what is medical model of disability essay

Disability Studies: Foundations & Key Concepts

This non-exhaustive reading list highlights some of the key debates and conceptual shifts in disability studies.

Disability studies emerged out of the disability civil rights movement in the late twentieth century. Early scholarship distinguishes the medical model of disability, which locates physical and mental impairments in individual bodies, from the social model, which understands the world as disabling people. The social model names both architectural and attitudinal barriers as the cause of disablement. Over the last few decades, the field has expanded to include individuals with a wide range of disabilities—not just physical conditions, but also mental and chronic ones.

This list, far from exhaustive, highlights some of the key debates and conceptual shifts in the field.  In addition to showcasing disability studies’ interdisciplinary focus, the list traces the relationship between D.S. and other minority fields of study. At its broadest, disability studies encourages scholars to value disability as a form of cultural difference. As the sources below reveal, ability should not be the default when it comes to human worth.

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Asch, Adrienne. “Recognizing Death while Affirming Life: Can End of Life Reform Uphold a Disabled Person’s Interest in Continued Life?” The Hastings Center Report , 2005

Bioethics scholar Adrienne Asch is one of the first scholars to bring a disability studies approach to bioethics. This essay addresses U.S. policy regarding decisions for end-of-life treatment and, more broadly, it critiques discourse surrounding “quality of life.” Asch attacks the slogan “better off dead than disabled” by showing how disability does not necessarily diminish one’s life. Instead, she argues, healthcare practitioners should focus on forms of care that give disabled people independence. She also offers pragmatic suggestions for how caretakers can affirm the humanity of patients receiving end-of-life treatment.

Baynton, Douglas. “Slaves, Immigrants, and Suffragists: The Uses of Disability in Citizenship Debates.” PMLA , 2005

Douglas Baynton’s groundbreaking essay foregrounds disability in accounts of American history. He assesses three U.S. debates regarding citizenship: the civil rights movement, women’s suffrage, and immigration legislation. This essay considers how disability has been used as a justification for the oppression of marginalized populations. For example, slaves were said to become “crazy” if they were granted freedom. Women were often described as mentally incapable of receiving an education. And immigrants have been cast as disabled due to racial difference. Baynton explores how attending to disability in its own right (rather than as a symptom of misogyny or racism) enables an intersectional analysis.

Brueggemann, Brenda Jo, Rosemarie Garland-Thomson, Georgina Kleege. “What Her Body Taught (Or, Teaching about and with a Disability): A Conversation.” Feminist Studies , 2005

Written from the perspective of three female scholars with disabilities, this essay is one of the first pieces of scholarship to address the presence of disabled faculty in the classroom. Brueggemann, Garland-Thomson, and Kleege explore the tension between wanting their disabilities to be normalized, but also wanting them to be present in students’ minds. In addition to discussing the difficulty of disclosure in the classroom, they explore how educators might adopt different approaches to teaching to accommodate instructors’ disabilities.

Davis, Lennard. “Crips Strike Back: The Rise of Disability Studies.” American Literary History , 1999

This essay reviews three publications that address disability studies from a humanities-based perspective. While D.S. first emerged in the social sciences, Davis makes a case for the centrality of disability studies scholarship in literary studies. More broadly, he proposes that disability studies should no longer be considered a narrow or specialized field. It’s applicable to us all.

Donaldson, Elizabeth J. “The Corpus of the Madwoman: Toward a Feminist Disability Studies Theory of Embodiment and Mental Illness.” NWSA Journal , 2002

This essay takes up the figure of the madwoman in literature. Adopting a feminist disability studies approach, Donaldson critiques the way feminist scholars read madwomen as merely symptomatic of patriarchal oppression, which discounts the reality of mental disability. She is resistant to framing disability as a metaphor and advocates for readings that consider disability alongside questions of gender.

Erevelles, Nirmala. “Race.” Keywords for Disability Studies (2015)

This short essay gives an overview of the relationship between disability studies and critical race studies. Erevelles shows how disability has been aligned with race. However, analogizing race to disability (or saying, “disability is like race”) eliminates the specificity of both identity categories. She uses special education as an example because it is a site where racial segregation takes place on the premise of disability. By attending to disabled people of color, she argues that we can achieve a more nuanced analysis, which accounts for how social forces like poverty and involuntary institutionalization exacerbate different forms of social marginalization.

Garland-Thomson, Rosemarie. “Feminist Disability Studies.” Signs , 2005

In placing feminist studies and disability studies in conversation, Garland-Thomson argues that both fields work to de-naturalize assumptions about embodiment and social roles. Her essay explores a range of pressing social issues, including selective abortion, caretaking, and reproductive rights.

Ginsburg, Faye and Rayna Rapp. “Disability Worlds.” Annual Review of Anthropology , 2013

Ginsburg and Rapp call for a critical approach to disability in the field of anthropology. Bridging the gap between the medical and anthropological fields, they shift toward understanding impairment as both environmental and cultural. They also consider what ethnography can bring to questions of disability within anthropological study.

Hershey, Laura. “Disabled Women Organize Worldwide.” o ff our backs , 2003

Recounting events from the NGO Forum on Women in China (1995) and the International Leadership Forum for Women with Disabilities in Maryland (1996), disability activist Laura Hershey moves beyond Western definitions of disability to offer a global perspective. In addition to showing how disabled women are doubly discriminated against, Hershey outlines how gender can influence the international movement for disability rights. She also considers how issues like poverty and illiteracy speak to the feminist and disability movements.

James, Jennifer C. and Cynthia Wu. “Editors’ Introduction: Race, Ethnicity, Disability, and Literature: Intersections and Interventions.” MELUS , 2006

This essay brings ethnic studies into conversation with debates regarding disability representation. From the nineteenth-century freakshow to forced sterilization, people of color have been disproportionately disabled, and James and Wu call for an intersectional approach to these complex subjectivities.

Kleege, Georgina. “Blind Rage: An Open Letter to Helen Keller.” Southwest Review , 1998

In this more personal essay, Kleege interrogates Helen Keller’s status as a disability icon. Kleege critiques the way disability has been individualized, refuting both tragic and triumphant representations of impairment. In describing her experience navigating everyday life as a blind woman, Kleege attends to the realities of living in a world not made for disabled people.

Kudlick, Catherine. “Disability History: Why We Need Another ‘Other.’” The American Historical Review , 2003

In this groundbreaking essay, Kudlick moves to situate disability studies in historical scholarship. Reframing disability as valuable, she argues that a renewed attention to bodily and mental impairments can revise our accounts of nearly all events in history—from women’s rights to labor movements. Her essay offers a comprehensive overview of books and articles pertaining to disability history, and, more specifically, deaf history.

Linker, Beth. “On the Borderland of Medical and Disability History: A Survey of Both Fields.” Bulletin of the History of Medicine, 2013

This essay addresses why the history of medicine and disability studies fail to interact. Linker begins by critiquing disability studies’ resistance to medical discourse. She argues that certain disabled people, especially those who are living with chronic conditions, often rely heavily on medical care, which is why the “medical model” should not be so readily dismissed. In turn, while disability history is typically understood as different from medical history, especially in the U.S., Linker argues for a greater need for cross-disciplinary collaboration.

Linton, Simi. “Reassigning Meaning.” Claiming Disability: Knowledge and Identity ,1988

One of the most foundational essays in the field of disability studies, Linton outlines how language has been important to naming disability as a political rather than medical category. She also addresses the problem of “overcoming rhetoric,” which fails to address disabled people’s need for access.

McRuer, Robert. “Crip Eye for the Normate Guy: Queer Theory and the Discipling of Disability Studies.” PMLA , 2005

McRuer is one of the first scholars to assess the relationship between disability and queerness. In this essay, he analyzes how the popular show The Queer Eye for the Straight Guy normalizes the disabled body. While representations of queer life often resist disability, he argues that queer and disability studies share a resistance to normalization, which should be embraced in future scholarship and activism.

Price, Margaret. Mad at School: Rhetorics of Mental Disability and Academic Life . University of Michigan, 2011

Price offers one of the first substantive accounts of mental disability, which has come belatedly to studies of physical disability. She focuses on higher education as a site that stigmatizes mental disability in its focus on rationality, cohesion, and cognitive agility. Her book offers a range of suggestions, many of which are pedagogical, for how mental disability might revitalize academic life.

Siebers, Tobin. “Disability in Theory: From Social Constructionism to the New Realism of the Body.” American Literary History , 2001

Siebers critiques the social model of disability, arguing that it fails to account for the experience of individual bodies. His term “the new realism of the body” calls for an assessment of the bodily effects of disability, which often cannot be altered through environmental transformations alone.

Wendell, Susan. “Unhealthy Disabled: Treating Chronic Illness as Disabilities.” Hypatia , 2001 

This article broadens the definition of disability to include individuals with chronic illnesses.  While people in the disability community often distinguish themselves from people who are ill, not all disabled people, she observes, are healthy. Wendell questions some of the main assumptions in disability activism and scholarship regarding social justice and reform. Dismantling the environmental effects of disablement will not always eliminate a body’s suffering, she argues.

Williamson, Bess. “Access.” Keywords for Disability Studies (2015)

This short essay gives a comprehensive account of the history of access and why it is a key term in D.S. Williamson argues that paying attention to access turns our focus away from the individual, highlighting instead the disabling makeup of the social world. Although access is easy to define, Williamson notes that it is hard to implement in practice because disabled people have conflicting needs.

Editor’s Note: This list has been updated to include publication dates.

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Disability: Definitions and Models

Philosophers have always lived among, and often as, people who could not see, walk, or hear; who had limited mobility, comprehension or longevity, or chronic illnesses of various sorts. And philosophers have lived in societies that respond to these and other bodily differences in a wide variety of ways. And yet philosophical interest in these conditions and the social response to them was piecemeal and occasional until the past hundred or so years. Some of these conditions were cited in litanies of life’s hardships or evils; some were the vehicle for inquiries into the relationship between human faculties and human knowledge (see entry on Molyneux’s problem ). But the treatment of disability as a subject of philosophical interest in its own right is relatively new.

The lack of attention to “disability” or the related concept of “impairment” may have a simple explanation: there were no such concepts to attend to until nineteenth century scientific thinking put variations in human function and form into categories of abnormality and deviance. Once such categories were established, it became possible to talk, and generalize, about (first) “the disabled”, and (then) “their impairments”, and philosophers have done so for various purposes [Hacking, 1990; L. Davis, 2002: Ch. 4]). The resurgent political philosophy of the second half of the last century, preoccupied with eliminating or reducing unearned disadvantages, tended to treat disability as a primary source of those disadvantages, to be addressed with medical correction or government compensation (Cohen 1993; Sen 1993). Somewhat later, social philosophers began to see disability as a source both of discrimination and oppression, and of group identity, akin to race or gender in these respects. And biomedical and other practical applied’ ethicists have been concerned to help policy-makers construct and interpret new legal and regulatory frameworks making central reference to “disability” and related concepts.

