Medical Model vs Social Model of Disability

So, this is a post where it’s not so much that I have a strong opinion on the various topics, but that in reading on the topic I can’t help but think that using philosophy and philosophical methods — specifically wrt conceptual analysis — would really help clear things up. Here Ania Onion Bula talks about the Medical and Social models of disability, and presents them as a dichotomy: either we take the Medical model, or the Social one, and she prefers the Social one.

So, to start, what are these models. First, we need to start with the idea of an impairment:

Impairment is a loss or deviation of normative physiological, psychological, or anatomical structure or function that can be caused by injury, illness, or congenital condition. It’s the description of what is happening in your body. So for example in the case of deafness, the impairment is a loss of hearing caused by x factor. Or in the case of my arthritis, it is the physical damage to my hip and the inflammation in the joint, caused by my arthritis.

Disability in turn is the restriction or inability to perform certain tasks or activities.

Under the Medical model, people have a physical or mental impairment, and that impairment itself leads them to be unable to do certain important things, and so they have a disability. Under the Social model, they may have an impairment, but it is the way that society is structured that turns that into a disability, as society is structured under the assumption that most people do not have that impairment and so there is no real need or desire to structure society to accommodate them. To put it simpler, the Medical model talks about people being disabled, while the Social model focuses on people being differently abled. Thus, the Medical model puts more focus on removing the impairment, while the Social model puts more focus on changing society to accommodate those different abilities.

The problem is that there are a lot of impairments that really do seem like they themselves are the main barrier to the life satisfaction of those who have them, like blindness, deafness, and so on, and so where the person’s life would definitely be greatly improved if the condition was simply eliminated. She tries to address that:

What about people who are disabled in more socially understood ways, like deafness, or blindness, or autism, who want a cure?

To start with, understand that many people who want a cure, want it because society makes it hard to exist otherwise. It would be like wanting a pill that would turn you straight because the world treat homosexuality as if it is something evil and not because it is evil in and of itself.

…

In order for it to be an ethical choice, one option cannot lead to punishment. If you punish someone for not taking a cure, how is it different from forcing them to take it?

This seems incredibly condescending to those who are blind or deaf, especially, as it seems to argue that they aren’t capable of determining whether or not, in general, they’d be better off not being blind or deaf because of some societal attitude. And this becomes even more problematic when we consider that the implication of this argument is that blind and deaf people’s lives would not be richer if their conditions were cured, which seems utterly ludicrous. There’s no societal change we can make that would allow a blind person to actually, say, really see a lovely sunset, or a deaf person to be able to experience a lovely symphony. It really does seem like their conditions deprive them of some experiences that they could have if they didn’t have it, and so curing their condition would at least give them significantly more choices of experiences and thus allow them to perhaps lead far more fulfilling lives.

It seems to me that for anything that we would generally and rightly call a “disability”, the main determining factor will be whether removing the condition, in and of itself, would greatly improve their quality of life. Let me use an example of mental conditions to highlight this, and talk about depression and introversion. Given that clinical depression, in and of itself, causes reduced affect and motivation and often leaves those people with a duller and less fulfilling inner life — for example, not being able to take pleasure in things that do give you pleasure — it would seem reasonable to suggest that simply eliminating the condition would improve their life no matter how accommodating society is to depression. Even if they could function reasonably well in society, those who have clinical depression still aren’t going to be capable of enjoying it as much as they might want. That doesn’t seem to be true for introversion, as there’s no argument that you can make that if you converted an introvert to an extrovert that therefore their life would automatically be better regardless of how society treats introverts. If society wasn’t so extrovert focused, there wouldn’t be any significant issues with being introverted. And we can thus call clinical depression a disability, and introversion simply a personality trait that is no better and no worse than any other. Thus those who are clinically depressed are disabled, and those who are introverted are, in fact, merely different.

So if we are going to talk about disabilities and have to choose either the Medical model or the Social model, it really does seem like the Medical model is the way to go for conditions where it really is the case that simply eliminating the condition would in and of itself improve the person’s quality of life, which includes her example of someone in a wheelchair. However, the dichotomy between the Medical model and the Social model is, in fact, a false one.

What we have come to understand is that there are people who have conditions, through no fault of their own, that in and of themselves limit their abilities. That means that, in some cases, they are going to be limited in what they do and what they can do based simply on the fact that they have that condition. For example, blind people are not going to be able to experience the visual sensation of a beautiful sunset. But there are, in fact, a number of cases where their condition simply makes them different, and so not fit into the standard model of the majority. Now, when people simply don’t fit the norm we tend to be less willing to accommodate them, instead asking them to accommodate so that the majority don’t have to make efforts to handle rare cases. But when someone has a medical condition, we are, in fact, more willing to make reasonable accommodations. That’s because simply being different is seen as being a choice, while being disabled is seen as not being a choice. But the long and short of it is that we can see someone as being hampered primarily by their impairment in some cases while recognizing that in some cases they are being hampered primarily by how society is structured.

Once we understand this, we ought to be see that society does need to, at least morally, accommodate these conditions. But that accommodation has to be “reasonable”. And for an accommodation to be reasonable, it seems to me that at least this condition must be met: It must be at least slightly easier for them to accommodate you than it would be for you to work around the condition.

