As indicated in the introduction, recent writings on disability have suggested that it has been understood in two mutually exclusive ways which have been termed the medical and the social models of disability. The debates that have ensued have been most visible in the UK and the following discussion therefore concentrates on those debates. It should be noted however that whilst it has been argued that two distinct formulations of the causes of disability exist, the medical model has in fact been defined by writers who advocate a social model of disability. This necessitates an understanding of the historical genesis of the social model as it is presently understood. It is also important to recognise that there is no single definition of disability. Different countries define disability differently. For example, in the USA some view disability as a functional requirement of ‘the disability business’ (Albrecht 1992) whereas in the UK some argue that disability is largely regarded as a personal tragedy caused by impairment (Oliver 1990).
The first part of this chapter reviews the different models of the causes of disability, their genesis, and how they have been embedded in research on disability. The second part examines different approaches to achieving equal opportunities for minority groups as illustrated in the work of Jewson and Mason (1986) in order to determine whether the same approaches are applicable to disabled people.
Models of disability
In the mid 1960s arguably the most influential challenge to the dominant
understanding of disability came from disabled people living in a Cheshire Home. Cheshire Homes are residential institutions which “care” for disabled people who are deemed unable to care for themselves. In one of these homes, the residents rejected advice from medical experts Miller and Gwynne from the Tavistock Institute, who were making decisions for these disabled people regarding the running of their lives (Miller & Gwynne 1972). Briefly, the disabled residents were seeking more active participation in the running and decision- making processes which affected their lives despite expert medical advice which suggested that decision-making should be in the hands of non-disabled professional carers as the most appropriate means of continued support. This led to the questioning of expert medical advice by many disabled residents and the formation of a resistance movement calling itself the Union of the Physically Impaired against Segregation (UPIAS). UPIAS was created as an
organization run and controlled by disabled people to promote independent living (Finkelstein 1991; Oliver 1990).
Later to become a member of UPIAS, Hunt (1966) wrote a paper which details the personal experience of disability and laid the foundations for a social model of disability. Hunt argued that disabled people were perceived as ‘unfortunate, useless, different, oppressed and sick’. He suggested this was because people with
impairments were perceived by the able bodied to be incapable of benefiting from modern society in terms of material goods and social inclusion. This was due, Hunt argued, to the central and key role that work played in Western culture. Disabled people were viewed as ‘useless’ because they were considered to be incapable of
contributing to economic prosperity. This in turn, enabled a non-disabled majority to stigmatise disabled people as a minority group. Hunt argued that disabled people represented everything that the able bodied feared: ‘tragic loss, dark, and the unknown’ (155).
Hunt’s (1966) analysis can be seen as the catalyst for the formation of a disability movement which challenged traditional understandings of the causes of disability by using phenomenological accounts.For example, in his book Stigma, Hunt (1966) drew on the experiences of several disabled people thus challenging traditional methods of research that constructed disabled people as ‘objects’. Hunt promoted the idea of disabled people as knowing subjects, capable of interpreting and determining the causes of their disability.
In a similar vein, Alan Sutherland (1981) advanced the concept of disability as
socially constructed through an analysis of the exclusion of the disabled from working life; the problems of access, and the role of stereotyping in the social scripting of a ‘disabled role’. Following in this tradition of personal narrative, Jenny Morris (1989, 1991) related the effects of spinal injury for disabled women. These authors
confronted the conventional view of disabled people in a ‘sick role’ (Parsons, 1951) where the consequences of impairment as an individual attribute were regarded as the cause of disability. Parsons further notes that disability constructed in this way is a condition that has come to be regarded as abnormal in westernized industrial societies.
Against a wider background, the disability movement could be regarded as an
movement in the USA (Dejong 1983; Oliver & Zarb 1989, 231). Hence it can be argued that the disability movement paralleled feminist and anti-racist movements in a fight against the ideological use of biological determinism and drew on experiential knowledge to challenge dominant theories of gender and ethnic differences.
Although the impetus for the disability movement came from personal experience, the origins of a theory to explain the challenge to dominant formulations of disability came from another disabled person and academic, Vic Finkelstein. Finkelstein (1980) reflected on the causes of disability and argued that they could be linked historically to the move towards industrialisation in Western society. In developing his thesis, Finkelstein considered history in three distinct phases. The first he classified as a feudal period which occurred prior to European industrialisation. Here, economic activity within society was to a large extent agrarian and cottage based; a means of production, he argued, which did not exclude impaired people. In phase two, industrialisation occurred and resulted in impaired individuals being excluded from work. In most cases, this was because they could not work at the rate demanded by the new industrial systems. This led to the marginalization of people with
impairments as they were excluded from social and economic activity. Many who fell outside the efficiency demands required by the new industrial systems were placed in residential institutions. The third stage, Finkelstein argued, would see the
emancipation of people with impairments from these oppressive systems by the use of technology and the assistance of helpers and allies.