For these reasons and others, philosophers have had much to say, initially in passing and now at length, about what disability is and what “disability” means. This entry will discuss both issues—first, detailing philosophical engagement with longstanding debates over the correct “model” or general framework for understanding disability as a phenomenon; second, asking how philosophers have come to understand the meaning of concepts denoted by words like “disability” and “impairment”, as those have been used in various empirical and normative discourses concerning people with disabilities.

1.1 Medical and Social Models

1.2 an affirmative model, 1.3 models, decisions, and policies, 2.1 philosophical discussion of official definitions of disability, 2.2.1 normal-function views, 2.2.2 the welfarist view, 2.2.3 social constructionisms, 2.2.4 inability views, 2.2.5 skepticism about defining disabilities, other internet resources, related entries, 1. models of disability.

Many different characteristics have been considered disabilities. Paraplegia, deafness, blindness, diabetes, autism, epilepsy, depression, and HIV have all been classified as “disabilities”. The term covers such diverse conditions as the congenital absence or adventitious loss of a limb or a sensory function; progressive neurological conditions like multiple sclerosis; chronic diseases like arteriosclerosis; the inability or limited ability to perform such cognitive functions as remembering faces or calculating sums; and psychiatric disorders like schizophrenia and bipolar disorder.

Disabilities like these have been objects of study in sociology, medicine, and policy debates for much longer than they have been subjects of sustained interest in philosophy. These discourses do not tend to define “disability” by way of the sort of rigorous necessary and sufficient conditions philosophers often prefer. But they have been centrally concerned with broadly definitional issues, often discussed under the heading of “models” of disability—that is, general theoretical perspectives concerned to say what in the world social scientists are investigating when they investigate disability. These models generally pick out, both (1) a set of phenomenon as what needs explaining, when we explain disability, phenomenon typically but not necessarily characterized as disadvantages ; and (2) an explanation of these phenomenon—again, typically, but not solely, an explanation of why disabled people experience the disadvantages they do.

In their extreme forms, the medical and social models serve to chart the space of possible relationships between bodily difference and functional limitation more than to reflect the actual views of individuals or institutions. (A variety of more formal models, described in Altman 2001, graphically represent the causal complexity of disability.)

The medical model explains disability disadvantage in terms of pathological states of the body and mind themselves. It regards the limitations faced by people with disabilities as resulting primarily from their bodily differences. The medical model is rarely defended explicitly, but aspects of it are often adopted unreflectively, when health care professionals, bioethicists, and philosophers ignore or underestimate the contribution of social and other environmental factors to the limitations faced by people with disabilities.

In contrast, the social model explains the characteristic features of disability in terms of a relation between an individual and her social environment: the exclusion of people with certain physical and mental characteristics, or “impairments”, from major domains of social life. Their exclusion is manifested not only in deliberate segregation, but in a built environment and organized social activity that preclude or restrict the participation of people seen or labeled as having disabilities. A variety of social models are embraced by disability scholars and activists in and outside of philosophy. The “British social model” associated with the Union of the Physically Impaired against Segregation (UPIAS 1976) appears to deny any causal role to impairment in disability:

In our view, it is society which disables physically impaired people. Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and excluded from full participation in society. Disabled people are therefore an oppressed group in society. Disability [is] 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 participation in the mainstream of social activities.

Two features of this influential statement are worth noting, although we will only discuss the second at length. First, it limits itself to physical impairments; second, it contrasts impairments , individual characteristics or conditions, with disabilities , disadvantages imposed by society on those with impairments. The first feature inaugurates a long tradition in disability activism and scholarship of focusing exclusively on “physical” disability, to the neglect, if not the exclusion, of intellectual, psychiatric, and other “mental” disabilities. Both scholars and activists have long criticized, and sought to broaden, this narrow focus, and even those philosophers who continue to focus on physical disability recognize that adequate models and definitions must include mental disabilities as well. In the rest of this entry, we will not distinguish between the two types of disability except when it is relevant to a particular model or definition; we will note when an account is limited to physical disabilities or criticizes other accounts for that limitation.

The second feature, the distinction between impairment and disability, will be more central to our discussion. It is through those terms that the medical and social models have been distinguished, and it is this “anatomy” of disability that several recent philosophical definitions have rejected or significantly modified.

Implicit in the UPIAS understanding of disability are two ways that society imposes limitations on disabled people, corresponding to two distinct strands that might be a part of any social model. When the UPIAS claims that society “excludes” people with impairments, this suggests the minority group model , which sees people with impairments as a minority population subject to stigmatization and exclusion. On this view, the main reason people with disabilities encounter hardship is because they suffer discrimination along the same lines as racial or ethnic minorities. Accordingly, civil rights protections and anti-discrimination laws are the proper responses to disability (e.g., Hahn 1987 [1997] and Oliver 1990). Perhaps the most familiar expression of the minority-group model is found in the preamble to the Americans with Disabilities Act (ADA), which describes people with disabilities as “a discrete and insular minority”—an explicit invocation of the legal characterization of racial minorities.

The UPIAS also asserts that “contemporary social organization” fails to “take into account” people with disabilities. This suggests the human variation model, according to which many of the challenges faced by disabled people do not result from their deliberate exclusion, but from a mismatch between their characteristics and the physical and social environment. On this view, disability is

an extension of the variability in physical and mental attributes beyond the present—but not the potential—ability of social institutions to routinely respond. (Scotch & Schriner 1997)

This view of disabilities as the result of human variations is closely related to the view that disability is a universal human condition (Zola 1989) or shared human identity (L. Davis 2002: Ch. 1). The claim that disability is universal can be taken as nothing more than a prediction that we will all acquire familiar disabilities at some point in our lives. But that claim is better construed as one about the nature of disability; as maintaining that all human beings have physical or mental variations that can become a source of vulnerability or disadvantage in some settings.

These two versions of the social model are not incompatible, differing mainly in emphasis. The discrimination stressed by the minority group model generally leads to, and is expressed in, the societal failure to accommodate people with various differences. In some contexts, it is appropriate to analogize people with disabilities to racial or other minorities; in others, it is important to reject a dichotomy between disability and normality and treat impairments as continuous variations. If one goal of social policy is to remove discrimination and its enduring disadvantages, another is to encompass the full range of human variation in the design of the physical environment and social practices.

Although the social model, in one version or another, is now the dominant legislative, social-science, and humanities paradigm for understanding disability, stronger versions of it – particularly the British Social Model exemplified by UPIAS – have been subject to extensive criticism. Some argue that an adequate conceptualization of disability requires a recognition of impairments as an objective basis for classification, to distinguish disability discrimination from other types of discrimination (Bickenbach 1993). Several critics argue that extreme versions of the model implausibly deny or understate the role of impairment itself as a source of disadvantage (Anastasiou & Kauffman 2013; Terzi, 2004, 2009; Shakespeare 2006). Others, however, contend that this criticism is misplaced, because the British Social Model does not deny the importance of impairments but rather seeks to restrict the application of the term “disability” to social exclusion and oppression (Beaudry 2016).

Another objection is that the social as well as the medical model both rest on a false dichotomy between biological impairments and social limitations. There are two versions of this objection. One maintains that disability is a complex phenomenon, in which biological impairment and social exclusion are deeply interwoven and difficult to tease apart (Martiny 2015; Anastasiou & Kauffman 2013). The other version of this objection rejects the treatment of impairment as a (strictly) biological phenomenon. “Impairment”, the argument goes, is no less a social construction than the barriers faced by people so classified (more on this below). Claims that there is a stable biomedical basis for classifying a variation as an impairment are called into question by shifting classifications; by the “medicalization” of some conditions (shyness) and “demedicalization” of others (homosexuality). Moreover, the social environment appears to play a significant role in identifying and, arguably, in constituting some impairments (dyslexia) (Cole 2007; Shakespeare 2006; L. Davis 2002: Ch 1; Tremain, 2001, 2017; Amundson 2000). What counts as an impairment may depend on which variations appear to be disadvantageous in familiar or salient environments, or on which variations are subject to social prejudice: Less-than-average height may be more readily classified as an impairment than greater-than-average height because the former is more often disadvantageous in environments designed for people of average height, or because it is generally seen as less desirable. For such reasons, it is difficult to establish the objectivity of the impairment classification by appeal to a clear and undisputed biomedical norm. Amundson (2000), indeed, goes so far as to deny that there is any biological basis for a concept of functional normality—a claim emphatically rejected by Boorse (2010).

The debate between the medical and social model about the source of the disadvantages disabled people experience has dominated academic discourse about disability since the 1970s. More recently, however, disability activists and disabled scholars have questioned the apparent shared assumption of both models, that disability is fundamentally a matter of disadvantage, exclusion, or functional limitation. This to take a (partly) different view on what an account of disability should explain; a view consistent in principle with either a more medical or more social view of what does the explaining. The affirmative model of disability and impairment, as articulated by John Swain and Sally French (2000), holds that disability is not in the first instance a problem—not simply or solely a “personal tragedy”, and implicitly, not simply or solely a social injustice either. Rather, disability is a different way of living in and experiencing the world, one not characterized by its disadvantages any more than its advantages.

Note that this is not a claim about what causally explains disability; rather, it is a claim about what aspects of the phenomena of disability should serve as the object of explanation in social scientific theories of disability. As such, the affirmational model is prima facie consistent with either the medical or the social model, and indeed tends to draw on considerations from both. The diverse mix of advantages and disadvantages that characterize life with disability can derive from biological factors, social factors, or interactions between the two. On the side of advantage, a person with a disability like blindness might celebrate the increased attention sightlessness saves for hearing and other senses as well as the solidarity they experience with other disabled people as they fight together against ableism and for social justice. On the side of disadvantage, the affirmational model will point to the considerations some would regard as personal tragedies as, instead, a combination of purely functional challenges to be overcome, and conditions of social exclusion that can make life harder without thereby making it any less valuable or worth living.

