Proponents of the social model, intent upon foregrounding oppression as the defining (indeed, exclusive) feature of disability, unwittingly were directing their movement towards a "somatic impasse". Although the social model had been conceived in diametric opposition to the "traditional" medical model, the disability-impairment binary at its centre – and so dear and elementary to its authors – inadvertently buttressed the exclusive mandate of medicine to "management" of impairment. By asserting – impetuously, to some – that "disability" is purely social, the social model's logic relinquished "impairment" to the realm of the purely
biological (Hughes, 2002a, p. 67; Thomas, 1999a; 2002b). In so doing, the social model
aligned itself with Cartesian medicine's view of the body as "a domain of corporeality untouched by culture" (Hughes, 2002a, p. 67). Impairment, therefore, was to become viewed within this philosophical position as a "reality" which has an existence independent of the cultural milieu in which it arises (Marks, 1999a, p. 17), recapitulating biomedicine's model of
the body as (nothing but) a "faulty machine" (Hughes & Paterson, 1997, p. 329). The irony evident in the profound convergence of the social model with a biomedical view of corporeality, in reproducing the problem of mind-body dualism, is, indeed, remarkable. The model tacitly concurs with traditional medicine, in constructing the body as a "pre-social, inert, physical object, as discrete, palpable and separate from the self ..." (Hughes & Paterson, 1997, p. 329). The construct, the conceptual space, of disability offered by the social model, thus was – and is – a disembodied one.
A further irony surrounds the extent to which the sociology of disability – in the form of the social model – has, over recent decades, been elaborating itself in an epistemological direction which markedly opposes the broader currents of sociological theory (Hughes, 2002a, p. 59). During an era in which paradigms such as post-structuralism and phenomenology have sought to assail traditional enlightenment dualisms, the social model has instead propounded a framework of irreducible polarities – the body and society, medicine and politics, therapy and emancipation, pain and oppression, and, of course, impairment and disability (Hughes & Paterson, 1997, p. 330). The need for such "clean" conceptual splits emanated from the social modelists' drive to stridently dissociate their orientation from the "murky" and "disablist" vagueries of medical sociology. But in doing so, these writers created a seemingly insurmountable obstacle to their own potential development of any sort of sociology of impairment (Hughes, 2002a, p. 59). A most dramatic contrast to this conception is provided by Susan Bordo (1993); for her, the body is everything but a stable or acultural constant. Instead, culture is always, a priori, inscribed upon and penetrated through the "living" of our bodies; there is no "natural" body – instead, "natural" is "the script of culture writ large on the body" (Bordo, 1993 cited in Michalko, 2002, p. 58). Far from the abandonment of the corporeal evidenced by the vanguard of disability studies, in other arenas of social and political conflict and turmoil, the body has become ever more the site of engagement (Hughes & Paterson, 1997, p. 327). Hancock et al (2000) paint the scene thus:
Meanwhile the body was making itself ever-present in social and political life, be it in the shape of a battered woman, a terminated foetus, a victim of torture or televised war, a proud celebration of womanhood, disability, colour or homosexuality, an organ in transit for transplantation, a human-machine stepping on the moon, a sample of DNA under the microscope, a man who was a woman or vice versa, a body transformed by diet, exercise or the surgeon’s knife, a homeless person camped on the streets of the world’s richest nation, a mass grave, another world record smashed.
But astonishingly, for disabled persons within the ambit of the social model's analysis, the living, breathing body had vanished; in its place, a "timeless, ontological foundation" (Hughes & Paterson, 1997, p. 327). The impaired body, notwithstanding its purported immersion in forces of oppression, remained itself a "dysfunctional, anatomical, corporeal mass obdurate in its resistance to signification and phenomenologically dead, without intentionality or agency" (ibid.). As Hughes (2002a, p. 66) timeously comments, the preoccupations of disability studies were with the "realities" of furthering the cause of disabled people via political means, rather than with the intricate conceptual trifles of aligning body, mind and society in some form of satisfactory theoretical synergy. However, the implications of these priorities have left the lived experience of impairment adrift in an isolating limbo, between the control and invalidation of biologism, and the unwelcoming disdain of repressive populism.
