difficult to respond adequately to the concerns they raise. For physicians, fully embracing social-model views would require political engagement and a greater focus on societal, rather than individual, problems. Even if most physicians do not adopt these roles, increased awareness of disability perspectives and familiarity with critiques of the medical model may help them to identify new ways of improving care for their patients, while also enhancing opportunities and support for clinical trainees and colleagues with disabilities.

The critique of the medical model originated in the psychiatry literature and has taken various forms since psychiatrist Thomas Szasz coined it in the mid-1950s. 2 One version, an antireductionist view, lamented the tendency of medicine to reduce disease and disability down to physiochemical factors. This genre of criticism was popular among health professionals, who called for reforming medical practice to make clinicians more sensitive to the complex psychosocial aspects of health and illness.

Disability self-advocates rally in San Francisco, California, in 1973 for improved governmental and social supports, and an end to the oppression of people with disabilities. This image is reprinted with permission from Anthony Tusler, AboutDisability.

A second, exclusionist strain — initially espoused by Szasz — did not seek to reform medicine, but to exclude certain areas from medical oversight. Proponents of exclusionist views argued that medical intervention in specific realms — like mental health and disability — was stigmatizing or oppressive. Some suggested that these issues required societal reform, not individual treatment.

Most physicians have found antireductionist critiques of medicine to be more palatable than calls for exclusion, because antireductionist reforms do not question the fundamental value of medicine in treating individuals with mental illness and disability. One prominent proponent of an antireductionist perspective in the 1970s was psychiatrist George Engel. He took on the medical model, calling for a move away from reductive natural science approaches, in favour of an alternative “biopsychosocial model.” Engel distinguished his view from Szasz and other “exclusionists” (Engel’s term) by arguing that mental illness was a disease, and that its biological causes should not be dismissed. 3 At the same time, Engel suggested that medicine required a more nuanced view of disease, which included recognition of psychosocial issues along with physiochemistry. 4 Engel’s biopsychosocial model retained a dominant role for physicians, while calling on them to look beyond laboratory findings to consider a patient’s social environment.

Although Engel did not specifically address disability, his biopsychosocial model was widely influential among clinicians who specialized in this area. An antireductionist form of medical model critique was prominently presented in the World Health Organization’s classification of disability, published in 1980 (since updated: www.who.int/classifications/icf/en ). Similar arguments were also espoused in other health-related books from this period, including Genetic Disorders and Birth Defects in Families and Society (1984), which featured chapters on the medical, ethical and social aspects of disability, written by physicians, patient advocates and clergy. In these forums, physicians acknowledged critiques of the medical model and accepted outside advice on how to make medicine more sensitive to psychosocial aspects of disability. However, this was done without questioning the medical view of disability as a problem that could be clinically defined and treated.

Outside of medicine in the 1970s, clinical psychologists and sociologists — influenced by Szasz — took up and expanded exclusionist perspectives, applying this strain of medical model critique to mental illness, behaviour and intellectual disabilities. Clinical psychologist George Albee was a vocal critic of psychiatric approaches to mental health, which he argued inappropriately pathologized people’s “problems of living.” 5 Similarly, clinical psychologist Wolf Wolfensberger criticized the application of the medical model to intelligence and behaviour. Albee and Wolfensberger called for alternative approaches, which removed these issues from medical oversight and focused on reforming social institutions to be more supportive of individual differences. Unfortunately, both men’s views were met with derision by many of their medical colleagues, and their perspectives remained little known by physicians.

Sociologists Erving Goffman and Kenneth Irving Zola also adopted an exclusionist strain of medical model critique, highlighting the isolation, stigmatization and medicalization of deviant behaviour. 6 , 7 Zola also helped to adapt Szasz’s exclusionist view of mental illness to encourage new perspectives on physical disabilities as a social rather than a medical issue. In doing so, Zola — who identified as having a physical disability — contributed in the 1980s to the burgeoning American disability self-advocacy movement. 7

At the same time, British scholar Michael Oliver adopted an exclusionist strain of the medical model critique in his formulation of the social model of disability. 8 The social model argued that disability was a status imposed on people with various forms of impairment, and therefore that disability was a political, not a health, issue. Social model proponents held that the medical model viewed personal impairment as the sole cause of disability, making an individual’s body the appropriate target for intervention. Oliver argued that disability was distinct from impairment, and instead was the product of an unaccommodating society. From a social model perspective, medicine’s focus on treating impairment reified the widespread conception of disability as an individual tragedy, rather than the outcome of oppressive social perceptions and arrangements. One way to combat oppression, social model advocates suggested, was to exclude disability from medical oversight.

Of course, everyone occasionally requires medical care, and for people with certain disabilities — especially progressive, chronic or painful conditions — medical interventions may be necessary to maintain well-being and livelihood. 9 Although the social model was an empowering new perspective for many people with disabilities, some struggled with the implication that their disability was entirely the result of social oppression, because this seemed to suggest that their individual impairments should be ignored.

During the 1990s, feminist disability scholars and self-advocates, including Jenny Morris and Liz Crow, called for a “renewed social model of disability,” one that largely retained an exclusionist perspective, but acknowledged that even in a world without disability discrimination, impairment would have negative individual impacts. 10 Crow argued that the negative effects of impairment, like chronic pain, can on their own interfere with one’s social engagement, and may be beneficially mitigated by medical intervention. 10

Since the 1990s, proponents of the social model of disability have widely embraced the view that impairment and disability interact, and that the individual challenges of impairment should not be disregarded. Nonetheless, many disability self-advocates continue to express substantial distrust in the medical community and its approaches.

How then can physicians, as helping professionals, enhance their care and support for people with disabilities? One option is greater political engagement: promoting the view that disability should be seen as a valued form of human diversity, rather than an individual and tragic problem to be lamented and solved.

Many physicians may believe that their strengths for fomenting change would be best realized working with individuals in the clinic, rather than in the political arena; and indeed, there remains plenty of work to be done within the clinical professions. One key area is mentorship: teaching trainees about disability perspectives, and why many self-advocates have adopted and maintained an exclusionist form of medical model critique.

Another very important avenue is in recruiting and supporting people with disabilities to join and thrive in the clinical professions. 11 Physicians have an important role to play in recognizing the unique strengths and equal competency of people with disabilities as clinical professionals. Many of these qualified individuals have recounted being made to feel out of place in medical culture. Fundamental changes to medical training programs and institutions that normalize disability accommodations for students, residents, fellows and practitioners have yet to be made. 12

If physicians want to take an important step in the evolution and renewal of their profession, to show that medicine is more supportive and accepting than many people with disabilities have, understandably, come to believe, then embracing a much more nationally representative group of people with disabilities to become full participants and respected members of the clinical professions would be an important and welcomed start.

