disability and society

• defining disability

  "Disability is a complex and much debated issue pertaining to impaired bodies, social structures and processes. […] Disability should not be seen as a purely medical problem since many of the problems faced by disabled people arise as the result of the way that society is organised." (Watson, 2013:76)
• defining disability

   UN Convention on the Rights of Persons with Disabilities (2006) describes disability as ‘an evolving concept that results from the interaction between persons with impairments and attitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis with others.
• outcomes for those with disability in the UK:

  • less are degree holders as their highest qualification
  • more had no qualifications compared to non-disabled counterparts
  • 1/2 of working aged disabled people work as compared to >80% non-disabled
  • young disabled people have lowest median hourly pay
  • generally more likely to report poorer health: impaired memory, dexterity, stamina, fatigue, mental health
• increased rate of material deprivation.

  material deprivation rate is s the inability to afford some items considered by most people to be desirable or even necessary to lead an adequate life.
• why is learning about disability important?

  • Legal reasons …. It’s the LAW

  • GMC ethical guidelines

  • Also, to consider how difference can impact upon clinical practice and treatment and how we can work with disability in a helpful way 

  Understand one’s own stereotypes and how they may enter into practice
• what are the protected characteristics in the Equality Act 2010?

  •Age

  •Disability

  •Gender Reassignment

  •Marriage and Civil Partnership

  •Pregnancy & Maternity

  •Race

  •Religion & Belief (spirituality)

  •Sex

  •Sexual orientation
• ‘Bodies’ are central to so much that we do 

  Attitude: take the body for granted 

  Sociology/anthropology: the body is more than purely a physical/biological fact 

  2 key ’social’ aspects:

  ­1. Impact of environmental, cultural, social and political influences on the body (menopause in India, Japan and the US)­

  2. Body is shaped by dominant discourses (e.g. medicine)
• assumptions about disability

  1. disability is located in biology, it is a given

  2. disability is a medical issue, not a social one or the one relating to social identity

  3. having a disability means needing help and support

  4. when a person with disability has a problem, the assumed cause is due to an impairment

  5. the person with a disability is a victim

  6. disability is central to self concept, self definition

  7. disability is a fundamentally negative situation, resulting in a negative bias.
• Medical/Individual model of disability

  •Subject of disability written by professionals who work with, medically treat or study disability. Discourse heavily medicalised and care and treatment orientated.

  •Biological impairment key determinant of disability; deviation from ‘normal’ has ‘undesirable’ consequences; rehabilitation or adaptations facilitate ‘normal’ functioning.

  •Associated with ‘otherness’

  •identify and meet ‘needs’ of disabled individuals to ‘function’ in society.

  •Medicalisation of disability - ‘solution’ is curative and rehabilitative medical intervention.
• Critique of the medical model of disability

  • Abnormal physiology - what is ‘normal’ functioning?

  •Historically constructed classification systems (individual behaviour, bodily and cognitive functions). Normality is socially defined?

  •societal differences in functional efficiency (dyslexia important where numeracy/literacy needed for socioeconomic participation)

  •deviations called anomalous, not necessarily stigmatised (Micronesia: birth defect disabling if paired with speech/hearing impairments - social participation)

  •Biological reductionism: individual deficit without social context
• • Impairment refers to 'any loss or abnormality of psychological, physiological or anatomical structure or function’.

  • 'Disability’ - '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’.
• •Left-handedness: “Numerous theories throughout history have claimed that being left-handed causes developmental and immune disorders. It has also been said that left-handers die younger, have more diseases and are even considered inept. None of these theories have been proven” (Rohrich, 2001)

  •Deafness - impairment or culture (linguistic minority)?
• ‘social model’ of disability states that it is the way society is organised which is disabling, not a person’s impairments or medical diagnosis.
• ‘[I]t is society which disables physically impaired people. Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and excluded from full participation in society’ (Oliver, 1996: 33)
• •  Redefines disability as ‘social oppression’ 
  • Politicises disability: shift from biomedically dominated discourse to politics and citizenship. 
  • disability does not necessarily mean ill or suffering
  • break causal link between impairment and disability -> not the cause of socioeconomic disadvantage
  • highlight incompatibility of impaired bodies with social norms as problematic -> discriminatory from the able-bodied majority
  • restricted opportunities
• compare the medical and social models of disability

  here

  
• Critiquing the social model

  •Overemphasises the social, all issues stem form society

  •Changing society would eliminate disability

  •Proposing a separation of impairment and disability, proposes the separation of body and mind

  •Follows traditional, cartesian, western meta-narrative (body = machine), as a pre-social, inert, physical object, separate from the self

  •Morris (1991): denies the embodied experiences of pain

  • Ignores the ‘lived experience’ of impairment  ‘impairment means the experience of our bodies can be unpleasant or difficult’ (Crow, 1996: 209)

  • The continuum of impairments
• Integration of the medical and social models of disability

  •An appreciation of how biological aspects of disability interact with the social aspects

  •Disability is not a bit of both; rather, disability emerges out of various interweaving and interacting social and biological processes.
•  Eugenics – began as a scientific thought in the 1800s­1900’s Coupled with social Darwinism, advocating the improvement of human genetic traits through the promotion and repression of reproduction in line with desired traits, to control human evolution and development
• types of discrimination against disabled people

   (Dis)ableism - discrimination and prejudice against people with disabilities. 

  Social/economic – education and employment 

  Physical – access to built environment (housing, transport)

  • Cultural – language used/images of disability 
  • Behavioural – Hate Crime, abuse and violence, staring, lack of friendship and intimacy
• types of discrimination against disabled people 

  • (Dis)ableism - discrimination and prejudice against people with disabilities. 
  • Social/economic – education (segregation), employment (more likely to be unemployed)
  • Physical – access to built environment (housing, transport)
  • Cultural – language/images used -> medicalised, patronising, dehumanise (3 common presentations: tragic victim, sinister villain, super crip)
  • Behavioural – Hate Crime, abuse and violence (twice as likely to be victims of violent crimes), staring, lack of friendship and intimacy
• SUMMARY

  •The medical model locates causes of disability in the body

  •The social model sees the causes of disability as a form of social oppression and discrimination

  •Criticism of the social model have led to understanding disability as an interaction between the impairment and contextual factors

  •Disability correlated with discrimination and inequality, has impact on health

  •People with disabilities discriminated in different aspects of life

  • Main types of discrimination are social/economic, physical, cultural (language) and behavioural.