Social Model of Disability - History
Bill Albert, Disability Knowledge & Research
“In the broadest sense, the social model of disability is about nothing more complicated than a clear focus on the economic, environmental and cultural barriers encountered by people who are viewed by others as having some form of impairment – whether physical, sensory or intellectual.” Mike Oliver5
Social model of disability
The critique of the traditional interpretation of disability, which eventually was transformed into the social model of disability, was developed from the 1970s within the disability movement in the UK. It offered a radical alternative to the individualized medical conception of disability by asserting that disabled people were disadvantaged not because of their impairments, but as a result of the limitations imposed on them by social, cultural, economic, and environmental barriers. Disability according to this formulation is not about health or pathology but about discrimination and social exclusion. From a social-model perspective disability is a socio-political issue. This in turn leads to fundamentally different policy priorities and choices, mainly around the removal of disabling barriers, as well as a strong emphasis on human and civil rights.
Unlike medical model assumptions of individual abnormality and the primacy of cure, the social model, while not rejecting medical intervention, implicitly acknowledges the normality of impairment. Furthermore, it is recognized that medical advances far from reducing the number of disabled people have led to an increase, as people not only live longer but are also better able to survive illness and injury. It might be said that the proportion of disabled people in a population is a good indicator of an economy’s prosperity.2
Fierce academic and political debates continue, both within the disability movement and from outside, about the nature of the social model, its relevance, as well as how and if it can be applied in any given situation.3 It is beyond the scope of this note even to outline these debates. Instead, after a brief account of some benefits of applying the social model in development, specific questions that have been raised about the social model in this context will be considered.4
Nothing about us without us
By projecting disabled people into a leading role in defining and controlling their lives, the social model offers a powerful device for the liberation of those who remain the poorest of the poor in all countries, both developed and developing8. The model is so powerful because it illuminates the fact that the roots of poverty and powerlessness do not to reside in biology but in society. The former is, for most disabled people, immutable; the latter, through purposeful collective action, can be transformed. A human rights approach offers both the platform for such societal transformation and a way for disabled people to transform their sense of who they are – from stigmatized objects of care to valued subjects of their own lives. For people who are poor and oppressed this is a key starting point of any meaningful process of social and economic development.
Perhaps the most common issue raised by critics of the social model is that it ignores the reality of what impairment means for disabled people. This, they say, is problematic in the North, but when applied to the South it is catastrophic. At one level this claim could be dismissed as it is most frequently made by non-disabled people, while the social model has been embraced by disabled people, in both the North and South, who clearly do know what impairment means on a daily basis.
But more to the point, advocating the social model does not mean ignoring the causes of impairment or the health care needs of anyone, including disabled people. Proper health care is a basic human right and provision of clean water, disease prevention, ending conflicts, eradicating poverty, and getting rid of landmines, all of which would remove major causes of illness and injury, are important for all. Finally, it should be stressed that the social model critique of the medical model of disability is, at least in part, about rejecting the lexicalization of disabled people, not rejecting medical intervention.
It has been claimed that the social model of disability ignores the differences among disabled people with respect to their impairments, and that there is an impairment, class and gender hierarchy (wheelchair-using, middle-class men being dominant) within the disability movement.15
Leaving aside the latter point, which is factually incorrect16, the criticism about a lack of homogeneity is rather curious as no one has ever made such an argument or even implied that differences do not exist or are not significant. Individually, disabled people, even those with the same impairment, have a vast range of life experiences, as do any other oppressed group such as women or ethnic minorities. What brings them together in a movement is the shared experience of discrimination and exclusion. This is precisely the focus given by the social model and one reason that it has been so important for, and embraced so avidly by, disabled people.
The social model of disability represents a protean challenge to traditional thinking about disability. If applied in the development context it has the potential to transform policies and practice as well as the lives of disabled people. However, neither it nor a human rights approach are magic wands. While many people may find the social model a helpful way to conceptualize disability and have even begun using disability rights language in reports and policy documents, this is not enough to make a real difference. A too-easy acceptance of the new disability paradigm may even be counterproductive: by being so easy it runs the risk of ignoring how negative assumptions and attitudes about disability (held by both disabled and non-disabled people) are so deeply ingrained and continually reinforced.