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Disability Studies: Foundations & Key Concepts

This non-exhaustive reading list highlights some of the key debates and conceptual shifts in disability studies.

Disability studies emerged out of the disability civil rights movement in the late twentieth century. Early scholarship distinguishes the medical model of disability, which locates physical and mental impairments in individual bodies, from the social model, which understands the world as disabling people. The social model names both architectural and attitudinal barriers as the cause of disablement. Over the last few decades, the field has expanded to include individuals with a wide range of disabilities—not just physical conditions, but also mental and chronic ones.

This list, far from exhaustive, highlights some of the key debates and conceptual shifts in the field.  In addition to showcasing disability studies’ interdisciplinary focus, the list traces the relationship between D.S. and other minority fields of study. At its broadest, disability studies encourages scholars to value disability as a form of cultural difference. As the sources below reveal, ability should not be the default when it comes to human worth.

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Asch, Adrienne. “Recognizing Death while Affirming Life: Can End of Life Reform Uphold a Disabled Person’s Interest in Continued Life?” The Hastings Center Report , 2005

Bioethics scholar Adrienne Asch is one of the first scholars to bring a disability studies approach to bioethics. This essay addresses U.S. policy regarding decisions for end-of-life treatment and, more broadly, it critiques discourse surrounding “quality of life.” Asch attacks the slogan “better off dead than disabled” by showing how disability does not necessarily diminish one’s life. Instead, she argues, healthcare practitioners should focus on forms of care that give disabled people independence. She also offers pragmatic suggestions for how caretakers can affirm the humanity of patients receiving end-of-life treatment.

Baynton, Douglas. “Slaves, Immigrants, and Suffragists: The Uses of Disability in Citizenship Debates.” PMLA , 2005

Douglas Baynton’s groundbreaking essay foregrounds disability in accounts of American history. He assesses three U.S. debates regarding citizenship: the civil rights movement, women’s suffrage, and immigration legislation. This essay considers how disability has been used as a justification for the oppression of marginalized populations. For example, slaves were said to become “crazy” if they were granted freedom. Women were often described as mentally incapable of receiving an education. And immigrants have been cast as disabled due to racial difference. Baynton explores how attending to disability in its own right (rather than as a symptom of misogyny or racism) enables an intersectional analysis.

Brueggemann, Brenda Jo, Rosemarie Garland-Thomson, Georgina Kleege. “What Her Body Taught (Or, Teaching about and with a Disability): A Conversation.” Feminist Studies , 2005

Written from the perspective of three female scholars with disabilities, this essay is one of the first pieces of scholarship to address the presence of disabled faculty in the classroom. Brueggemann, Garland-Thomson, and Kleege explore the tension between wanting their disabilities to be normalized, but also wanting them to be present in students’ minds. In addition to discussing the difficulty of disclosure in the classroom, they explore how educators might adopt different approaches to teaching to accommodate instructors’ disabilities.

Davis, Lennard. “Crips Strike Back: The Rise of Disability Studies.” American Literary History , 1999

This essay reviews three publications that address disability studies from a humanities-based perspective. While D.S. first emerged in the social sciences, Davis makes a case for the centrality of disability studies scholarship in literary studies. More broadly, he proposes that disability studies should no longer be considered a narrow or specialized field. It’s applicable to us all.

Donaldson, Elizabeth J. “The Corpus of the Madwoman: Toward a Feminist Disability Studies Theory of Embodiment and Mental Illness.” NWSA Journal , 2002

This essay takes up the figure of the madwoman in literature. Adopting a feminist disability studies approach, Donaldson critiques the way feminist scholars read madwomen as merely symptomatic of patriarchal oppression, which discounts the reality of mental disability. She is resistant to framing disability as a metaphor and advocates for readings that consider disability alongside questions of gender.

Erevelles, Nirmala. “Race.” Keywords for Disability Studies (2015)

This short essay gives an overview of the relationship between disability studies and critical race studies. Erevelles shows how disability has been aligned with race. However, analogizing race to disability (or saying, “disability is like race”) eliminates the specificity of both identity categories. She uses special education as an example because it is a site where racial segregation takes place on the premise of disability. By attending to disabled people of color, she argues that we can achieve a more nuanced analysis, which accounts for how social forces like poverty and involuntary institutionalization exacerbate different forms of social marginalization.

Garland-Thomson, Rosemarie. “Feminist Disability Studies.” Signs , 2005

In placing feminist studies and disability studies in conversation, Garland-Thomson argues that both fields work to de-naturalize assumptions about embodiment and social roles. Her essay explores a range of pressing social issues, including selective abortion, caretaking, and reproductive rights.

Ginsburg, Faye and Rayna Rapp. “Disability Worlds.” Annual Review of Anthropology , 2013

Ginsburg and Rapp call for a critical approach to disability in the field of anthropology. Bridging the gap between the medical and anthropological fields, they shift toward understanding impairment as both environmental and cultural. They also consider what ethnography can bring to questions of disability within anthropological study.

Hershey, Laura. “Disabled Women Organize Worldwide.” o ff our backs , 2003

Recounting events from the NGO Forum on Women in China (1995) and the International Leadership Forum for Women with Disabilities in Maryland (1996), disability activist Laura Hershey moves beyond Western definitions of disability to offer a global perspective. In addition to showing how disabled women are doubly discriminated against, Hershey outlines how gender can influence the international movement for disability rights. She also considers how issues like poverty and illiteracy speak to the feminist and disability movements.

James, Jennifer C. and Cynthia Wu. “Editors’ Introduction: Race, Ethnicity, Disability, and Literature: Intersections and Interventions.” MELUS , 2006

This essay brings ethnic studies into conversation with debates regarding disability representation. From the nineteenth-century freakshow to forced sterilization, people of color have been disproportionately disabled, and James and Wu call for an intersectional approach to these complex subjectivities.

Kleege, Georgina. “Blind Rage: An Open Letter to Helen Keller.” Southwest Review , 1998

In this more personal essay, Kleege interrogates Helen Keller’s status as a disability icon. Kleege critiques the way disability has been individualized, refuting both tragic and triumphant representations of impairment. In describing her experience navigating everyday life as a blind woman, Kleege attends to the realities of living in a world not made for disabled people.

