Main Concepts Underpinning the Social Model - Essay Example

?Critically outline the main concepts underpinning the ‘social model’ and contrast them to those informing the ‘medical model’ of disability. What are the advantages and disadvantages of each model? Disability is a term widely used for the social condition recognised as resulting from any type of physical or mental impairment mainly identified through medical procedures. Some are present at birth while other impairments occur at various stages of an individual’s life either as manifestations of genetic conditions or as the result of conflicts (e.g. war), and accidents. Examples are varying degrees of blindness, deafness, speech impairments (dumbness) and loss of limbs. Chronic illnesses too should be added to this list. Usually prosthetic devices such as spectacles, magnifying glasses, Braille, hearing aids, sign language, crutches, wheelchairs and other similar aids have been designed to ameliorate handicaps in living, experienced by disabled people. Impairment as ‘the loss or limitation of physical, mental or sensory function on a long-term or permanent basis’, with Disablement defined as ‘the loss or limitation of opportunities to take part in the normal life of the community on an equal level with others due to physical and social barriers’ (Disabled People International, 1981). Since all serious impairments giving rise to disability appear to stem from a recognised medical condition, historically, disability studies relied on a medical model centred almost solely on the individual. Following the medical model the disabled were segregated from ‘normal’ people and seen as deficient, lacking in self-efficacy, needing care. The disabled were defined by their deficiencies, in what they could not do, and not by what they could do. Society at large made no attempt to adjust to the requirements of the disabled, to integrate them, instead tending to isolate them in institutions or at home. Impairment was seen as the problem, and the disabled were restricted to being passive receivers of medication, care, and targeted assistance through state intervention or charity. As befitting the medical model disabled people are regarded as requiring rehabilitation. They are subject to negative stereotyping and prejudice by the rest of society. Further, the ubiquitous built environment imposes restrictions on their mobility, access to employment, and recreation. [(To customer): This is a summary of information put into my words gathered from a very wide range of sources, therefore there is no citation possible, or required] Mike Oliver (2004), an academic with first-hand experience of disability and what it entails, saw the medical model also as an ‘individual model’ making a ‘binary distinction’ between it and the social models developed later by the Disabled People’s Movement. These were based on ‘the distinction originally made between impairment and disability by the Union of the Physically Impaired Against Segregation (UPIAS 1976). The medical model ‘was underpinned’ by ‘the personal tragedy theory of disability, which Oliver (1990) refers to as the ‘medicalisation ... rather than the medical model of disability’. Oliver discards the idea of a ‘medical model’ saying that ‘there is no such thing. For him, ‘medicalisation of disability is inappropriate’. Instead the ‘social model of disability can provide a more adequate basis for all kinds of professional involvement including that of medical intervention’ (Oliver 1990). According to Oliver, problems attendant on disability should not be regarded exclusively as the responsibility of the medical profession and other ‘experts’ who, from a position of power, see the problem as located in the individual. For Oliver (2004), and most others working in the disability arena around the 1970s, ‘disability is a social state and not a medical condition’. (http://www.leeds.ac.uk/disability-studies/archiveuk/Oliver/info20soc%dis.pdf These pioneers were influenced by Marxist rhetoric much in evidence at the time. Thomas (1999 p. 60) adapting the UPIAS pronouncements defines disability as .. a form of social oppression involving the social imposition of restrictions of activity on people with impairments and the socially engendered undermining of their psycho –emotional wellbeing. The individual discourse on disability (medical model) is allied to World Health Organisation pronouncements, as for example, by the ‘International Classification of Functioning, Disability and Health (WHO 2001). It owed its existence to early advances in science and medicine which placed individuals into medical categories for the convenience of medical practitioners and other health professionals, which in subsequent years was seen to be, perhaps unintentionally from the professionals’ point of view, an oppressive situation. The linear causal model of modernist science widely accepted before the advent of philosophical movements such as postmodernism and social constructionism helped to legitimise the medical model of disability. There is inherently nothing wrong with disability, or more correctly, impairment being initially identified and treated as a medical condition affecting the individual. Indeed this is necessary both as a first step, and often for continuing medical care. It is when such treatment excludes the social