Social model thinkers may defend their orientation by pointing to the fact that certain ideological analyses of impairment have, in fact, been developed within their framework. Here, primarily within the work of Paul Abberley (1987; 1996) and Mike Oliver (1996), the social origins of impairment are interrogated. Abberley (1996, p. 63) argues – quite correctly – that impairment of various forms always occurs within a certain historical and political context, which may contribute to its emergence, its exacerbation, or its amelioration. Thus, unsafe working conditions, the efficiency of health systems, access to appropriate vaccination, levels of public safety – these and a host of other contextual factors shape the incidence and consequences of impairment (Abberley, 1987; 1996). Whilst the context of factors implicated in bodily impairment is highly salient and deserving of critique, this analysis, however, falls massively short of creating a platform for the examination of impairment as a complex, embodied process comprising both societal and personal aspects. Instead, Abberley (1987) introduces the issue of the social underpinnings of impairment via a structuralist analysis, but then abruptly sets aside the resultant phenomenon of impairment as a reified, unproblematic and consensual "reality" (Paterson & Hughes, 1999, p. 599). The theoretical gateway to an exploration of the social and psychological nature and constitution of impairment experience, thus, remains firmly closed. Loyal to the social modelist penchant for separation, no possibility is proffered here for exploring disability and impairment as interpenetrating, mutually incorporated experiences (ibid., p. 598). For Paterson and Hughes (1999, p. 598), the "Cartesianised" subject fashioned by the social model's binaries eliminates the possibility of disabled people building an "emancipatory politics of identity" – one born of and based upon the delineation and mutual validation of the interwoven threads of cultural and corporeal existence.
One strategic exit route from the conceptual confusion of circumscribing what – and where – disability is, is provided by post-structuralist and social constructionist approaches, following the writings of Michel Foucault, and the traditions of postmodernism and epistemological relativism (Turner, 2001, p. 255). Within the post-structuralist universe, no direct perception of a unified "reality" of any sort is provided for; all that is available to our grasp are "versions" of our world (Marks, 1999a, p. 18). Consequently, this view holds that it is not just the slippery notion of disability, but also impairment, which is entirely an artifact of social construction (ibid.). The secure, stable ground of essential characteristics and intrinsic identities is left far behind, in favour of a subject composed of fluid, shifting and continually negotiated repertoires. From a social constructionist standpoint, the concepts and categories with which the world is delineated and dissected are viewed as entirely culturally and historically specific, arbitrary, and containing no inherent or transcendant robustness (e.g. Gergen, 1985). Disability researchers operating within this paradigm would seek to wrest control of "disability meanings" from positivist accounts, which incorporate a "western conception of objective, individualistic, ahistoric knowledge" (Gergen, 1985, p. 272). Such a re-alignment, which repositions disability as a social accomplishment rather than an inherent characteristic, embodies a valuable counterpoint to biological essentialism. Yet, within the critical constructionist view, it must be noted that all such accounts are equally illusory.
Whilst the view of disability as a product of society's organisation is shared by social constructionist approaches and the social model, the units of societal analysis prioritised by these orientations differ. The social model, identified by Priestley (1998, p. 80) as a social
creationist position, focuses primary concern on the structural "realities" of society's disabling
barriers. By contrast, a social constructionist agenda foregrounds the cultural representations of disability which predominate within a society, holding that it is the production and perpetuation of these meanings which provides the repertoire, the subject matter, for oppressed disability experience (ibid., p. 81). Of course, the principles of these and other approaches are not entirely mutually exclusive, but for the purposes of explication, it is helpful to contrast the essential leanings of each. Within a rigorously constructionist account of disability, the body is momentarily "rehabilitated" as a salient frame of discursive struggle – along with endless others – but then immediately engulfed by the imperatives of deconstruction, which evacuate it of any shred of non-contingent meaning (Turner, 2001, p. 254; Price & Shildrick, 1998; Thomas, 2002a). As noted earlier, a form of biological essentialism is, by default, acceded to via the social model's abstention with regard to the body. This essentialism, true to its positivist character, allows no scope for the unique
"living" of the disabled body. But the social constructionist perspective fails to balance the equation, instead replacing an arid biological essentialism with an equally depersonalising "discursive essentialism" (Hughes & Paterson, 1997, p. 333; see also Hacking, 1999). Instead of breathing life into the body, deconstruction dissolves the body into nothing more than the constituent cultural signifiers that imbue it (transitorily) with meaning (ibid.). Rosemarie Garland Thomson (1997a) takes a pragmatic, strategic view, which seeks to make the most of the interrogative and emancipatory potentials of both orientations. First, she argues, it is imperative to employ a "strategic constructionist" argument in order to launch a "denaturalising" assault on reductionist accounts which portray disability as bodily incapacity, substituting this with a critical and contextualised analysis of disability as the product of an interaction of bodily difference with a misattuned cultural environment (ibid., p. 282-3). Here, group delineation of the identity of "disabled" is unclear; an illusory product of ascribed, rather than inherent, identity characteristics. Second, Thomson advocates that this constructionist view be amalgamated with a "strategic essentialism", in order to affirm, to preserve, the historical reality of the disabled body. Embodied differences, such as the use of a wheelchair or living without sight, may thus be claimed and elaborated – both personally and collectively – by those who live them, rather than be left to the denigrations of a prejudiced society (ibid.). She explains the compromise:
Thus, a strategic constructionism destigmatises the disabled body, locates difference relationally, denaturalises normalcy, and challenges appearance hierarchies. A strategic essentialism, by contrast, validates experience andconsciousness, imagines community, authorises history, and facilitates self naming.