Kudlick, Catherine. “Disability History: Why We Need Another ‘Other.’” The American Historical Review , 2003

In this groundbreaking essay, Kudlick moves to situate disability studies in historical scholarship. Reframing disability as valuable, she argues that a renewed attention to bodily and mental impairments can revise our accounts of nearly all events in history—from women’s rights to labor movements. Her essay offers a comprehensive overview of books and articles pertaining to disability history, and, more specifically, deaf history.

Linker, Beth. “On the Borderland of Medical and Disability History: A Survey of Both Fields.” Bulletin of the History of Medicine, 2013

This essay addresses why the history of medicine and disability studies fail to interact. Linker begins by critiquing disability studies’ resistance to medical discourse. She argues that certain disabled people, especially those who are living with chronic conditions, often rely heavily on medical care, which is why the “medical model” should not be so readily dismissed. In turn, while disability history is typically understood as different from medical history, especially in the U.S., Linker argues for a greater need for cross-disciplinary collaboration.

Linton, Simi. “Reassigning Meaning.” Claiming Disability: Knowledge and Identity , 1998

One of the most foundational essays in the field of disability studies, Linton outlines how language has been important to naming disability as a political rather than medical category. She also addresses the problem of “overcoming rhetoric,” which fails to address disabled people’s need for access.

McRuer, Robert. “Crip Eye for the Normate Guy: Queer Theory and the Discipling of Disability Studies.” PMLA , 2005

McRuer is one of the first scholars to assess the relationship between disability and queerness. In this essay, he analyzes how the popular show The Queer Eye for the Straight Guy normalizes the disabled body. While representations of queer life often resist disability, he argues that queer and disability studies share a resistance to normalization, which should be embraced in future scholarship and activism.

Price, Margaret. Mad at School: Rhetorics of Mental Disability and Academic Life . University of Michigan, 2011

Price offers one of the first substantive accounts of mental disability, which has come belatedly to studies of physical disability. She focuses on higher education as a site that stigmatizes mental disability in its focus on rationality, cohesion, and cognitive agility. Her book offers a range of suggestions, many of which are pedagogical, for how mental disability might revitalize academic life.

Siebers, Tobin. “Disability in Theory: From Social Constructionism to the New Realism of the Body.” American Literary History , 2001

Siebers critiques the social model of disability, arguing that it fails to account for the experience of individual bodies. His term “the new realism of the body” calls for an assessment of the bodily effects of disability, which often cannot be altered through environmental transformations alone.

Wendell, Susan. “Unhealthy Disabled: Treating Chronic Illness as Disabilities.” Hypatia , 2001 

This article broadens the definition of disability to include individuals with chronic illnesses.  While people in the disability community often distinguish themselves from people who are ill, not all disabled people, she observes, are healthy. Wendell questions some of the main assumptions in disability activism and scholarship regarding social justice and reform. Dismantling the environmental effects of disablement will not always eliminate a body’s suffering, she argues.

Williamson, Bess. “Access.” Keywords for Disability Studies (2015)

This short essay gives a comprehensive account of the history of access and why it is a key term in D.S. Williamson argues that paying attention to access turns our focus away from the individual, highlighting instead the disabling makeup of the social world. Although access is easy to define, Williamson notes that it is hard to implement in practice because disabled people have conflicting needs.

Editor’s Note: This list has been updated to include publication dates.

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Enabling America: Assessing the Role of Rehabilitation Science and Engineering (1997)

Chapter: 3 models of disability and rehabilitation, 3 models of disability and rehabilitation.

Models assist understanding by allowing one to examine and think about something that is not the real thing, but that may be similar to the real thing. People use a variety of models to obtain a clearer understanding of a problem or the world around them. Such models include physical models, three-dimensional graphical models, animal models of biological systems, mathematical or ideal models, and computer models. When relationships are highly complex, however, as they are in rehabilitation processes and other areas of human endeavor, it is seldom possible to develop models that are quantitatively predictive. Nevertheless, it is often possible to establish rough relationships between various variables that are observable.

Models based on partial knowledge are often called conceptual models. Conceptual models may help people to think about behaviors of components in complex systems, even though they may not yield quantitative answers. They may allow one to understand general relationships without the necessity for an extensive verbal or written description. In this way they are like an out-of-focus picture that partially reveals relationships. It is common in science and engineering to use models to help develop hypotheses that can be examined experimentally, but even as models assist scientists in moving forward with new understanding, they are abandoned for new versions. Experimental results may suggest that the models must be altered or even abandoned in favor of new models.

The models discussed in this chapter are conceptual in nature.

Such models must constantly be changed as new knowledge is gained if they are to adequately represent processes or systems that are in flux. Rehabilitation science and engineering, at its current stage of development, does not have a comprehensive paradigm or a universally accepted theoretical model. It is an emerging field of study, and as such, is still evolving. This chapter presents a brief look at the history of models of disability, which is useful in understanding the current status and direction of disability and rehabilitation research, and then presents a model of disability that builds upon and elaborates previous models, as well as adding several new elements. It presents this model verbally, schematically, and mathematically. Finally, it introduces a matrix that defines rehabilitation research.

Evolution of models of Disability

The prevailing wisdom about the causes of disability has changed in the last several decades. In the 1950s, impairment of a given severity was viewed as sufficient to result in disability in all circumstances; in contrast, the absence of impairment of that severity was thought to be sufficient grounds to deny disability benefits. Thus, the American Medical Association's Committee on Medical Rating of Physical Impairments stated that "competent evaluation of permanent impairment requires adequate and complete medical examination, accurate objective measure of function, and avoidance of subjective impressions and nonmedical factors such as the patient's age, sex and occupation" (American Medical Association, Committee on Medical Rating of Physical Impairment, 1958).

By the mid-1970s, Nagi (1976) outlined a process by which a pathology (e.g., arthritis) gave rise to an impairment (e.g., a limited range of motion in a joint), which may then result in a limitation in function (e.g., an inability to type), which, finally, may result in a disability (inability to work as a secretary). While outlining a process that would seem to move inexorably from pathology to loss of a job, Nagi noted that correlations among impairments, functional limitations, and work loss were poor, and he speculated that the extent to which the environment accommodated limitations largely determined whether disability would result from the onset of a medical condition. In the interim, at least three others have developed models or modifications: the WHO (International Classification of Impairments, Disabilities, and Handicaps, 1980), the IOM ( Disability in America, 1991), and the NCMRR (1993). All of these models attempt to facilitate and improve understanding by describing the concepts and relationships

among medical conditions, impairments, functional limitations, and the effects of the interaction of the person with the environment (i.e., handicap, disability, societal limitation) although each uses different nomenclatures for the components.