environment which to a large extent defines the parameters within which the disabled are expected to function, that problems arise. This inevitably invites social exclusion or disadvantage, segregation and stigmatisation, which is the fundamental criticism levelled against the medical model. However, there are still apologists for the medical model of disability. By and large, they are proponents of medical sociology. For example, Michael Bury (1997 and 2000) who writes extensively on chronic illness and disability regards as questionable Mike Oliver’s (1996) denial that impairment has any causal connection with disability. Bury claims that this is an ‘oversocialized’ and overly politicized view. He ‘understands disability to be both biologically and socially caused, though the more significant causal weight lies with the former ...’ (Bury 2000 p. 179). Simon Williams (1999, p 801), from a ‘critical realist theoretical perspective’ argues for the sociological significance of the body and complains that the social model suffers from ‘somatophobia’ due to an ‘overly drawn’ view of society. For Williams the ‘body is, diseased or otherwise, a real entity.’ It ‘like all other social and natural domains, has its own mind-independent generative structures and causal mechanisms’. Thomas (2004, p 578) avers that ‘Bury and Williams have never recognised that a form of social oppression is at play... that they go no further than ... that impaired people might also experience social disadvantage. ’ For them, the human body cannot be factored out of any realistic consideration of what it is to be disabled. Shakespeare and Watson (2001, p. 17) stress that impairments play a role in disability and that ‘embodied states are relevant to being disabled.’ Therefore they do not discard the medical model in its entirety. People are disabled by social barriers and their bodies. This is straightforward and uncontroversial. The British social model approach, because it ‘over-eggs the pudding’, risks discrediting the entire dish. .... Disability is a complex dialectic of biological, psychological, cultural and socio-political factors, which cannot be extricated except with imprecision (Shakespeare & Watson, 2001 p 17). Thomas (2004, p 578) is critical of the stance adopted by Bury, Williams, Shakespeare and Watson. Their understanding of disability refuses to accept the concept of disabilism allied to similar concepts such as racism, sexism, and homophobia. They confine themselves to the ‘commonplace meaning of disability ... as ‘not being able to do things’ and as ‘restricted activity’. Agreeing with Finkelstein (1980) Thomas argues for a ‘social relational understanding of what constitutes disability’ (Thomas, 2004, p 578). Vic Finkelstein, a pioneering academic and activist in the field of disability, himself disabled, was a refugee from apartheid South Africa where he had been in prison for five years. Having been actively engaged in the civil and human rights struggle in Africa, he was immediately sensitised to the ghetto-like existence of the disabled in the UK, denied participation in the mainstream social and political life of the country. Finkelstein and Paul Hunt were the originators of the Union of the Physically Impaired Against Segregation (UPIAS). Hunt had been living in residential institutions (Cheshire Homes) from childhood and campaigned with other residents for a stake in the management of such Homes. The medical model had instituted compensatory measures to meet the needs of the disabled, but disabled activists like Finkelstein and Hunt saw it as oppression of a minority by society at large. To these activists the medical model was no model but the default position of the disability ‘industry’ staffed by care managers, social workers, physiotherapists, occupational therapists, clinical psychologists and medical practitioners. Disabled persons’ powerless and socially inferior position was reinforced in such circumstances, however sympathetic and dedicated these professionals were in their treatment of the disabled person. It is only after the establishment of the Union of the Physically Impaired Against Segregation by Finkelstein, Hunt, and like-minded people, that the political landscape changed. UPIAS framers took time considering the prevailing interpretations of the nature of disability and came to the unequivocal conclusion that ‘... 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 (UPIAS, 1976). Apart from the horrors of the Holocaust which enabled doctors to experiment on disabled victims, there is at least one documented case of clinical abuse of disabled children in the United States. Referred to as the Willowbrook Experiment, disabled children at a state school in Staten Island, New York, were deliberately infected with viral hepatitis to monitor the progress of the disease over a long period beginning 1956 and lasting for over 14 years. Parents were reportedly pressurised to accede to it. This had been approved by the New York State Department of Mental Hygiene (Goldby, S., Kingsman, S., Pappworth, M.H., & Edsall, G. 1971). This type of early medical model was rightly condemned as a custodial discourse. How far practitioners in the field have moved over the last 30 years (since UPIAS) may be judged by the changes in clinical psychology which now boasts of a sub-discipline of paediatric