Models of Disability: Moral, Medical, and Social Perspectives
Models of disability
Moral/Religious, Medical, and Social
Models of Disability
Impairment
•
Impairment
–
is “
lacking all or part of a limb, or having a
defective limb, organ or mechanism of the body
(UPIAS, 1976).
–
refers to "any loss or abnormality of psychological,
physiological or anatomical structure or function"
(WHO, 1980).
Disability
•
Disability is “any restriction or lack (resulting from
an impairment) of ability to perform an activity in
the manner or within the range considered
normal for a human being” (WHO, 1980)
•
Disability is “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 participation in the
mainstream of social activities” (UPIAS, 1976).
Labelling
•
Those who are in favor of the principle of
‘people/person-first’ language (those who
support the phrase “persons with disabilities”)
argue that it is essential to recognize that
individuals are people
first
, and that disability
may be just one of a person’s characteristics,
not the overriding characteristic of the
individuals.
Labelling (cont)
•
However, many scholars in disability studies in
the UK assert that person-first language implies
that disability is located within individuals rather
than a societal construction.
•
Such scholars contend that disabled people “are
not people ‘with’ disabilities, rather, they are
people who are disabled (disadvantaged) by
society’s response to their differences”.
•
Thus, they use “disabled persons” in referring to
these group of people.
Moral/Religious Model
•
The moral/religious model represents the oldest
and also the most pervasive framework for
understanding disability.
•
By promulgating the belief that impairments are
the result of sin, witchcraft, the evil eye, the
wrath and judgment of God/gods or an ancestor’s
anger, religions have sought to regulate and
control the behavior of their adherents through
fear and the threat of supernatural punishment.
Moral/Religious Model (cont)
•
Shared by most cultures throughout the
world, this model is evident in all the major
religions.
•
In the Old Testament, disabled people were
regarded as ‘unclean’.
•
Characteristics that would keep a priest from
the temple included being blind, being lame,
having a malformed foot or a misshaped hand,
being a dwarf, or having a broken bone.
Disability in Hinduism and Buddhism
•
Hindu mythology portrays impairments in
extremely negative terms: as flaws or
deficiencies that must be endured to repay
past sin; associating impairment with deceit,
mischief and evil.
•
Buddhism teaches that impairments
constitute a form of ‘educational rebirth’ for
wrong conduct in previous incarnations.
Positive Implications
•
Judeo-Christian religious tradition offers many
lessons on the dignity and worth of persons with
disabilities.
•
Moses had a significant speech impairment.
•
God implied, in choosing Moses as a leader, that
some people with disabilities are worthy and
capable of leadership.
•
When Moses remained unconvinced, God
provided what we might today term "reasonable
accommodation" in Aaron to help Moses speak
to his people.
Medical/Individual Model
•
Commonly referred to as either the medical
model or the individual model of disability,
this model is the most well-known
understanding of disability both by the
general public and professionals throughout
the modern history of societies
•
This model is rooted in the scientific method
of medical science with a belief that science
could solve any problem.
Basic Characteristics of the Medical
Model
•
The focus of the problem of disability
exclusively centers on the individual with the
disability; not on the environment
•
Biological impairment is the fundamental
starting point and disability is interpreted
according to an epidemiological standpoint
•
Profound reliance on the knowledge and skills
of professionals for solutions and intervention
to problems
Basic Characteristics of the Medical
Model (cont)
•
Making its focus on functional limitations and
their effects on daily living activities, the
medical model seeks preventing, curing,
perfecting, eradicating the physical or mental
dysfunction, normalizing the abnormal
through treatment, or when these goals fail to
achieve, caring for disabled people.
Basic Characteristics of the Medical
Model (cont)
•
In sum, the medical model regards disability
as a problem of the person, directly caused by
disease, illness, injury, or other forms of
health issues, which require
interventions/treatments provided by medical
and other professionals with the aim of
curing, or bringing about behavior change or
one’s adjustment to the environment.
Criticisms
•
For their “individualization”, “medicalization”,
“professionalization”, and “objectification” of
disability, the individual perspectives are
severely critiqued by scholars and activists in
the field of disability.