(Thomson, 1997a, p. 283)
Seminal work concerning the human experience of disease and disability within the social constructionist paradigm is that of the Foucaultian discourse analytic tradition (Foucault, 1976; 1995; Stiker, 1982). As alluded to above, notwithstanding the piercing social critique embodied in these investigations – notably surrounding the notion of normalisation – the discourse analytic view allows little conceptual space for exploring the nature of subjectivity, or providing for the possibility of individual agency (Whyte, 1995 cited in Turner, 2001, p. 255). In fact, on the nature of the everyday lived experience of the subjective world, discourse analysis is altogether silent – ruling out, in the words of Shakespeare and Watson (1995), the development of an "ethnography of physicality" (cited in Turner, 2001, p. 257).
In addition, whilst the "strategic essentialism" recommended by Thomson above does admit the body as palpable, the positivist biomedical realm which is its natural home is not well suited to an elaboration of the intricate threads of subjective embodiment. Thomson (1997a, p. 282) develops her position by positing a "universalising disability discourse", which, drawing on the feminist altercation with gender hegemony, asserts the body as a "cultural text which is interpreted, inscribed with meaning, [and] indeed, made within social relations of power" (my emphasis). The critique wrought by this assertion is crucial in the destigmatisation of "damaged" social identities, but it also tends toward obscuring the "real" material (lived) effects of those differences, simultaneously destabilising the very social identity categories with which we render oppressed experience collectively meaningful (ibid.). We are oppressed by the ascriptions of these categories (gender, race, disability), yet require their reificatory effects for the legitimation of our – otherwise groundless – experience, not to mention for the purposes of critical social analysis. In Thomson's (1997a, p. 282) words, "the post-structuralist logic that destabilises identity potentially frees marginalised people from the narrative of essential inadequacy, but at the same time it risks denying the particularity of their embodied experience". The complex implications of this predicament for the development of a cohesive disability movement – one able to attract clear identification from its constituency – will be considered in some detail later (see Identity
politics and the movement, p.191)
The (presumed) nature of "different" bodies is, doubtless, at the heart of the medicalising domestication of disabled persons; yet, the specific character of this embodiment seems an essential – an elemental – aspect of the lived reality of oppression, and, perhaps consequentially, of identity (Turner, 2001, p. 254). Deconstructing contested social categories will, to some extent, neutralise or obscure the political aspects of the material differences which they signify (Thomson, 1997a, p. 282). In reducing the body to a "phantasm" of collected representations, much of the self, the subjective life, of disabled individuals risks similar corrosive deconstruction. At the current point in history, the disability movement at large simply cannot afford to discard the category of disability as per the post-structuralist critique of identity (ibid.). Interestingly, a sector of the global deaf community has adopted this tactic, choosing, via the principles of deconstruction, to promote the community as a cultural and linguistic minority, whilst stridently disidentifying with the disability movement (e.g. Corker, 1994). From this standpoint, it is not only "disability" which is attacked as an arbitrary socio-linguistic product, but "impairment" as well. In sum, though, the scepticism expressed by a range of authors regarding the ultimately self-defeating
relativism, and lack of explanatory capacity, of a radically constructionist approach seems well founded (Thomas, 1999a, p. 117; 2002). Perhaps more significant, however, is the groundswell of (predominantly) feminist-oriented writings within disability studies which call for a simple, visceral – common-sense – return to the lived reality of bodies. As reflected upon in the previous section, "impairment", for these writers, is an essential aspect of disabled life, and must, therefore, be conceptually provided for.
Crow (1996) is vociferous in her critique of how the social model has marginalised the experience of impairment in her own life. She writes that the disability movement, under the auspices of the social model approach, has sought to portray impairment as "irrelevant, neutral, and, sometimes positive, but never, ever as the quandary it really is" (Crow, 1996, p. 208). For Crow (1996), this "glossing over" of that layer of subjective life which concerns impairment disguises the contradictions and complexity, the confusion and ambivalence, which are inevitably incorporated within the physicality of social life in an impaired body (ibid.). If pain, for example, is subjectively meaningful – and in psychological terms this seems incontrovertible – it must, therefore, also be culturally meaningful (Paterson & Hughes, 1999, p. 602). Within this socially mediated view of pain, its experience is not viewed as "physical sensation with additions of meaning, but as permeated with meaning, permeated
with culture" (Jackson, 1994 cited in Paterson & Hughes, 1999, p. 602 – my emphasis).