Nagi's model of disability explicitly brought the environment into the conceptualization. His model initiated a search for the factors in family, community, and society that affect disability as an outcome. With respect to disability in the work setting, for example, research has focused on the social and demographic characteristics of the individual and family, the individual's prior occupation and the industry in which the individual was previously employed, the flexibility of the workplace with respect to the physical tasks of work and hours of work, the nature of the local economy, customs and laws governing employment, and the extent of income transfer programs (Yelin, 1992).

Although the Nagi model included the environment, it was limited in how it conceived of the environment. In his model, the environment impinges on individuals only when activity limitation interacts with the demands placed on those individuals; the process that gives rise to disability is still inherently a function of the characteristics of medical conditions and attendant impairments.

The IOM model (IOM, 1991) was derived directly from Nagi, defining disability as "a function of the interaction of the person with the environment" and beginning to describe certain subsets of environmental factors that could potentially affect the development of and movement within a disabling process. In this model, physical and social environmental risk factors (as well as biological and lifestyle risk factors) were described as independent variables that exist at all stages of the process. These factors affect progression within the model, and their control therefore affects (prevents) disability.

The NCMRR model adds emphasis to the importance of environment by adding a category called societal limitations to account for restrictions that society places on individuals and that limit their ability to participate independently in tasks, activities, and roles. The unwillingness of employers to provide accommodations and the lack of ramps that deny access to public buildings to persons with disabilities are given as examples.

Building on these models, this committee describes a model where the environment interacts with the individual to determine whether disability will result. Nagi's nomenclature is used in describing the stages of the model and the relational nature of disability, as described in the IOM model, is now enhanced and clarified. In this new model, the environment plays a critical role in determining whether each stage occurs and if transitions between the stages occur.

A New Model for the Enabling-Disabling Process

A common understanding of such terms as injury, impairment, handicap, functional limitation, disabling conditions, and disability is essential to building effective, coherent programs in rehabilitation science and engineering. As described above, several frameworks have been advanced to describe disability-related concepts, but none of these has been universally adopted. The lack of a uniformly accepted conceptual foundation is an obstacle to research and to other elements critical to rehabilitation science and engineering. Using the definitions laid out in Chapter 1 , this committee presents a new set of models, based primarily on the previous IOM model (1991), designed to enhance the robustness of the previous models with respect to reversing the disabling process, i.e., rehabilitation. This section presents an overview of "the enabling-disabling process," explains its stages, and describes the nature of disability.

An Overview of the Enabling-disabling Process

An overview of how disabling conditions affect a person's access to the environment is shown in Figure 3-1 . Access to the environment, depicted as a square, represents both physical space and social structures (family, community, society). The person's degree of physical access to and social integration into the generalized environment is shown as degree of overlap of the symbolic person and the environmental square. A person who does not manifest disability (a) is fully integrated into society and therefore has full access to both: 1) social opportunities (employment, education, parenthood, leadership roles, etc.) and 2) physical space (i.e. space access equivalent to persons without disabling conditions). A person with potentially disabling conditions 1 has increased needs (expressed by the size of the individual) and is dislocated from their prior integration into the environment (b).

The rehabilitative process attempts to rectify this displacement, either by restoring function in the individual (c) or by expanding access to the environment (d) (e.g., building ramps). This model does not mean to imply that the two methods (which may be generally characterized as cure and care) are mutually exclusive. Indeed, the most effective rehabilitation programs include both. The model separates the two only to illustrate that disability is the interaction between the potentially disabling

FIGURE 3-1 Conceptual overview of the enabling-disabling process. The environment, depicted as a square, represents both physical space and social structures (family, community, society). A person who does not manifest a disability (a) is fully integrated into society and "fits within the square." A person with potentially disabling conditions has increased needs (expressed by the size of the individual) and is dislocated from his or her prior integration into the environment (b) that is, "doesn't fit in the square." The enabling (or rehabilitative) process attempts to rectify this displacement, either by restoring function in the individual (c) or by expanding access to the environment (d) (e.g., building ramps).

conditions of an individual and the environment, and therefore strategies that affect the environment or the pertinent potentially disabling conditions both target disability. While this model provides an overview, more detail is provided below.

The New IOM Model

Looking at the enabling-disabling process with more scrutiny requires greater detail in the model. To this end, this report adopts the IOM model (1991) and makes some modifications designed to both improve the model and to tailor it more towards rehabilitation (see Figure 3-2 ). The original IOM model was conceived with prevention in mind, and the need for identifying risk factors whose control would facilitate the prevention of disability. The 1991 IOM model (IOM, 1991) established a new conceptual foundation in the field of disability in that it analyzed and described the components of the disabling process in such a way as to allow for the identification of potential points for preventive intervention. Identifying and describing the importance of the different types of risk factors that affect the disabling process as well as the interaction and integral nature of quality of life were fundamental contributions to the emerging field of disability prevention. Over time, however, some shortcomings in the 1991 IOM model have emerged, including the implication that the disabling process is unidirectional, progressing inexorably toward disability without the possibility of reversal. The unidirectionality was implied by the arrows in the model that pointed only to the right, that is, toward the condition of disability. Although this may have been a result of that committee's focus on developing interventions to prevent progression in the disabling process rather than reversal, that is, rehabilitation, it is a shortcoming in the original model that needs correction and clarification, especially in the context of rehabilitation.

A second apparent shortcoming in the 1991 IOM model is its limited characterization of the environment and the interaction of the individual with the environment. Although the importance of the environment is discussed in the text in some detail, it is not clearly represented in the model except as a category of risk factors involved in the transition between the various categories of the disabling process.

The third apparent shortcoming in the 1991 IOM model that the committee identified as needing improvement is the representation of societal limitation. Some enhancements to the original model address these shortcomings.

The new IOM model (Figures 3-2 , 3-3 , and 3-4 ) is designed to show disability more clearly as the interaction of the person with the environ-

FIGURE 3-2 Modified IOM model. The Disability in America model (Institute of Medicine, 1991) is revised to include bidirectional arrows and a state of "no disabling condition," and to show transitional factors and quality of life interacting as part of the enabling-disabling process. The state of "disability" does not appear in this model since it is not inherent in the individual but, rather, a function of the interaction of the individual and the environment.

