“In recent years there has been … a significant shift in the definition of disability from a medical orientation … to a socio-political perspective” (Hahn 1997, 172). In a context of equality, describe and evaluate significant differences between medical and social models of disabilities.

In my essay I will discuss the movement from the medical model of disability to the social model of disability and how it has moved from an individual perspective to an environment/socio political perspective.

I shall first give a description of what both models entail and consist of. I will be looking at certain readings from the course to do so, including the papers from Mike Oliver, Colin Cameron, John Swain and Sally French, Jenny Morris and Shelley Tremain’s paper on Foucault’s Governmentality, and critical disability theory.

Firstly I will describe what both models entail. I shall then evaluate the major differences and major implications both models have on society, by looking at the differences between them, in the way that they evolved. I shall also look at how the affirmation model has a crucial role to play in the development of the social model. These models of disabilities are particular understandings of disabilities, within the period of time that they were made. The relationship between disability and society has been ever changing over time. It has been different in the past, it is different today and it will be different again in the future. Why is this though? Foucault thinks that it was society’s ways of managing a problematic element of society. So these changes that we see within our theories of disabilities, is perhaps more a reflection on the way in which society is managing these problem elements of society.

Medical Model

The medical model of disability quintessentially states that the disability lies with the individual. “Any economic or social deprivation encountered by disabled people was located within the individual and their impairment.” (Swain, French, 2003).

It is inherent in the person. This illness or “disability” effects the person in their day to day lives, leading to a diminished quality of life, and may cause serious implications to how one is to lead a “normal” life and the disadvantages that this may cause the individual.  The medical model believes that the way to approach disability or illness is to identify the illness or disability within the individual and then look for a way to “cure or treat” it. It is done by the use of medical professionals, who are trained to deal with such “disabilities”. Foucault speaks of the “psy” sciences and how their influence somewhat shows how the medical model approaches the matter of disability. It is/was seen as a compassionate outlook that with better funding and training of these experts would lead to a more profound view of these individuals needs and there for, be advantageous in helping them have a more “normal” life. The medical professionals are seen within this model as the fundamental responsibility in the area of disability. Off course this was the first model written up and there have been advancements and different outlooks as to what disability actually is or the way it is portrayed. This I will look at later. However staying with the medical model, I would like to look at some of the advantages of this first before we look at any other models.

Although there is a huge critique to the medical model and it is undoubtedly outdated, there are some positives from it. It does provide support to the individual or “disabled” person who needs help.  It gives the individual a better understanding of their impairment and in doing so provide the tools to be pro active in their daily lives. Chatting to medical professionals would inspire a positive reaction, as it makes their situation more “normal” and acceptable to the person. It helps create a better understanding to the individuals needs, and to use the term loosely “normalise” their situation somewhat. However the implication of a “cure” being the only solution has many more negative responses than it does positives. However I do feel it important to point out, that this model was the first significant shift in support to those that needed it. It was the first small step in the conversation of what disability actually is. However dated it is, it still provides the foundation and promotion in awareness to a field which is evolving every second. Our awareness and knowledge has vastly improved and will continue to do so with more open conversation.

Social Model

A change in the way we understand disability and society.

This denies anything to do with personal characteristics or flaws.

Disability is the outcome or a product of the relationship between the individual and the society which they live in. This society creates barriers which exclude people, and it is these barriers that create disability. Disability is therefore not a personal characteristic; it’s a social or a political product. As Mike Oliver says, what produce’s a disability is the barriers presented within society. This can be a number of things, handles on doors too high, doors wrong size etc. It is basically a form of discrimination. The social model encourages us to think about disability as a question of equality that will produce a different mindset, in to how we approach researching the matter.

The social model evolves in a way where governmental issues are not just to provide financial support or assistance to those who need it, but to improve the civil rights of these individuals. The “disability” is a social construction of environmental matters. This can be broadened to include attitudes within society or social behaviours. These behaviours are a result of the attitudes of the institutions that exist within our society and the values in which they reflect. This influences the way in which society as a whole views what disability is, and what is normal in the range of the functionality of human beings.

