Copyright Democracy, Disability, and Society Group 2003
Last week I wrote about the ‘medical model of disability’ – a way of understanding disability as being fundamentally a medical problem. I discussed my criticisms of it – I talked about how disability has shaped me and isn’t a tragedy, and about how the problems that really affect my life are often about the barriers placed in my way – not my body at all.
The social model of disability was designed to look at disability from an entirely different angle, and to focus on the things society prevents people from doing, not the things our bodies prevent us from doing. It does this because activism can change society in a way it can’t our bodies.
The social model
The social model of disability is a completely different way of understanding what it means to be disabled. It starts from the barriers disabled people face in the world and focusses its energy on dismantling them. The social model distinguishes between impairment and disability in a way that can be initially quite confusing.
It sees impairment as a defect, difference, or lack in function as compared to people society considers not to be disabled. This means that the fact that my legs don’t work is an impairment. So are my learning difficulties. The fact that I need glasses isn’t an impairment – because society has adapted itself to people with slightly poor needing glasses. Its definition for non-disabled includes people who need glasses, as long as they don’t have significant visual impairment.
It then defines disability as the additional limitations put on people with impairments. So I have the impairment that my legs don’t work, and I am being disabled when I try to go to a shop but it’s up a step with no ramp. The problem isn’t my legs not working, it’s the lack of ramp. People are being disabled when they’re passed over for a job because of a history of mental illness. I am being disabled by being expected to sit through a 2 hour lecture, rather than lots of short segments with breaks. People are being disabled when a promising treatment exists for their condition but they’re being denied access to it.
Some people would argue with me on that last one – they would say that the social model focuses on barriers that arise from peoples’ impairments, not on access to medical care. I believe that access to adequate medical care is very much a social model of disability issue.
When I needed a smear test, I couldn’t have one done at my local surgery because they didn’t have a a hoist to get me onto the bed. It was gently hinted that “did I really need a smear?” but I was lucky enough that they decided I did, and fought for me to be seen at a hospital where there was a hoist. When I had it, it came back abnormal, but luckily the repeat was normal. Many disabled people are barred from access to smear tests entirely – they’re told that their local surgery can’t meet their needs, so they won’t be receiving one. Here, disabled people are being asked to take on significant health risks in skipping a smear test; they’re facing barriers non-disabled people aren’t asked to face. This is an example of people with impairments being discriminated against – being disabled.
The process of being disabled is that of facing barriers that non-disabled people aren’t asked to face. Barriers that prevent people from participating fully in the world. The social model inherently encourages us to try to tackle those barriers and change the world – it’s a very activist model.
The social model has limitations. It’s relatively recent that it’s paid attention to another category: impairment effects.
Historically, the social model has always resisted the idea that there could be anything difficult about having impairments. This is because people have worried that if we talk about difficulties with impairments, people will start talking about treating those impairments, rather than removing the barriers that prevent us participating in the world. People have also worried that if we talk about the negative aspects of impairments other people will then say “see, we knew how dreadful it was to be disabled, the poor souls” and look at disabled people with pity, rather than looking at how to remove the barriers we face.
However, it’s important that we acknowledge that there can be difficult aspects of having impairments, in and of themselves. For example, my condition causes me quite a lot of pain. Being in pain is unpleasant. I would rather not be in pain than be in pain. Similarly, I have limited energy, and I would rather not have limited energy. This does not mean it’s dreadful or tragic to be disabled, but it does mean there are aspects of having impairments that can be hard – impairment effects.
The social model isn’t perfect. For example, in its original version, it doesn’t acknowledge the extent to which impairments themselves change, mutate, progress, flare, cause chronic illness and unpleasant symptoms, and relate back and forth to being disabled. This can get confusing. Being disabled can worsen your health. For example, I was forced into an inappropriate wheelchair to enter an inaccessible house, which has contributed to a worsening of my contractures.
I didn’t like the social model initially, because I felt like it undermined the importance of my own relationship with my body – it told me that being disabled wasn’t a bad thing, at a time when I struggled with it a lot. Only when I understood that the social model wasn’t about my relationship with my body but society’s relationship between people with impairments and a disabling world did I start to understand it.
In the same way as the ‘personal tragedy’ model is an application of the medical model of disability to peoples lives, the ‘affirmative model’ works as an application of the social model. It acknowledges that impairments are a part of who people are, and that although we should focus on eliminating barriers in a societal sense, we can also accept that having impairments and living in the world can be a part of who people are. The affirmative model would understand that even though I struggle with my impairments, they’re a part of who I am, and I like and am proud of being that person.
The social model works well in an academic context, and as a way of understanding service provision. For example, social care and benefits should be provided on an understanding that they are mitigating the impact of an inaccessible world. At the moment there’s a very charitable model – that we’re given these things because we’re needy and society is nice, when instead they should be given to us because we’re in an inaccessible world in which we can’t participate without those things.
It doesn’t always apply to the life of an individual so well – because it wasn’t designed to talk about how I relate to my body. It was designed to talk about how society relates to disabled people – and it does that very well.