FIGURE 3-3 The person-environment interaction. The enabling-disabling process is depicted as being an active part of the individual person. The physical and social environments are depicted as a three-dimensional mat, with social factors on one side and physical factors on the other. The interaction of the person and the "environmental mat" is depicted as a deflection in the mat.

ment and also to show the possibility of movement in the direction of rehabilitation. To accomplish this diagrammatically, the new model is three-dimensional and has the following new features:

FIGURE 3-4 Disability as displacement of the environmental mat. The amount of disability that a person experiences is a function of the interaction between the person and the environment. The amount of displacement in the environmental mat is a function of the strength of the physical and social environments that support an individual and the magnitude of the potentially disabling condition. The amount of displacement represents the amount of disability that is experienced by the individual.

• has been moved from being a part of the disabling process to being a product of the interaction of the person with the environment.

Each of these enhancements is described in greater detail below.

Assembling the Model

As shown in Figure 3-3 , the new model can be shown as having three parts: the person, the environment, and the interaction of the person with the environment (disability).

The Person In the new model a new designation was added to indi-

cate people with no disabling conditions. This feature of the model will allow for ''complete" rehabilitation (designating also both the origin of the disabling process and the termination of the enabling process).

Transitional Factors In the new model, the committee defines the converse of risk factor as "enabling factor." Risk factors are phenomena that are associated with an increase in the likelihood that an individual will move from left to right in the new model, that is, from no disabling condition toward functional limitation. In contrast, enabling factors are phenomena that are associated with an increase in the likelihood that an individual will move from right to left in the new model, that is, toward less limitation.

The general types of enabling factors are the same as the general types of risk factors, that is, environmental (social, psychological, and physical) along with lifestyle and behavioral. So, for example, access to appropriate care and assistive technology would be an enabling factor (social environment), but lack of access would be a risk factor, or a disabling factor; curb cuts and universal design would be enabling factors (physical environment), but a lack of these would be disabling factors; the age of the person is a biological factor that can be either enabling or disabling; and compliance with pharmaceutical prescription regimens would be enabling, whereas drug abuse would be a disabling (behavioral and lifestyle) factor.

Thus, since both disabling and enabling factors affect transitions between the stages of the model, the committee groups them together as "transitional factors."

The Environment The environment is represented as a flexible three-dimensional mat in the new model. The strength and resilience of this mat are proportional to the quantity and quality of accessible support systems and the existence of various barriers. Stronger mats equate with more supportive environments, for example, access to appropriate health care, the availability of assistive technology and social support networks, and receptive cultures. Weaker mats equate with nonsupportive environments. For example, physical barriers, discrimination, lack of accessible and affordable assistive technology, and lack of appropriate health care result in greater displacement of the mat and, therefore, cause greater disability.

Thus, a person with a given level of impairment or functional limitation (i.e., potential disability) will experience greater disability (more displacement of the mat) in a less supportive environment than he or she would experience in a more supportive environment (indicated by a stronger mat and less resulting displacement). The amount of disability is pro-

portional to the amount of displacement in the mat that represents the environment.

The environment is represented as having two general categories: the social-psychological and the physical. Examples of the types of things that might be included in each category include:

Psychological and Social Environments

• Discrimination
• Access to health and medical care
• Appropriate care
• Access to technology
• Community organizations
• Access to social services
• Traits and personality factors
• Attitudes and emotional states
• Access to fitness and health-promoting activities
• Spirituality
• Independence

Physical Environments

• Architecture
• Transportation
• Appropriate technology

Each of the items listed in the social and physical environments could be thought of as layers in the mat; for example, access to assistive technology would be a layer in the environment mat, and so if an individual had good access to assistive technology, a strong layer for assistive technology would be added to the mat. If there were no access to assistive technology, then this layer would be missing from the mat, thus weakening the overall support and increasing the resultant disability.

In keeping with this model, it is important to note that the environment interacts at all points in the process (e.g., the environmental risk factors described in Disability in America [Institute of Medicine, 1991]).

Reflecting the increasing focus on the interaction of the individual

and the environment, recent research on disability and rehabilitation has described the constituent parts of the environment in as much detail as Nagi's model gave to the individual pathway (Fawcett et al., 1994; Fougeyrollas and Gray, 1996; Fougeyrollas, 1997; Law et al., 1996). These researchers see the environment of the person with a disabling condition as including elements that are proximate, such as the immediate home and work environments (termed the microsystem of the individual), and distal, such as the community in which the individual lives (termed the mesosystem ) and the society, economy, and, perhaps above all, the culture in which the local community is embedded (termed the macrosyste ) . However, these researchers do not include psychological or intrapersonal factors as part of the microsystem, an omission that the enhancements of the model described in this chapter are meant to rectify. In this chapter, psychological factors such as one's thoughts, beliefs, or expectancies are included in the intrapersonal environment.

Although the person with a disabling condition experiences the microsystem tangibly every day, the extent to which a particular condition is expressed as a disabling condition may be determined as much at the macro- or mesosystem level as by the nature of the local environment. For example, research on disability in the work setting indicates that the economic status of the overall labor market has a far greater impact on the employment status of people with disabling conditions than the willingness of individual employers to provide accommodations or the extent of the physical or mental impairment for that matter, even though both accommodations and extent of impairment do have some effect (Yelin, 1992). Similarly, the overall culture frequently determines whether a limitation will be considered disabling. In the broader U.S. culture, for example, a severe limitation in hearing is considered a disability. In a society in which the culture supports the use of sign language, a hearing loss may not be limiting (Groce, 1985).

The relative importance of the different elements of the environment may differ among kinds of activities. The extent of family help and the nature of the landscape and the built environment—microsystem and mesosystem characteristics, respectively—may affect an individual's ability to get around the community more than the overall culture (macrosystem characteristics). Even in that example, however, the importance of the overall culture becomes clear, because in some societies the provision of such services flows quite naturally from a communitarian ethos, whereas in others it is left to individuals and families to fend for themselves.

Disability The definition of disability has not changed, but its representation in the model has. In the new model, disability is a dependent variable whose value is determined by the relationship between two other

variables: the person and the environment. Since disability is not a part of the person, but rather is a function of the interaction of the person with the environment, the box that represented disability in the 1991 IOM model has been removed from the person component in the new model (see Figure 3-4 ). Disability is now represented as the quantity of deflection in the mat that represents the environment.

Thus, in the new model disability is a relational outcome. Although many parts of the process are not well understood at present, the areas in which knowledge is strong and those in which it is weak can be specified in the new model.