“All disabled people experience disability as social restriction, whether those restrictions occur as a consequence of inaccessibly built environments, questionable notions of intelligence and social competence, the inability of the general population to use sign language, the lack of reading material in Braille or hostile public attitudes to people with non-visible disabilities”. (Oliver, 1990)

This model approaches the matter of “disability” in a way that other minority groups are stigmatized. The “disabled” are also a minority group, within these social and political structures in place. These structures restrict and limit opportunities for the individual as a result of the institutional values and legal constraints that exist within our modern day society. This restricts and almost victimises the individual, limiting their opportunities to live a “normal” life. The problem exists within the socio-political framework and how people with impairments are seen. This model brings a new found attentiveness on the deeper issues that are seen in what disability is. Foucault’s idea on governmentality has been related directly to these factors within disability. He speaks of the social constructs in place within society and their affect on it. How this minority group, “disabled” have suffered from the medical model protocol and how their “subjectification” has been the ramifications of this. These are a direct result of his ideas of governmentality, through what he calls “bio-power” or “bio-medicine”. Perhaps it is important to point out that Foucault didn’t write specifically about disability. His first major work did explore what he called madness and that could be construed to what disability is, however I’m more interested in his ideas of governmentality and how it relates to the idea of what disability is today. He was not directly talking about disability. But these ideas heavily influence the evolution within the subject disability and equality.

Focault

Foucault’s works helped in the shift from the medical to the social model, and are influential in how we evolve even further to our understanding of what disability is.

So how do we relate Foucault in relation to evaluating the differences between the medical and social models?

Shelly Tremain says in her article,” politicized conceptions of disability and the increasing consolidation and visibility of the social movement, that spawn have predicated significant social change.” (Tremain, 2005)

By this she means the “normalisation” of what disability is, and how Foucault’s idea of governmantality, especially to do with bio power has led to this new found understanding of what disability is.

I will focus on Foucault’s ideas as they now can be used as critical reflections on existing practices in regards to how disability is perceived. Foucault speaks of subjectivication and how human beings are been made subjects of, by the very institutional practices that exist in our society. By this I mean his object is to create a history of different modes by which our culture have been made into subjects. It can be said that it is like objectivication, which is a process of turning people into subjects by a process of domination, like those of the institutional practices we have today. There are three ways of doing so according to Foucault; dividing practices, scientific classification and self formation.

Foucault is interested in the relationship between knowledge and power. There is no distinguishing element between them, because as he sees it, they are two sides of the same coin.

“Power must be analysed as something which circulates, or rather as something which only functions in the form of a chain. It is never localised here or there, never in anybody’s hands, never appropriated as a commodity or piece of wealth. Power is employed and exercised through a net-like organisation. And not only do individuals circulate between its threads; they are always in the position of simultaneously undergoing and exercising this power”. (Foucault, 1980).

Disciplinary power or bio-power as he more commonly phrases it has a huge relationship as to how we see the relationship between disability and society. It is operated through surveillance and this is the key factor to managing people’s behaviour, which focuses on the human body. This surveillance permits knowledge and thus power in the management of these groups. It creates a sort of ranking order as to where people exist within the “norm”.  This circulating power can be seen in our schools, hospitals and many other institutions that exist within western society. But the surveillance Foucault talks off has become softer, in the sense that we now cannot see who is doing the surveillance. It has now taken a somewhat invisible form through modern technology in the use of CCTV, smart-phones, credit cards etc. So the subject is visible at all times through these mechanisms. You are unaware that you are been incorporated in power, within this mode of disciplinary power, like keeping to timetables at work or schools. It creates a kind of docile body and in doing so regulates the subjects in question. Those who are incarcerated within different types of institutions are more subject to these practices through power and knowledge. It is easier to gather information on them. These institutions support these practices. The purpose of this disciplinary power is to produce these efficient docile bodies, because the more docile they become, the more use they have for them within society.

The dividing practices that exist within these practices of power and knowledge are fundamental in linking how disability is perceived and how it leads to inequality. Those individuals who are earmarked as been problematic are then segregated from the “normal” society. Many examples are still seen today like hospitals or prisons. But there are also less direct ways incorporated. Through what Foucault calls, scientific classification, or with the use of the, “psy’s” . He notes that medicine operates on two strands; one focusing on the individual (disciplinary power) and one focussing on the population as a whole or groups of the population (Bio-power). These scientific disciplines emerged and developed their own individual classifications based on the knowledge of each of the disciplines involved. Along with these institutions, they developed a “panoptic practice”, something which Foucault says guarantees order. The use of the word panoptic is a metaphor for the relationship of these institutions in social control and the power/knowledge concept, and how through this invisible surveillance people became subject to what the social norm is. These people were ignorant of what constituted their best interests, especially in relation to mental health and so these institutions were designed to relieve people of these flaws.