Hughes and Paterson (1997, p. 333) point to the sinister implications of social modelist "dumming down" of the lived nature of impairment, correctly observing that the bodies and impairments concerned are generated within a biomedical frame, hence offering "sovereign" control of the nature of impaired life to medical authority. Michalko (2002, p. 56) concurs, arguing that the social model's "naturalisation" of impairment embodies an impediment to the political conscientisation of disabled people. The social model, thus, offers no harbour to Crow's (1996) experience of "quandary"; instead, she finds her experience negated, and herself subjectively marooned. But Hughes and Paterson's (1997) alarms run still deeper; surely, in their analysis, a biomedical discourse which has had "free reign" over the realm of impairment would render bodies, and to some extent, subjective states, continuous with its categories – that is, "a particular genus of body with its appropriate signs, symptoms, behaviour and normative expectations" (ibid., p. 333). The challenge, then, for disabled persons such as Crow, is not simply to express her experience of impairment, but, first and
foremost, to find that experience amongst the control and debris of a socialisation steeped in a medicalising, depersonalising silence. Turner (1994) seems to hold hope for this endeavour, remarking that, in the postmodern era, the body is singular in its capacity to defy regulation – an arena in which desire will always, in some form, survive the subordinating onslaught of reason (Turner, 1994 cited in Hughes & Paterson, 1997, p. 327).
Thomas (1999a, p. 38) grounds the discussion by simply asserting that a layer of the everyday, palpable realities of impairment must remain irreducible to both medical and deconstructionist abstractions. "Surely", she writes, "it is obvious that some restrictions of activity are caused by limited physical, sensory or intellectual functioning?" (ibid.). This observation does not necessitate a corresponding value judgment placed upon the richness or worth of impaired life; instead, the path is opened to exploration of the multiplicity of ways in which life, with its ubiquitous hopes and dreads, may be lived and imagined (Wasserman, 2001, p. 222). Wendell (1997), with a candour disarming to constructionists and materialists alike, asserts that many, and perhaps most, forms of impairment draw upon the energy and stamina of the impaired individual, in a manner which may have a limiting effect beyond the confines of restriction in a particular (impairment-salient) area of activity (Wendell, 1997, p. 271). In a similar, if somewhat more conservative vein, French (1993a) has noted how parts of the lived implications of her sight impairment, whilst clearly having a social aspect, are not amenable to environmental modification – instead, these facets of impaired life occupy a "middle ground" between the social and the somatic (French, 1993a, p. 17). Shakespeare (2006, p. 56), in further elaborating his orientation as social model dissident, states, simply, that "people are disabled by society and by their bodies" – and, that it is "inescapable that some forms of impairments are more limiting than others". Arrival at such a seemingly self- evident conclusion might, to the less careful observer, belie the very real and complex political concerns which have caused the path thence to have meandered so. The location reached via this bewildering journey – a place where impairment may be re-admitted – is altogether different from the biomedical view which begins, and remains, within the reactionary territory in which physicality informs social status (Hughes & Paterson, 1997, p. 326). The social model, thus, is required to engage in a critique of its own philosophical – that is, dualistic – foundations, in order to provide for the now evident necessity of a body which is "part of the domain of history, culture and meaning" (Hughes & Paterson, 1997; 326). Whether the model is sufficiently robust to survive this interrogation remains a question upon which opinion is divided.
Thomas (1999a; 2002a) presents her own solution to the crisis by circumscribing the bounds of a "materialist ontology of impairment and impairment effects" – an ontology which is "neither biologically reductionist nor culturally determinist" (Thomas, 1999a, p. 125). She believes it to be feasible that these constructs be applied alongside the retained essence of the social model, within an "extended" social-relational approach. As noted earlier, her concept of "impairment effects" is defined as "restrictions of activity which are associated with being impaired but which are not disabilities in the social relational sense" (Thomas, 1999a, p. 43). These "effects" are "profoundly bio-social, that is, shaped by the interaction of biological and social factors", and "are bound up with processes of socio-cultural naming" (ibid.). Impairment, thus, becomes re-located at the juncture where biology and culture meet (Hughes & Paterson, 1997, p. 329). Disability and impairment, here, are not experienced as discrete entities, in "separate Cartesian compartments", but as part of "a complex interpenetration of oppression and affliction" (Hughes & Paterson, 1997, pp. 335-5). This view of the body as the very "stuff of human affliction and affectivity" as well as the subject and object of