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Models of Disability

Oct 1st, 2008

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Review of Last Class

Language Person First Language Pride Language

Basic Concepts Ablism Overcoming Pity Super Crip

Definitions Impairment Handicap Disability

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Definitions

Impairment

Handicap

Disability

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Impairment:

Refers to physical or mental limitations such as difficulty walking

Represents a deviation from the person's usual biomedical state.

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Impairment:

When does physical / mental variation become an impairment?

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What is the difference between:

Impairment

Illness / “being sick”

Chronic Health Conditions?

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Minimal Expected Variation State

Minor Variation

Minor Variation

Unexpected Variation(DISABILITY)

Unexpected Variation(DISABILITY)

MIND / BODY STATE (Condition)

Impairment (aches/pains, illness/sick/injury, chronic illness/disease, short/tall, manic/depressed…. ) =Variation

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Handicap

Different meanings throughout time and situation…

The disadvantage experienced by a person as a result of impairments

(Now considered offensive)

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Disability

Oh so many definitions… Let’s start with the legal (US) definition:

ADA (Americans with Disabilities Act): (1) has a physical or mental impairment that

substantially limits a major life activity, (2) has a record of such an impairment, or (3) is regarded as having such an impairment.

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World Health Org. (WHO) 1980

Disability Restriction or lack (from an impairment) of ability

considered normal for a human being

Handicap The disadvantage experienced by a person as a result of

impairments

*ICIDH-1 (1980)

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Sequence of ConceptsWHO 1980

Impairment

Disease ordisorder

Disability Handicap

----------------------------------------------------------------------------------

impairment at the organ level

disability at the person level

handicap at the societal level

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WHO 2001

Disability : outcome or result of a complex relationship

between an individual’s: health condition personal factors external factors

Health Condition Health Condition ((disorder/diseasedisorder/disease))

Interaction of ConceptsWHO 2001

Environmental Environmental FactorsFactors

Personal Personal FactorsFactors

Body Body function&structure function&structure

(Impairment(Impairment))

ActivitiesActivities(Limitation)(Limitation)

ParticipationParticipation(Restriction)(Restriction)

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Classifying

classification b11420 Hierarchy:

b Bodily structures

b1 Mental functions

b11 Global mental functions

b114 Orientation functions

b1142 Orientation towards others

b11420 Orientation towards one-self.

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Quantifying

Quantifying functionality:0-4% 0 No impairment5-24% 1 Light impairment25-49% 2 Moderate impairment50-95% 3 Serious impairment96-100% 4 Total impairment 8 Non specified

9 Non applicable

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Where is the subjective (QOL)?

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Other classification systems

DSM IV ICD

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Review of some of the definitions: ADA

An individual with a disability is defined as a person who has a physical or mental impairment that substantially limits one or more major life activities

a person who has a history or record of such impairment, or a person who is perceived by others as having such

impairment.

ICF Disability is an umbrella term for impairments, activity

limitations or participation restrictions. Environmental and personal factors influence all aspects of

health, functioning and disability.

Surgeon General July 26, 2005 “… disabilities are characteristics of the body, mind, or senses

that, to a greater or lesser extent, affect a person’s ability to engage independently in some or all aspects of day-to-day life.”

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67 US acts / programs that define disability 35 have self-contained definitions (although

some contain more than one definition)

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Disability Activists (UK)1976 (UPIAS - Union of Physically Impaired Against Segregation)

Disability

“the disadvantage or restriction of activity caused by a contemporary social organization which takes no or little account of people who have physical impairments and thus excludes them from the mainstream of social activities”

Changes the focus of disability away from the individual to Society. (1st articulation of the “Social Model of Disability”)

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Which definition do you choose? Obviously no one has this figured out…

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Models of Disability

Moral Personal Tragedy Medical Social

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Moral Model

Two Parts Religious and Spiritual origin

Punishment from God (ie: due to displeasure) Evil spirits (possessed) Witchcraft Bad Karma (did something evil in the past) Gift from God (cross to bear, angelic)

Character weakness Corruptness Immoral-ness

Examples: villains in movies, refrigerator mothers, faking, unmotivated

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Moral Model (cont.)