Consequences of the Moral/Religious
and Medical Models
•
Manifestations of the disadvantages of the
moral/religious and medical models
–
Containment—limiting the choices, exposure, and
life experiences of disabled persons, as well as the
opportunities for disabled persons to fully
participate in society, and may be geographical,
psychological, or social;
–
Expendability—the feeling that the lives of people
with disabilities are expendable (they are better of
dead);
Consequences (cont)
–
Compartmentalization (the stereotyping of PWDs,
or placing them in predetermined categories);
–
Blaming the victim (believing lives of PWDs are
limited because of their disabilities or lack of
pluck); and
–
Denial of disability (either PWDs pretend as they
were not disabled or redefined obvious disabled
attributes in a nondisabled fashion).
Social Model of Disability
•
The root of the social model of disability is
traced in the political action of disability rights
movements in the UK in the 1960s through
the 1990s and civil rights movements in the
US in the 1960s and 1970s.
•
However, this model is often referred to as the
“minority group” model in the US and caused
the independent living and civil rights
movements of PWDs there.
UPIAS
•
In 1976, the British Union of the Physically
Impaired against Segregation (UPIAS)
published its manifesto under a title
“Fundamental Principles of Disability” from
which the social model of disability had
originated.
•
In 1983, Mike Oliver introduced the term
“social model” and added a research
perspective on what UPIAS proposed.
The Social Model
•
Interprets disability is all the things that impose
restrictions on disabled people (through
individual prejudice, institutional discrimination,
inaccessible public buildings, unusable transport
systems, segregated education, and excluding
work arrangements)
•
therefore, claims that disability is a particular
form of social oppression that takes place in a
disabling society, and the disabled constitute
amongst the group of oppressed population
The Social Model (cont)
•
hence, take disability not to be something
wrong with an individual, rather, disability is
something wrong with society
•
consequently, call for social reform or change
in the hostile socio-political environment
which is disabling people with impairments.
Impairment and Disability in the Social
Model
•
An inability to walk is an impairment, whereas an
inability to enter a building because the entrance
is up a flight of steps is a disability. An inability to
speak is an impairment but an inability to
communicate because appropriate technical aids
are not made available is a disability. An inability
to move one’s body is an impairment but an
inability to get out of bed because appropriate
physical help is not available is a disability
(Morris, 1993, as cited in Barnes, 2003, p.17).
Impacts of the Social Model
•
Adoption of various international declarations
and conventions which are concerned with
the issues of the disabled
•
The global expansion of community-based
rehabilitation programs
•
The introduction of a number of anti-
discrimination laws at national levels
throughout many countries in the world
•
The worldwide push for inclusive education
Critiques of the Social Model
•
Focusing too much on persons with physical
disabilities
•
Neglecting of impairment as an important aspect
of many disabled people's lives and
underemphasizing problems related to medical or
clinical conditions
•
The analogy of disability with gender and racial
oppressions
•
The social model is an urban model of disability
•
The concept of the barrier-free utopia
ICF
•
On their own, neither the medical/individual
model nor social model is adequate.
•
Both are partially valid and hence, we cannot
wholly reject either kind of intervention.
•
ICF thus is a
bio psychosocial model-
an
integration of
medical and social models
.
•
Disability is a complex phenomena that is both
a problem at the level of a person's body, and
a complex and primarily social phenomena.
Functioning and Disability
•
In ICF, disability and functioning are viewed as
outcomes of interactions between
health
conditions
(diseases, disorders and injuries)
and
contextual factors.
•
Disability is always an interaction between
features of the person (the person with a
certain health condition) and features of the
overall context in which the person lives.
Functioning and Disability (cont)
•
Functioning is an umbrella term for body
functions, body structures, activities and
participation. It denotes the positive aspects of
the interaction between an individual (with a
health condition) and that individual's contextual
factors (environmental and personal factors).
•
Disability is an umbrella term for impairments,
activity limitations and participation restrictions.
It denotes the negative aspects of the interaction
between an individual and his/her contextual
factors
Body Function, Body Structure,
Impairment
•
Body functions are the physiological functions of
body systems, including psychological functions.
