Disability is really a term trusted for the social condition recognised as resulting from any sort of physical or mental impairment mainly identified through medical procedures. Some are present at birth while other impairments occur at various stages of a person's life either as manifestations of genetic conditions or because the result of conflicts (e.g. war), and accidents. Examples are varying levels of blindness, deafness, speech impairments (dumbness) and lack of limbs. Chronic illnesses too should be added to this list. Usually prosthetic devices such as for example magnifying glasses, Braille, hearing aids, sign language, crutches, wheelchairs along with other similar aids have already been designed to ameliorate handicaps in living, experienced by disabled people. Constitution of Disabled Peoples' International (1981) defines 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 standard life of the community on the same level with others due to physical and social barriers' Since all serious impairments giving rise to disability may actually stem from the recognised condition, historically, disability studies relied on a medical model centred almost solely on the individual. Following medical model the disabled were segregated from 'normal' people and seen as deficient, without self-efficacy, needing care. The disabled were defined by their deficiencies, in what they might not do, and not by what they might do. Society most importantly made no try to adjust to the requirements of the disabled, to integrate them, instead maintaining isolate them in institutions or in the home. Impairment was seen as the problem, and the disabled were limited to being passive receivers of medication, care, and targeted assistance through state intervention or charity. Even today, as befitting the medical model, disabled folks are thought to be 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. Mike Oliver (1996), an academic with first-hand connection with disability and what it entails, calls the medical model an 'individual model' making a binary distinction between it and the social models which followed the Disabled People's Movement in the 1970s. Vic Finkelstein, another academic and Paul Hunt, an activist, were also involved in assisting to form the Union of the Physically Impaired against Segregation (UPIAS). Oliver struggled the 'medicalisation' of disability denying that there never was a 'medical model' of disability. Oliver believed that problems attendant on disability shouldn't be regarded exclusively because the responsibility of the medical profession along with other similar 'experts' who, from the position of power, see the problem as entirely located within the average person. For Oliver and others working in the disability field around the 1970s disability was a social state rather than a condition. These pioneers were influenced by Marxist rhetoric much in evidence at the time. The individual discourse on disability is allied to World Health Organisation pronouncements, as for example, by the International Classification of Functioning, Disability and Health. It owed its existence to advances in science and medicine which placed disabled individuals into medical categories for the convenience of medical practitioners along with other health professionals. This, though eminently practical and appropriate at the time, was later experienced by the disabled population as an oppressive situation. They felt themselves labelled, manipulated, and powerless vis-a-vis their very own bodies and personhood. There's inherently nothing wrong with impairments being initially identified and treated as a medical condition. Indeed, it is a necessary first step, particularly when individuals require continuing, lifetime health care. It really is when such treatment excludes or disregards the social environment, which to a large extent defines the parameters within that your disabled are expected to function, that problems arise. It inevitably invites social exclusion and disadvantage, segregation and stigmatisation, that is the fundamental criticism contrary to the narrow medical model. Still, there are apologists for the medical model of disability. They regard as questionable Mike Oliver's denial that impairment has any causal correlation with the societal notion of disability. For them this is an 'oversocialized' and overly politicized view. Although he accepts that disability is both biologically and socially caused, he places 'more significant causal weight' on the former. They recognise the sociological need for the body, but complain hat the social model is suffering from 'somatophobia' due to an over-emphasis on the social context. Other researchers are keen to emphaise that there surely is social oppression at play in neuro-scientific disability. Shakespeare and Watson (2002) stress that 'embodied states are highly relevant to being disabled'. They believe that social model advocates 'over-egg the pudding' by stating that disability is entirely a creation of society rather than accepting that 'disability is a complex dialectic of biological, psychological, cultural and socio-political factors, which cannot be extricated' to any great extent. However, Carol Thomas (2004) is crucial of anyone not recognising the importance of disabilism within their discussion of disability. She thinks they confine themselves to a 'commonplace meaning of disability' ignoring the much larger significance allied to similar concepts like racism, sexism and homophobia. Vic Finkelstein, a pioneering academic and activist in the field of disability, himself disabled, was a refugee from apartheid South Africa where he previously experienced prison for five years. Having been mixed up in civil and human rights movement in South Africa, he was immediately sensitised to the ghetto-like connection with the disabled in the UK. He saw that they were denied participation in the mainstream social and political life of the country. Among Finkelstein's collaborators Paul Hunt, have been surviving in residential institutions (Cheshire Homes) from childhood and campaigned with other residents for a role in the management of such Homes. Following medical model Cheshire Homes believed it had provided 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 most importantly. These activists saw the