Historically, biomedical sciences and social sciences worked in a manner that separated the academic focus on the physical body from the study of social processes. While there were clashes between the disciplines in regards to issues such as ‘nature vs nurture’, the biological determination was usually deemed most important, and so the biomedical sciences laid the foundation for disability policy, especially in regards to the Biomedical model of disability. The biomedical model of disability reflects modern essentialism which views certain phenomena as natural and biologically determined.
Therefore, the biomedical model of disability implies that a disabled person can be ‘fixed’ or ‘cured’. While some people are disabled by chronic illnesses, others are disabled not due to an illness, but also have chronic health conditions due to their disability. However linking disability to illness is problematic, because it leads to the medicalisation of disability, much like the biomedical model does, and thus leads to the view that disability is a personal misfortune in which a person suffers from a physical or mental health issue that can be fixed, cured, treated or prevented (Oliver 1990). The view of illness is that it causes someone to be incapacitated and unable to function at a level deemed socially normal or economically valuable, through associating illness to disability it perpetuates the myth that disabled people are incapacitated and devalues them socially (Amundson, 1992, pgs 113–14).
The devaluation of disabled people is evident across history and across cultures, with disabled people viewed as someone to be pitied, tragic or disposable, they are also more likely to face abuse and violence, though some societies credit disabled people has having special powers to heal, but this isn’t a dominant narrative.
The move to distance illness from disability is reflected by Clare (1999),
To frame disability in terms of a cure is to accept the medical model of disability, to think of disabled people as sick, diseased, ill people…. My CP simply is not a medical condition. I need no specific medical care, medication, or treatment for my CP; the adaptive equipment I use can be found in a computer catalog, not a hospital. Of course, disability comes in many varieties. Some disabled people, depending on their disabilities, may indeed have pressing medical needs for a specific period of time or on an ongoing basis. But having particular medical needs differs from labeling a person with multiple sclerosis as sick, or thinking of quadriplegia as a disease. The disability rights movement, like other social change movements, names systems of oppression as the problem, not individual bodies. In short it is ableism that needs the cure, not our bodies. (Clare, 1999 pgs 105–6)
However, in contrast to this biomedical approach, a separate approach was forming in the social sciences that challenged the biomedical model through a social-constructionist lens. The term social constructionism can be used quite broadly in the social sciences, and on a simple level is used to refer to social influences on an individuals experiences. More specifically, it is a term used for a particular paradigm, that assumes that, “reality is socially constructed” (Berger & Luckmann, 1966, pgs. 1).
The social constructionist approach led to the rise of the Social model of disability, which encouraged a rethinking and challenging of how society viewed the disabled body. It moved the discussion away from onotological or causation approaches to query the social reality that leaves a person disabled within society.
Constructionists consider knowledge and truth to be created by the mind and not discovered (Schwandt 2003). This doesn’t mean that realism isn’t consistent with constructionism because the belief in concepts being constructed doesn’t mean that they don’t relate to something tangible and real. Reality is linked to the subjective experience of every day life and incorporates how the world is understood by those in it rather than focusing solely on the objective reality of the natural world.
Steedman (2000) argues that most of what is known and what attempts at knowing that are done are attempts at making sense of what it means to be human compared to scientific knowledge which focuses on more objective facts. This approach helped to show the capacity of cultural discourses and social structures to define bodies and shape the lived bodily experience of disabled people, especially via hierarchies of bodies with some being preferred and seen as ‘normal’ and others as strange and ‘other’
The Social model suggested that whatever a persons ‘differences’ were from a socially defined ‘norm’, that persons ability to operate in society was determined by how that society recognised their needs and provided accessible and enabling environments, for example, if a person was in a wheelchair, did buildings in that society have ramps so they could be accessed by all? if not, the lack of a ramp was disabling to the person, and so the person despite their apparent differences from the social ‘norm’ were disabled by the society and not because of physiological issues.
It was moment filled with numerous challenges to the dominant view of marginalised groups and the disabled body, from debates on the biomedical models of causation, power and privilege over marginalised group and the ahistorical classifications of disabled bodies and bodies more generally.Attempts at approaching the embodiment of disability in disability studies has been contentious, and led to the countering of the medical model with the social model by activists.
The social model is according to Thomas (1999) not as simple as it might appear, and has two approaches and thus doesn’t provide a simple unifying model of disability.
