Individual Paradigms of Disability

Disciplines that focus on the individual are often included under the multi-disciplinary practice of rehabilitation (M. Barnes & Ward, 2000) and are included in both the individual materialist and individual idealist quadrants of Priestley’s (1998) typology.

3.4.1.1. Individual Materialist

The individual materialist paradigm, often called the medical model, is considered by many to be an extreme view with no actual adherents and is nothing more than a counterfoil developed by disability activists to explain all that they consider wrong with

the medical view of disability (Shakespeare, 2006). While it can be debated that there are no actual adherents to this paradigm it can be said that there are disciplines that do have the individual and impairment as their foci.

As can be seen in Figure 3.2 the disciplines that have the individual and the

impairment as their foci include physicians in medical rehabilitation, physiotherapists, occupational therapists, rehabilitation ergonomists, nurses, and social and vocational rehabilitation instructors.

Medical rehabilitation physicians focus on the individual and seek to reduce the impairment in order to help the individual regain function after an injury or illness (Lequerica & Korette, 2010). Physiotherapists focus on the individual and seek to reduce the impairment and improve function through the application of physical interventions (Allet, Burge, & Monnin, 2008). Occupational therapists focus on the individual and seek to help them reduce the impact of their impairments and participate in activities of daily living by modifying the activity or the environment (World

Federation of Occupational Therapists, 2012). Rehabilitation ergonomists focus on the interaction between individuals and their physical environments and design assistive Figure 3.2. A typology of disciplines and perspectives of disability.

Medical Rehabilitation (Lequerica & Korette, 2010)

Physiotherapy (Allet, Burge, & Monnin, 2008)

Occupational Therapy (World Federation of Occupational Therapists, 2012) Rehabilitation Ergonomics (Dong, 2007)

Social Models (C. Barnes, 2009; M. Oliver, 1990) Political Studies (Godley, 2011; Morgan, 2012)

Critical Psychology (Prilleltensky, 2009)

American Cultural Model (Linton, 1998; Mitchell & Snyder, 1997) Minority Group Model (Linton, 1998) Affirmation Model (Donoghue, 2003) Materialist Social Individual Idealist Nursing (P. Kearney, 2003) Social and Vocational Rehabilitation (La Grow, 1998) Special Education (Lindsay, 2003) Social Work (Gilson & DePoy, 2002)

Psychology (Geyh, Peter, Muller, Stucki, & Cieza, 2011; Dunn Dougherty, 2005)

Sociology (Morgan, 2012) Inclusive Education (Lindsay, 2003) Social Work (Morgan, 2012; Gilson & DePoy, 2002)

Cultural Studies (Godley, 2011; Morgan, 2012)

technology to suit individual’s needs (Dong, 2007) while nurses also have a focus on the individual and mediating the affects of their impairment (P. Kearney, 2003). Social and vocational rehabilitation instructors, on the other hand, focus on quality of life and seek to provide opportunities to facilitate participation in society for individuals with impairments (La Grow, 1998). Despite the different foci of these disciplines they have all found that the International Classification of Functioning, Disability and Health (ICF) (World Health Organization, 2001) has been useful to guide practice, research and education as discussed below.

The ICF, a biopsychosocial model of human functioning, considers how biological, social, behavioural, environmental and cultural factors dynamically interact to produce risk and disabling and/or enabling factors that create an enablement/disablement continuum. It also seeks to describe how environmental modifications and intervention strategies help mitigate disability (Pledger, 2003). Medical rehabilitation physicians are increasingly finding that the ICF helps to provide a framework (Stucki, 2005) for

considering the multiple factors that help to restore function (Lequerica & Korette, 2010). Physiotherapists have found that the ICF is not only useful for classifying impairments but also for structuring assessments and interventions, guiding decision- making and facilitating communication (Allet et al., 2008). Occupational therapists have found the ICF to be a useful conceptual framework for research, clinical practice and education (Pettersson, Pettersson, & Frisk, 2012) while some rehabilitation

ergonomists consider that the use of the ICF may provide a framework for the

discipline merging the understanding of basic ergonomics and rehabilitation principles (Leyshon & Shaw, 2008). Social and vocational rehabilitation instructors have also found the ICF model useful for developing a framework and common language for assessment and intervention (Escorpizo et al., 2010) and for comparing quality of life instruments (Cieza & Stucki, 2005).

The ICF has had a significant impact on the international disability field and it has been used to frame disciplinary understandings and to train teachers, medical professionals and others involved with individuals with impairments (P. Kearney, 2003; Monti & Tingen, 1999). Some consider, for example, that the ICF has the potential to provide an overarching paradigm that encompasses the many perspectives that exist within nursing including the social aspects of disability and should be used as a framework within nurse education (P. Kearney, 2003; Monti & Tingen, 1999).

