1 April 3rd, 2007 Week 2, Session 3 I. Definitions Disability Handicap Impairment II. Models Social Medical Moral Personal Tragedy

2  Disability ?  Impairment ?

3 Definitions (Cont.)  Impairment: refers to physical or mental limitations such as difficulty walking represents a deviation from the person's usual biomedical state.

4 Definitions  What is the difference between: Impairment Illness Chronic Health Conditions?

5 Impairment:  When does physical / mental variation become an impairment?

6 World Health Org. (WHO) 1980 Disability: Restriction or lack (from an impairment) of ability considered normal for a human being Handicap : The disadvantage experienced by a person as a result of impairments (Now considered offensive) *ICIDH-1 (1980)

7 Sequence of Concepts WHO 1980 Impairment ImpairmentDisease or or disorde r Disability Handicap

WHO 2001 Disability : outcome or result of a complex relationship between an individual’s: - health condition -personal factors -external factors

Health Condition ( disorder/disease ) Interaction of Concepts WHO 2001 Environmental Factors Personal Factors Body function&structure (Impairment ) Activities(Limitation)Participation(Restriction)

10 ADA ( Americans with Disabilities Act)  Disabled Person: (1) has a physical or mental impairment that substantially limits a major life activity, (2) has a record of such an impairment, or (3) is regarded as having such an impairment. ( No mention of Handicap!)

11 67 US acts / programs that define disability - 35 have self-contained definitions (although some contain more than one definition) Surgeon General July 26, 2005 “… disabilities are characteristics of the body, mind, or senses that, to a greater or lesser extent, affect a person’s ability to engage independently in some or all aspects of day-to- day life. “

12 II. Disability Models -- Moral -- Medical -- Personal Tragedy -- Social

13 MORAL MODEL  Religious / Spiritual: Judea-Christian society Bodily difference = evil spirits, the devil, witchcraft, God's displeasure. Or reflecting the "suffering Christ", angelic or a blessing Buddhism: Bad Karma - Past Lives  Character: Refrigerator mother (Autism); weak / uncooperative / faking

14 MEDICAL MODEL MEDICAL / Biomed / Individual/Pathological Rehab - P. Health - Special Education - Psych - Nursing /SW WHO (WORLD HEALTH ORGANIZATION) US Code (ADA, SSDI, Voc Rehab…)

15 Personal Tragedy  Charities  Telethons  Inspirational Stories Often Mixed in with Medical or Moral

16 Disability Activists (UK)1976 (UPIAS - Union of Physically Impaired Against Segregation) Disability: “the disadvantage or restriction of activity caused by a contemporary social organization which takes no or little account of people who have physical impairments and thus excludes them from the mainstream of social activities” (1 st articulation of the “Social Model of Disability”) Changes the focus of disability away from the individual to Society. (1 st articulation of the “Social Model of Disability”)

17 SOCIAL MODEL States that inappropriate and discriminatory: Social Attitudes (Ableism), Sociopolitical Structures, Cultural Phenomena are the central problem for disabled people

18 SOCIAL MODEL ( Variants) Social (Creation)- UK Social (Construction)- US Independent Living- ILM Minority (Political/Cultural) Human Variation Post-Modern / Dismodern

19 SOCIAL MODEL -- Social (Creation) - UK industrialization and capitalism sees the historical convergence of industrialization and capitalism as restricting impaired people’s access to material and social goods, which results in their economic dependency and creates the category of disability Marxist and materialist Marxist and materialist interpretation of the world

20 SOCIAL MODEL -- Social (Construction) – US discriminatory social attitudes cultural phenomena It assumes that inappropriate and discriminatory social attitudes and cultural phenomena are the central problem for people with impairments

21 Social Model  Independent Living Model (ILM) states that current sociopolitical structures produce access barriers for and dependency in impaired people resulting in disability is based on a consumer driven movement that fosters autonomy, self-help and the removal of societal barriers and disincentives

22 Social Model  Minority (Political/Cultural/Affirmation)  inappropriate and discriminatory social attitudes, sociopolitical structures - cultural phenomena are the central problem for disabled people  political based used to counter discrimination and advocate for civil rights  disABILITY identity / Pride / Culture

23 Social Model -- Human Variation  Universal Design re-think= The built environment; economic, social, cultural, and political entities including organizations that provide employment, education, health care, transportation, communication, and the full range of public services.