Thomas (1999 pg 40) suggests that the first approach deals with the relationships of disabled people with able bodied people which manifests as oppressive practices and exclusion. The second approach views disability as the property of the disabled person, due to the restrictions they face due to social policies and practice. Both of these suggested approaches within the social model of disability deny that the body or embodiment is relevant to disability. This approach contrasts with the Biomedical approach that focuses on a problem or impairment in the body that needs to be remedied.
The Social model places the disabled person in a socio-material world in which the disabled person is acted upon or in which they can act against and resist, it involves the creation of a sense of self and that of ‘other’ within which disabled people fight for rights and equality, but it also exists as a sense of self and other for able bodied people and their rejection of those who do not meet societal ‘norms’. In both the body is a given, however it has no part in the subjectivity of the person as it merely acts as a flesh and blood vessel for the person disabled or able bodied to express themselves.
Postmodernism challenges the Social model, viewing it as exclusionary due to the ‘otherness’ and proposes an embodied subjectivity. Embodied subjectivity is reproduced and created via social interactions with other social-bodies. The body is no longer a stable entity, but something that is always growing and changing and materialises through discourse. Relationships with others are enacted not only through social interactions but bodily actions and interactions with each other leading to mutual constitutive effects on each other. Through this lens, disability is not the sole property of any person, but that it is much more than a mere imbalance of powers between the disabled and the able bodied. While modernist perspectives look towards the fight for rights, this post-conventional approach looks at the sense of self and how one orientates themselves within society is linked to the bodies of those around us.
Biomedical science has reached a point where it acknowledges social processes that produce bodily outcomes such as disease and injuries. Therefore biology and society are not separate entities nor are they able to add together neatly. This creates, as Roberts suggests, ‘co-construction’ of the biological and the social.
Social history has replaced biological evolution to become the main process that leads change in society, this doesnt return the conversation to ‘nature vs nurture’ because social history can be independent of physical bodies. Connell (2011 pgs 1370-1371) calls this social embodiment and it refers to,
“the collective, reflexive process that embroils bodies in social dynamics, and social dynamics in bodies.”
Connell believes that social embodiment has two sides, for example, disability is about how bodies participate in social dynamics, whereas impairment is about how social dynamics affect bodies. The key to understanding social embodiment is to understand the agency of bodies as material objects and their productive power in social relationships. Many issues that affect the body, such as ageing or fertility are considered important social processes, but they aren’t external to society. Berghs (2008) showed how variations in disability can lead to differing social practises, for example, in Sierra Leone those who had an amputated body reflected the national history of violence, their bodies had participated in the social dynamics of violence, and so the impairment of the amputation led to social aid schemes. In comparison, those who had an intellectual disability remained hidden from the public view and understanding. Unlike the amputation which could be understood via the social dynamics of violence, the intellectual disability could not be understood due to lack of visibility about how it participated in social dynamics, and therefore those affected where impaired by the social dynamics that caused it to be invisible.
Embodiment and Episodic Disabilities
The issue of disability and embodiment, and how it is approached and viewed via models such as the social model, is further complicated by disabled people who live with ‘episodic disabilities’ because those who have an episodic disability do not fit neatly into social categories for disability. In terms of the Social Model, if a person with an episodic disability had their ability to operate in society determined by how the society recognised their needs, it would be episodic, leaving them in a liminal phase between able bodied and disabled because they can’t fit neatly into one category as a sole identity. They are disabled, but they are also able bodied at times, this episodic reality can be oppressive as those with episodic disabilities struggle more to access benefits and assistance as required.The Biomedical model would view them as not well but not entirely sick either because they are not completely or always incapacitated by their disability. This presents the problem of those who are disabled being viewed as not disabled enough within the existing parameters of the biomedical model of disability for example, as Young (2000) explains about accessibility and accommodation in the workplace,
“… Disability is a matter of degree, and it is arbitrary where the line is drawn between not disabled enough to warrant accommodation, and disabled enough. A politics of resentment motivates some people to draw that line as far down the extreme end of the continuum as possible so that almost everyone will be legally expected to conform to the normal workplace demands.”(Young 2000, 171)
Overall, both the biomedical and social model are open to criticisms, and Thomas’s (1999) approach that dissects the social model into two distinct forms merits further examinations. However, the challenge of invisible, fluctuating disabilities within a model of disability remains.
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