Still: though logically independent of claims about the evaluative import of disability, the medical and social models suggest different views about the impact of disability on well-being, and different views about how disability is relevant to reproductive decisions, medical interventions, and social policy. The affirmational model is likely to be more in sympathy with social than medical models here. Those who accept a social model of disability regard the association between disability and well-being as highly contingent, mediated by a variety of environmental and social factors (Campbell & Stramondo 2017). They also tend to question conceptions of well-being that give a central role to the possession or exercise of the standard array of physical and mental functions, as those conceptions imply, or are often taken to imply, that well-being is precluded or diminished merely by the absence or limitation of those functions (see entry disability: health, well-being, and personal relationships ). As a result, they generally see the disadvantages of disability not only as externally caused, but as less formidable than they appear to people who view disability in largely biomedical terms. These differences are reflected in the conflicting assessments of life with disabilities found in the bioethics and public policy literature on the one hand, and disability scholarship on the other (contrast Brock 2005 with Goering 2008).

The different models of disability—and particularly, the medical and social models—have always been interpreted as favoring different responses to disability. The medical model appears to support the correction of the biological condition (or some form of compensation when that is impractical); the minority group model appears to favor measures to eliminate exclusionary practices or at least recognize their injustice; the human variation model appears to favor reconstruction of the physical and social environment to take into account a wider range of differences in human structure and function (measures that could in turn make the social environment less exclusionary).

But claims about the causal explanation of disadvantage do not always yield straightforward prescriptions for their remediation (Wasserman 2001; Samaha 2007; Barclay 2018). In some cases, medical or surgical “correction” may be the most effective way to escape discrimination; if correction is not appropriate, that is because it reinforces discriminatory attitudes and practices, not because it is discriminatory per se . Even an affirmational model does not straightforwardly imply that we should change society rather than disabled bodies: that disabled people have reason to be proud of their disabilities and/or impairments does not immediately entail claims in justice on the rest of us to incur the costs of accommodating these differences. This is to be expected: the proper response to the disadvantages associated with disability depends not only on causal attributions and prudential evaluations, the domains of the three “models”, but also on moral judgments about responsibility, respect, justice.

This is not to say that these causal attributions, much less prudential judgments, are morally irrelevant: to the extent that social causation of disability disadvantage makes social institutions morally responsible for the limitations disabled people face, it may be unfair and disrespectful for society to ask disabled people to change themselves rather than changing itself to be more inclusive (Aas 2020). Moreover, “correcting” disability may (as the affirmational model reminds) us involve destroying valuable forms of life and reducing the vibrant diversity of human embodiment; or it may not do not enough to counterbalance the benefits of uniformity (Garland-Thomson 2012). Contra the sense that the social, medical, and affirmational models each come bundled with obvious policy consequences, it seems clear on reflection that there is much yet to do to understand just what these different explanations of disability imply as to how we should respond to it.

2.Definitions of Disability

Until relatively recently, there was little independent philosophical discussion of definitions of disability. Instead, philosophers focused primarily on developing and interpreting legal and regulatory definition needed to implement disability policy. The legal definitions, in turn, were heavily influenced by the two-part “anatomy”—impairment and social response—of the social model of disability, which was developed by activists seeking to influence legislation and policy.

Thus, two familiar features are shared by most official definitions of disability, such as those in the World Health Organization (1980, 2001), the Disability Discrimination Act (UK), and the Americans with Disabilities Act (United States): (i) a physical or mental characteristic labeled or perceived as an impairment or dysfunction and (ii) some personal or social limitation associated with that impairment. Impairments are generally seen as traits of the individual that he or she cannot readily alter. Just what makes a condition a trait or attribute of an individual is obscure and debatable, but there seems to be agreement on clear cases. Thus, poverty is not seen as an impairment, however disabling it may be, nor is tasteless clothing, even if it is a manifestation of impaired fashion-sense rather than scarce income. On the other hand, diseases are generally classified as impairments, even though they are often neither permanent nor static conditions. Diseases that are especially transient, however, such as the flu and the measles, do not normally count as impairments.

As in early philosophical debates about competing models, the most controversial issue in defining disability is the relationship between these two features. At one extreme are definitions that imply, or are read to imply, that biological impairments are the sole causes of limitation. The definitions in the World Health Organization’s 1980 International Classification of Impairment, Disability, and Handicap, and the Disability Discrimination Act (UK) have been interpreted this way. At the other extreme are definitions that restrict the limitations faced by disabled people (as such) solely to “contemporary social organization”, such as the definition given by the Union of the Physically Impaired Against Segregation (UPIAS 1976). In between are definitions which assert that individual impairment and the social environment are jointly sufficient causes of limitation. Perhaps the best-known example is the WHO’s International Classification of Functioning, Disability and Health (World Health Organization 2001, referred to as ICF), which emphasizes that disability is a “dynamic interaction between health conditions and environmental and personal factors”.

Through much of the first two decades of this century, philosophers were largely content with this definitional approach to disability as a relationship or interaction, disagreeing primarily on the comparative contribution of the two elements and the policy relevance of their contributions. As noted in the last section, dissenters mainly focused on the characterization of one or both elements, as, e.g., on the first as social vs. biological, rather than on the “anatomy” itself. More recently, however, there has been some movement away from reliance on these two-part approaches to defining disability (e.g., Barnes 2016, and much of the literature responding). One reason may be that in most settings, we do not think of or refer to disabilities as relationships or interactions, but as individual somatic or psychic traits, states or conditions (including absences and deficiencies). These commonsense referents are hard to find in, for example, the multifactorial charts by which the ICF illustrates its definition of disability as a complex interaction of health conditions with environmental, social, and personal factors.

Some might argue that ordinary usage is ideological, shaped by false failure to be conscious of the insights of social and interactionist models. But defining “disability” in rough conformity to ordinary usage hardly implies that its referents are selected by biomedical criteria, let alone that the traits selected cause the disadvantages faced by their bearers or dictate the appropriate social response to those disadvantages. Rather, this view on what “disability” and “people with disabilities” refer to is compatible with a wide variety of positions on how those referents are picked out: e.g., by biomedical criteria; by the rules of a civil-rights movement; by the assumptions of the dominant ideology about bodily dysfunction; or by the demands of justice. The extent to which what counts as a disability, or a person with a disability, varies with context will depend on the account adopted; on biomedical accounts, the extension of “disability” will be as stable as human biology; on other accounts, it will change with changing social norms, economic needs, or political developments. Further, on some accounts, the referents will have common features, identifiable by inspection; on others, what they have in common can only be understood in terms of an ideology or a theory of justice.

After discussing several types of accounts, we will address the claim, inspired by the diversity of traits and conditions they pick out, that “disability” has no core meaning, and that it may be futile and distracting to search for one.

2.2 Philosophical Definitions of Disability

Outside of legal and policy interpretation, philosophers have made a number of claims about the definition of “disability”—at first, mostly only in passing, during discussion of other matters, like “disease” and “health”; later as an increasingly important philosophical topic in its own right.

Given the pervasiveness of medical models of disability in the culture, one would think that at least some recent philosophers would defend a view of disability on which it is defined in terms of pathology or departure from normal functioning (see entry on concepts of health and disease ). So far we can tell, however, no one has done so explicitly, in print. Christopher Boorse, perhaps, comes closest, when he says:

at first sight, one expects disability […] to consist of a pathological condition severe enough to have certain morally and legally important effects. (Boorse 2010: 60–61)

Though Boorse only broaches the possibility of such a definition, without defending, his broader views about health and disease may seem to support this approach. If, as Boorse argues there is a good naturalistic sense of “pathology” as (statistically) downward departure from species-typical functioning, then that notion can be inputted into our moral and political thinking to produce a definition of disability on the following pattern:

S is disabled, in a context C , iff

• S has a pathology—that is, some part of their body performs its normal function at statistically subtypical levels,
• In C , that pathology causes effects that make a difference, of kind D , to how S ought legally or morally to be treated

To fully develop this view, of course, one would need to say what sort of moral/legal difference pathology is supposed to make—not just any difference will do, since it would not follow from the fact, say, that everyone has a legal or moral right to treatment for transient injuries or diseases that all these conditions are disabilities. Note also that, though this view mentions the medical concept of pathology, as a definition of disability it does not entail a medical model, or indeed even the denial of the affirmational model. The medical/social debate will turn on the extent to which it is pathology itself that makes a moral difference, rather than pathology in combination with social factors. The affirmational model debate will turn on just which effects are definitive of disability; if these are all negative or harmful, it will be harder to understand disability as something to be proud of. But the bare fact that disability arises from pathology, on this definition, does not necessarily preclude pride in it, given Boorse’s normatively neutral definition of pathology.

That said, few philosophers seem inclined to defend this way of defining disability. Many philosophers are skeptical of the analytic division between facts about bodily function and social and ethical norms, arguing that there is no way to define disease or pathology independent of “normative” considerations (Wakefield 1992; Kingma 2007; entry on concepts of health and disease ). Those sympathetic to the claims of the disability may have more specific qualms, as well. Those attracted to the “human variation” version of the social model may be skeptical that all of the bodily difference that make for disability are statistically atypical in the required way, e.g., very common or universal conditions like age-related hearing loss or atherosclerosis. Those who tend more to a “minority group” model will tend to see the bodily differences that matter to disability as perceived or represented difference, rather than actual difference. And anyone with any sympathy to the social model at all will tend to think that, as-so-far stated, this definition puts its philosophical precision in the wrong place: that it is at least as important to understand what social, moral, and legal effects characterize disability as to understand which sorts of causes these effects must have to count as “disabling”.

Kahane and Savulescu (2009; Savulescu & Kahane 2011) propose a reforming definition of disability that promises to avoid potentially problematic references to pathology. Their basic idea is that a disability is a (broadly) bodily condition that makes its bearer worse off. To wit:

“disability” should refer to any stable physical or psychological property of subject S that leads to a significant reduction of S ’s level of wellbeing in circumstances C , excluding the effect that this condition has on wellbeing that is due to prejudice against S by members of S ’s society. (Savulescu & Kahane 2011: 45.)

This view adopts certain insights of the social model: in particular in holding that disability is relative to circumstance and in downplaying the role of pathology or biological abnormality in defining disability (note there is no reference to “impairment”, not even records or appearance of impairment).