Furthermore, understanding the strength and social authority of these attitudes demands a genuine awareness of the unequal power relationships that define the reality of disability. This applies equally to gender and ethnicity. For example, you cannot challenge sexism and racism in a ‘white man’s world’ by using non-sexist, non-racist language while accepting the power relationships in that world. Until this problem is addressed and the insidious layers of institutionalized disablism18 are exposed and stripped away it will be impossible to develop and implement effective policies to address the poverty and disadvantage so endemic among the hundreds of millions of disabled people in the developing world.
Bill Albert, Disability and Knowledge
Ending Disability Discrimination: Strategies for Social Workers (Paperback)
by Gary May (Author), Martha Raske (Author)
Disability Services Queensland's social workers negotiate, on behalf of people with a disability and their families, with government officials and organisations providing services. As a social worker with Disability Services Queensland, you are there for the 'every day' as well as in times of crisis.
My job is all about helping people find their own strengths and then building on those strengths."
Michelle Saint-Hill, social worker, has worked as both a social worker and supports facilitator for Disability Services Queensland
The social model of disability proposes that barriers and prejudice and exclusion by society (purposely or inadvertently) are the ultimate factors defining who is disabled and who is not in a particular society. It recognizes that while some people have physical, intellectual, or psychological differences from a statistical mean, which may sometimes be impairments, these do not have to lead to disability unless society fails to accommodate and include them in the way it would those who are 'normal.' The phrase 'differently abled' is sometimes used to convey an aspect of the social model of disability, although the model is not generally taken as denying that some attributes (or loss of) can be seen (when unaided) as impairments. The origins of the approach can be traced to the 1960s and the Civil Rights Movement/human rights movements; the specific term itself emerged from the United Kingdom in the 1980s.
The approach behind the model is traced to the 1960s. In 1976, the UK organization Union of the Physically Impaired Against Segregation (UPIAS) claimed that disability was: ‘the disadvantage or restriction of activity caused by a contemporary social organization which takes little or no account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities.’ In 1983 The disabled academic Mike Oliver coined the phrase ‘social model of disability’ in reference to these ideological developments. Oliver focused on the idea of an individual model (of which the medical was a part) versus a social model, derived from the distinction originally made between impairment and disability by the UPIAS.
The 'social model' was extended and developed by academics and activists in the UK, US and other countries, and extended to include all disabled people, including those seen as having mental impairments or disabilities.
A fundamental aspect of the social model concerns equality. The struggle for equality is often compared to the struggles of other socially marginalized groups. Equal rights are said to give empowerment and the 'ability' to make decisions and the opportunity to live life to the fullest. A related phrase often used by disability rights campaigners, as with other social activism, is "Nothing About Us Without Us."
The social model of disability often focuses on changes required in society. These might be in terms of:
- Attitudes, for example a more positive attitude toward certain mental traits or behaviors, or not underestimating the potential quality of life of those with potential impairments
- Social support, for example help dealing with the above barriers, resources, aids or positive discrimination to overcome them.
- Information, for example using suitable formats (e.g. Braille) or levels (e.g simplicity of language) or coverage (e.g. explaining issues others may take for granted)
- Physical structures, for example buildings with sloped access and elevators.
The social model of disability implies that attempts to change, 'fix' or 'cure' individuals, especially when against the wishes of the patient, can be discriminatory and prejudiced. It is often contended that this attitude, often seen as stemming from a medical model and a subjective value system, can harm the self-esteem and social inclusion of those constantly subjected to it (e.g. being told they are not as good or valuable, in some overall and core sense, as others).
Some communities have actively resisted 'treatments', often alongside defending a unique culture or set of abilities. Some examples include: deaf parents arguing against cochlear implants for deaf infants who cannot consent to them, and valuing sign language even if most do not 'speak' it; people diagnosed with an autism spectrum disorder arguing against efforts to change them to be more like others.