Theoretical Quantification and Mathematical Model of Disability

As a relational concept, disability lends itself to mathematical modeling. At present this can be done only on a conceptual basis, since quantification of the variables is not yet reliable and reproducible. Nonetheless, a mathematical model is useful in further clarifying the relationship that exists between the person and the environment and how they interact to create disability.

Beginning with the variables of pathology (P), impairment (I), and functional limitation (FL), the first assumption is that the sum of these variables represents a quantity known as an individual's potential disability, or PD: P + I + FL = PD. Potential disability is referred to as "potential" because it is only the interaction of potential disability with the environment that creates true disability. In addition, some (or all) of these variables may be equal to zero. If all are equal to zero, then there is no potential disability.

Environment (E) is the denominator in the mathematical model, because it is the influence of the environment that creates disability from any given potential. The environment is the variable factor against which the other factors are measured and that determines the existence of disability. Without environmental factors there would be no disability. Thus, disability (D) can be represented mathematically as the relationship of potential disability (PD, or P + I + FL) to environment (E): (P + I + FL)/E = D or PD/E = D.

Take the following example. If the range of PD (i.e., the sum of P + I + FL ) is 0 to 10 (where 10 is the maximum potential for experiencing disability) and the range of E is 0.1 to 10 (where 1.0 is a neutral environment, 10 is a very accessible and supportive environment, and 0.1 is a very inaccessible and nonsupportive environment), then the resultant quantity of D would range from 0 to 100 (where 100 is maximum disability).

So, for example, if PD were 5 and the environment were a very "good"

TABLE 3-1 Estimating the Effects of the Environment on Disability

one (e.g., E = 10), then the level of disability would be 0.5. However, with the same PD (i.e., PD = 5) but a less supportive environment (e.g., E = 1), then the level of disability would increase from 0.5 to 5. (When E is equal to 1, the effect of the environment is neutral and PD is equal to D. )

Mathematically, to allow the environment to exert a truly negative effect in the model, the range of quantities for the denominator (i.e., the environment) should be less than 1.0 but greater than zero; thus, the range would be from 0.1 to 10. Using the example above, if E is equal to 0.5 instead of 1, then the level of disability would increase from 5 to 10. If the environment was at its worst (i.e., E = 0.1), then the amount of disability would increase to 50 in this example.

In summary, maintaining the level of potential disability constant ( PD = 5) and varying the quality of the environment ( E is from 0.1 to 10) results in the moderate disability scores listed in Table 3-1 for the example cited above.

Conceptual Matrix for Rehabilitation Research

The conceptual models presented here could form the basis for a new science—rehabilitation science and engineering—that embodies the underlying, rudimentary paradigm implicit in each. The committee believes that there is a legitimate and distinct field of study that justifies the term "rehabilitation science." Rehabilitation science emphasizes function, focusing on the processes by which disability develops and the factors in-

fluencing these processes. The vision of rehabilitation science is that better understanding of the causes and factors contributing to disability will lead to better treatments and technology for those with disabling conditions. To help define the parameters of rehabilitation science and engineering, the committee developed the conceptual matrix presented in Table 3-2 . The matrix is useful as a tool for identifying the focus of rehabilitation science and engineering, defining which research activities address rehabilitation, and providing new possibilities for future research.

Table 3-2 demonstrates that rehabilitation science and engineering targets the enabling-disabling process, which runs across the stages of disability, and addresses the disabling conditions and the environment. The cells of this matrix (i.e., the different letters, A l through M 4 ) match disability-related variables in the rows to performance measures in the columns. A single cell (e.g., A l or C 3 ) in the matrix constitutes the minimum requirement for research classified as associated with the new academic field of rehabilitation science and engineering. If a row variable is studied across several performance states, the multi-cell begins to represent the enabling-disabling process. Every research study in rehabilitation science and engineering must have some measure of disability-related function (columns) and some measure of a disability-related variable, either of the person or of the environment (rows). It is not sufficient to study a classification of illness or disease without a measure of performance. This requirement defines the subset of pathology and pathophysiology research in medicine that overlaps with rehabilitation science and engineering. It also serves as a guide for defining the rehabilitation science and engineering relevant research in basic biological, physical, behavioral, and social sciences and in the health professional and engineering disciplines. The highest priority in rehabilitation science and engineering is for studies yielding causal explanations of disabling and rehabilitative processes.

The matrix also reveals the unique nature of rehabilitation science and engineering. First, rehabilitation science emphasizes function. Second, rehabilitation science focuses on factors that lead to transitions between pathology, impairments, functional limitation, and disability. Third, rehabilitation science examines physical, behavioral, environmental, and societal factors that influence these transitions. Although rehabilitation science is multidisciplinary and utilizes methods from many fields including medicine, biomedical engineering, material sciences, sociology, architecture, and even economics, it is distinct from other scientific disciplines due to its emphasis on function, factors, and interventions that disable or enable people. Rehabilitation science and engineering combines knowledge from these otherwise distinct disciplines to create a knowledge structure for the understanding of performance deficits un-

TABLE 3-2 Conceptual Parameters of Rehabilitation Science and Engineering

derlying disability, the processes in which disabling conditions develop, progress, and reverse, and the factors that mediate the disabling and enabling processes.

Table 3-2 finally creates possibilities for new research. The matrix identifies combinations of variables which can be researched, but are not likely studied in the separate, existing basic science, health professional, and engineering disciplines. The variables in the rows (i.e., person and environmental variables) may be investigated as dependent or independent variables with the performance realms (columns) as the respective independent or dependent variable counterpart. Switching the independent variable from column to row will allow elucidation of the impact of disabling or rehabilitative processes on the person or society, on the one hand, or the impact of person or environmental variables (as positive or negative effectors) on enabling and disabling processes. The new knowledge of rehabilitation science and engineering will stimulate insights into rehabilitative processes and innovations into rehabilitation therapeutics.

The matrix in Table 3-2 can also be used to evaluate current data collection efforts with respect to the prevalence of and impact of disability. Currently, federal surveys routinely collect information on the extent of pathology, impairments, and on limitations in major classifications of activities. The National Health Interview Survey collects some information on behavioral factors and in the use of health care. In addition, some episodic surveys such as the Longitudinal Study on Aging and Health and Retirement Survey collect some information on accommodations provided by government, family, and employers. However, no ongoing surveys routinely collect information on the experiential and resource domains within personal factors and none collect information on such external environmental factors as the natural and engineered environment, access to rehabilitation specific therapies and health care, the availability of social supports, and the experience of the laws and regulations governing disability policy. In short, information on disability is almost exclusively within the personal domains and even so, tends to focus on definitions of disability that accord with much more primitive models of disability.