2nd part of moral model: Character weakness

Corruptness Immoral-ness

Examples: villains in movies, refrigerator mothers, faking, unmotivated

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Personal Tragedy Model

Disability is considered a tragedy Society needs to take care and protect

persons with disabilities If someone with a disability achieves

something that a “normal” person does, then the person with a disability is looked at as inspirational (super crip)

This is often mixed with the Moral and Medical Models

Examples: inspiration news story, telethons, charities

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Medical Model

An individual with a disability has a physical or mental impairment

The disability is within a person Focus is on minimizing or eliminating the

impairment Examples: think bell curve, rehabilitation,

pharmaceuticals

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Social Model

Instead of disability originates within the person, disability originates from society

Disability results from barriers in society and the environment Physical barriers Attitudinal barriers

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Disability Activists (UK)1976 (UPIAS - Union of Physically Impaired Against Segregation)

Disability: “the disadvantage or restriction of activity caused by a

contemporary social organization which takes no or little account of people who have physical impairments and thus excludes them from the mainstream of social activities”

Changes the focus of disability away from the individual to Society. (1st articulation of the “Social Model of Disability”)

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Social Model

States that inappropriate and discriminatory Social Attitudes (Ableism), Sociopolitical Structures, and Cultural Phenomena

are the central problem for disabled people

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Social Model Variants

Social (Creation)- UK Social (Construction)- US Minority (Political/Cultural) Independent Living Model- ILM Human Variation Post-Modern / Dismodern

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Social Model Variants - Social (Creation)

UK The historical convergence of industrialization

and capitalism as restricting impaired people’s access to material and social goods, which results in their economic dependency and creates the category of disability

Marxist and materialist interpretation of the world

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Social Model Variants - Social (Construction)

US Assumes that inappropriate and discriminatory

social attitudes and cultural phenomena are the central problem for people with impairments

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Social Model Variants - Minority

Inappropriate and discriminatory social attitudes, sociopolitical structures - cultural phenomena are the central problem for disabled people

political based used to counter discrimination and advocate for civil rights

disABILITY identity / Pride / Culture

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Social Model Variants – Independent Living Model (ILM)

States that current sociopolitical structures produce access barriers for and dependency in impaired people resulting in disability

is based on a consumer driven movement that fosters autonomy, self-help and the removal of societal barriers and disincentives

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Social Model Variants – Human Variation

Universal Design re-think= The built environment;

economic, social, cultural, and political entities including organizations that provide employment, education, health care, transportation, communication, and the full range of public services.

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Social Model Variants – Postmodern Theory

sees disability as constructed via discursive practices (Talk / write=create disability) perceives disability identity as fluid and its

boundaries dependent on context and the dynamic interaction of other self-identities

emphasizes a dialogic relation between impairment and disability (not an analytical privileging of one over the other)

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"Through framing disability, through conceptualizing, categorizing, and counting disability, we create it.”

Higgins, Paul. (1992) Pp. 6-7 Making Disability: Exploring the Social Transformation of Human Variation. Springfield, Il: Charles C. Thomas

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Social Model Variants – Dismodern Theory

L. Davis Sees imperfection as the norm Normal is a fairly new term…

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1.disability is restricted activity (caused by social barriers)

2. disability is a form of social oppression

3. disability is created by categorizing bodies/minds as normal or abnormal

Social Model Variants – Summary

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Initially: Social model tries to breaks the bio-medical chain of causation:

Impairment Disability

Why was this strategically important to DRM (Disability Rights Movement)?

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While the social model redefines “disability,” it stops short of questioning the status of “impairment”

Impairment is a necessary condition for disability.

Impairment is a “real entity,” a condition of the body, which remains the exclusive domain of medical interpretation and/or intervention.

Minimizes the experience of impairments

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Models – Summary

Problem is the Individual Moral Personal Tragedy Medical

Problem is Society Social

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Why should we care?

How Disability Is Defined Determines What Is Measured

Policy implications Allocation of resources

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