They argue instead for acceptance of neurodiversity and accommodation to different needs and goals; people diagnosed with a mental disorder arguing that they are just different, don't necessarily conform, or have a psychosocial disability ultimately caused by discrimination or exclusion by society.
The social model implies that practices such as eugenics are founded on social values and a prejudiced understanding of the potential and value of those labeled disabled.
The social model of disability is often based on a distinction between the terms 'impairment' and 'disability.' Impairment is used to refer to the actual attributes (or loss of attributes) of a person, whether in terms of limbs, organs or mechanisms, including psychological. Disability is used to refer to the restrictions caused by society when it does not give equivalent attention and accommodation to the needs of individuals with impairments.
The social model also relates to economics. It proposes that people can be disabled by a lack of resources to meet their needs. It addresses issues such as the under-estimation of the potential of people to contribute to society and add economic value to society, if given equal rights and equally suitable facilities and opportunities as others.
Medical model says:
- You are a sufferer
- You are the problem
- Your disability needs curing
- You cannot make decisions about your life
- You need professionals to look after you
- You can never be equal to a non-disabled person
British Red Cross
Why is a social model of disability needed?
The standard way of thinking about disability in the past was the so-called medical model. That remains fine for doctors, but it is less useful for others. The medical model, naturally enough, concentrates on disease and impairments. It puts what is wrong with someone in the foreground. It is concerned with causes of disease. It defines and categorizes conditions, distinguishes different forms and assesses severities.
All these are important in diagnosis, prognosis, devising treatment programmes and in prevention. But they are not very relevant to the way that someone with a disability lives their day-to-day life. If you have epilepsy, you know what your seizures are like. It isn't necessary to know whether doctors regard them as mild, moderate or severe. It may be interesting for someone to know that the Latin name for their movement disorder is hemiplegia. But the chances are they are concentrating on more practical things.
Perhaps the most important consequence of the medical model is that bringing the impairment into the foreground risks pushing the person into the background. They become less of a person, and more a collection of symptoms.
What is unhelpful about the medical model?
It is likely to inspire pity, or even fear. Pity is not a useful commodity. Many people are scared of impairments, sometimes irrationally so. The model risks objectifying people, lumping them together because of their condition, not because of who they are. It is not nice to be told you are a typical case of something or other – and even worse to be viewed like that.
What is more, it doesn't have very much to say about people's lives and how they live them.
How is the social model of disability different?
Instead of emphasizing the disability, the social model puts the person at the forefront. It emphasizes dignity, independence, choice and privacy.
A key concept of the social model is that society disables people. Another way of saying that is that disability is a social construct. How we organize things in our culture limits and restricts what some of its members can do. That takes some understanding, so first it is worth clarifying some terminology.
Words are important, not because of the need to use the fashionably correct terms, but because the terminology reveals the thinking behind them. Here are some definitions of two key words:
Impairment. Having an impairment means there is something not working properly with part of the body, mind or senses. Someone who has had a leg amputated has an impairment. So does someone whose learning disability makes it difficult for them to remember things. So does someone is partially blind, or deaf, or who has epileptic seizures, or who has unwanted muscular spasms, or any number of things that don't work properly.
Disability occurs when a person is excluded, because of their impairment, from something that other people in society take for granted. That might be the chance to attend an event, access some service or get involved in an activity. It might be to live independently, to earn a living, to be kept informed, or just to make choices for themselves.
You might assume that the impairment causes the disability. Wrong. It is the choices society makes that causes someone to be disabled. Organize things differently, and they are suddenly enabled – though the impairment hasn't changed.
An obvious example might be a deaf person wanting to attend a conference. If no sign language interpreter is there, or no loop for a hearing aid, there is not much point in going. The person is excluded – disabled. But with a signer operating alongside the speakers, or a loop, the person can take part just the same as anyone else. They still have the same hearing impairment. But they are not disabled.
The same applies to a wheelchair user wanting to get on a bus. If it has room and access for wheelchairs, they are fine. If not, they are disabled. And so with a visually impaired person wanting to find out what the council is doing. If information is available on tape, they are enabled. If not, they are disabled.
