Practice Contexts: Disability Jonathan

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Introduction

In this assignment, the author will aim to provide the reader with an overview of two
prominent models of disability: the medical model and the social model. More
specifically, the intention is to outline the differences between these models’ theory
and practice.

Firstly, a definition of what a model of disability is and its relevance in disability

studies will be inspected. Additionally, a comparison of definitions from both models
will be looked at. Secondly, the main aim of the assignment is to be achieved by
providing a general outline of the social and medical disability models, which will be
used to highlight the differences of their theoretical bases and practice methods.

This will serve the reader with an overview of both disability models, which
acknowledges the differences to how disability can be defined and approached in
society.

Outlining the differences of the medical and social models of

disability, giving detail of their respective theory and practice

Impairment, disability and the use of models of disability

A clear definition of the term disability, it can be widely presumed, has never been
universally agreed upon by any lay or in-depth study. This can be due to disability
pertaining to different viewpoints; ultimately, the person who experiences the
impairment and the person who does not. Another factor can be the norms found in
various world cultures (Thomas, 2002). There is also conflicting discussion on the
contextual nature of impairment, which is vital to denoting disability. Used to signify

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a defective bodily organ or appendage, examples of impairment would include:
blindness of the eyes, loss of hearing, or immobility of legs or arms.

Toward a definition of disability and its encompassing model

In organising the various views, a model of disability is needed. As Karen Hammell

(2006, p. 55) states, a model ‘encapsulates specific knowledge and perspectives and
posits links between data…shaped by ideas’. Hence, a model provides an
understanding of disability. This is achieved by arriving at clear definitions to
impairment and disability based on justifiable theory, and noting relevant practice
methods.

Two of the most prominent models of disability in today’s practice have been the
medical model and the social model. It should be understood that the fundamental
difference between both models lies in their definitions of impairment and disability.
Only when there is definition can there be a progression to practicality for a person
with an impairment.

The social model, advocated by the prominent Union of the Physically Impaired
Against Segregation (UPIAS) in the USA, conclude that disability is ‘[restrictions
placed] by a social organisation which takes no account of people with physical
impairments and excludes them from participation’ (Barnes & Mercer, 2003, p.11).
The UPIAS describes impairment as having any partial or complete defection of a
bodily part or organ.

Disability, defined within the theory of the medical model, is finely exemplified by
the World Health Organisation’s (WHO’s) International Classification of
Impairments, Disabilities and Handicaps (1980). Here, disability is designated as a
‘lack of ability to perform…without the range considered normal for a human being’
(Barnes & Mercer, 2003, p.13). Similarly to the social model, impairment is
considered as an absence or defect of a bodily function – however, impairment is also
considered an abnormality. It should be noted by the reader that the WHO have since
adapted less medical-based definitions (WHO, 2001).

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The theory of the medical model

The medical model of disability is a reference of information that strictly emphasises

the study and practice of the biological nature of impairment. The primary aspect of
the medical model first evolved in the 18th century. The period known as the Age of
Enlightenment produced and gave value to science, involving the experimentation and
analyses of subject material (Hammell, 2006). In Michel Foucault’s study on power
and knowledge relations in society, he noted how medicine and other sciences gained
importance and power in society by a reputed knowledge base, which in turn garnered
a greater reputation of knowledge. Medicine, as Foucault assumed, considers all
individuals to have a ‘docile body...subjected, used, transformed, and improved’
toward its diagnosis and practice (Barnes & Mercer, 2003, p.29). This was followed
by a similarity drawn between illness and impairment, with gave necessity and
authority to medicine in disability studies.

By medical analyses of its condition, impairment was biologically deemed an

abnormality and therefore a striking flaw incomparable to the able-bodied/minded
(Cameron, French & Swain, 2005). Within this abnormality, impairment ‘signifies
disorder, indiscipline and unreliability, (ibid., p.23). This idea is compounded within
the social context in western societies of the 18th century which gave great promotion
to individualism (a given value placed on personal independence), amid the impact of
capitalism. As a result, impairment inevitably overlapped with the notion of being
incompatible within various societal contexts, an idea which was carefully justified by
works in the study of biomedicine (Thomas, 2002).

