Approaches to disability

The diverse and numerous approaches to disability reflect its complexity. The medical and social models of disability are presented here so as to illuminate core issues in disability studies. In addition, they are presented because they are models that typify approaches to the study of communication disability.

2.1 The medical model of disability

Many of the early approaches to disability were based on spiritual beliefs that viewed disability as the embodiment of evil spirits, witchcraft, the devil or G-d’s anger (Clapton, 1997). The biomedical philosophy of disability that emerged around the 19th century changed conceptualisations of the locus of the problem. Disability came to be seen as a disorder of bodily function or bodily attributes, and was seen as caused by a range of material factors such as physical trauma, infection, the ingestion of toxic substances, and so on.

Within the medical approach, then, disability came to be viewed as a problem residing within the individual body. Because of the historical preeminence of biomedicine as a social

institution, this individualised view of disability has come to dominate Western thinking, academic theorising, and institutional practice for centuries (Thomas, 2008). In addition, and more pervasively, the biomedical approach to disability has wielded tremendous power in broader philosophical thinking and socio-political locations (Thomas, 2007). This, then, is the source of the term ‘medical model’ which is used in reference to an individualised model of disability.

Because of the esteem in which medical personnel are held in many societies, the biomedical approach lends credibility (Mostert, 2002; Scully, 2008), cultural respectability (Lifton, 1986; Thomas, 2008), and economic advantages (Scully, 2008) to systems that adhere to its

approach. Biomedical approaches are powerful, pervading societal structures on all levels (Barnes, 2012; Barnes & Mercer, 2003; Tremain, 2008). This pervasiveness and power was palpable, for example, in the abhorrent eugenic practices of the twentieth century. At the turn of the twentieth century, many of the world’s scientists were influenced by Darwin’s theories that posited that the health and endurance of a species is defined by the genetic strength of its progenitors. Groups of theories subsequently applied Darwin’s theory to social evolution, espousing that competition drives social evolution and thus the genetic purity of a nation defines its fitness. In this inappropriate extension of Darwinism, natural selection is replaced

25 by social policy which allows the most powerful, not the fittest, to survive. A mass of work, based primarily on pseudo-data, showed differences between groups of people on a range of measures such as race, behaviour, and wealth. According to Mostert (2002, p. 158), these studies “not only reinforced popular social prejudices, but enshrined them as irrefutable scientific fact”.

Eugenics, a social interpretation of Darwin’s theory first promoted by Francis Galton in the 1860s, posited that social morals had to adapt to prevent the less fit from breeding and the more fit from under-breeding. The eugenics movement took root with vigour in many countries including the United States Japan, Sweden, Canada, Finland, France and the United Kingdom (Emanuel, 1994). Indeed, it was the eugenics movement in Germany that laid the foundations for the central policy of Race Hygiene in Nazi ideology that provided the footing for the Holocaust. Bred within a climate of socio-political chaos, the perverse

application of these philosophies culminated in the sterilisation of 400 000 disabled German men and women, and the deaths of more than 250 000 disabled German children and adults (Lifton, 1986). The Holocaust followed this eugenic programme. The Race Hygiene policy was predominantly conceptualised by, managed by, and supervised by medical personnel (Lifton, 1986). There can be no more powerful example of the power and pervasiveness of the biomedical model.

Apart from the extremism of radicalised eugenics, biomedical approaches fuelled, and continue to fuel, social policies that position disabled people as outcasts, as peripheral members of society (Tremain, 2008). Society has been fed by centuries of socialisation around the medicalisation of the body, the ostracism of disabled people from mainstream society, and the threat of disabled people to the health of society (Barnes, 2008). There is an enormous body of evidence that has shown that the preoccupation of the biomedical approach with the body, and in particular with the “disordered”, “abnormal”, or “defective” body, results in society marginalising disabled people on the basis of the body alone (Morris, 2001; Watermeyer & Swartz, 2008).