A leading example is that of our primary school system. These were set up to defuse flaws that existed with its subjects. Impaired ambition, impaired in ways with loyalty to the state could be some examples. This regulation of people through disciplinary power is the governmentality that Foucault speaks of. It is a process of identification, then institutions are created in order to set up surveillance, then social order than be controlled. This incites a reflection on the role of the human sciences in organising and identifying and then justifying a response to these perceived impairments. There is a knock on effect in this type of regulation, as the policies and services that are provided and created are more about the regulation and management of these potentially troublesome populations, rather than providing equal access to services, to the population as a whole.

Foucault’s work has been used as a critical reflection on the medical model, and how disability is not what it is portrayed in it; as an individual problem. Rather the stepping stone of the social-political model is a result of this critical thinking in regards to how we view disability and to what is a perceived impairment. These questions need to be asked in regards to social policy making and decision making in the field of disability. The findings have been crucial in the progress of disability studies, and the formation of the social model is proof of this.  I will take a look now at works from both French and Cameron in their critique of the social model and how perhaps a newer model would lessen the gap of inequalities within the field of disability.

The Affirmation Model and beyond

The social model has had many people criticising it. Mike Oliver who was its founding father, in his defence does claim that it is not the absolute answer to lessening the gap of the inequalities we see.

“I have never seen the social model as anything more than to improve peoples lives, and I am happy to agree that it does not do many of the things it opponents criticise it for not doing”.(Oliver 2013).

I would like to look at the idea of the affirmation model proposed by swain and French and how it can help lessen the gap between disability and the inequalities which exists in our culture. They claim that if a more personal experience was incorporated in non catastrophic way, a better understanding may be pooled.

“It is essentially a non-tragic view of disability and impairment which encompasses positive social identities, both individual and collective, for disabled people grounded in the benefits of lifestyle and life experience of being impaired and disabled”.(Swain and French 2000).

The proposal of the affirmation model is not a complete critique on the social model, rather it is a stepping stone to “normalise” what it is to be disabled or to have impairment.  The main critique is however that the social model disassociates impairment from disability. It states to claim that having a perceived impairment is not a tragedy and that there are benefits from having impairments too. Also it points out that certain “impairments” are not addressed in the social model. They say that pain and chronic illness have not been addressed by the social model. These are not only restricted to disabled people, as non-disabled people experience both of these things too. Jenny Morris also criticises the social model in so far as it predominantly looks at the social barriers in society and it fails to take a look at personal experiences of disability. “There is a tendency in the social model theory to deny the experiences of our own bodies”. She argues that because disability is seen as mainly a social and political issue, a barrier has been placed to the acknowledgment of the effects that having a perceived impairment can have on an individual.

The affirmation models main progression from the social model is that it brings to light personal experiences to those individuals with “impairments”. These experiences have shed some light on how they feel; that their “impairment” has actually made their lives better and less complicated than if they didn’t have. Examples given are for women in society to form relationships, have kids etc. Those with perceived impairments are not under the scrutiny and pressure of society’s norms. They are left to their own devices, and to actually live a life which they want to live, not under the watch of our society’s invisible protocol of behaviour. Swain and French also discuss how being born with an impairment can give a clarity or perspective on life that one would not have being non-disabled. I think there is a lot of power within this statement. In its essence it means that whatever way you enter the world, maybe its through poverty, having an impairment or having no family or support network; all these things

can

present a problem in how we view what normal is in our society. It is up to the individual to live the way they want to live. Whatever social structures or barriers that might be in place, having perspective can always make you overcome any obstacle. I feel this is the main thought of disabled people. Life to them is normal. Their impairment is just part of their existence and who they are. Just like those who came from poverty. It is part of your identity and nothing can change that; being true to who you are and proud of it is the key to a life of fulfilment. The problem lies again in what Foucault says about regulation or defining the norm. And once this exists, there will always be barriers in place in society and hinder the prospect of collectively embracing every person as unique. This is why the affirmation model is fundamental to breaking down these societal “norms” through shared experiences of those with impairments, both collectively and individually. It will only help unify the disabled world with the non disabled world. Also with the development of the affirmative model, it signifies an ownership with impairment. This will help bring us further away from the medical model,  with new awareness of what medical intervention is actually doing to our bodies, and if we choose to accept it.