In other ways, however, it seems to be significantly out of step with both the letter and the spirit of social models of disability. On this definition, a condition which is only harmful in virtue of social prejudice would not be a disability. Even the softer social model implicit in the Americans with Disabilities Act allows that some people are disabled solely in virtue of being “regarded as” impaired; those in that group who experience discrimination as a result would still not be “disabled” on Kahane and Savulescu’s view. Just how out of step this judgment is with the usual commitments of the social model, may depend on the relative importance it places on prejudice as compared to other factors in producing disability disadvantage. A social model that cleaves closely to a “minority group” understanding of ableist injustice may find that this definition excludes the paradigm cases of disability, people who experience gross or net reductions in advantage due to prejudicial phenomenon like stigma and intentional exclusion. A “human variation” account of most disability disadvantage would see more possibility for people to be disadvantaged by non-prejudicial mismatches between atypical bodies and societies built for typicality, since this account will say that many of the welfare costs experienced by people with atypical bodies are not a result of prejudicial attitudes per se , even if they often reflect structurally unjust failures of inclusion.

It should be even more clear that the affirmational model of disability is in substantial tension with this harm-requiring definition of disability. Granted, affirmation of disability may not be formally inconsistent with defining it in terms of harm, since it is possible in principle to take pride in or otherwise be glad about something that leads to a reduction in our well-being (since there are things in life that matter, besides our own well-being). But affirmational models generally hold that being disabled is not always or in general a cost to our well-being (Swain & French 2000; Barnes 2016). This would be a conceptual falsehood, on the welfarist view: something which is not a cost to well-being in some context is simply not a disability.

Are these decisive problems for defining disability in terms of welfare? Much depends here on what we intend to do with definitions of disability. If the goal is to capture ordinary usage, a welfarist view may be on the right track. It might account, for instance, for the broad appeal of slogans like “deafness is not a disability” and euphemisms like “differently abled”; these expressions, on this view, would be ways of emphasizing some of the substantive evaluative intuitions behind the affirmative model, that most conditions we call disabilities are not so bad absent prejudice. That said, disability scholars and activists have tended to be skeptical of such expressions, on the grounds that they undermine efforts to see disabled people as a politically salient group with similar experience of ableism and strong reason to work together for justice, rather than to simply commiserate. If a definition of disability should advocate in favor of usages that produce a better or more just world, this might be a reason to reject Kahane and Savulescu’s view, in favor of one that allows people to be disabled due to prejudice and/or in the absence of harms to well-being. Or at least, this will be so if the social and/or affirmational models of disability have the moral and political advantages proponents advertise for them.

Most philosophers who have considered the definition of disability in recent years have written in sympathy with either or both of the social or affirmational model of disability.

Elizabeth Barnes’s critique of definitional claims implicit in the social model has been a signal moment in the recent debate. Barnes is concerned that thinking of disability as a stigmatizing, oppressive, and exclusionary response to bodily difference does not distinguish disability from other properties grounded in responses to the body, like (on many accounts) race, gender, and sexual orientation identities.

Barnes develops an alternative view which still defines disability as a social property—but in a way that fits the affirmational model better than the definitions suggested by classic social models, doing away with the distinction between disability and impairment and making no direct reference whatsoever to injustice or disadvantage. Barnes (2016) proposes to define disability in terms of the judgments of disabled people themselves, not society as a whole. To wit, S is (physically) disabled if and only if:

• S is in some bodily state x ; [such that]
• The rules for making judgments about solidarity employed by the disability rights movement classify x in context C as among the physical conditions that they are seeking to promote justice for.

This makes who is disabled a social construction—dependent on the attitudes and commitments of a particular, self-identified group of people in contemporary society, the “disability rights movement”, composed of self-identified disabled and nondisabled members. It thus raises the concern that a disability movement might seek justice for the wrong people. Couldn’t some of those people complain that they should be included in the aims of that movement, precisely, because they are disabled? Barnes responds in two ways. The first is to note that she appeals to the rules for judgment-making, rather than judgments themselves; some people might not actually be included in the disability rights movement—say, because of internal prejudices on the part of those within the movement—but if this is inconsistent with the reasons for including others, then the excluded people will count as disabled too, on Barnes’ account. Still one might ask, what if the rules themselves were bad rules, wrongly but consistently excluding some people form the ambit of the struggle against ableism? Barnes, in response to this, rigidifies, insisting that we judge disability relative to the rules of the actual disability movement, even when we are imagining situations where that movement should use different rules than it actually does.

Some are not convinced by this last reply. For it can seem to give too much weight to judgments of the actual disability rights movement. As Jenkins and Webster point out, “rigidifying” to the actual world in this way means that imagining a world with a different disability rights movement isn’t imagining a world with different disabled people. But what if the disability rights movement is different there because social conditions are different, warranting a different set of rules for determining which people with pathologized bodily difference to seek justice for? And indeed isn’t there a sense in which “there” could be “here”? That is, couldn’t the disability right movement as it actually is, use rules that even when consistently applied lead it to seek justice for the wrong people (Wasserman 2018; Howard & Aas 2018; Lim 2018)?

This last concern can be generalized. Chong-min Lim, responding to Barnes, questions why the disability movement alone should have the authority to constitute disability. Where, we might ask, does this leave the experience of disabled people not part of the movement, or of those caregivers and/or non-disabled loved ones who advocate for them? And couldn’t the disability movement be overinclusive too, in principle, attempting to expand solidarity beyond what makes sense morally or politically. To address this problem (and in the process, expand the account to cover cognitive and other “non-physical” disabilities), Lim proposes that we make the following modification to Barnes’ account:

S , is disabled in context, C , if and only if:

• S is in some state, x ;
• x is constitutive, in C , of some constraint on S ’s legitimate interests;
• x is regarded, in C , as the subject of legitimate medical interest;
• the rules employed by the disability rights movement classify x in C as among the traits that they are seeking to promote progress and change for. (Lim 2018: 987)

Relative to Barnes, II and III are new restrictions, while IV is a substantially broadened version of the main clause of Barnes’ approach—in effect, broadening the relevant goals to include any improvement in the lives of putatively disabled people, whether that comes from social change or bodily transformation. Relatedly, III seems to bring back in medicalization—though now constrained by the requirement that the medical interest in question be “legitimate”, meaning, not apt in the traditional sense (not, concerned with pathology ) but rather just or right ; morally legitimate in light of whatever morally appropriate role medicine has to play in our society. Lim introduces these conditions to reflect the fact that expert communities outside of the disability rights movement have expertise relevant to constituting the disability population; parents or caregivers, even those not part of the movement itself, may have insight into whether and how a condition affects legitimate interests, while physicians will have important (though not exclusive) knowledge of which limitations on function are legitimately subject to medical interest.

The (intended) effect of Lim’s modifications, then, would be to limit the authority of the particular political judgments of the actual disability rights movement in determining who is disabled. This points to what may be a deeper problem for Barnes’ account, and the parts of Lim’s that follow her in making recognition by the rules that guide the disability movement determinative of disability. If the disability movement ought to adopt rules that pick out a certain group, isn’t that precisely because that group shares some other property, that makes that choice reasonable? That is, isn’t there something that those the disability rights movement share, that explains why they ought to seek justice in solidarity together? Wouldn’t that thing, whatever it is, make a better candidate definition of disability? To put the question for Lim’s account in particular: why would we want to deny that a condition is a disability, it if were a medically interesting constraint on legitimate interests, but not recognized as such by the rules of the disability rights movement?

Howard and Aas (2018) respond to Barnes in a different way, developing a definition that harkens back to the classic social model of disability. Building on the work of Sally Haslanger (2000) on gender and race, they define disability classically as a certain sort of social response to impairment. On their view, person S is disabled in a context C , iff

• S is in some bodily or psychological state x [such that]
• x is regularly assumed in the ideology in C to involve an impairment: a dysfunctional bodily state that limits a major life activity, and
• in the dominant ideology of C , that someone in x has an impairment explains why they can be appropriately pitied, stigmatized, and excluded from socially valued activities and statuses.
• The fact that S is in this state plays a role in S ’s systemic disadvantage: that is, (i)–(iii) actually explains why S is involuntarily excluded from certain valued activities or relegated to a marginal status along some significant social dimension. (2018: 1128–1129)

Impairment is critical on this analysis. Disability is distinct from other bodily-based social categories on this definition precisely because it is a response, of a certain distinctive sort, to social perception about bodily properties, namely impairment . Race, gender, and orientation identity would be different (thought possibly overlapping) responses to different (again, possibly overlapping) bodily properties. Howard and Aas do not, however, defend the biological reality of impairment; it suffices for their account that society itself employs some notion of biological abnormality or insufficiency, saying with the classic social model that disability is a matter of being classified as impaired, and excluded on that basis.

Barnes (2018) responds that, because of this last feature, this account does not after all give sufficiently central place to bodily difference. In particular, she thinks it makes it hard to see how the bodily differences characteristic of disability could be, as the affirmation model has it, something to be proud of. They are, after all, picked out negatively, by reference to disadvantage and social exclusion. Bodily features picked out for their role in the struggle for disability justice seem to be a better candidate source of joy, identification, and pride. The success of Barnes’ response depends on how exactly disability pride is supposed to work, and on how exactly definitions like these are supposed to serve the interests of the struggle against injustice. Among other things, reflection on related cases involving racialized body features suggests that it is possible to take pride in something that others respond to in oppressive and stigmatizing ways. On this understanding, the pride is not in the oppression, but in the oppression-triggering feature itself or in a skillful or solidaristic response to oppression.

Jenkins and Webster (2021) propose a different sort of social-construct definition of disability—or actually, three different but closely related definitions. Like Barnes, Howard, and Aas, they are interested in understanding what bodily differences are centrally relevant to disability. But they cleave closer to the human variation model than the minority group model in understanding these differences. Their key notion is what they call marginalized functioning : having a body that does not work in the way that our socially constructed world expects. Each of their three definitions of disability presuppose this notion; to wit:

MF1 : A subject S is [physically] disabled if they have marginalized functioning relative to a context, C , where this is the case iff:

• there is a set of social norms N , comprising \(n_1,\) \(n_2,\) …\(n_n,\) each of which serves as a default for the purposes of constructing common social environments and structuring common social interactions in C ; and
• there is some norm in N , \(n_x,\) such that S cannot physically function in a way that satisfies it. (2021: 8)

It might seem that this account, and indeed Howard and Aas’s, implies that there could be no disability in a just society. Though this is a classic claim of the traditional British social model of disability (UPIAS 1976), some find it implausible. Note, however, that neither of these views in fact implies the impossibility of disability in a just society (even if their language sometimes suggests it). For neither view, in itself, implies that the social responses that constitute most disabled people as such are necessarily unjust (though surely all four authors would agree that in the actual world, they usually are). If it is morally legitimate to set society up in a way that is designed for the functioning of most but not all its members—and it may well be, given how costly it would be to get anywhere near complete and comprehensive inclusion (Barclay 2018)—then some forms of functioning could be marginalized or be a source of disadvantage, even in a just society. And, thus, those that function in those marginalized ways, could be disabled.