psychology. Based on patient-centred care, they believe they have a ‘better understanding of the psychosocial impact of medical conditions on children and families. ... users of health care often perceive psychosocial issues to be as important as the medical issues’(Jacobs et al, 2012, p 191). Indeed, they even acknowledge the existence of ‘medically unexplained symptoms’ as requiring attention. Even within a medical environment, socio-ecological factors like ... ‘low levels of family conflict, good family relations and support, marital satisfaction and a social support network... (Cadman et al, 1991) are extremely relevant and come within their purview. So, we see the medical model of disability evolving to reflect changing world views. A good example of a drastic change in the medical model is that only about four decades ago, the universally acclaimed Diagnostic and Statistical Manual of Mental Disorders (DSM) listed homosexuality as a mental illness. Psychiatrists and psychologists practised aversion therapy (among others) to ‘cure’ these ‘unfortunates’. In spite of objections from a few extreme right religious adherents, it is now regarded as a normal and positive variation of human sexuality. Indeed equal opportunity and human rights legislation have recognised the ‘gay’ community as a minority group. Some states even allow marriage or civil union between homosexual couples. Early at the turn of the previous century Helen Keller, a deaf/blind woman from the USA, achieved spectacular success as a writer, speaker and political activist that is celebrated even to this day. There are others who have bucked the trend expected from the medical model. Finkelstein (2001) points to ‘the prominent celebration of a person with major impairments in the public arena’ when according to the medical model, ‘the rule is to hide disabled people away (for reference see below). Standing proudly on his column in London’s Trafalgar Square the statue of Horatio Nelson defies modern infatuation with physical perfection by flouting his impairments. How is this possible? The answer surely, when we refer to the insight provided by the social model of disability is, that Admiral Nelson was not a disabled person despite his arm and eye impairments. In his time the disabling barriers he faced were overcome to ensure that he could function as a vice admiral. Nowadays, of course, he would be disabled and there would be no public statue because modern British culture says disabled people can’t be on active service in the armed forces! To emphasise the validity of the social model of disability Finkelstein refers to a prominent figure from the modern era, the wartime USA President Franklin Delano Roosevelt. Unlike ‘Admiral Nelson he was born into a modern culture where having an ‘impairment’ was supposed to directly ‘disable’ a person.’ A public statue of Roosevelt sitting in a wheelchair was unthinkable at a time when ‘body perfection was an obsession’. ‘So now we are presented with a statue to a major USA public figure that takes care to hide any evidence of his impairment (Finkelstein, 2001http://www.independentliving.org/print/67) The central thesis of this essay is that there are advantages and disadvantages in both the medical model and the social model of disability. The indubitable fact is that they are both incomplete to explain all the historical nuances of disability experienced by those affected in a rapidly changing world. Take for example the celebrated theoretical physicist Stephen Hawking. He suffers from multiple disabilities requiring speech amplifiers and wheelchair use. He is in no way defined by his impairments. On the contrary, he is celebrated for his academic achievements, with his impairments completely irrelevant to his academic and professional status. Without the medical advances that recognise his impairments making it possible for him to get the right treatment and continue living and working as he does, there would not be a social role available for him to fill with such distinction. However, the opposition to an articulated social model of disability at the time of its inception should not be underestimated. An example is the book A Life Apart widely read at the time, authored by Miller & Gwynne (1972). Finkelstein says that it came to be regarded eventually as ‘the epitome of entrenched bigotry’. The conclusion arrived at by the authors was that as the function of residential institutions (like Cheshire Homes) ‘was to maintain disabled people who were “socially dead” until actual death, this should be done under “horticultural” rather than a “warehousing” stewardship. The ‘warehoused’ residents felt, ... that they were badly let down by social research ...’(Finkelstein 2001). Institutionalised residents, to this day, have little control over their lives. This is an instance of the disadvantage of the medical model being entrenched in the culture of the time that criticism from those advancing the social model went unheeded. Finkelstein’s (2001, http://www.independentliving.org/print/67 ) attempts to convince the then well-established organisation, Spastic Society - aimed at individuals with cerebral palsy - of the social model, failed due to their rejection of the new approach as being advanced by ‘extremists’. They ‘could point to the passive and dependent “cripples” in the Spastic Society and put them on display.’ He once went to a segregated school to argue the case for social integration and addressed the children ..., ... but the teacher knew the implications of the argument very well (seeing that it obviously challenged the segregated education system which maintained her career). She let me finish and then, turning to the students, said “We don’t agree with him do we!” She selected one of the students adding “You don’t agree do you?” And of course the child could do little but agree with the teacher (Finkelstein 2001). In Australia, a variation of the social model was referred to as the rights-based model of disability. As in the UK, disabled people as a group there sought a political voice. Such activism and advocacy has brought gains, but they admit that there are also limitations. Although as a political strategy it helped to bring about needed changes through legislation, it locks people into an identity defined as being members of a minority community. This way the conceptual barrier between ‘normal’ and ‘abnormal’ is maintained. There are also new challenges when the latest genetic and reproductive technologies include a larger proportion of the population as carriers of ‘bad’ genes and unwittingly placed in the disabled category inviting discrimination and avoidance. Rights-based discourse fails to meet these challenges, for rather than seeking to dismantle the entire concept of disability it actually relies upon such a construction to support its claims to rights and entitlements (Clayton and Fitzgerald, 2012) Three decades or more after the Finkelstein (2001) reported incident, we now have the spectre of Remploy Ltd. a government owned factory network across the UK established in 1945 offering both employment, and employment placement services, to the disabled, being dismantled. Remploy had been producing or assembling a vast range of products in its 54 factories spread across the country. Towards the end of the last century it even moved into service sector work. In 2009/10 Remploy placed 10,500 disabled people in jobs in a range of sectors. This year the Coalition government has decided to close 36 Remploy factories making 1700 workers redundant (press reports). It is unlikely that UPIAS would accuse Remploy as being in the business of segregating the disabled, but at some early point in a disabled person’s life that is always likely to have been necessary. On doctrinaire grounds alone neither the medical model nor the social model would be privileged in explaining changes in circumstances such as those occurring now in the UK as exemplified by the fate of Remploy Ltd. Shakespeare and Watson (2002) take somewhat of a middle ground between the two models. For them disability is a ‘post-modern concept, because it is so complex, so variable, so contingent, so situated. It is at the intersection of biology and of agency and structure. Disability cannot be reduced to a singular identity: it is a multiplicity a plurality.’ According to Shakespeare and Erickson (2000), any social theory ought to include ‘all the dimensions of disabled people’s experiences: bodily, psychological, cultural, social, political, rather than claiming disability is either medical or social’. They found people unwilling to identify themselves as disabled. They wanted to see themselves as normal though different. Many people with learning difficulties refuse to be referred to as disabled (Finlay & Lyons 1998). People have many different identities. Those who do not accept being labelled disabled may own up to various other identities as more salient. For example, gender, ethnicity, sexuality, class or marital status (Morris, 1991 and 1996; Vernon, 1996). The social model developed in the 1970s is no longer useful or valid. There needs to be a paradigm shift. It is perfectly possible that what is politically progressive and opens up discursive opportunities in the 1970s and 1980s can become a form of closure – and have a repressive value – by the time it is installed as the dominant genre. ... It will run out of steam; it will become a style; people will use it not because it opens up anything but because they are being spoken by it, and at that point you need another shift (Bailey and Hall, 1992). Shakespeare and Watson (2002) argue against a ‘crude determinism’ in favour of a more sophisticated approach to disability. For them, disability is not just a medical condition. Neither should it be reduced to being the result of social oppression, ‘overlaid with negative cultural meanings’. The disability literature has been plagued with overgeneralisations and it is now time to admit that it cannot speak for over six million people with impairments in Britain alone, and over half a billion across the planet. On the other hand, researchers in the field have accepted the notion that all human beings are impaired in one way or another. Attributed to Bickenbach (1996) is the view that ‘disability is actually a fluid and continuous condition which has no boundaries but which is, in fact, the essence of the human condition’ (quoted in Clapton and Fitzgerald, 2012 http://www.ru.org/human-rights/the- history-ofdisability-a-history-of-otherness.html ). Another example: We must demolish the false dividing line between ‘normal’ and ‘disabled’ [meaning impaired] and attack the whole concept of