Cameron builds on the affirmation in his paper by suggesting that impairment is not a problem for those with impairments, but rather it is manufactured by those around them. They only become aware of their impairment when in a social situation, i.e. someone else’s awkwardness in their company. This social awkwardness makes impairment more relevant to those who have it. They become negatively aware of their own bodies because of these types of situations. He feels that because of these barriers that exist, that those who don’t have impairments struggle to deal with situations like this. They almost have a pitiful remorse in these types of situations. This is not that persons fault however; it is just another element of the difficulties faced with breaking down the barriers that exist between the disabled and the non disabled world. Because of the governmentalty that Foucault speaks of, we have been alienated into different groups, and this divide has created a social tension which exists in these types of situations.

“When he became aware of the gaze of the waiter standing behind him however his mode of awareness changed. He became an object for the other, and aware of himself as an object of scrutiny, fascination and perplexity. In other words he became aware of himself as a disabled person”. (Cameron, 2015)

Cameron relays on Foucault’s ideas when he talks of industrialisation and that before it was introduced, people with perceived impairments were included within community life. However post industrialisation, a divide made it self present as to what normal behaviour was, in relation to the factory setting. This element of capitalism cast aside those who were not fit to keep up with these production norms, and so the normal standard of behaviour was redefined by this movement. This was the catalyst for them to be” medicalised”. I find this point he makes very interesting. We have seen a transcending plot through how institutionalisation has been the founding father of what defining the norm is. However at the root of all this is the capitalist society in which we all partake in. Money breeds power. Almost like what Foucault resonates, that knowledge and power are two sides of the same coin. The element of money is a contributory factor to power, and holds a big grip on society today. Social structures today are set up in allegiance with how capitalism operates. It casts aside those who they feel cannot maintain a normal input to its mode.

The affirmation model is the next step into breaking down the social relationship that exists in the field of disability. Education and awareness within the population as a whole is the only way these barriers can be removed.

I have hoped to show that with the evolution of these models, steps are being made toward a greater understanding to what disability is and how it is portrayed in the world today. The stare of the medical model still lies in the root of the division and social awkwardness and constraints that still exists. Oliver’s social model is the stepping stone in a new found awareness of what disability actually is. It is a social construct of Foucault’s work on governmentality or more specifically bio-power.  The social-political model brings light to the structural barriers that must be overcome to lessen the divide between disability and inequality. These barriers are the foundations of the oppression that exists within the disability world. With this new found understanding, Swain and French’s Affirmative model came about. It sheds more light on what it is to have a perceived impairment. Its main critique of the social model is that it disassociates impairment from disability. Its main objective is to get into the nuances of what living with a perceived impairment is like, looking at personal experiences. It takes into account what is like to live with a perceived impairment and not simply shove the issue to one side. Taking these accounts into consideration can only bring about a more non tragic notion to what disability is. Cameron builds on this again and that the non-disabled world are guilty of making disabled person more aware of their impairments through socially awkward behaviour.  So it must be a collective movement in order to eliminate this crazy divide in our population in which social and political structures have put in place.  The regulation that Foucault spoke of is at the epicentre of this inequality that exists. We are all living and breathing human beings, sharing a space on this planet, in order to live. What is it to be normal or abnormal? How can we express our true feelings in a society which is set up to repress that? New found awareness and open conversation is vital to breaking down these social constraints of which society employs. I think it only right to let Foucault have the last word.

“Maybe the target nowadays is not to discover what we are, but to refuse what we are…the conclusion or would be that the political, ethical, social, philosophical problems of our day is not to try and liberate the individual from the state, and from the state’s institutions, but to liberate us birth from the state and type of individualization which is linked to the state”. ( Foucault,1982)

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