medical model because the default position of the disability 'industry' staffed by care managers, social workers, physiotherapists, occupational therapists, clinical psychologists and doctors. Disabled persons' powerless and socially inferior position was reinforced in such circumstances, however sympathetic and dedicated these professionals were in carrying out their duties. It was only after the establishment of UPIAS that the political landscape changed. UPIAS (1976) concluded that '... it is society which disables physically impaired people. Disability is something imposed on top of our impairments incidentally we have been unnecessarily isolated and exclude from full participation in society. Disabled folks are therefore an oppressed group in society'. Apart from the horrors of the Holocaust which enabled doctors to experiment on disabled victims, there's a minumum of one documented case of clinical abuse of disabled children in america. Known as the Willowbrook Experiment, in 1956 disabled children were deliberately infected with viral hepatitis to monitor progress of the disease over a lengthy period of 14 years. Parents had been under great pressure to accede to it. It had been also approved by the brand new York State Department of Mental Hygiene. To a big extent such extreme measures are no more evident, but one can see how disability had been a custodial discourse. A good example of a drastic change in the medical model is that no more than four decades ago, the universally acclaimed and used Diagnostic and Statistical Manual of Mental Disorders (DSM) listed homosexuality as a mental illness. Psychiatrists and clinical psychologists practised aversion therapy (amongst others) to 'cure' these 'unfortunates'. Regardless of objections from the few extreme right politicians and religious fanatics, it is now accepted as a standard 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 civil union and even marriage between same sex couples. How the society's views and treatment of the disabled have changed through the years is demonstrated by the example of Lord Nelson and President Roosevelt. With an arm amputated and blind in one eye, 'the statue of Horatio Nelson defies modern infatuation with physical perfection by flouting his impairments.' He contrasts Admiral Nelson with the wheel-chair using wartime US president Franklin Delano Roosevelt. Unlike Nelson, he was created right into a modern culture where having an 'impairment' was supposed to directly 'disable' an individual. Therefore, a 'public statue of Roosevelt sitting in a wheel chair was unthinkable' So now we have been offered a statue to a major USA public figure that takes care to cover any evidence of his impairment. There will not be a call to erect a statue to a far more modern celebrity like Prof. Stephen Hawking, but one must grant that minus the medical advances that recognise his impairments making it possible for him to receive the right medical treatment and continue living and working as he does, there would not be a social or academic role for him to fill with such distinction. 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 effect a result of needed changes through legislation, it locks people into an identity defined as being members of a minority community. In this manner the conceptual barrier between 'normal' and 'abnormal' is maintained. There are also new challenges when the latest genetic and reproductive technologies add a larger proportion of the population as carriers of 'bad' genes and unwittingly put into the disabled category inviting discrimination and avoidance. Four decades following the Cheshire Homes incident, we've the spectre of Remploy Ltd. a government owned factory network over the UK established in 1945 offering both employment, and employment placement services, to the disabled, being dismantled. Remploy have been producing or assembling a massive range of products in its 54 factories spread across the country. Towards the end of the final 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 to be available of segregating the disabled, but at some early point in a disabled person's life that kind of provision was always more 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. Others in the field take somewhat of a middle ground. For them disability is really a 'post-modern concept, since 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 one identity: it is a multiplicity a plurality.' They assert that any social theory must 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 wished to see themselves as normal though different. Many people with learning difficulties won't be referred to as disabled. People have a variety of identities. Those who do not accept being labelled disabled may admit various other identities as more salient. For example, gender, ethnicity, sexuality, class or marital status. The social model developed in the 1970s is no longer useful or valid. There must be a paradigm shift. Additional reading argue against a 'crude determinism' towards a more sophisticated method of disability. For them, disability is not only 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 and energy to admit that it cannot speak for over six million people who have impairments in Britain alone, and over half of a billion over the planet. On the other hand, researchers in the field have accepted the idea that all humans are impaired in a single way or another. Disability may be the normal condition of all humanity; it is not limited to a little minority of people. 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 behind the historical oppression and exclusion of ostensibly impaired people by nearly all so-called normal people. This is said to be due to a need for denial of their own vulnerability, frailty and mortality, projecting them to others less in a position to defend themselves. The far-reaching insight that people are impaired should alert us to the truth that simplistic models may serve their purpose, however in a time-limited and contingent manner. The above is a far reaching exploration of academic discourse comparing and contrasting the concepts of the medical model and the social model of disability. Exploration of 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 this type of continually shifting paradigm.
Additional reading