The influence of the different branches of medicine and the Industrial Revolution
accumulated with impairment being considered a ‘personal tragedy’ (Oliver, 1996).
Any lack of participation of people with impairment in areas of society is seen not by
any fault of the society itself, but by the misfortune of being born with or incurring a
defective body. Therefore, any consequence of having an impairment is considered to
be the sole responsibility of that person (Oliver, 1990).

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The theory of the social model

The formation of the social model arose specifically from criticisms of the medical
model. Paul Hunt provided studies which highlighted a ‘relationship gap’ between
western society’s impaired and able-bodied/minded individuals (Barnes & Mercer,
2003, p.9). He examined how such separation occurred by negative stigmas attached
to impairment, incontestably gained from the medical model. The work of Charles W.
Mills was also used to criticise the medical model, demonstrating the model’s
reference of knowledge was the result solely of subjective reasoning by medicine’s
self-perpetuating authority on disability studies (Barnes & Mercer, 2003).

Early literature of the social model encapsulated a single message which declared
disability as oppression and discrimination by society’s norms (Thomas, 2002). Here,
a societal exclusion of impairment occurs not by an inability to match the capabilities
of the able-bodied/minded. Instead, it is deemed that the form of society and its
dominant influences lends impairment to be abhorrent and illegitimate with a given
falsehood of being deviant. Therefore, the social model provided a new definition to
the term disability. In tackling the medical-based deviant nature of impairment,
Howard Becker, noted that deviance ‘is not a quality of the act the person commits
but a consequence of the application by others of rules and sanctions’ (Barnes &
Mercer, 2003, p.4).

A chief writer of the social model, Mike Oliver, explains the model was formed to
provide a wider context for disability studies. Those with impairment should consider
medical treatment, but not to the extent considered necessary within the medical
model (Oliver, 2006). The main aspect of the social model sees how having an
impairment is unaccommodated by ‘disabling environments, barriers and cultures’
(Barton & Mercer, 2003, p.21). This is seen as a great concern of those with
impairment, whereby societal norms and values were seen as active in restricting
participation in various areas. Dr. Frank Bowe elaborated on such social exclusion in
the fields of ‘architectural, attitudinal, educational, occupational, legal and personal’
aspects (Barnes & Mercer, 2003, p.10). A motion toward social inclusion is then
exemplified by: restructured buildings for greater accessibility, removal of the

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negative stigma of impairment found within the general public, desegregation in
employment and education, and facilitation of those with impairment in recognising
themselves as equally valued members of society.

The practice of the medical model

The science of medicine and the medical model gained influence in western society
from the 1800s (Oliver, 1990), with involvement in institutional areas such as
education, law and employment. Any findings of impairment in these areas were
labelled a ‘social problem’ to be ostracised (Barnes & Mercer, 2003, p.27).

With the Industrial Revolution, impairment was considered a hindrance to high-level

production and excluded from employment. Consequently, impairment became
associated with poverty. This is seen at the turn of the 21st century. American studies
found two-thirds of people with impairment were unemployed, with 60% unemployed
in British findings (Barnes & Mercer, 2003).

The considered incapacity of impairment in a labour intensive aspect of society crept

into general social attitudes. As a result, ‘charitable paternalism’ emerged, which
emphasised that those with impairment would need constant dependency (Hughs,
2002, p.62). This was met by public funding toward charity agencies and supporting
alms giving (ibid.). Labels of common use to impairment are seen to have originated
from this time. Generally recognised in present times as derogatory and over-
generalised, terms included ‘sufferer’, ‘cripple’, ‘victim’, ‘physically challenged’,
‘spastic’, ‘feeble-minded’, and ‘handicapped’ (Cameron, French & Swain, 2003;
Oliver, 1990)

Institutional provision was a priority for impairment care. A great number of

psychiatric asylums were built to house intellectually impaired and mentally ill
people. Segregation was also found in education, especially of children with
impairments, with mainstream schooling deemed adequate, resulting in the building
of specialist schools (Barnes & Mercer, 2003; Oliver, 1990). In addition, alms houses,

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Poor Law workhouses and charitable homes segregated those with impairment from
having an active role in society (Oliver, 1990).