physical normality. We have to recognise that disablement [impairment] is not merely the physical state of a small minority of people. It is the normal condition of humanity (Sutherland, 1981 p 18, Italics in original). The refusal to acknowledge that disablement or impairment is not just limited to those very obviously disabled but is a ‘normal condition of all humanity’ is clearly the reason for the historical oppression and exclusion of ostensibly impaired people by the majority of so-called normal people. This is said to be due to a need for denial of their own vulnerability, frailty and mortality, projecting them on to others less able to defend themselves. The far-reaching insight that we are all impaired should alert us to the fact that simplistic models may serve their purpose, but in a time-limited and contingent manner. In the above pages a wide ranging exploration of the academic discussions following the concepts of the medical model and the social model of disability were discussed. Exploration of the advantages and disadvantages of either model as situated in historical context gave rise to the notion of disability as a universal human condition that neither model could explain comprehensively. Researchers and commentators today need to acknowledge that no one model could comprehensively encompass such a continually shifting paradigm. *** References: Bailey, D. & Hall, S. (1992) ‘The vertigo of displacement: shifts within black documentary practices. In D. Bailey & S. Hall (Eds) Critical decade: black British photography in the eighties. London: Ten-8. Bickenbach, J. (1996) ‘Equity Participation and the Politics of Disability’. Paper presented at the Rehabilitation International 18th World Congress; Auckland, New Zealand. Bury, M. (1997) Health and illness in a changing society London: Routledge. Bury, M. (2000) ‘On chronic illness and disability, in: C.E. Bird, P. Conrad & A.M. Fremont (Eds.) Handbook of medical sociology (5th edn) New Jersey, PA, Prentice Hall. Cadman, D., Rosenbaum, P., Boyle, M. & Offord, D.R. (1991) ‘children with chronic illness: Family and parent demographic characteristics and psychosocial adjustment’ Paediatrics. 87. 884-889. Clapton, J. & Fitzgerald, J. (undated) ‘The Social Model of Disability: A history of otherness’ in: New Renaissance 12 (2) Queensland, Australia. Diagnostic and Statistical Manual of Mental Disorders (DSM iv) Finkelstein, V. (2001) A personal journey into disability politics The Disability Studies Archive UK, Centre for Disability Studies, University of Leeds. Finkelstein, V. (1980) Attitudes and disabled people: issues for discussion New York, World Rehabilitation Fund. Finlay, M. & Lyons, E. (1998) ‘Social identity and people with learning difficulties: implications for self-advocacy groups. Disability & Society 13 (1) 37-52. Goldby, S., Kingsman, S., Pappworth, M.H., & Edsall, G. The Willowbrook Letters: Criticisms and Defense The Lancet, May, June, & July 1971. Jacobs, K., Titman, P. & Edwards, M. (2012) ‘Bridging psychological and physical health care’ The Psychologist 25 (3) 190 – 193. Miller, E.J. & Gwynne, G.V. (1972) A Life Apart: a pilot study of residential institutions for the physically handicapped and the young chronic sick London: Tavistock Publications. Morris, J. (1991) Pride Against Prejudice London: The Women’s Press. Morris, J. (Ed.) (1996) Encounters with strangers: feminism and disability London: The Women’s Press. Oliver, M. (1990) The politics of disablement Basingstoke: Macmillan. Oliver, M. (1996) Understanding disability: from theory to practice Basingstoke: Macmillan. Oliver, M. (2004) If I had a hammer: the social model in action, in: C. Barnes (Ed.) The social model of disability – theory and research Leeds: The Disability Press. Schneider, M. (2001) ‘Participation and environment in the ICF and measurement of disability: Classification, Assessment, Surveys and Technology’ : Paper presented at the WHO United Nations Meeting on Measurement of Disability, New York. Shakespeare, T. W. & Watson, N. (1997) ‘Defending the social model’ Disability & Society 12 (12) 293-300. Shakespeare, T. W. & Watson, N. (2002) ‘The social model of disability: an outdated ideology? In: Research in social science and disability, Vol. 2, 9-28 (Elsevier Science Ltd). Shakespeare, T.W. & Erickson, M. (2000) ‘Different strokes: beyond biological essentialism and social constructionism’, in S.Rose & H.Rose (Eds.) Coming to life New York: little, Brown. Sutherland, A. (1981) Disabled we stand. London: Souvenir Press. Thomas, C. (1999) Female forms: experiencing and understanding disability Buckingham: Open University Press. Thomas, C. (2004) ‘How is disability understood? An examination of sociological approaches’ Disability & Society 29 (6). UPIAS (1976) Fundamental principles of disability London: Union of the Physically Impaired Against Segregation. Williams, S. (1999) ‘Is anybody there? Critical realism, chronic illness and the disability debate’ Sociology of Health and Illness, 21 (6) 797-813. World Health Organisation (WHO) (2001) International Classification of Functioning, Disability and Health (ICFF). > http://www.independentliving.org/print/67 < > http://www.ru.org/human-rights/the-history-of-disability-history -of-otherness.html < > http://www.leeds.ac.uk/disability-studies/archiveuk/Oliver/info20%/dis.pdf < *** Read More