A more significant prima facie concern for MF1 is that it seems to include amongst the disabled people with merely transitory mismatch between body and society—say, someone who broke one or both arms, and therefore cannot open doors or otherwise do what society expects people to be, physically, able to do. These people do not normally identify and are not normally identified as disabled. To capture this, Jenkins and Webster propose that we might move, simply, to:

MF2: someone is disabled in a context if and only if they have lasting marginalized functioning in that context; OR

MF3: someone is disabled in a context if and only if they experience disability-characteristic oppression because they have marginalized functioning in that context

MF2 solves the problem of temporary conditions by stipulation. This may or may not be good enough here, depending on whether we think temporary conditions (e.g., post-concussion syndrome or pregnancy) can be disabilities. MF3 faces some of the same problems as other social-model-inspired definitions—particularly, that it seems to define disability in terms of a kind of oppression, and therefore in terms of something bad, something that is therefore (arguably) difficult to be proud of or happy about. Further, by requiring that oppression be caused by functioning that actually fails to fit going norms and expectations, it does not clearly classify as disabled people who are disadvantaged by false perceptions regarding their bodily differences—again, failing to follow the ADA in its well-considered inclusion of people “regarded as”, but not, impaired, in its definition of disability (Francis 2018). It remains to be seen whether the advantages of this definition are great enough to justify excluding such “regarded” as people as disabled.

In their influential book From Chance to Choice , Buchanan, Brock, Daniels, and Wikler (2000) propose the following definition, meant as an explication of the legal and policy decisions considered above.

To have a disability is to be unable to perform some significant range of tasks or functions that individuals in someone’s reference group (e.g., adults) are ordinarily able to do, at least under favorable conditions, where the inability is not due to simple and easily corrigible ignorance or to lack of the tools or means ordinarily available for performing such tasks or functions. (2000: 286)

This defines disability colloquially, in terms of ability; disability is, roughly, an unusual inability. Barnes and others object, however, that this definition is too broad. It seems to make it the case, for instance, that someone who cannot “roll their tongue” or do mental subtraction is disabled; since most people can do this under favorable conditions. Conversely, this sort of view also seems to undergenerate disabilities, since some (fibromyalgia or depression for instance), only make it more difficult to do things, without making any particular task or function straightforwardly unachievable. And it is not entirely clear how this account avoids the obviously problematic implication that identity categories like race, gender, and sexual orientation imply disability; someone subject to social prejudice in virtue of their gender or the color of their skin might be, for that reason, unable to do things others can do.

Alex Gregory (2020) takes a different approach to defining disability in terms of inability:

The Inability Theory: To be disabled is to be less able to do something than is typical, where this degree of inability is partly explained by features of your body that are atypical. (2020: 26)

This definition of disability brings the body into the definition, but it is meant to be neutral between more-medical and more-social ways of seeing disability. “Atypical” features need not be “abnormal” in a medicalizing sense; they are simply different, not necessarily worse. To say that an inability that comes to disability must be at least partly explained by bodily features is consistent, both, with saying that it is entirely explained by them (a la the medical model) and that it is also partly explained by social factors. This in itself rejects the medical model as a general claim, as well as the less nuanced statements of the social model, that would definitionally exclude non-social inabilities from the ambit of “disability”.

The initial statement of the Inability Theory would still seem to be overinclusive; someone who cannot get a good job because of the color of their skin, or marry the person they love because of their sexual orientation, has an atypical inability explained by an atypical bodily feature. To rule these cases out, Gregory moves to:

The Final Inability Theory: To be disabled is to be less able to do something than is typical, where this degree of inability (1) is partly explained by features of your body that are atypical, and (2) is not explained by anyone’s attitudes toward those bodily features. (2020: 33)

This does plausibly avoid the problem of classifying sexual and racialized minorities at least as disabled; any inability engendered by color of skin is explained entirely by prejudicial attitudes. (Or so it may seem; more below). But in the process it also raises a recurring problem—where an atypical feature is only inability-generating because of attitudes specifically about whether it is inability-generating . If people think that people with, say, Down syndrome, cannot benefit from education, they will not be educated; when they do not develop the skills they could have developed, that lack of skill is, then, explained by a combination of atypical bodily features and attitudes towards those features. It can seem plausible to say, with the ADA, that discrimination rooted in a pathologized understanding of a trait is a kind of disability discrimination.

Moreover, this analysis also raises some of the same concerns as those Barnes and others pressed against Buchanan et alia ’s explication of disability as biologically abnormal limitation. For here even more than there it seemed like not every limitation on ability, not even every one explained by atypicality or abnormality, is a disability properly-so-called. Gregory, however, has a novel response here—insisting that these are, really, disabilities, but just not normally worth calling attention to as “disabilities”, since the aptness of this ascription in conversational context depends on the significance of the abilities at issue.

This proposal raises other problems, however.. Recall race and sexual orientation. A person with light-colored skin cannot work in even relatively moderate sun all day without getting a sunburn. Someone with exclusively same-sex orientation cannot have procreative sex with someone for whom they have romantic and sexual feelings. These are inabilities explained by bodily difference, not by attitudes, and they are not insignificant or trivial ones: yet it seems they are not disabilities, not even a little bit.

Why not? The social constructionist views considered above would give one kind of answer—pointing to the facts that (depending on the view):

• the disability rights movement is rationally unconcerned with properties like race and orientation; or
• that race and orientation are not targeted by ableist ideology for exclusion and stigmatization; or
• that our actual social norms do not marginalize these configurations of bodily function, in the way they marginalize paradigm impairments.

An alternative, more positive approach, which remains focused squarely on ability, would hold that these inabilities, like the minor inabilities considered above, are not relevant to disability because their absence does not place claims on others, in justice. To wit, Jessica Begon (2021)

Thus, I define disability as the restriction in the ability to perform those tasks human beings are entitled to be able to perform as a matter of justice, as the result of the interaction between an individual’s impairment, their social and political context, and the resources they have available to them. (2021: 936–937)

It turns out that by impairment Begon simply means “atypical or unusual functioning”, not pathological or life-limiting functioning; so, this account is actually structurally more similar to Gregory’s than to Buchanan et alia. The difference is that the specific absence of ability that constitutes a disability is the atypicality-caused absence of abilities we ought to have , or anyway that our societies ought to provide for us.

This account has a natural response to the problems of non-disability inabilities. No one is entitled to roll their tongue (at least in any social environment remotely like our own); thus, nobody is disabled because they cannot do so. Nor, in most circumstances, are we entitled to sit unprotected all day in the sun without paying the consequences. We might be entitled to protection by sunscreen, or to the opportunity to escape the sun, but we are not entitled to have the ability to withstand the sun if we choose to forgo these protections. Similarly, it seems plausible to deny that anyone is entitled to procreate sexually with their romantic partner; there may be entitlements to become a parent, perhaps even a genetic parent, but they need not be realized in this way. Thus, Begon’s account appears at first glance not to overgenerate disabilities, as other inability-based accounts seem to.

That said, the account still faces some of the problems we see with other ability-limitation-based accounts. The non-pathologizing sense of impairment as “functional difference” may not in the end be specific enough to distinguish disability from other kinds of unjust absence of ability. Begon addresses this in the case of sex difference, arguing—in effect, with Boorse—that differences in the “reference class” or appropriate functional norms applying to males and females of the species make for differences in what counts as an impairment between males and females. So, for instance, an inability to get a good-paying job resulting from possession of the capacity to menstruate is not a disability, because that capacity is not atypical for female human beings . Such a way to address the problem may not cover all forms of oppression since much oppression seems to be evoked by differences that are functional in some sense—sexual orientation relates to the function of our dispositions to sexual attraction; absence of athletic ability (within the normal range) to the function of the musculature; even pigmentation, to the function of the epidermis in protecting the organism from the environment.

Begon’s view could avoid classifying inabilities down to these differences by further multiplication of “reference class”, so that, say, being unable to get a job because you are gay is not a disability because gay people function typically “for gay people”. But as Elselijn Kingma has argued, in response to similar maneuvers in the health literature, this kind of specificity seems problematically arbitrary—in the limit, threatening to trivialize the relevant notion of “functional typicality” (Kingma 2007). These concerns seem to press back in the direction of Lim’s restriction of disability to responses to “medically significant interests”, or Howard and Aas’s definition in terms of traits perceived or represented as functional deficits in the reigning biomedical ideology.

There are also questions about how we are to understand the set of entitlements relevant to determining when the absence of ability is unjust. Begon discusses these issues only briefly (2021: 954, n30); a more fully developed version of the view would have to do more. It seems important to abstract from resource constraints, since we would not want to say that someone is only disabled if habilitating them is cost-effective relative to other priorities justice gives us, given what resources we happen to have. But this abstraction threatens to make too many of us disabled, since justice might, absent resource constraints, give us powerful reasons to enable one another to do all sorts of things—to give those of below-average height the ability to dunk a basketball, say; or to give women well-past childbearing age the ability to conceive and gestate children. Perhaps we should do these things in response to these functional atypicalities; that does not make people disabled, until we are rich enough to do them.

Two sorts of skeptical responses have greeted the effort to define disabilities as individual traits, conditions, or functions, selected by some set of rules or criteria. The first critique is inspired by the work of Michael Foucault on biopower as a form of control exercised by modern states over the bodies of their populations (Tremain 2017). This critique argues that to focus on individual characteristics in defining disability is to miss the forest for the trees. “Disability” refers not to a set of individual characteristics, or to a concept that encompasses such a set, but to a mechanism that identifies various types of individual characteristics for the purpose of social control. Notably, Shelley Tremain analyzes disability as a mechanism constructed and maintained by laws, informal norms, cultural understandings and other exercises of biopower. Impairments and disabilities only exist within this culturally and historically contingent apparatus that arose in part as a means for people who saw themselves as “normal” to regulate those they labeled as “deviants”.

[D]isability is not a metaphysical substrate, a natural, biological category, or a characteristic that only certain individuals embody or possess, but rather is a historically contingent network of force relations in which everyone is implicated and entangled and in relation to which everyone occupies a position. That is, to be disabled or non-disabled is to occupy a certain subject position within the productive constraints of the apparatus of disability…. (2017: 22).