So the impairments themselves don't matter?
Obviously, they still matter. Not being able to see, hear, walk, has an important effect on people. But generally speaking people find ways to cope – they get used to living with the impairment. And in any case what someone with an impairment cannot do is always much less than what they can do – if they are given the chance. The idea of the social model of disability is to give them a chance, remove the barrier that society places.
So impairment does not have to lead to disability?
That is right. Think about people who are have poor vision – short sight or astigmatism. Without spectacles or contact lenses very many would have a much reduced quality of life. They could not join in many events and activities, and may even be a danger to themselves and others in certain circumstances. But society provides an ophthalmologist on every high street, and a system of getting affordable corrective lenses. As a result, people with bad eyesight don't have to be excluded from anything. If we ordered life differently, the same could be true of people with learning disabilities, epilepsy, spina bifida, deafness, arthritis and all the other conditions we think of as "disabilities". People with these impairments could live the lives they wanted, getting involved with others and making informed choices about what they do.
Isn't using aids and adaptations for everyday life still a disability?
No. Or if it is, we are all disabled. We all rely on aids and adaptations of some sort in our daily lives. We use motor vehicles for transport, electronic aids for entertainment and accessing information. We rely on flushing toilets and water on tap for comfort and hygiene. We need electrical gadgets for cooking and washing clothes. Our society would disable everyone if these were not so readily available. How disabled would you be if you had to find a private space and dig a hole every time you wanted to use the toilet?
What does the social model mean for disabled people?
The logic is that only disabled people – as individuals or groups – know how their ability to participate in society in the way that they want to is affected. It is not something you can easily identify from outside. So, to find out what needs to be different, disabled people need to be listened to. That puts them at the centre of things, replacing the paternalistic "we know what's best" approaches of the past.
Areas for discussion with students
- Who knows most about a particular disability – a doctor or someone with the condition? Talk with students about the realities of living with an impairment. How many of the day-to-day issues that a disabled person faces are truly medical matters? What other issues are likely to matter more?
- Discuss the way society makes things harder or easier for different groups of people. Don't think initially of people with impairments. For example, see how life is made difficult for pedestrians on pathless country roads. Compare that with how cyclists are catered for in some areas, or car drivers on motorways. Discuss how much money we spend as a nation, providing facilities for some, not others.
- Invite students to imagine what a room - for example, a kitchen - might look like if it was designed just for someone who used a wheelchair. High level wall shelves or low cupboards would not be useful. But a suspended gantry running the length of the room to hang equipment from might be. If that was in reach of someone sitting in a chair, it could well be around 1.6 meters from the ground – or chin height for an able-bodied person standing up. With that installed, who would be disabled when using that kitchen?
- Think of other examples, where someone without an impairment might be disabled. Talk about someone with no useful sight who put no light bulbs in their home. Would it be reasonable to ask friends who visited at night to bring a torch? Discuss how that might be compared with the way disabled people are expected to find their own solutions to problems that could be sorted by town planners or building designers.
- With a group that has a good rapport, invite contributions about disabled people that students know well. How do they regard their disability? Talk about the difference involved in seeing the person first, and the impairment as secondary.
Intellectual Disabilities and Social Service
Towards a social model of intellectual disability
People with intellectual disabilities have often been devalued and disadvantaged throughout history (see Figure 1). Valuing People looks to redress this, on the basis of four key principles:
The White Paper does not, however, avoid the challenges ahead (see Figure 2).
The emphasis is now firmly on issues of rights and responsibilities, social care models, and social inclusion and citizenship; but there are potential hazards. The move away from a biomedical model of disability and towards a social model has meant that in some areas the NHS has withdrawn attention and resources from intellectual disability. This is particularly problematic as the proportion of people with profound, multiple disabilities living into adulthood has greatly increased in the last 20 years, as has the number of those with complex challenges such as autism. The new primary care trusts (PCTs), which could be a major force for good in working with individuals and their families, are under financial pressure and seem to be struggling to cope with a complex commissioning agenda. Organizational divisions in local authorities have led in some areas to a decline in the good practice that was developed in the 1980s. Resource constraints in local authorities and the NHS have resulted in a tightening of eligibility criteria, leaving a number of vulnerable people with inadequate services.