Summary and Conclusions

The prevailing wisdom about the causes of disability has shifted dramatically in the span of the last several decades. From the deterministic position of the American Medical Association Committee on Impairments of the 1950s, in which pathology was viewed as equivalent to disability, to the probabilistic one in more recent years of Nagi, IOM, and National Center for Medical and Rehabilitation Research (NCMRR) that, although

still focusing on the characteristics of the individual, viewed the relationship among pathology, impairment, functional limitation, and disability as contingent, to the view espoused here, that the environment and characteristics of the individual conjointly determine disability, the underlying notion of why someone is unable to function in the major activities of life has been transformed.

The notion that disability arises from the interaction of a person's physical condition and the person's environment has several implications. These implications affect research, professional training, and policy. Although there is not space here to discuss these implications in depth, their outlines will be sketched briefly in the hopes that others will investigate them further.

One implication of the notion that environments can be enabling is that disability does not always have to be viewed through a "deficit" model. Rather, it should be recognized that in an environment that is strongly enabling, a person with a substantial physical impairment can live a life that is indistinguishable in important ways from that of a similar person without such an impairment. That is, the person with the impairment can hold a good job, be married and have a family, engage in non-work-related activities, enjoy social relationships, and be part of a community. Not much research has been done from this perspective. Some exceptions are the works of Gray (1996), and White et al. (1995). The committee strongly recommends that more research be done which emphasizes the effects of enabling environments on the lives of people with impairments and functional limitations. If disability is a function of the environment, it is not a stable attribute across situations. Rather, it will depend on the particular environment or the particular situation. For example, it is possible that a person with a certain type of impairment might be more disabled in his or her work environment than in the family environment. This would be true, for example, of a deaf person working with hearing coworkers who did not know how to sign, who worked for a company that provided interpreters only for large or important meetings, but whose spouse and children all signed fluently. Or an impairment might affect a person's ability to use public transportation, but not the ability to work once arriving in the workplace.

For research, this means that one measurement of impairment or functional limitation cannot be developed to indicate degree of disability in all situations. One measurement that attempts to indicate how disabled a person is would be misleading. If the measurement were limited to a specific, clearly defined situation, such as a workplace, it might be possible to include enough environmental indicators that a valid and reliable measurement might be developed; however, this measurement

is unlikely to apply across all situations. This will, for the short run, make the tasks facing researchers much harder.

This conception of disability also carries with it implications for professional training. If the goal of professional training in rehabilitation is to impart the skills needed to reduce disability, training programs will need to teach many forms of environmental modification. Training may need to be broader than it has been, and it will need to include more professional fields and skills (see Chapter 9 for further discussion of this issue).

Finally, even though disability policy is not the focus of this report, it is worth noting that the policy implications arising from this definition of the concept are enormous. Disability determination will not be able to be a single event. Rather, a determination of disability status, for example, for the purpose of receiving Social Security Disability Income benefits, will have to be tied to a specific time, place, set of skills, and type of job. It cannot be permanent, for not only will changes in the person's own health or educational status change it, but so will changes in aspects of the work environment. Additionally, any single disability determination might not be acceptable across programs, since different programs apply to different environments.

Recommendations

Recommendation 3.1 Researchers and educators should adopt the model for rehabilitation and the enabling-disabling process presented here. Programs supporting rehabilitation-related research should adopt its terminology and use it as an organizing tool.

Recommendation 3.2 Based on the model of the enabling-disabling process described in this report, methods for quantifying disability should be developed that are sensitive to the characteristics of both the person and the environment. Such a metric would facilitate additional research into the factors that affect transitions between disability and other states of the enabling-disabling process, and the development of effective preventive and rehabilitative intervention strategies.

The most recent high-profile advocate for Americans with disabilities, actor Christopher Reeve, has highlighted for the public the economic and social costs of disability and the importance of rehabilitation. Enabling America is a major analysis of the field of rehabilitation science and engineering. The book explains how to achieve recognition for this evolving field of study, how to set priorities, and how to improve the organization and administration of the numerous federal research programs in this area.

The committee introduces the "enabling-disability process" model, which enhances the concepts of disability and rehabilitation, and reviews what is known and what research priorities are emerging in the areas of:

• Pathology and impairment, including differences between children and adults.
• Functional limitations—in a person's ability to eat or walk, for example.
• Disability as the interaction between a person's pathologies, impairments, and functional limitations and the surrounding physical and social environments.

This landmark volume will be of special interest to anyone involved in rehabilitation science and engineering: federal policymakers, rehabilitation practitioners and administrators, researchers, and advocates for persons with disabilities.

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Medical and social models of disability.

Leaders in the disability rights movement have constructed two distinct models of how society views disabilities: the Medical Model and the Social Model. These models provide a framework for how people perceive those of us with disabilities. While the Medical Model is a helpful way of understanding illness and loss of function, people in the disability community have largely rejected it in favor of the Social Model. The Social Model promotes the idea that adapting social and physical environments to accommodate people with a range of functional abilities improves quality of life and opportunity for people with and without impairments.

Medical Model 

The Medical Model views disability as a defect within the individual. Disability is an aberration compared to normal traits and characteristics. In order to have a high quality of life, these defects must be cured, fixed, or completely eliminated. Health care and social service professionals have the sole power to correct or modify these conditions.

Many of us, including those of us with significant functional limitations, communication difficulties and high support needs, strongly identify with our disabilities. They represent important elements of how we see ourselves and how we connect to our families and to the larger society. We may have lower self-worth when we internalize the belief that a central piece of our personhood is wrong and needs to be fixed.

When disability is seen in a negative light, messages of pity and shame are often conveyed through the media, by people in our own communities, and sometimes by health care professionals. The messages can take the form of inspirational stories of people with disabilities accomplishing basic, everyday tasks or of non-disabled people extending common decency towards people with disabilities. These messages convey a form of low expectations that can lead to fewer opportunities. Other messages highlight people’s fears about becoming disabled. They convey notions of weakness, dependence, and abandonment. Sometimes, these messages take the form of treatments meant to normalize, but which do not improve our ability to function or participate in our chosen activities of daily living.