At first glance, Tremain’s Foucauldian claim can seem to be talking past the interlocutors considered above; no more a distinctive analysis of disability to compete with the foregoing than was Foucault’s famous claim that “knowledge is power” a competitor to Plato’s or Goldman’s or Sosa’s analytic definitions of knowledge (see entry on the analysis of knowledge ). As in that case, however, a recognition of the role the concept of disability plays in reproducing unjust social conditions can cast doubt on reliability of the commonsense judgments and linguistic intuitions appealed to by rival analytic definitions. Such judgments and intuitions are, so the Foucauldian could argue, products of the apparatus, not an independent basis for assessing or understanding its assignment of positions. However, several of the analytic accounts discussed in the preceding action were developed with awareness of and due skepticism towards the ideological roots of prevailing convictions about disability and do not explain disability as a natural, biological category. It is unclear then, if a Foucauldian challenge could undermine the evidence used to develop these accounts.

The second critique, rather than dismiss the value of philosophical definitions, emphasizes their multiplicity, maintaining that different definitions are appropriate in different contexts and for different purposes. On this view, the problem with these definitions is that they see themselves as competitors in pursuing a goal that is both unattainable and undesirable: a single unified or core definition of disability:

Many philosophical disagreements about disability simply overlook the fact that the disputants are talking about different phenomena (impairment vs. oppression; care vs. justice; legal vs. extra-legal obligations, etc.). Some of those disagreements are more productively articulated as disagreements on how to handle the polysemy of disability. (Beaudry 2020: 5; see also Beaudry 2016).

Though certain ethical or political contexts might call for specifying or stipulating a definition, this view holds that we have little reason to think we can find, or should seek, a definition of “disability” as a general matter. We are unlikely to find one because these different definitions will have conceptual and practical advantages in different contexts; we should not seek one because adopting a canonical definition would foreclose our recognition of other characteristics and phenomena with moral and practical affinities to what we have decided to call “disabilities”. An open-ended approach, in contrast, “can create avenues for new kinds of emancipatory self-understandings” (Beaudry 2020: 13).

Beaudry acknowledges that even open-ended approaches have evidentiary constraints, but these constraints are far looser than any which a single definition, however nuanced and complex, would impose:

Disability remains a term that at least denotes or connotes “abnormal embodiments”, including phenomena entirely external to the bodies of “disabled persons” (such as prejudices directed at imagined abnormal embodiments or strictly cultural artifacts). It is a useful commonality between a constellation of discourses that relate to objects that are at least united by this family resemblance and may overlap or interact with each other, even though it is unlikely that a “master theory” would neatly choreograph all such interactions. (Beaudry 2020: 17)

This deflationary pluralism, however, arguably overlooks the value of continuing to seek a single unified or core definition of disability, however unlikely we are to agree on one. Most philosophers who have taken this tack do so not on the supposition that “disability” or even “impairment” are natural kinds—objective properties that legal and regulatory definitions ought to track. Rather, they are largely motivated by a belief that there is a set of personal experiences and social responses that people with disabilities have in common, and that ways of precisifying the meaning of “disability” and “impairment” are likely to work better than others for purposes of framing policies and building political movements to address the needs and claims of individuals those sharing such personal experiences and aimed at addressing the moral and political of this group.

Whether and to what extent the practical aims these various models of disability seek to serve are best accomplished by many separate contextual definitions, or one sophisticated one is, in the final analysis itself likely to be a difficult ethical, even political, question. Proponents of social constructionist, ameliorative views of disability, like proponents of similar views of race and gender, have tended to think that there are good practical reasons to define these notions broadly, to draw attention to forms of injustice that many experience, together, as a means for building larger and thus more powerful coalition to push for positive change. And they have, or anyway could, argue that the flexibility and inclusiveness pluralist call for can be accommodated by an open-minded and sensitive debate over just what this one solidaristic definition should or should not include. They might be right, or they might be wrong, but if they are wrong, it is not because the philosophical and political project of offering a unifying definition is a priori misguided.

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disability: and health care rationing | disability: and justice | disability: health, well-being, personal relationships | feminist philosophy, topics: perspectives on disability | feminist philosophy, topics: perspectives on sex and gender | health | knowledge: analysis of | Molyneux’s problem | self-knowledge

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Rethinking disability: the social model of disability and chronic disease

Sara goering.

Department of Philosophy, University of Washington, Box 353350, Seattle, WA 98195 USA

Disability is commonly viewed as a problem that exists in a person’s body and requires medical treatment. The social model of disability, by contrast, distinguishes between impairment and disability, identifying the latter as a disadvantage that stems from a lack of fit between a body and its social environment. This paper describes the social model of disability and then considers how it might deal with chronic disease or impairment and why medical professionals should learn about disability perspectives to improve their practice.

Introduction

A standard medical approach, indeed a common lay-person’s approach, to thinking about disability involves viewing it as a problem that exists in a person’s body. As a consequence, that individual is thought to require treatment or care to fix the disability, to approximate normal functioning, or perhaps as a last measure, to help the individual adapt and learn to function despite the disability [ 1 ]. So construed, disability is primarily an individual’s medical problem in need of treatment. As disability scholar Liz Crow notes, this medical model of disability holds that “a person’s functional limitations (impairments) are the root cause of any disadvantages experienced and these disadvantages can therefore only be rectified by treatment or cure” [ 2 ]. No doubt, many individuals with musculoskeletal disorders present themselves in the clinic as people looking for a cure, a treatment, or help dealing with their condition. But, as with many chronic conditions, many of them will not find a cure nor will they find complete relief for the symptoms they experience. Recognizing how their lives may be disabled—and what can be done about that—involves taking a closer look at what we mean by disability and its attendant disadvantages.

Effects of the medical model of disability

One result of the common medical understanding of disability is that people with disabilities often report feeling excluded, undervalued, pressured to fit a questionable norm, and/or treated as if they were globally incapacitated. People with disabilities often express frustration when they are met with pitying attitudes or incredulity if they speak about anything positive related to living with their conditions. Many memoirs and books now attest to this common experience (e.g., Encounters with Strangers [ 3 ], Waist-High in the World [ 4 ], Moving Violations [ 5 ], The Rejected Body [ 6 ]). For many people with disabilities, the main disadvantage they experience does not stem directly from their bodies, but rather from their unwelcome reception in the world, in terms of how physical structures, institutional norms, and social attitudes exclude and/or denigrate them. As Lois Keith remarks, “Doing disability all day long can be an exhausting process. I don’t mean having an impairment, in my own case not being able to walk. Like most disabled people I can deal with this. I mean having to spend a significant part of each day dealing with a physical world which is historically designed to exclude me and, even more tiring, dealing with other people’s preconceptions and misconceptions about me.” [ 7 ]

The social model of disability

In response to the traditional medical model of disability, disability activists and scholars have offered a social model of disability [ 8 ], which relies on a relatively sharp distinction between impairment and disability. Within the social model, impairment is understood as a state of the body that is non-standard, defined as “lacking part of or all of a limb, or having a defective limb, organ or mechanism of the body” ([ 8 ], p. 22). As such, impairment may or may not be met with a negative evaluation by its possessor [ 9 ]. People who are blind from birth, for instance, often understand their blindness as a neutral way of being, rather than as a deficit or a problem. Consider Deborah Kent, who reports that “…from my point of view, I wasn’t like a normal child – I was normal. From the beginning I learned to deal with the world as a blind person. I didn’t long for sight any more than I yearned for a pair of wings…I premised my life on the conviction that blindness was a neutral characteristic” ([ 10 ], p. 57–58). Similarly, and even in regard to acquired impairment, Oliver notes that “impairment is, in fact, nothing less than a description of the physical body.” ([ 8 ], p. 35) Disability, by contrast, is 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 participation in the mainstream of social activities” ([ 8 ], p. 22). The point of making and emphasizing this distinction is to show how much and sometimes all of what is disabling for individuals who have impaired bodies has to do with physical and/or social arrangements and institutional norms that are themselves alterable (e.g., stairs vs. ramps; presentation of data using only auditory means vs. universal design for communication, restrictive definitions of job requirements vs. expansive accommodations for different modes of performing work, etc.). People with impairments of a particular kind may be in a minority [ 11 ], but they are typically not thereby rendered incapable of work and social relationships. They need a more inclusive framework in which to participate.

In addition to pointing to the tangible environmental and structural changes that could be made to be more inclusive for people of differing body types, the social model of disability focuses attention on the attitudinal obstacles faced by people with non-standard bodies. Other people’s expectations about quality of life, ability to work, etc. for a person with a disability not only affect the ways in which physical structures and institutional norms are made and sustained (based on presumptions about inability to perform), but also can create additional disability by making it harder for such individuals to feel good about themselves. For instance, Jenny Morris raises concerns about how “all the undermining messages, which we receive every day of our lives from the non-disabled world which surrounds us, become part of our way of thinking about ourselves” [quoted in 7 , p. 22].

The impairment/disability distinction is powerful in lending support to people with disabilities who face unjust treatment and the tendency to medicalize their problems. In the words of one disability activist, it tells us that “ableism needs the cure, not our bodies.” [quoted in 12 , p. 18]. Indeed, as Crow acknowledges, the social model has done wonders for the disability rights movement. “It has enabled a vision of ourselves free from the constraints of disability (oppression) and provided a direction for our commitment to social change. It has played a central role in promoting disabled people’s individual self-worth, collective identity, and political organization. I don’t think it is an exaggeration to say that the social model has saved lives” ([ 2 ], p. 207).

We should not, however, lose sight of the fact that people living with impairments can experience negative effects tied more directly to their bodily conditions. People with impairments that involve, for example, fatigue, pain, depression, or chronic illness may want both to overcome social barriers and discrimination that oppress all people with disabilities, and to voice their desire to remove or address the troubling accompaniments of their impairments, through medical or other means. They may want attention to what have been called “impairment effects” [ 13 ]. No doubt, many medical professionals who might be sympathetic to the disability rights movement in general also see the downside of impairment effects and aim to address them with their medical expertise.

The social model of disability in medical practice

So how might a medical professional appropriately integrate the social model of disability into practice, particularly in relation to disorders that are often chronic in nature? Several scholars have articulated important aspects of this integration [e.g., 14 , 15 ]. Two additional points are worth exploring here. First, we must ensure that medical professionals talk candidly about negative impairment effects while maintaining full respect for individuals with disabilities and fighting for disability justice, for full inclusion of people with disabilities in society. Second, perhaps, we should think more openly about how we understand the place of chronic illness in the disability/impairment distinction.

