The Medical Model of Disability

The medical model of disability originated in the 19th century, along with the development of the medical profession and technological developments created in the field of medicine (Drake, 1999). Those with disabilities were managed by medical professionals, responsible for providing rehabilitation so as to assist in the facilitation of a normal life.

This model centred on the individual with a ‗problem‘ seen as a ‗victim‘. Disability was perceived as an individual tragedy, with no perceived need for societal change (Barnes, 1999). Accordingly, the medical model commonly centres on those with disabilities who are socially excluded (Morris, 1991).

The emphasis of the medical model is on the individual‘s disorder or abnormality. Disease is viewed as a disturbance of normal functionality, which can be identified through the application of diagnostic instruments or via chemical examination. Such analysis can provide insights into various symptoms and signs commonly believed to be particular to a specific classification, cause and/or diagnosis (Seale et al., 2001). The medical modal‘s attention is directed towards sickness or deficit within the individual,

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with the view that specific diagnoses could result in social problems, such as discrimination and stigma (Williams and Heslop, 2005).

The model has been reinforced and supported through genetics, with extensive efforts to identify those genes that may cause diseases. Essentially, the physical body is viewed as an object, and those with disabilities are recognised as patients with a disease that may undergo medical treatment (Drake, 1999). Accordingly, people are classed as having a disability according to certain psychological or physical criteria (DePoy and Gilson, 2004).

The medical model centres on physical elements, and recognises disability as resulting from physiological impairment through disease or damage (Llewellyn and Hogan, 2000). It directs attention to the fact that individuals with disabilities are dependent on others, such as supporters and professionals. This perspective has two key consequences. First, it demands physical adjustment, achieved through various interventions for care or cure, including rehabilitation schemes with the aim of maximizing the likelihood of returning to a near-normal state. Secondly, psychological adjustments are critical, and assist the individual in accepting and managing his or her physical restrictions (Oliver, 2009). This model, although predominantly focusing on the individual, suggests a supportive role for society.

Through this perspective, disability as a construct is described in terms of poor inclusion in mainstream society. Those who are disabled are commonly marginalized due to their inability to perform social activities, and because of their functional limitations. Accordingly, someone who may not be fully mobile can be recognised as disabled for this reason (Oliver, 2009).

The rehabilitation process is facilitated and supported through the development of technological devices. For instance, those with hearing impairments might be helped by operations or hearing aids, as well as learning sign language and lip reading, while Braille may be a viable option for those with visual impairments (Pandey and Advani, 1995). Technological developments may not only help those with disabilities to overcome technical issues; but also provide more equality in a work environment

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(Roulstone, 1998). Nevertheless, technological development in itself does not eliminate discrimination or social oppression.

At one level the medical model is extremely valuable, owing to the impact of the medical field and technologies utilised across this domain (Marks, 1999; Oliver, 2009). However, under the medical model, service providers have maintained their perspective of individuals with disabilities as a problem, directing focus on what they can not do, and what their disability inhibits (Dowling and Dolan, 2001). Early ideas concerning the delivery of education to children with disabilities were centred on a medical model of ‗defects‘ (Thompson, 1998). However, the medical model of disability has been the focus of much criticism since the 1970s, particularly by proponents of the social model of disability, to be discussed later, and by those adopting a rights-based approach to disability. The medical model holds that disability marks an individual person‘s physical or mental limitations, and is mostly unconcerned with the social or geographical setting. From that, it is easy to see how people who have disabilities might become stigmatised as ‗lacking‘ or ‗abnormal‘.

Barnes (1999) criticizes the three definitional categories adopted by the medical model: impairment is the first, which implies physical abnormality; disability is the second, which refers to the lack of ability to perform tasks and activities in the same way as an able individual; the third is handicap, which focuses on disadvantage (Barnes, 1999). Nevertheless, physical and psychological normality cannot be described without being subject to cultural, situational and temporal factors (Barnes, 1999). Furthermore, by focusing on the physical functionality, the definition fails to include non-medical causes of disadvantage, and ultimately encourages the concept of abnormality. Furthermore, the medical model fails to consider the experiences of those with the disability, as well as how such disabilities are perceived culturally. Moreover, much of the rehabilitation needed by those with disabilities cannot be delivered only by medical professionals and/or doctors (Oliver, 2009); rather, there is also a need for community rehabilitation. Moreover, the medical model categorises those with disabilities in terms of their medical diagnoses. Accordingly, such individuals are recognised as, for example, ‗mentally ill‘ (Williams and Heslop, 2005). This broad label might fail to distinguish between

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categories of disability, which might include those with dyslexia, or "attention deficit disorder", or "autistic spectrum disorders" who are within the ‗normal‘ range of intelligence (Rice and Brooks, 2004). In addition, through focusing on the disability or deficit within the person, who is labelled according to his or her disability, the medical model does not adequately acknowledge disability as a social response to impairment. The ‗labels‘ used in the medical model approach mean there is no onus or responsibility on society. However, abandoning labels altogether would be likely to result in less resource or service provision and a lack of understanding.

Another criticism is that the medical model fails to recognise that in addition to the limitations that the impairment encompasses, societal reactions might also be degrading, insulting and patronising, thus inducing subsequent limitations. Social responses to those with disabilities can therefore prove to be just as debilitating as the actual problem itself. Moreover, more conventional approaches to impairment may be recognised as pathological, meaning that the individual is recognised either as a hero to be admired or a helpless individual warranting pity (Barnes, 1999).

Obviously, the above consideration of the medical model has important implications for the Saudi education system, particularly with reference to inclusion in primary schools. Prejudicial perspectives towards those with disabilities are widespread, learned through interaction with the prejudice and ignorance of others (Aboela, 2008). Hence, challenging discrimination against disabled people must begin in schools, with the fight for the inclusion of all children.

Another limitation of the medical model is the idea of quantification of the degree of disability, on a scale from mild to severe, depending on how much an individual deviates from a social norm. Such norms are arguably man-made constructs created to protect the ‗self‘ as not having a disability (Slee, 1996). This arguably serves to maintain prevailing levels of social hierarchy (Slee, 1996). This limitation with the medical model of disability is also noticeable in the Saudi context in the IQ tests that are used in a deterministic way to assess Saudi children with learning difficulties on a scale from mild to severe, according to comparison with the perceived ‗norm‘ and to decide their educational setting accordingly. Whilst the medical model focuses on deviance and

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difference in the individual there is a contrasting model which contests this view: the social model of disability. The subsequent section provides a discussion of this alternative disability model: the social disability model.