Medical studies have since defined new variants of impairments, from different forms
of mental illnesses to physical conditions of various specifications. Multi-disciplinary
professions, such as occupational therapy, physiotherapy and psychiatric nurse care
are found to work within institutional frameworks (ibid.)

The practice of the social model

The social model provides immediate contrast to the medical model by placing
importance and authenticity on the experience and opinion of the person with
impairment. From the early 1960s onwards, the medical model faced scrutiny from
organised lobbyist movements, originally in the USA and Western Europe. They
strongly criticised the existing general practice of working with impairments, such as
segregation found in education and employment and an insisted dependency on
medical-based professions (Barnes & Mercer, 2003). These practices were seen to
create oppression, negative stereotyping and an undermined citizenship.

Strong organisations in advocating greater social inclusion include the Independent

Living Movement (USA) and UPIAS, both established in the early 1970s (ibid.). In
the UK, the Royal Association for Disability Rights (RADAR) also calls for an
improved allowance of participation for people with impairments (RADAR, 2010).
The best seen possibility of impairment inclusion is the introduction of new social
policies that are anti-discriminatory in nature. Therefore, government legislation is
generally the most practical-based form of the social model.

One of the first policy enactments has been the Americans with Disabilities Act 1990
(USA). In the UK, similar legislation was made law with the Disability
Discriminations Act in 1995 (Barnes & Mercer, 2003). These legislative steps were
subsequently taken in other western countries, including the Disability Act of 2005 in
Ireland (Considine & Dukelow, 2009). In practice, such legislation is almost an
antithesis to the practical history of the medical model. The acts help illegalise many

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forms of discrimination against impairment, such as access to education, employment
(including equal pay), and other public services (Barnes & Mercer, 2003; Considine
& Dukelow, 2009).

Conclusion

As this essay relays, both the medical and social models of disability have been and
remain useful to understand and provide practice measures of disability. It has been
shown that there is much distinction between disability and impairment, which might
escape the layperson’s knowledge. It is also interesting to note how changes in society
and periodical thought have been the catalyst for the developments of disability
theories.

The difference between both the models of disability has been shown by recognition
of their contrasting theoretical framework and practice methods. By a constraint of
this essay’s word limit, the theory and historical practice of the disability models
could not be studied in greater depth. The author would recommend further reading of
relevant literature.

The medical model, reflective of medical science, seems to give much consideration
to biological function at the expense of a person’s personal need for validity. The
social model is an antithesis to the medical model, and perhaps also considers too
highly the raised issues of disability as specific to the environment. The author asks,
would a fusion of both models allow for a greater ontological perspective, therefore,
providing the greatest authenticity toward disability studies? A relatively new
approach presently exists (known as the biopsychosocial model), and covers virtually
all aspects of disability. However, it has been criticised for an incoherence of ideas
and errors in the model’s practicality (McLaren, 1998). As it stands, disability studies
perhaps remains in need of a model which can have universal appeal.

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Bibliography

Barnes, C & Mercer, G. 2003. Disability. Cambridge: Polity Press

Cameron, C., French, S. & Swain, J. 2005. Controversial Issues in a Disabling

Society. Berkshire: Open University Press

Considine, M. & Dukelow, F. 2009. Irish Social Policy: A Critical Introduction.

Dublin: Gill & Macmillan

Hammell, K. 2006. Perspectives on disability & rehabilitation: Contesting

Assumptions; Challenging Practice. Philadelphia: Churchill Livingstone

McLaren, N. 1998. ‘A Critical Review of the Biopsychosocial Model’, Australian

and New Zealand Journal of Psychiatry, Vol. 32, No. 1: pp. 86 - 92

Oliver, M. 1990. The Politics of Disablement. London: The MacMillan Press Ltd

Oliver, M. 1996. Understanding Disability: From Theory to Practice. Hampshire:

Palgrave

Royal Association for Disability Rights (RADAR). 2010. Accessed from

http://www.radar.org.uk/radarwebsite on the 6th November 2010

Thomas, C. (2002). ‘Disability Theory: Key ideas, Issues and Thinkers’, In: Barnes,
C., Barton, L. & Oliver, M. Disability Studies Today. Cambridge: Polity Press. pp: 38
– 57

World Health Organisation. 2001. International Classification of

Functioning and Disability II. Geneva: World Health Organisation

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