This does lead to something she complains about:

Acting as though chronic illnesses or even just severe temporary illnesses like cancer, are not disability further plays into the ableist idea that people have to prove they’re “disabled enough”. Many people with chronic illnesses struggle with insecurities related to their own disability. We feel as though we are doing something wrong by asking for accessibility.

But I think her interpretation here is false. The whole point is to assess whether or not the proposed accommodation is the appropriate one for the situation. Let’s look at some of the things she proposes as reasonable accommodations:

When I was in university, for example, I was frequently too sick to come to class. A part of this had to do with the fact that I took the bus to and from school. The bus route did not have consistent access to restrooms. As a result, if I was having the kind of day where I’m running to the bathroom frequently, a bus trip put me in the situation of risking having a public accident. Taking the bus is also exhausting. It takes longer, is inconsistent with whether or not I will be able to sit down, involves me having to walk to the stop, and so it uses up more spoons. Some days I had to stay home, not because I didn’t have the energy for class itself but because I didn’t have the energy for the additional tasks that physically going to class would entail.

Under the medical model, there is not much I can do except maybe take so many pain meds that anything I try to learn that day will likely be gone forever before I’m even done processing the prof’s sentence.

Under the social model, however, there would be additional options – the professor could work with me to let me watch the lecture from home via skype, or pre-recorded videos. The professor could assign assignments that would make it possible for me to learn and show the work, without having to be physically there. Perhaps the university could help arrange some sort of ride share or carpooling program so that I can spend less of my energy going to class.

Now, most universities in Canada, at least, have departments dedicated to accessibility, even for temporary conditions. And that was 20 years ago, so she almost certainly had access to that if she went to a Canadian university. So there might well have been options, especially if Skype was an option. But let’s look at what options she could drive herself that might improve her situation. For example, if she needed to miss class because of her illness, there’s a time-tested method for getting what she missed, which is borrowing the notes from another student. If she made her concerns clear to the professor, that might be something that the professor could help facilitate, as well as the car pooling issue. As for assignments, that’s harder, but again I was accommodated for a broken wrist where they had a student volunteer sit with me and write things out for me, and I proctored an exam one for a student who had a condition that required that she have extra time to write it. The only issue is where you get participation marks, but again for an actual disability — as, for example, opposed to someone who is introverted — accommodation could be made for that by, say, not counting those marks.

While her thoughts here might just be suggestions, what they do — and what her huge “Treat disabled people as people!” rhetoric pushes — is the idea that she has an issue and other people need to do things to accommodate that. But in any discussion of accommodation what the person themselves can do and ought to do comes into play. For missing classes, it’s a reasonable question to ask why she can’t just get the notes from someone else. Sure, it isn’t as good, but it ought to work.

What if instead we created a world that accommodated different ways of being? Imagine a classroom where students had access to both a noise room and a quiet room to work in, and they could come and go and choose as they please? Imagine having access to different styles of chair to fit what they feel most comfortable sitting in, or have the option to stand or kneel or even pace. Imagine if schools made it possible for you to learn in different ways so that you could get information in the ways that work best for you, and if you could present your gained knowledge in the way most comfortable for you.

But again here we see the very self-centered view of accommodation. There’s little thought here put into how this would impact the teacher or, well, everyone else. Being able to come and go as you please doesn’t work if the teacher wants to do a group lesson, and there are too many students in classes to do everything individually. And this also applies to, well, everything else on the list. I like to pace while I think, too, but I don’t do it in meetings because it will bother everyone else. We can’t really accommodate what everyone would want or what works best for them, as that would be too chaotic. That’s one of the reasons why having separate classrooms where things can be done more individually is a benefit, and then you can integrate for classes and conditions where accommodation isn’t as required. But the entire attitude here is indeed a “I want this, so restructure society for me!” and while that might work and benefit society in general, it might not either.

Here’s the most egregious one:

It is about teaching hearing children and adults the appropriate sign language for the region they’re in so that it isn’t up the Deaf person to have to undergo either painful treatments or go through speech therapy if they can’t or don’t want to.

So, the “reasonable accommodation” is for everyone in the world to learn sign language because they might come across someone who is deaf who can’t or won’t do things to make that less or unnecessary and thus might need to communicate with them in sign language. Also, since the region matters, they might have to relearn it, again just so that they can communicate with someone there who, again, happens to be unable to communicate any other way. That’s … kinda ridiculous. She tries later to argue that this could be a benefit for people who are not deaf, but shouldn’t that be their choice? Are we all going to have to learn to write in braille too? Ultimately, part of agency is accepting the consequences of your choices. If this deaf person chooses not to learn things that could help them, we aren’t obligated to bend over backwards to accommodate them. If we are going to have to do things and put in the effort, they are going to have to, too.

This is why my minimum condition compares the effort that the disabled person would have to make to the effort that the others would have to make. If it would be easier for the disabled person to work around their condition than it would be for us to accommodate it, it seems the height of selfishness to insist that we need to do the accommodation. But on the other hand, if us accommodating it would be easier than their working around it, what excuse do we have for not accommodating it? And all of this comes from rejecting the false dichotomy of the “Medical vs Social model”.