2.2 The social model of disability

The rejection of traditional models of disability coincided with the American Civil Rights Movement; post World War II liberation policies; the growing understanding of the horrors of the extreme eugenic policies of the Nazis; the rise of socialism and Marxist approaches

26 within sociology; as well as the emerging feminist literature. The activism took different forms in different contexts.

In Britain, the challenging position was articulated very clearly: disability was seen not as an individual problem, but as one of social oppression. Rejecting the medical model, disability activism began to emerge in the early 1970s. The Union of the Physically Impaired Against Segregation (UPIAS), a British organisation whose membership was exclusive to disabled people, defined disability as “disadvantage or restriction of activity produced by

contemporary social organizations which underestimate the worth of those with physical impairments and exclude them from the principal activities of social life” (Union of Physically Impaired Against Segregation, 1976, pp. 3-4). The development of the social model of disability followed this important work (Goodley, 2011).

Many early disability activists aligned with a Marxist materialist view of capitalism as a major contribution to notions of the human being as being valuable primarily in terms of his or her contribution to society (Finkelstein, 1980, 2004; Oliver, 1990, 2009). It has been suggested in the nomadic and/or agrarian societies of pre-industrialisation, disabled people lived in their communities within their families. According to historians, they were given tasks to do that they were capable of, and played their part in society. There were conditions under which disabled people were shunned, but as a rule, disability was viewed as a natural part of the cycle of life in rural communities (Finkelstein, 1980). Proponents of the Marxist material view claimed that it was the rise of industrialisation and capitalism that led to the repositioning of the lives of disabled people as reduced in value. In addition, capitalism was – and continues to be – viewed as a form of social control wherein disability is viewed as constructed by the beliefs and values of society which places tremendous value on individualism. In this way, disabled people have their societal roles removed, and their marginalisation is exacerbated by their relative lack of value (Barnes, 2012; Oliver, 1990). Positioning disability within the organisation of society, calling on issues such as human rights and justice (Oliver, 1996), was a major shift, both theoretically and in practice. In the social model, exclusionary social systems defined disability (Oliver, 1999). Where many advocates of the medical model saw disability as a personal tragedy, advocates of the social model saw it as social oppression; the medical model focus was on individual treatment and the social model focus was on social action. The activists, then, initiated the struggle against social oppression and worked for the emancipation of disabled people from an oppressed and

27 marginalised position towards inclusion in society (Hughes & Paterson, 1997). Oliver (1996), one of the early protagonists of this opposition and the person credited with naming the “social model” stated, it “turned the understanding of disability completely on its head” (p. 43). Its purpose was political.

The focus in the USA was on the economic implications of disability in a highly competitive capitalist society in which individualisation and financial success were highly valued. Aligning with American political thinking, disabled people were seen as a political minority group, which gave credibility to its opposition to discrimination and prejudice (Linton, 2008). American disability activism has focused to a large extent on ensuring that discrimination and oppression of disabled people is mitigated though legislation. The minority group approaches have been very clear about the need for society to adapt to accommodate the needs of

disabled people rather than disabled people having to adapt to society (Linton, 2008). The Independent Living Movement that developed in North America in the 1970s stressed the de- institutionalisation, de-medicalisation and mainstreaming of disabled people (Barnes & Mercer, 2010).

Similarly, in Nordic countries, the medical approach to disability was rejected. Somewhat resonating with the North American human rights approach, but in line with broader Nordic socialist political philosophies, these countries have embedded their approaches to disability within a human rights perspective. The approach has been broad in that they have not aligned with one theory, but with a range of approaches. The Nordic approach has been called the “relational model”. The main characteristics of this model are that disability is seen as a person-environment mismatch; that disability and context are interdependent; and that disability is not a fixed entity but is relative (Tøssebro, 2004). According to Goodley (2011), disability studies in the Nordic countries was immersed in the context of welfare.

Furthermore, the relational model has been influenced by the idea of the normalisation of disabled people, particularly intellectually disabled people. This is one form of activism that reflected the needs of people with lifelong disabilities, in contrast to the British and North American approaches that were – and remain - championed mainly by people with acquired physical disabilities.

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