The social model of disability and framing disease II – Critiques on the social model of disability

Author: Berend Mul

This is the second post in a three-part series.

The social model of disability has been very successful within British and American disability studies as well as outside the academy. It has influenced national and international policies on disability in governmental and non-governmental organizations. Yet, notwithstanding these successes, the social model has faced various forms of critique in the last two decades. This critique is the subject of this second post in this blog series. The following inventory is by no means exhaustive, but it may point to the type of limitations of the traditional social model of disability in the twenty-first century. Both for the sake of transparency and to stay in line with the format of the medium of the weblog as such however, I will first briefly address my own thoughts on this subject.

When I originally encountered the social model of disability, my initial reaction was scepticism. It seemed a radical position to wholly separate bodily or mental impairment from its functional consequences and regard the later solely as the result of the way in which society and civilization have shaped the build environment and cultural attitudes. Impairment and disability instead seem intrinsically linked in complex ways. To me it seems that, as the British sociologist Tom Shakespeare (on whom more below) points out in his controversial 2006 monograph, “impairment is a necessary but not sufficient element in the disability relationship” (p. 45). If we accept this premise, to ignore one element (impairment) of this relationship and focus solely on the other (disability) can only serve to obscure both. To illustrate this coming from the field of medical history, to ignore a certain biological property of a disease, for example its potentially fatal outcome or its contagious nature, might make it difficult to explain the sociocultural attitudes towards said disease. The British philosopher and historian of science Nick Jardine has even introduced a theory of conceptual anachronism, to explore how it might be valuable to apply present-day categories to understand historical developments on the longue durée. In Jardines view, if historians limit their explanation of the past to the perspective and to the knowledge and categories that were available to the historical actors themselves, this also limits the potential of a critical and creative examination of the past. Only with knowledge ‘in hindsight’ – with knowledge external to the historical context – does it become possible to ask historical questions that actors in the past could not have thought off, and to recognise how earlier events related to later events and thus to chart longer term developments. Still, in order to avoid crude anachronisms and a ‘Whig’ interpretation of history, it remains crucial to pay close attention to the material, institutional, cultural context of the historical actors (Jardine, 2000; Jardine 2003; Jonker, p. 7).

Most critiques of the social model of disability have not come from historians of medicine however, but from medical sociologists and from scholars working in the field of disability studies itself. Firstly, early criticism arose from feminist scholars interested in disability, who argued that disability studies did not adequately theorise disability from a gendered perspective. In the 1990s similar arguments were put forth with regard to ethnicity, sexuality and class (Roulstone et al. 2012, p. 16). Perhaps noticing this trend, Bill Hughes and Kevin Paterson in an article published in 1997 voiced concern about the sharp delineation in the social model of disability between impairment and disability. The body as such, they argue, has become a key site of political and theoretical debates in sociology. In their view the conventional social model left sociologists of disability unprepared to join with this new ground of emancipatory identity politics, because it had largely ejected the body from disability discourse. It had separated impairment from disability and the body from culture, leaving the body and impairment (at least implicitly) defined in entirely a-historical, biological term – a body ‘devoid of history’. These separations, in Hugh and Paterson’s view, are untenable (Hugh and Paterson 1997, pp. 325-28). Their solution to this problem was to expand on the social model through post-structuralism and phenomenology. Through a post-structural approach impairment itself may be deconstructed and a phenomenological theory of impairment may take account of the fact that impairment and disability are both intertwined lived experiences (pp. 325-35).

Somewhat in line with Hughes and Paterson’s view, what may be defined as a postmodern perspective on the social model emerged. Indeed, this postmodern perspective (or rather, perhaps inherently to ‘postmodernity’, these perspectives) rests on a typical rejection of “grand theories” and encompassing conceptual dualisms such as the distinction between impairment and disability. Postmodern approaches have criticised the first wave social model of disability that emerged in the 1970s for its materialist emphasis on economic and environmental barriers, and instead focus on the way in which disability is created through culture, language and discourse. The sociologist Shakespeare is considered by some as an exponent of this ‘cultural turn’ (Barnes 2012, pp. 29-33, Williams 2001, p. 3). In recent years, scholars working with critical disability theory have put forth the argument that many current efforts towards improving accessibility in the build environment reinforce discrimination against disabled people. Alleviating or eliminating disability (defined as functional limitation) through architecture and design, in this view, equals eliminating ‘”the possibility of discovering alternative ways of being in the world, to foreclose the possibility of recognizing and valuing interdependence.”’ (quoted in: Hamraie 2016, p. 301). To do so is to reinforce the ideology of ‘ableism’; the idea that disability represents a deviation from the norm, and that life without disability is preferable to living with disability (Hamraie 2016, pp. 286-7). Thus, in a sense this line of thinking turns the social model of disability on its head. It acknowledges the central idea to the social model of disability that disability is caused by social or external factors to the individual, but instead concludes that disability as such should be preserved on the social level too.

Above I already referred to Shakespeare’s 2006 monograph, Disability Rights and Wrongs. In the first part of this book Shakespeare argues for the wholesale dismissal and replacement of the British social model of disability, on the grounds that it has been politically potent but ‘has largely failed to produce good empirical research, because it relies on an overly narrow and flawed conception of disability’ (p. 12). To discuss Shakespeare’s full critique here would fall outside the scope of this blog post. Of relevance here is his attack on the strict biological impairment/social disability dichotomy in the social model of disability. Shakespeare brings forth three points as to why the two cannot be strictly separated. Firstly, impairment may not be a sufficient cause of disability, but it is a necessary one. Secondly impairment itself is often, but not always, caused by social arrangements. Thirdly, not only are impairments frequently caused by social arrangements, what counts as an impairment is also a social judgement. Impairment is not solely a biological given but is also culturally laden. In Shakespeare’s view impairment and disability are not dichotomous, but instead disability is a complex interaction between biological, cultural and socio-political factors which are difficult to differentiate with precision (Shakespeare 2006, pp. 27-30; see also: Shakespeare and Watson 2001).

To replace the social model of disability with an alternative conception that can account for these complex interactions, Shakespeare draws on critical realism to propose an ‘interactional model of disability’. At the core of critical realism stands the distinction between ontology and epistemology. Critical realism, in response to (extreme) social constructionism, (re)affirms the acceptance of an external reality and the existence of objects independent of our knowledge of them. However, according to proponents it avoids reductionism by focussing on the interplay between – in the context of disability – biological reality and social-cultural interaction. (Williams 1999, p. 805-810, see also Danermark and Gellerstedt 2004). Following this, disability should then be understood as an interaction between individual (biological as well as psychological) and social (cultural as well as environmental) levels or factors (Shakespeare 2006, pp. 43-44) – hence the term ‘interactional model’.

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