Recognizing impairment effects without sanctioning disabling practices

Discussion of the negative effects of impairment was, for a long time, excluded from disability rights writing, in large part because of the worry that acknowledging such realities would undermine the important work of addressing disability oppression and discrimination. The gains made by the disability rights movement are still fragile and partial [ 16 ]. Given the pervasiveness and depth of belief in the medical model, people with disabilities may hesitate to acknowledge publicly any difficulties they experience. Jenny Morris expresses the worry this way: “For many this feels a very dangerous thing to say, in that we feel it makes us vulnerable to non-disabled people turning round and saying – ‘there you are then, we always knew that your lives were awful because of illness or incapacity, we always knew what a tragedy it is’.” ([ 3 ], p. 13). As a consequence, concerns about the negative side of impairment are sometimes discussed among people with disabilities privately, but rarely voiced in the public realm.

Reassurance and demonstrated practice that disabled people can talk about negative impacts of impairment in the clinic as well as in public, without fear of being treated as inferior, is central to treating people with disabilities justly. This may require education regarding disability rights and disability pride. Physician Kristin Kirschner, for instance, sees disability studies as a way to help enact a more biopsychosocial model of medicine and to address the troubling legacy of medicine and bioethics in respect to disability: “ignorance, lack of attention to and training about disability, top-down goal setting and decision making, resource and power inequities, and so on” ([ 17 ], p. 60). Calls for cultural competency in medicine might expand to consider disability competency as well [ 18 ].

The social model reminds us to be careful about what we presume to be irremediable through social change and to question the ways in which we currently understand disability. Challenging standard definitions of disability and impairment will require listening carefully to the experiences of people living with those impairments and thinking creatively about possibilities for inclusion, accommodation, and accessibility.

Rethinking chronic illness

How much could social change—even radical social change—actually impact the disadvantages of living with a condition like chronic pain? Can the social model of disability really handle chronic illness? Susan Wendell, a philosopher who lives with myalgic encephalomyelitis (ME), challenges readers to think carefully about their intuitions. On the one hand, Wendell argues in favor of ending ableism and working to address the oppression and discrimination experienced by people with all kinds of disabilities. On the other hand, she also would welcome a cure for her condition. Her position, set forth originally in her book The Rejected Body :

“I want to have more energy and less pain, and to have a more predictable body; about that there is no ambivalence….Yet I cannot wish that I had never contracted ME, because it has made me a different person, a person that I am glad to be, would not want to have missed being, and could not imagine relinquishing, even if I were ‘cured.’ … I would joyfully accept a cure, but I do not need one.” ([ 6 ], p. 83–84)

In a subsequent paper, Wendell reports that her readers have expressed surprise at this statement [ 12 ]. If she would welcome a cure, then how can she believe that contracting ME is something worth experiencing? Is she just trying to make herself feel better, given the lack of available cure? Isn’t the impairment itself really her problem rather than societal attitudes or barriers?

To help explain her somewhat complicated position, Wendell considers a new distinction: healthy vs. unhealthy disabled. The healthy disabled are those who have bodily conditions that are “stable and predictable for the foreseeable future,” who consider themselves healthy, and whose medical needs are typical for a person of their age. Someone who is deaf, paraplegic, or living with down syndrome may readily fit this description. Of course, one who is healthy disabled need not remain in that category continuously, but Wendell suggests that the broad distinction may nonetheless be useful. The unhealthy disabled, by contrast, have conditions that require medical treatment, that if untreated or untreatable cause individuals to feel ill and unable to take advantage of otherwise available opportunities, and that may fluctuate rapidly.

Having made the distinction, we might be tempted to think of the healthy disabled as clearly falling within the bounds of the social model, but perhaps not the unhealthy disabled. Wendell cautions against this move. She wants us to think broadly about the experience of all kinds of impairment, with careful attention to its diverse forms, meanings, and effects. She advocates acknowledgement not only of what is valuable about impairment (e.g., advances in understanding the structure and contentious nature of what is “normal” and what can be done to accommodate difference, rethinking of self-identity and social values, experience of and appreciation for alternative modes of functioning, etc.) but also what can be troubling about it (pain, fatigue, insecurity of health, etc.).

Part of this project requires rethinking the nature of illness itself. Why should we be willing to acknowledge that living without a limb is an acceptable form of human diversity [ 19 ], while living with an illness is not? Wendell asks, for instance, “Is illness by definition an evil, or have we made less progress in recognizing chronic illnesses as potentially valuable differences than we have in relation to other disabilities?” ([ 12 ], p. 30) If we see deafness and paraplegia as different but not necessarily lesser ways of being in the world (if we can celebrate them as distinctive ways of being that may even sanction a certain kind of cultural pride), then why not do the same for chronic illness or “unhealthy” disabilities? They too promote different ways of understanding and appreciating the world, of conceiving the self, of questioning the foundations of “normal.” For most people, the difference has to do with suffering, physiological or mental suffering that cannot be remedied by social change. But Wendell carefully parses the significance of suffering, noting that “although most of us want to avoid suffering if possible, suffering is part of some valuable ways of being.” ([ 12 ], p. 31). Some conditions of the body may be inseparable from physiological suffering (e.g., living with chronic pain or nausea), but the ways of life that people form within them may be quite valuable, and the suffering they experience may play some significant constituent role in what brings the value. Perhaps, not all who live with such conditions long to be rid of them given the chance; others would welcome the opportunity to eliminate the suffering, but might still value the perspective they have gained through it. As Wendell notes, “there are, I think, many versions of disability pride.” ([ 12 ], p. 31).

The social model of disability points to several ethical considerations for health care professionals. First, many impairments and their effects that are presumed by the non-disabled to be quite negative may not be experienced as such by people with disabilities, or at least not in the ways the non-disabled presume. Listening to and engaging openly with the testimony of people with impairments is important. Non-disabled frames of reference have their own epistemic limitations. Consider the words of Harriet McBryde Johnson, a lawyer, sometime politician, and disability rights activist who employed a personal care attendant for much of her life. In her collection of essays, Too Late to Die Young , she remarked on how the kind of daily personal care for the body she relied upon is not undignified, but in many respects a deep form of comfort and connection that makes her wonder about the oddity and loneliness of a supposedly fully independent life. She says “I sometimes think how strange it would be to do these morning things in solitude as non-disabled people do, and to regard, as many of them do, a life like mine as a dreadful and unnatural thing. To me it is so natural to feel the touch of the washcloth-covered hands on flesh that is glad to be flesh, to rejoice that other hands are here” ([ 20 ], p. 251).

Second, even when the experience of impairment is negative, the reasons for the negative experience are often quite different from what the non-disabled presume. Again, many autobiographical accounts of living with impairments and fighting the disadvantages of disability explicitly point out that the main and sometimes the only disadvantage of the impairment is not physiological, but social; the ugly and unwelcoming attitudes of others, the strict insistence on the standard modes and levels of functioning, and the physical impediments to access all make people suffer. In this respect, the social model is very powerful at pointing to the ways that social norms can be disabling.

Third, even when the experience of impairment is negative and for reasons closely tied to the impairment itself (and not due strictly to social barriers), it still may not be overwhelmingly negative. As Wendell points out so well, suffering is something we generally seek to avoid if possible, but suffering is also an inevitable accompaniment of some quite valuable ways of being [see also, 21 ]. Attending more carefully to the negative aspects of some impairments that seemingly cannot be accommodated or remedied may spur greater research, not just for ways to “cure” but also for social and technological ways to facilitate inclusion.

Finally, given that impairment is often not what it is presumed to be, we should be wary of our tendency to fear it as mightily as we often do. Presuming that we live long enough, we will all, eventually, be impaired in one way or another, if we are not already. Learning to accept this fact will not only perhaps help to eliminate the us/them divide that continues to segregate many people with disabilities in social life but could be used to diminish the desperation with which many people seek the elusive state of perfect health. Reducing our fear doesn’t mean that we cannot take measures to prevent impairment, only that we recognize how we can learn to live with them when they inevitably come, and how making social accommodations now will be beneficial to all of us in the long term.

Crow remarks that disability pride comes “not from ‘being disabled’ or ‘having an impairment’ but out of our response to that. We are proud of the way we have developed an understanding of the oppression we experience, of our work against discrimination and prejudice, of the way we live with our impairments.” ([ 2 ], p. 223). This kind of pride surely does not require ignoring the negative side of some impairments, just as it need not involve “supercrip” stories of overcoming personal tragedy. It comes from the hard work of making the world a better and more just place for everyone, no matter what their bodily conditions may be. The social model of disability deserves more uptake within medicine.

Compliance with Ethics Guidelines

Conflict of interest.

Sara Goering declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

This article is part of the Topical Collection on Ethics

Mad Lab at Cal

The Berkeley Disability Lab

Medical Model, Charity Model, and the Social Model

Disability 101.

A lot of people start their disability journey thinking in terms of what is called the medical model of disability. The medical model holds that disability is a problem within people’s bodies. It sees disabilities as imperfections that should and need to be “fixed,” to return the person to being nondisabled. The medical model is intertwined with ableism (more on this later) viewing that disabled bodies and minds are less valuable than that of nondisabled people. “The medical model tends to believe that curing or at least managing illness or disability revolves around identifying the illness or disability from an in-depth clinical perspective (in the sense of the scientific understanding undertaken by trained healthcare providers), understanding it, and learning to control and/or alter its course” ( Source ). The medical model is extremely prevalent in society, but there are lots of other ways to understand disability. 

A model similar to the medical model is called the charity model. This model considers disabled people as objects of pity and reliant on nondisabled people to be included in society. It is “relying on the good will of others to fund services for people with disability, rather than recognizing personal support as a right that the government has an obligation to support” ( Source ). “The Charity approach to disability is viewed as being in the ‘best interests’ of disabled people but it does not consider disabled people’s experiences and knowledge as necessarily valuable or essential” ( Source ).

Related to the charity model, there is also the religious model of disability which “is a pre-modern paradigm that views disability as an act of a god, usually a punishment for some sin committed by the disabled individual or their family. In that sense, disability is punitive and tragic in nature” ( Source ). The religious model is still prevalent in a lot of thinking about disability, but there are some efforts to push back against these notions of disability within religious groups.

One model looking to push back on the prior view of disability is called the social model of disability. Instead of focusing on the “problem” inside someone’s body or mind, the social model identifies that it is society’s lack of access and attitude towards disability that ends up disabling people. In other words, “while physical, sensory, intellectual, or psychological variations may cause individual functional limitation or impairments, these do not have to lead to disability unless society fails to take account of and include people regardless of their individual differences” ( Source ).