“Body” refers to the human organism as a whole,
and thus includes the brain.
•
Body structures
a
re the structural or anatomical
parts of the body such as organs, limbs and their
components classified according to body systems.
•
Impairment is a loss or abnormality in body
structure or physiological function (including
mental functions).
Activity and Activity Limitation
•
Activity is the execution of a task or action by
an individual.
•
Activity limitations are difficulties an
individual may have in executing activities. An
activity limitation may range from a slight to a
severe deviation.
Participation and Participation
Restriction
•
Participation is a person's involvement in a life
situation. It represents the societal
perspective of functioning.
•
Participation restrictions are problems an
individual may experience in involvement in
life situations.
Contextual Factors
•
Contextual factors (personal and environmental
factors) are the factors that together constitute
the complete context of an individual’s life.
•
Environmental factors constitute a component of
ICF, and refer to all aspects of the external or
extrinsic world that form the context of an
individual’s life and, as such, have an impact on
that person's functioning.
•
Personal factors are contextual factors that relate
to the individual such as age, gender, social
status, life experiences and so on.
Aims of ICF
•
to provide a scientific basis for understanding and
studying health and health-related states,
outcomes and determinants;
•
to establish a common language for describing
health and health-related states in order to
improve communication between different users,
such as health care workers, researchers, policy-
makers and the public, including people with
disabilities;
•
to permit comparison of data across countries,
health care disciplines, services and time
Strengths and Limitations of ICF
•
Strength:
–
Non-reductive in theorizing disability
–
Universality-ICF is about all of humanity; it is not a
classification for or about a particular group of
people
•
Limitations:
–
Lack of specificity and clarity to what activity and
participation constitute.
–
Offers no account of how or
why
disability comes
about
Social Constructionist Version of
Disability
•
There is no inherent meaning of disability
other than ones assigned by a community.
•
Thus, disability only emerges once it has been
interpreted.
•
even the most observable disorders such as
visual impairment, are no more than cultural
and linguistic expressions which do not have
existence by their own and independent of
culture and society.
Social Constructionist Version (cont)
•
Disability is an elastic social category which is
formed and reformed by public policy and
professional practice, and underlying them, by
societal arrangements and cultural values.
•
Consequently, the attributes of disability
varies across cultures ranging from negative
discrimination, acceptance, and to positive
attribution of supernatural powers and hence,
disability is hardly a unitary concept.
Critiques
•
Critiques argue that social constructionist
version of disability is by far divorced from
reality because of which has brought no
meaningful effect in the lives of PWDs.
•
Moreover, as critiques argue, it is not at all
useful for advocacy strategy as well as service
provisions for PWDs facing barriers and
discrimination and who are in need of our
intervention
The concept of disability is explored through moral/religious, medical, and social models. Impairment refers to a loss or abnormality in structure or function, while disability is a restriction in performing activities. The discussion also delves into the significance of person-first language and the moral/religious model attributing disabilities to sin or supernatural causes.
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Presentation Transcript
Models of disability Moral/Religious, Medical, and Social Models of Disability
Impairment Impairment is lacking all or part of a limb, or having a defective limb, organ or mechanism of the body (UPIAS, 1976). refers to "any loss or abnormality of psychological, physiological or anatomical structure or function" (WHO, 1980).
Disability Disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being (WHO, 1980) Disability is 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 participation in the mainstream of social activities (UPIAS, 1976).
Labelling Those who are in favor of the principle of people/person-first language (those who support the phrase persons with disabilities ) argue that it is essential to recognize that individuals are people first, and that disability may be just one of a person s characteristics, not the overriding characteristic of the individuals.
Labelling (cont) However, many scholars in disability studies in the UK assert that person-first language implies that disability is located within individuals rather than a societal construction. Such scholars contend that disabled people are not people with disabilities, rather, they are people who are disabled (disadvantaged) by society s response to their differences . Thus, they use disabled persons in referring to these group of people.
Moral/Religious Model The moral/religious model represents the oldest and also the most pervasive framework for understanding disability. By promulgating the belief that impairments are the result of sin, witchcraft, the evil eye, the wrath and judgment of God/gods or an ancestor s anger, religions have sought to regulate and control the behavior of their adherents through fear and the threat of supernatural punishment.