Finkelstein’s analysis has been criticised for its over simplistic consideration of the means of production and its excessive optimism about the ability of technology and unspecified ‘allies’ to liberate disabled people (Barnes 1990, 1997; Oliver 1990;
Meekosha 1998; Roulstone 1998). The critique most relevant to this research was developed by Roulstone who considered the relationship between disabled people, technology, and work. He argued that the primary use of new technology, rather than offering an unproblematic means of emancipation may, paradoxically, individualise disabled people. He highlights terms including ‘augmentative’ or ‘compensatory’ technology, which he suggests can have the effect of constructing the ‘language’ of new technologies, placing the individual’s impaired body as the focus of employment problems. Hence for Roulstone, the technological paradox enables individual
disabled people to benefit from technology although this may be at the cost of accepting that technological remedies are based on correcting individual deficits and thus reinforcing the traditional understanding that disability is caused by an
individual’s impairment.
Although Finkelstein’s analysis has been criticized, his work has formed the basis of perhaps the most influential writings on disability to date in the UK. Oliver (1990) provided a more comprehensive analysis of the implications for disabled people of the transition to capitalism in Western society. He produced a materialist analysis which provided a focus on the social construction of disability as ideological. For Oliver, economic progress brought new and changing perceptions of society and problems of maintaining order which had epistemic effects that altered the perception of
impairment. Oliver maintained that an important consequence of industrialisation for disabled people was the institutionalisation of social care and control. This, together with the increasing tendency under an emergent capitalist system to individualize and search for medical/psychological solutions to `cure’ social problems (see for example, Rose 1985) led to an increase in medical intervention for individuals with
Oliver considered this ‘personal tragedy theory’ of disability to be a form of ideological hegemony as it has now become incorporated into everyday belief systems and assumptions which are considered to be common sense. The following chapter will consider in detail the concepts of ideology, hegemony and common sense used by Oliver. However, in this chapter the implications of Oliver’s personal tragedy theory and the ways in which it underpins the two opposing models of disability will be considered.
The essence of the two model dichotomy is founded in an historical understanding of impairment as the root cause of disability; a view that is encapsulated by the medical model. Many advocates of the social model of disability which contends that
disability is caused by oppressive disabling societies (Swain et al 1993) provide evidence to support their claims through a critical analysis of the mechanisms that have been used by government and other institutions (notably medicine and
psychology) to determine the nature of disability. Although Oliver was influential in providing an alternative framework to the dominant ideology of disability as a ‘personal tragedy’ the actual writing of a social model of disability was provided by other disabled authors.
The original definition of a social model of disability was contained within the UPIAS document: The Fundamental Principles of Disability (UPIAS 1976). Within this text and many early analyses of ‘disability’ (Brisenden 1986; Finkelstein 1980, 1981; Hunt 1966; Oliver and Zarb 1989), emphasis was placed on the relationship between physically impaired people and their social environment. Two factors were seen to be important in defining disability: the built environment – which was seen to be
people towards others with impairments. Taken together these two factors, it was argued, caused disability (Barnes 1990; Finkelstein 1980; Oliver 1990). Whilst this was initially based on the experiences of physically impaired people, the model was refined to accommodate all forms of impairment.
The inclusion of all forms of impairment gave additional political force to a challenge to the historical oppression of disabled people, by using the concept of a mass
political movement (Campbell and Oliver 1996). Throughout this thesis, the
definition of the social model of disability will be taken from this more inclusive later model (Swain et al, 1993). Within this model impairment is defined as ‘the lack of part or all of a limb, organ or mechanism of the body’ (Finkelstein and French 1993, 28), and disability is defined as:
The loss or limitation of opportunities that prevents people who have impairments from taking part in the normal life of the community on an equal level with others due to physical and social barriers. (Finkelstein & French 1993, 25)
This social model aims to remove any causal association between impairment and disability. In other words impairment itself is not seen to cause disability. However, one difficulty which arises in attempting to break the link between impairment and disability occurs because social model theorists have generally failed to theorise the nature of impairment. As a result this task has generally been left to medical experts; arguably, this is not a politically astute position (Hughes and Paterson 1997). Hence the model is weighted towards an analysis of disability only, which is largely
accounted for by environmental and social attitudes that discriminate against impaired people.
universally to all forms of impairment have been acknowledged by some in the disability movement to be problematic. In the cases of learning impairment (Chapell, 1996), visual impairments (French 1993), and hearing impairment (Corker 1996) there is an acknowledgement that such impairments do, to varying degrees, cause social disadvantages that may be difficult to overcome simply by altering
environments and disabling attitudes. It is difficult to see how the social model could help a blind person, for instance, who wishes to participate in a visual art exhibition, unless visual art itself is defined as a discriminatory form of expression. The social model remains silent about the stubborn fact that the blind person is disabled by their inability to participate fully because of an individual lack of visual ability. It can be argued with some force that no degree of environmental or attitudinal change would allow the full subjective experience of visual arts to be accessed by a blind person. Although a co-author of the social model, Sally French (1993, 22) acknowledges this inherent problem but nonetheless she supports a homogenised concept of disability, arguing that the political strength of the model will be weakened if divisions between impairment specific groups are allowed to surface.
