Transcript Document 7375482

Oct 4th, 2007
Week 2, Session 3
I. Definitions
 Disability
 Impairment
II. Models




Social
Medical
Moral
Personal Tragedy
1
The Body
2
Disability ?
Impairment ?
3
Who is Disabled?
Everybody?
4
Linton: Claiming Disability pg13
“Gill says the answer is no to those whose
difference "does not significantly affect
daily life and the person does not [with
some consistency] present … to the world
at large as a disabled person" (46). I
(Linton) concur with Gill; I (Linton) am not
willing or interested in erasing the line
between disabled and nondisabled
people, as long as disabled people are
devalued and discriminated against,
and as long as naming the category serves
to call attention to that treatment.”
5
Impairment:
 refers to physical or mental limitations
such as difficulty walking
 represents a deviation from the person's
usual biomedical state.
6
Impairment:
When does physical / mental
variation become an
impairment?
7
What is the difference between:
 Impairment
 Illness / “being sick”
 Chronic Health Conditions?
8
MIND / BODY STATE (Condition)
Unexpected Variation
(DISABILITY)
Minor Variation
Minimal Expected Variation State
Minor Variation
Unexpected Variation
(DISABILITY)
Impairment (aches/pains, illness/sick/injury, chronic illness/disease,
short/tall, manic/depressed…. ) =Variation
9
Disability
ADA (Americans with Disabilities Act):

(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.
10
World Health Org. (WHO) 1980
lack (from an
impairment) of ability considered normal
Disability: Restriction or
for a human being
Handicap: The disadvantage experienced by a
person as a result of impairments
*ICIDH-1 (1980)
11
Sequence of Concepts
WHO 1980
Disease
Disability
or
Handicap
Impairment
disorde
r
------------------------------------------------------------------------------------------------------impairment at the organ level
disability at the person level
handicap at the societal level
12
WHO 2001
Disability :
outcome or result of a complex
relationship between an individual’s:
- health condition
- personal factors
- external factors
13
Interaction of Concepts
WHO 2001
Health Condition
(disorder/disease)
Body
function&structure
(Impairment)
Activities
(Limitation)
Environmental
Factors
Participation
(Restriction)
Personal
Factors
Classifying
classification b11420 Hierarchy:
b Bodily structures
b1 Mental functions
b11 Global mental functions
b114 Orientation functions
b1142 Orientation towards others
b11420 Orientation towards one-self.
15
Quantifying
Quantifying functionality:
0-4%
0
No impairment
5-24%
1
Light impairment
25-49%
2
Moderate impairment
50-95%
3
Serious impairment
96-100%
4
Total impairment
8
Non specified
9
Non applicable
16
Where is the subjective (QOL)?
Participation = + QOL
17
Other Classification Systems
DSM IV
ICD
18
ADA-ICF
 ADA: An individual with a disability is defined as a
person who has a physical or mental impairment that
substantially limits one or more major life activities, a
person who has a history or record of such
impairment, or a person who is perceived by others as
having such impairment.
 ICF: Disability is an umbrella term for impairments,
activity limitations or participation restrictions.
Environmental and personal factors influence all
aspects of health, functioning and disability.
19
67 US acts / programs that define
disability
- 35 have self-contained definitions
(although some contain more than one
definition)
20
CONFUSION REIGNS
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”
Changes the focus of disability away from the individual to
Society. (1st articulation of the “Social Model of Disability”)
22
SOCIAL MODEL
States that inappropriate and
discriminatory:
Social Attitudes (Ableism),
Sociopolitical Structures,
Cultural Phenomena
are the central problem for disabled
people
23
24
II. Disability Models
Moral
Medical
Personal Tragedy
Social
25
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
26
MEDICAL MODEL
(MEDICAL/Biomed/Individual/Pathological)
Rehab - P. Health - Special Education - Psych Nursing /SW
WHO (WORLD HEALTH ORGANIZATION)
US Code (ADA, SSDI, Voc Rehab…)
27
Personal Tragedy
Charities
Telethons
Inspirational Stories
Often Mixed in with Medical or
Moral
28
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”
Changes the focus of disability away from the individual to
Society. (1st articulation of the “Social Model of Disability”)
29
SOCIAL MODEL
States that inappropriate and
discriminatory:
Social Attitudes (Ableism),
Sociopolitical Structures,
Cultural Phenomena
are the central problem for disabled
people
30
SOCIAL MODEL
(Variants)
Social (Creation)- UK
Social (Construction)- US
Minority (Political/Cultural)
Independent Living- ILM
Human Variation
Post-Modern / Dismodern
31
SOCIAL MODEL
-- Social (Creation) - UK
 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 interpretation
of the world
32
SOCIAL MODEL
-- Social (Construction) – US
It assumes that inappropriate and
discriminatory social attitudes and
cultural phenomena are the central
problem for people with impairments
33
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
34
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
35
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.
36
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)
37
"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
38
Social Model
Dismodern Theory -L. Davis
sees imperfection as the norm
39
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
40
Initially: Social model tries to breaks
the bio-medical chain of causation:
Impairment
Disability
Why was this strategically important
to DRM (Disability Rights Movement)?
41
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.
42
Others: impairment should not be
taken as simply a “natural state”
Some disability studies work challenges whether
impairment is just biological, an “objective, transhistorical, 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….”
43
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.”
44
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 ‘bodyperfect’ 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.”
45
Culture & the body
Body image
Body work
 “the body is becoming increasingly a
phenomenon of options and choices.”
Anorexia/bulimia example?
46
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
47
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”
48
Models – Summary
Problem is the Individual
 Moral
 Personal Tragedy
 Medical
Problem is Society
 Social
49
WHY CARE?
How Disability Is Defined
Determines What Is Measured
= Allocation Of Resources
50
TWO EXAMPLES
World Bank
Oregon
In 1989, passed legislation rationing
health care to all state residents who
were on Medicaid.
51
Summary
• Introduced Basic Concepts
– (Disability / Impairment)
• Introduced Four Models of Disability
– ( Social Model; Moral Model; Medical Model;
Personal Tragedy Model)
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