Moral/Religious Model (cont) Shared by most cultures throughout the world, this model is evident in all the major religions. In the Old Testament, disabled people were regarded as unclean . Characteristics that would keep a priest from the temple included being blind, being lame, having a malformed foot or a misshaped hand, being a dwarf, or having a broken bone.
Disability in Hinduism and Buddhism Hindu mythology portrays impairments in extremely negative terms: as flaws or deficiencies that must be endured to repay past sin; associating impairment with deceit, mischief and evil. Buddhism teaches that impairments constitute a form of educational rebirth for wrong conduct in previous incarnations.
Positive Implications Judeo-Christian religious tradition offers many lessons on the dignity and worth of persons with disabilities. Moses had a significant speech impairment. God implied, in choosing Moses as a leader, that some people with disabilities are worthy and capable of leadership. When Moses remained unconvinced, God provided what we might today term "reasonable accommodation" in Aaron to help Moses speak to his people.
Medical/Individual Model Commonly referred to as either the medical model or the individual model of disability, this model is the most well-known understanding of disability both by the general public and professionals throughout the modern history of societies This model is rooted in the scientific method of medical science with a belief that science could solve any problem.
Basic Characteristics of the Medical Model The focus of the problem of disability exclusively centers on the individual with the disability; not on the environment Biological impairment is the fundamental starting point and disability is interpreted according to an epidemiological standpoint Profound reliance on the knowledge and skills of professionals for solutions and intervention to problems
Basic Characteristics of the Medical Model (cont) Making its focus on functional limitations and their effects on daily living activities, the medical model seeks preventing, curing, perfecting, eradicating the physical or mental dysfunction, normalizing the abnormal through treatment, or when these goals fail to achieve, caring for disabled people.
Basic Characteristics of the Medical Model (cont) In sum, the medical model regards disability as a problem of the person, directly caused by disease, illness, injury, or other forms of health issues, which require interventions/treatments provided by medical and other professionals with the aim of curing, or bringing about behavior change or one s adjustment to the environment.
Criticisms For their individualization , medicalization , professionalization , and objectification of disability, the individual perspectives are severely critiqued by scholars and activists in the field of disability.
Consequences of the Moral/Religious and Medical Models Manifestations of the disadvantages of the moral/religious and medical models Containment limiting the choices, exposure, and life experiences of disabled persons, as well as the opportunities for disabled persons to fully participate in society, and may be geographical, psychological, or social; Expendability the feeling that the lives of people with disabilities are expendable (they are better of dead);
Consequences (cont) Compartmentalization (the stereotyping of PWDs, or placing them in predetermined categories); Blaming the victim (believing lives of PWDs are limited because of their disabilities or lack of pluck); and Denial of disability (either PWDs pretend as they were not disabled or redefined obvious disabled attributes in a nondisabled fashion).
Social Model of Disability The root of the social model of disability is traced in the political action of disability rights movements in the UK in the 1960s through the 1990s and civil rights movements in the US in the 1960s and 1970s. However, this model is often referred to as the minority group model in the US and caused the independent living and civil rights movements of PWDs there.
UPIAS In 1976, the British Union of the Physically Impaired against Segregation (UPIAS) published its manifesto under a title Fundamental Principles of Disability from which the social model of disability had originated. In 1983, Mike Oliver introduced the term social model and added a research perspective on what UPIAS proposed.
The Social Model Interprets disability is all the things that impose restrictions on disabled people (through individual prejudice, institutional discrimination, inaccessible public buildings, unusable transport systems, segregated education, and excluding work arrangements) therefore, claims that disability is a particular form of social oppression that takes place in a disabling society, and the disabled constitute amongst the group of oppressed population
The Social Model (cont) hence, take disability not to be something wrong with an individual, rather, disability is something wrong with society consequently, call for social reform or change in the hostile socio-political environment which is disabling people with impairments.