In summary, the medical model of disability suggests that disability is rooted in the individual impaired body. In order to remove the disability it is necessary to repair the impairment. In contrast, the social model suggests that there is no necessary link between impairment and disability and that there is no logical reason why someone who has an impairment should experience it as disabling. Disability is a social construction generated by the social environment and social attitudes of people who have no experiential knowledge of impairments. It follows from this perspective that disability can be removed if changes to the environment and social attitudes can be achieved.
The following section will review the ways in which both models achieved historical legitimacy alongside a burgeoning welfare state as governments found it increasingly important to determine the size of the disabled population in order to enable the budgeting and delivery of services to those disabled people in need of support.
The quantification of disability: reinforcing a medical model
For the purposes of this analysis, the discussion will be restricted to the post Second World War period. This restriction has been made because this time period became one in which the quantification and measurement of the disabled population received more government attention than ever before. The after effects of the Second World War forged a relationship between the impaired body and work. Two pieces of legislation called for quantification and measurement systems to ensure the target population of the legislation was clearly defined.
The 1944 Disabled Persons Employment Act (DPEA) introduced, to a limited degree, the necessity for a quantification of impairment (Ministry of Labour 1946c).
Additionally, the 1948 National Assistance Act (NAA) obliged local authorities to compile registers of all disabled people in their communities, to provide employment (where appropriate) and recreational services. However, these Acts operated under separate bureaucratic domains (the Departments of Employment and Health
respectively) with little communication or sharing of information between the two departments (HMSO, 1973).
It was not until the 1970s that a uniform approach to the classification and quantification of disabled people occurred. This was partly a result of the Local Authority Social Services Act 1970. This Act created integrated social services
Act 1970 to monitor and provide welfare services for severely impaired people in their communities. This duty provided the impetus for the first of two official surveys of disabled people in the UK (Bury 1996; Harris et al 1971a, 1971b) conducted by the Office of Population Census and Statistics (OPCS). It was the quantification methods used in the OPCS surveys which drew much criticism from a number of disabled people who argued that quantification methods reinforced the medical, personal tragedy theory of disability (Abberley 1991; 1992; Barnes 1991; Oliver 1990; Shakespeare 1994). The following review considers both OPCS surveys and details how the authors concluded that this method represented a historical continuity and a reiteration of disability as an individual medical deficit.
The first OPCS survey
The first OPCS survey considered a limited definition of impairment and its effect on handicap (Harris et al 1971a, 1971b). Harris's work primarily investigated people with physical impairment - lacking or limitation of limb function - and how such
impairment affected interactions in the social world. The Harris survey was
underpinned by an ontological understanding ofimpairment as the cause of functional restriction of the body which consequentially led tothe social disadvantage of
handicap. It categorised impaired people into one of four groups depending on the level of handicap they experienced. Adoption of this simplistic device, however, excluded people with sensory impairments or mental health problems (Abberley 1991, 1992; Bury 1996).
However, a need for linguistic clarity and accuracy became apparent, as there was confusion about the terms used in the Harris survey where concepts were often employed interchangeably, for example, impairment and handicap (Bury, 1996). In
fact, impairment is located in the corporeal body whereas handicap was defined as the social disadvantage faced by impaired people. So, if a person is referred to as
‘handicapped’ rather than impaired, then the social disadvantage becomes a personal attribute in addition to impairment. Hence the problem becomes a personal medical condition in which sight is lost of the social cause of handicap.
Subsequent research (Topliss, 1979) also found the use of terms problematic. For Topliss, ‘disability’ was often appliedinaccurately especiallywhen considered against other terms such as ‘disease’ which is more certain in meaning. Disease may have social or environmental causes but inevitably symptoms manifest themselves within the body. In part, as an attempt to end these terminological ambiguities, the World Health Organisation (WHO 1980) developed a health focused taxonomy (Bury 1987): the International Classification of Impairments, Disability and Handicap (ICIDH).
The ICIDH defined disability and its correlates into a three stage model; it was this model which represented an exemplar for the medical model of disability for many disabled people (Bury 1996; Pfeiffer 1998; Shakespeare 1994). As illustrated above, the Harris survey utilised a two-stage model incorporating physical impairment and handicap (Harris et al 1971a, 1971b). Perhaps the most significant feature of the ICIDH was to expand the concept into a three stage model of disability. These stages were impairment, disability and handicap, and were defined as:
Impairment: Any loss or abnormality of psychological, physiological, or anatomical structure or function.
Disability: Any restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.
(WHO 1980 cited in Shakespeare 1994, 112-14)
Within this three-stage relationship, impairment is rooted in the corporeal body; disability is a limitation in activity (such as an inability to walk) caused by the impairment; and handicap defines social or cultural disadvantage caused by either impairment or disability. For some, principally those committed to a social
constructionist account of disability, fixing all three elements in relation to impairment reinforced a dominant medical model which they felt had historically oppressed disabled people (Campbell & Oliver 1996; Finkelstein 1993; Oliver 1990).
In defining impairment the ICIDH appeared to take a rather simplistic approach, categorising every ‘normal’ human condition and then assuming its opposite was impairment (Shakespeare 1994). To illustrate this, some of the conditions that were