Social Model

The Social Model takes a different approach. This model states that disability is the inability to participate fully in home and community life. The interaction between functional limitations or impairments and physical and social barriers to full participation create disabling environments. The social model distinguishes between disabilities and impairments. Disabilities are restrictions imposed by society. Impairments are the effects of any given condition. The solution, according to this model, lies not in fixing the person, but in changing our society. Medical care, for example, should not focus on cures or treatments in order to rid our bodies of functional impairments. Instead, this care should focus on enhancing our daily function in society.

The Social Model calls for an end to discrimination and oppression against people with disabilities through education, accommodation, and universal design. This education will lead to changes in the way people think about disabilities. Ideally, these changes influence how architects incorporate universal design and accessibility features into building plans, how governments consider our rights and needs when passing new laws, how people with disabilities are included in education, and how clinicians approach the care of their patients with complex disabilities.

By valuing a spectrum of abilities, we only add to our collective richness and diversity. When we try to remove disability from the human experience, society misses out on all the beautiful and brilliant things our community has to offer. As disabled writer and scholar Alison Kafer says, “To eliminate disability is to eliminate the possibility of discovering alternative ways of being in the world, to foreclose the possibility of recognizing and valuing our interdependence.” 1

How are real world situations viewed through each of the models?  

Scenario #1: Physical ability versus architectural barrier

A woman using a wheelchair is excited to meet her date at a trendy, new restaurant located inside of an older, historic building. However, two steps prevent her from entering the restaurant.

Medical model: Her inability to walk up the steps prevented the woman from entering the restaurant.

Social Model: The absence of a ramp prevented her entrance. It also limited the access of families with infants in strollers, and delivery people using wheeled carts, which can also reduce their risk of injury.

Scenario #2: Perceived intellectual abilities versus employment accommodations

A man with an intellectual disability applies for employment at a retail store.

Medical Model: The man’s learning deficits are perceived to prevent him from performing the duties of this job, and his application is rejected.

Social Model: The potential employer recognizes that the man’s strengths such as loyalty, consistency, and reliability benefit the store. The employer also recognizes that the man’s job coach not only helps the man successfully perform essential job duties, he also identifies opportunities to increase efficiency, frees supervisors and managers from routine tasks, and improves training.

Scenario #3: Presumed quality of life versus lifesaving care

A twenty-year-old woman with cerebral palsy and high support needs is admitted to the hospital with pneumonia. Her mom has accompanied her to the hospital. The woman is having difficulty breathing and the physicians cannot understand her communication

Medical Model: Severe disability is assumed to represent a lower quality of life. This new illness only increases her suffering and adds to the heavy burden already placed on her mom and her other caregivers. Since the attending physician does not understand her wishes, they encourage her mother to let nature take its course. Her hospitalization is extended because she is extremely anxious about her care. Relationships between her supporters and the hospital staff break down, so she develops complications.

Social Model: Her life is valuable and meaningful regardless of her disability. The woman has chosen her mom to help her make and communicate her medical decisions. Her decisions are respected. To facilitate a speedy discharge, the hospital social worker inquires about her needs and helps the woman communicate her needs and preferences, and her mom find additional support services so she is able to go home as soon as medically stable.   

Footnote: 1 Kafer, Alison. Feminist, Queer, Crip. Bloomington, Indiana :Indiana University Press, 2013. (p. 83).

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Models of Disability from Religious Tradition: Introductory Editorial

Journal of Disability & Religion

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Deborah Creamer

Disability theology explores the ways in which religious traditions have engaged (or failed to engage) notions of disability and impairment, and offers constructive possibilities for inclusive theological work in the future. This essay reviews four primary models of disability (moral model, medical model, social model, and limits model) and explores how these relate to religious understandings and practices. The image of the Disabled God is highlighted, as are the ways this field has come to engage varieties of disability experience (including cognitive disabilities and autism) and diversity more broadly. Philosophical notions (such as those around normalcy or human flourishing) are explored alongside advocacy and access issues (particularly with regard to religious practices such as preaching, religious education, and biblical interpretation). Future possibilities and directions for disability theology are also proposed.

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Essay on Models of Disability

Today, diverse models of disabilities develop different concepts of disabilities and, therefore, offer different policies in relation to people with disabilities. In spite of the diversity of models and different approaches to disability, which they offer, there is no universal model that would take into consideration special needs of each patient with disabilities.

Medical model of disability is grounded on the juxtaposition between normalcy and pathology. Patients with disabilities are treated as individuals with pathology, who have special needs and require treatment. Unlike other models, the Medical model focuses on the physical or mental health condition of individuals and deviations from the norm to a certain extent is disability. Therefore, individuals with disabilities are supposed to be treated with relation to their specific health problem (Hamre, et al., 2006). Unlike other models, the Medical model does not take into consideration social factors that influence patients with disabilities. For example, the social environment of people with disabilities does not matter for the Medical model. Therefore, the Medical model suggest no assistance to patients in terms of the maintenance of their social relations and their integration into their community. Therefore, the Medical model focuses on the maintenance of the health of patients with disabilities minimizing the effect of disabilities on health of patients but not on their social life.

Social Constructivist model holds the premise that the concept of disability is a social construct that means that disability is what makes individuals incapable to perform basic functions, which the individual is supposed to perform, according to existing social norms and beliefs (Bayton, 2001). The main idea of the Social Constructivist model is the creation of the social environment that is comfortable for people with disabilities. Unlike the Medical model, which focuses on health issues only, the Social Constructivist model focuses on social issues mainly and aims at helping people with disabilities to integrate into their social environment and be a part of their community.

Sociopolitical or minority model views patients with disabilities as minority and their distinct feature is disability. As a result, unlike other models, the Sociopolitical model views all individuals with disabilities, regardless of their cultural or social background, as one social group, where people have a set of health problems, social problems and other issues caused by their disability status (Biklen, 1988). Therefore, unlike the Medical model and Social Constructivist model, the Sociopolitical model focuses on the treatment of people with disabilities as a solid social group focusing on their specific social and health problems. In a way, the Sociopolitical model combines elements of both Social Constructivist and Medical model addressing both social and health issues of patients with disabilities.

At the same time, along with the aforementioned differences, there are certain similarities between the three models mentioned above. These similarities uncover the imperfectness of these models in their understanding of disability and distinction of people with disabilities. In fact, the aforementioned models view patients with disabilities as a social group with certain health or social issues, which they confront. However, the problem is that these models fail to take into consideration the diversity of patients with disabilities. Each patient with disability has special needs. Even though each model recognizes those special needs, they do not offer the personalized approach to each patient with disability. Instead, they focus on their treatment as a distinct social group with certain health or social issues.

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