Gaps in the ICF’s understanding of disability, however, have also been identified by a number of these disciplines. For example, some physiotherapists consider that while it is a useful tool to guide assessments and interventions it is insufficient to describe how to undertake assessments (Allet et al., 2008). Some occupational therapists, on the other hand, have found that it does not encompass the subjective experiences of those with impairments (Pettersson et al., 2012). Vocational instructors agree and consider that the lack of recognition of the subjective dimension of disability is a significant shortcoming of the ICF. Despite these weaknesses, however, it is hoped that by using the ICF to guide practice and research and to train professionals that practitioners will be able to communicate using a common language and that its adaptability and applicability across cultural, social and disciplinary differences (Threats, 2010; Zakirova-Engstrand & Granlund, 2009) means that it will lead to better cross-

disciplinary understanding and collaboration (Francescutti et al., 2009). This building of a common understanding of disability based on the ICF model could help promote cross-disciplinary collaboration between disciplines that reside under the broad umbrella of the individual materialist quadrant as they engage in cross-disciplinary collaboration in this study.

The literature discussed in this section would suggest that rather than adhering to the medical model described by Priestley (1998), many of the disciplines that have the focus on the individual and consider aspects of the impairment and its impact on functioning, are moving towards using the ICF as a biopyschosocial model to help define and explain their understanding of disability and inform their practice. Although still rooted in the individual materialist quadrant, the disciplines adhering to this understanding would seem to sit near the boundaries of both the social materialist quadrant as it considers the impact of the social, natural and built environment on an individual’s functioning and the individual idealist boundary as it considers some of subjective experiences of the individual and their quality of life. As well as the potential of the ICF to provide a common language and understanding between the disciplines within this quadrant the fact that some of the disciplines also lie close to the boundaries with other quadrants means that there is the potential for some shared understanding across these boundaries as individuals from the different quadrants come together in cross-disciplinary collaboration.

3.4.1.2. Individual Idealist

The focus in the individual idealist quadrant of Priestley’s (1998) typology is the individual experience of disability that is often considered the realm of psychology as

shown in Figure 3.2. Psychology, in relation to disability, has traditionally focused on the individual’s adaptation to impairment and seeks to reduce psychological distress that may arise as a result of the impairment through counselling and therapy (Geyh, Peter, Muller, Stucki, & Cieza, 2011). Some practitioners from positive psychology undertake this therapy by focusing on an individual’s strengths (Dunn & Dougherty, 2005). As identified by the occupational therapists and the vocational instructors earlier, there is a lack of focus on the subjective dimension or individual experience in the ICF. Despite this lack of focus on the subjective dimension, some consider that there are a large number of concepts in the ICF that are relevant to psychology that could be used to not only structure the disciplines own understanding but could provide a basis for a common language that could enhance communication and promote cross- disciplinary collaboration when psychologists work with other professionals who use the ICF framework (Geyh et al., 2011). However, it is considered that the discipline of psychology as a whole, and practitioners in general, have not adopted the ICF model (Geyh et al., 2011). This understanding of disability, whilst sharing many characteristics of the individual idealist, would also seem to lie towards the boundary of the individual materialist with its foci on the individual’s impairment and its impact on the individual’s experience of disability.

There is also a counter trend within psychology called critical psychology that aligns with the perspectives of disability activists and focuses on social justice and the factors that hinder wellbeing (Olkin & Pledger, 2003). Critical psychologists focus research and interventions on subjective wellbeing and life satisfaction and how these are impacted by environmental factors. These psychologists recommend a more composite model of disability that is politically motivated and incorporates some of the individual and social aspects of disability (Prilleltensky, 2009). This understanding while having

characteristics that sit within the individual idealist paradigm could also be placed close to the social materialist quadrant with its political and social justice focus.

Again, within this quadrant it can be seen that the ICF has the potential to develop a common understanding between some in the individual idealist paradigm and those in the individual materialist paradigm. Trends within critical psychology, however, have the potential to build a common understanding with those in the social materialist quadrant. It would, therefore, seem that there are perspectives within this

understanding that could potentially build cross-disciplinary understanding and promote cross-disciplinary collaboration between the individual idealist, the individual materialist

and the social materialist.

From a consideration of these individual paradigms it can be seen that there have been moves towards building common ground between the disciplines and perspectives in these two quadrants through the use of the ICF and across the individual and social paradigms through such things as critical psychology. This assertion is supported through the work to develop more integrative frameworks for explaining and researching disability including using a systems approach to expand the ICF to consider quality of life and human development (McDougall, Wright, & Rosenbaum, 2010); a consideration of the concepts of dignity, rights and capabilities of individuals with impairments (Siegert & Ward, 2010); the use of holistic frameworks to evaluate interventions that include the service user voice (Dean, Siegert, & Taylor, 2012); and a focus on working with families using narrative and solution focused theories to develop interventions (Stejskal, 2012).