24 Social Model  Postmodern Theory sees disability as constructed via discursive practices (Talk / write=create disability)  perceives disability identity as fluid and its boundaries dependent on context and the dynamic interaction of other self-identities  emphasizes a dialogic relation between impairment and disability (not an analytical privileging of one over the other)

25 "Through framing disability, through conceptualizing, categorizing, and counting disability, we create it.” Higgins, Paul. (1992) Pp. 6-7 Making Disability: Exploring the Social Transformation of Human Variation. Springfield, Il: Charles C. Thomas

26 Social Model  Dismodern Theory (L. Davis) sees imperfection as the norm

27 1.disability is restricted activity (caused by social barriers) 2. disability is a form of social oppression 3. disability is created by categorizing bodies/minds as normal or abnormal

28  Social model breaks the bio-medical chain of causation (?): Impairment Disability  Why was this strategically important to DRM (Disability Rights Movement) ? Social barriers Disability

29 While the social model redefines “disability,” it stops short of questioning the status of “impairment”  Unstated premises of SM: Impairment is a necessary condition for disability. Impairment is a “real entity,” a condition of the body, which remains the exclusive domain of medical interpretation and/or intervention.

30 Others: impairment should not be taken as simply a “natural state”  Some disability studies work challenges whether impairment is just biological, an “objective, trans- historical, trans-cultural entity.” (Disability/Postmodernity, eds. Corker & Shakespeare). Carol Thomas: impairments are “shaped by the interaction of biological and social factors, and are bound up with processes of socio-cultural naming.” Thomas Laqueur, Making of the Modern Body (1987): “Scholars have only recently discovered that the human body itself has a history…. It has been lived differently, brought into being within widely dissimilar material cultures, subjected to various technologies and means of control….”

31 Don’t we all have negative experiences of our bodies?  DS and feminist writers Jenny Morris: “There is a tendency within the social model to deny the … personal experience of physical and intellectual restrictions, of illness, of the fear of dying.” Liz Crow: “experiences of our bodies can be unpleasant or difficult.” Susan Wendell: “live with the suffering body, which that which cannot be notices without pain, and that which cannot be celebrated without ambivalence.”

32 Is everybody who’s “imperfect” impaired?  Social model founder Vic Finkelstein “The prevailing view that it is personal impairments that disable us is reinforced every day by the media, medical forms, etc. In order to locate the problem in the disabling society it is necessary to break the I-D link. However, impairment = disability is a core value of the modern ‘body- perfect’ culture and extremely resistant to change…. “Ridiculous diets, surgical interventions, absurd clothing and endless exercises all aim at making the non-disabled body perfect. This ‘abstract perfection’ is located in our culture…and therein lies the true ‘ableness’. The ‘ableness’ of humanity is an abstraction, an ideal.”

33 Culture & the body  Body image  Body work “the body is becoming increasingly a phenomenon of options and choices.”  Anorexia/bulimia example?

34 MENTAL ILLNESS  Subjective, shifting, contested diagnoses? DSM IV (Diagnostic and Statistical Manual of Mental Disorders) “biomedical assumption that there are clear boundaries between diseases and between the sick and healthy.”  Psychiatric survivors movement since 1970s. Argue that their differences are not helpfully categorized or treated as impairments.  Insiders’ POV; narratives of living with bodily/mental difference.  Sick or criminal? Problems of deinstitutionalization.  Newly invented disabilities (and treatments) Social anxiety disorder

35 What Is Mental Health?  The state of "mental health" is difficult to define.  U.S. Surgeon General’s definition of mental health: “the state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity”

36 Models – Summary  Problem is the Individual Moral Personal Tragedy Medical  Problem is Society Social

37 WHY CARE? How Disability Is Defined Determines What Is Measured = Allocation Of Resources

38 TWO EXAMPLES  World Bank  Oregon In 1989, passed legislation rationing health care to all state residents who were on Medicaid.

Summary Introduced Basic Concepts –(Disability / Handicap / Impairment) Introduced Four Models of Disability –( Social Model; Moral Model; Medical Model; Personal Tragedy Model)

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