Impairment and Disability in the Social Model An inability to walk is an impairment, whereas an inability to enter a building because the entrance is up a flight of steps is a disability. An inability to speak is an impairment but an inability to communicate because appropriate technical aids are not made available is a disability. An inability to move one s body is an impairment but an inability to get out of bed because appropriate physical help is not available is a disability (Morris, 1993, as cited in Barnes, 2003, p.17).
Impacts of the Social Model Adoption of various international declarations and conventions which are concerned with the issues of the disabled The global expansion of community-based rehabilitation programs The introduction of a number of anti- discrimination laws at national levels throughout many countries in the world The worldwide push for inclusive education
Critiques of the Social Model Focusing too much on persons with physical disabilities Neglecting of impairment as an important aspect of many disabled people's lives and underemphasizing problems related to medical or clinical conditions The analogy of disability with gender and racial oppressions The social model is an urban model of disability The concept of the barrier-free utopia
ICF On their own, neither the medical/individual model nor social model is adequate. Both are partially valid and hence, we cannot wholly reject either kind of intervention. ICF thus is a bio psychosocial model-an integration of medical and social models. Disability is a complex phenomena that is both a problem at the level of a person's body, and a complex and primarily social phenomena.
Functioning and Disability In ICF, disability and functioning are viewed as outcomes of interactions between health conditions (diseases, disorders and injuries) and contextual factors. Disability is always an interaction between features of the person (the person with a certain health condition) and features of the overall context in which the person lives.
Functioning and Disability (cont) Functioning is an umbrella term for body functions, body structures, activities and participation. It denotes the positive aspects of the interaction between an individual (with a health condition) and that individual's contextual factors (environmental and personal factors). Disability is an umbrella term for impairments, activity limitations and participation restrictions. It denotes the negative aspects of the interaction between an individual and his/her contextual factors
Body Function, Body Structure, Impairment Body functions are the physiological functions of body systems, including psychological functions. Body refers to the human organism as a whole, and thus includes the brain. Body structures are the structural or anatomical parts of the body such as organs, limbs and their components classified according to body systems. Impairment is a loss or abnormality in body structure or physiological function (including mental functions).
Activity and Activity Limitation Activity is the execution of a task or action by an individual. Activity limitations are difficulties an individual may have in executing activities. An activity limitation may range from a slight to a severe deviation.
Participation and Participation Restriction Participation is a person's involvement in a life situation. It represents the societal perspective of functioning. Participation restrictions are problems an individual may experience in involvement in life situations.
Contextual Factors Contextual factors (personal and environmental factors) are the factors that together constitute the complete context of an individual s life. Environmental factors constitute a component of ICF, and refer to all aspects of the external or extrinsic world that form the context of an individual s life and, as such, have an impact on that person's functioning. Personal factors are contextual factors that relate to the individual such as age, gender, social status, life experiences and so on.
Aims of ICF to provide a scientific basis for understanding and studying health and health-related states, outcomes and determinants; to establish a common language for describing health and health-related states in order to improve communication between different users, such as health care workers, researchers, policy- makers and the public, including people with disabilities; to permit comparison of data across countries, health care disciplines, services and time
Strengths and Limitations of ICF Strength: Non-reductive in theorizing disability Universality-ICF is about all of humanity; it is not a classification for or about a particular group of people Limitations: Lack of specificity and clarity to what activity and participation constitute. Offers no account of how or why disability comes about
Social Constructionist Version of Disability There is no inherent meaning of disability other than ones assigned by a community. Thus, disability only emerges once it has been interpreted. even the most observable disorders such as visual impairment, are no more than cultural and linguistic expressions which do not have existence by their own and independent of culture and society.
Social Constructionist Version (cont) Disability is an elastic social category which is formed and reformed by public policy and professional practice, and underlying them, by societal arrangements and cultural values. Consequently, the attributes of disability varies across cultures ranging from negative discrimination, acceptance, and to positive attribution of supernatural powers and hence, disability is hardly a unitary concept.
Critiques Critiques argue that social constructionist version of disability is by far divorced from reality because of which has brought no meaningful effect in the lives of PWDs. Moreover, as critiques argue, it is not at all useful for advocacy strategy as well as service provisions for PWDs facing barriers and discrimination and who are in need of our intervention