Positive working relationships between primary care, secondary care and social care are essential in assisting individuals and their carers to achieve valued lifestyles. One of the ironies of the current situation in the UK is that, in large measure, we know what works, but good practice is still not being developed into standard practice.
Subhuman Lacks the emotional and physical needs of 'normal' people. Primitive and unpredictable behavior No rights. People with intellectual disabilities segregated and controlled
Threat to society A weak mind in a strong body with potential for unpredictable behavior and procreation Control and segregation leading to a denial of freedom and possibly destruction
The eternal child Catered for as children with no responsibilities and no rights Stress on care but not development
Scapegoat Tolerated and cared for until society comes under pressure Segregated and perhaps killed at times of societal stress
The uneconomic unit A burden on society Segregation into units to fit economics of scale and exploitation
Burden on charity Judgment of weakness from a strong moralistic standpoint Basic needs are met in return for submission and gratitude
Object of pity Suffering individuals of whom no demands should be made Paternalistic. Shelter against risk. Low expectations
Sick person Seen as sick and the passive recipient of medical care Hospital model of care with emphasis on diagnosis and prognosis
Developing individual An optimistic view of the individual with potential for growth Stress on individuality, dignity and personal responsibility
The unfulfilled hope Seen as not having met society's expectations after increased expenditure on education and training Return to antagonistic or paternalistic ideology
FIGURE 2: Social care services today: problems and challenges
• Poorly coordinated services for families with disabled children, especially for those with severely disabled children
• Poor planning for young disabled people at the point of transition into adulthood
• Insufficient support for carers, particularly for those caring for people with complex needs
• People with learning [intellectual] disabilities often have little choice or control over many aspects of their lives
• Substantial healthcare needs of people with learning [intellectual] disabilities are often unmet
• Housing choice is limited
• Day services are often not tailored to the needs and abilities of the individual
• Limited opportunities for employment
• The needs of people from minority ethnic communities are often overlooked
• Inconsistency in expenditure and service delivery
• Few examples of real partnership between health and social care or involving people with learning [intellectual] disabilities and their carers
• The social perspective
The disabilities and experiences of individuals are often much more to do with society's attitudes than the original impairment. Vital to the whole issue, as the historical perspect¬ive shows, is the notion of citizenship and social inclusion. The Government's Social Exclusion Unit defines the concept as 'a combination of linked problems … that lead people or places to be excluded from the mainstream' (Social Exclusion Unit, 1999).
Recently, the newly formed Social Perspectives Network defined a 'modern social model' for the connected area of mental health. Key factors included the need to understand and relate to the complexity of human health and well-being, and how social and biological factors interact in the construction of health (Duggan et al., 2002).
• Social care and social work
Within this overall framework sit both social care - 'the function of supporting people to lead independent lives' (Behan, 2002) - and social work, with its emphasis on using the self and personal skills in order to empower individuals and groups to work towards purposeful and positive change (see Thompson, 2000; Gilbert, 2003). As the revised British Association of Social Workers Code of Ethics points out, 'principles of human rights and social justice are fundamental to social work' (BASW, 2002).
• A valued lifestyle
No single approach is an end in itself. Sarah Rooney (2002) remarks that 'work is not a panacea for loneliness, or a guarantee of companionship'. Similar issues relate to respite care (see Oswin, 1984), in which it is vital that the service attends to the emotional and social needs of the child or adult as well as the respite requirements of the family. One of the main challenges that remains, even when services are successful, is the issue of developing valued friendship networks other than with immediate family and staff, in a society where difference still creates barriers (see Richardson and Ritchie, 1989).
In essence, the innate dignity and value of each individual must be considered at all times. One of the most powerful statements of the past few years has been the drama, art and poetry (see Atkinson and Williams, 1990) that results as people with intellectual disabilities say 'know me as I am'.