Here is a blog series on different types of models of disability: https://www.drakemusic.org/blog/nim-ralph/understanding-disability/  

For other models of disability, check out this website: https://www.disabled-world.com/definitions/disability-models.php  

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An Essay on Modeling: The Social Model of Disability

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From its first exposition almost half a century ago, the social model of disability has been aimed at altering both theory and practice, bringing about profound changes in people’s understanding of disability, and in the daily lives of disabled people as well. The social model’s foil, and on some accounts its antithesis, is the medical model of disability. Both models treat disability as a locus of difficulties. While the medical model takes disability to be a problem requiring medical intervention—and as both the prerogative and the responsibility of medical professionals to fix—the social model understands disability as a political problem calling for corrective action by citizen activists who alter other people’s attitudes and reform the practices of the state. These two conceptualizations of disability have been treated as competitors, as if one must prevail over and eradicate the other in thinking about who disabled people are and what should be said and done in regard to them.

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Silvers, A. (2009). An Essay on Modeling: The Social Model of Disability. In: Ralston, D., Ho, J. (eds) Philosophical Reflections on Disability. Philosophy and Medicine, vol 104. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-2477-0_2

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Disability Theory: Medical/Rehabilitative Model

• Medical/Rehabilitative Model
• Social/Independent Living Model
• Researching Disability Theory

Medical Model of Disability

The medical model of disability focuses on the medical aspects of a disability and seeks to "cure" a person of their disability so that they can return as closely as possible to a able-bodied state. In the past and even today, this is a common way that people think about disability. The problem is contained in the individual who has the disability instead of the problem being with the environment around them. A disability's solution is by medical professionals who can cure the effect of a disability with things like prosthetics, surgeries, and medications. The rehabilitative model is closely related to the medical model. It focuses on the belief that belief that if the person with a disability makes an effort and works with rehabilitative services, they can overcome their disability.

This model is criticized by many people who are disabled and disability studies researchers and advocate because of its narrow view of the full lives that people lead despite and because of their disability. Many people who are disabled feel that their disability is not something to be cured, but an integral part of their identity. The medical model is often critiqued by the social model of disability. The image below illustrates the two different models.

Information from "Disability Studies" in Sage Key Concepts: Key Concepts in Learning Disabilities .

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A basic interpretation of the models of Disability

Dave Lupton aka the cartoonist Crippen gives an in-depth explanation and history of the Medical and Social Models of Disability with reference to other various academic approaches to understanding the role of disability within society.

Baring in mind that I’m no academic, I thought I’d share with DAO readers my attempt at a slightly more accessible explanation that will hopefully serve as a resource for artists and people more generally with an interest in disability and the inclusion of disabled people within culture.

The Medical Model Understanding of Disability

Traditionally the Medical Model understanding of disability has been the method by which disability has been viewed by the rest of society. This has meant that disabled people have been identified by their impairment, and the limitations that these impose. It has also encouraged the separation of disabled people from the rest of society, being seen as a homogeneous group and identified collectively as ‘the disabled’.

Blamed for their differences and seen as having problems that needed curing or, if that failed, being incarcerated in impairment-specific institutions or hospitals, disabled people have experienced abuse and cruelty in equal measures over the centuries.

Medical Model – Crippencartoons.com

By attaching ‘labels’ with regard to the limitations their impairments impose, it focuses on the things that disabled people can’t do, such as not being able to climb stairs or to work beyond certain periods of time without a break. Again, this impairment focus, or Medical Model bias has reinforced the belief that disabled people have little value and are a burden on society.

The Early History

In order to fully understand how the Medical Model understanding has played such a restricted part in the lives of disabled people, we need to look back in history. Prior to the industrial revolution, unless disposed of at birth, disabled people were often looked after in the small villages in which they were born. They would be employed as bird scarers or given the small, repetitive tasks that freed up others to work on the land. A person with a learning disability would also be accepted as the village ‘idiot’, kept around for the general amusement of the villagers. The Church during this time would also provide shelter and food for disabled people.

However, once these communities began to break up and people moved to the towns to work in the new factories, disabled people were literally abandoned. Although perversely, more people became disabled due to the unsafe practices employed in the factories. Various philanthropic projects were launched by well-meaning individuals to provide support in the form of workhouse style accommodation, but essentially disabled people had become surplus to requirements.

Normal Society

It was during the late 19th century that the medical profession became more involved with the ‘problem’ of disabled people. They began to group people by their impairment, devising cures and treatments that would ‘fix’ the problem and allow disabled people to fit into ‘normal’ society. Some of the ‘cures’ devised for people with mental health issues were truly barbaric during this period of our history, a trait that continued through the 1900s.

If it wasn’t possible to cure a person of their impairments then they would be segregated, shut away in some specialised institution or isolated at home, where only their most basic needs were met. It is argued that this focus on a person’s impairment, and the grouping of similar impairments with an emphasis on cure or incarceration was the start of what we have come to term the Medical Model of Disability.

Dependency Culture

Based upon a dependency culture and reinforced by the many stereotypes of disability that promote pity and patronising attitudes, the Medical Model is still the main method used by disability professionals to determine the support that disabled people are entitled to. These non-disabled professionals having become the gatekeepers to services for disabled people, determining every aspect of their life – literally from the cradle to the grave.

The Medical Model understanding creates a cycle of dependency and exclusion, which has been very difficult to break, especially as this is the view that many of the disability charities also hold. By splitting disabled people into impairment groups, the charities use advertising and other means to promote feelings of pity, often focusing their fundraising on finding a ‘cure’. As a result, many of the disabled people in their care feel disempowered by the dependency culture that is generated.

Lip Service

Unfortunately, despite using the appropriate ‘buzz words’ associated with the Social Model understanding, many of the services for disabled people, from government departments to health care providers, still use the Medical Model understanding. This ‘lip service’ causes real anger and frustration amongst disabled people in the UK resulting in protests and demonstrations about the continued lack of access to education, housing, public transport and the benefits system in particular.

The Social Model Understanding of Disability

It wasn’t until the 1960’s that the Medical Model of disability began to be challenged by a radical new look at disability. This was to become known as the Social Model  understanding which turned the whole culture of blame on its head. The problem was no longer seen solely as the fault of the disabled person but could now be directed at an inaccessible society that had erected barriers to effectively disable a person.

Medical Model – crippencartoons.com

Critical Condition

The initial thinking behind the concept that was to become the Social Model understanding of disability first came into existence in an essay called Critical Condition , written in 1966 in part by disabled activist Paul Hunt . He argued that people with impairments are viewed as: “unfortunate, useless, abnormal, different, oppressed and sick, and are unable to contribute to the economic good of the community”.

He also suggested that disabled people therefore pose a direct challenge to commonly held Western values. This analysis led Hunt to the view that disabled people encounter “prejudice which expresses itself in discrimination and oppression.”

Further Research

Hunt’s essay was followed a few years later by a paper called Fundamental Principles of Disability published by the Union of the Physically Impaired Against Segregation (UPIAS). However, it wasn’t until the 1980’s that Vic Finkelstein took the core definition further and gave it academic credibility, which was then added to by further studies undertaken by Prof Colin Barnes and Mike Oliver  in the 1990’s. Together they identified that it is the barriers that prevent a disabled person from playing a full and active part in society that is the problem, not the disabled individual. It was also at this time that the concept became known as the Social Model understanding of disability.

A Vital Tool

The Social Model understanding has since become the ‘workshop manual’ of the disabled people’s movement in the UK, a vital tool with which to challenge those out-dated concepts that have historically kept us dependent upon charitable hand-outs and in a position of subservience within the mainstream society. It is in direct opposition to the traditional way of viewing disabled people as medical tragedies who are the ‘problem’ and who need to be fixed or cured.

Identifying the Barriers

By identifying those barriers which effectively disable people from participating as equals and providing a means to identify the distinction between physical impairment and the social situation (called ‘disability’), this has enabled disabled people to empower themselves like never before.

Barriers – crippencartoons.com

By identifying as ‘disabled people’ – people disabled by the barriers within society – and not as ‘people with disabilities’, the onus of responsibility has been shifted from those people with impairments to the wider community. Disabled people are no longer the problem, needing to be fixed or sheltered within special institutions, but can be included as part of the solution, identifying, and then dismantling the barriers that exist.

Dismantling the Barriers

By society adopting the Social Model understanding of disability, outdated legislation can be rewritten, transportation systems can be redesigned to include everyone who wishes to travel, and by a process of re-education society can begin to accept disabled people’s right to everything from a fully integrated educational system to being able to fully access employment opportunities. These are the barriers that can be identified, challenged, and then removed to provide a level playing field.

Only by also challenging the use of disabling language as part of this process, can society’s perception of disabled people be changed. For example, by using the term ‘the disabled’, society has taken away the individuality of each disabled person, effectively dehumanising them and re-enforcing the perception that they are a homogeneous group, separated from mainstream society.

Also, the devaluing of disabled people through negative imagery and language in the media – films, television and newspapers – is also a barrier which, also having been identified challenging and then changing. Indeed, many disabled people internalise negative views of themselves that create feelings of low self-esteem and achievement, further reinforcing non-disabled people’s assessment of their worth.

Describing Disability

How disabled people are described is another important consideration when addressing disability. Many people with impairments in Europe and the United States prefer the term ‘person with a disability’. They feel that by putting the term ‘people’ first, this somehow elevates the disabled person from the stigmatising attitudes of society. However, from a Social Model perspective, there is a radical difference between Impairment and Disability:

Impairment is an individual’s physical, sensory, or cognitive difference such as being blind, having MS or being Autistic.

Disability is the name for the social consequence of having an impairment. Where people with impairments are disabled by society, disability is therefore a social construct that can be changed or removed.

Following on from this, those who describe themselves as a ‘disabled person’ are using a political term to emphasise the social cause and nature of the exclusion and discrimination that they face as people with impairments. It is a political description of the shared, disabling experience that people with impairments face in society. When people use the term ‘people with disabilities’, this confuses impairment and disability and implies disability is an individual matter, and that a person with impairments has something wrong with them.

Time to Move On?

The Social Model of disability has fundamentally changed the way in which disability is regarded and has had a major impact on anti-discriminatory legislation. It also sees people with impairments as being disabled by society, therefore making it a human rights issue. This is a vital difference for disabled people. However, some disabled people and academics are involved in a re-evaluation of the Social Model  and argue that the time has come to move beyond this basic position. Others argue that the Social Model understanding has only scratched the surface of public awareness and to change it at this stage would be detrimental to any further progress being made.

Other Models

Charitable and Biopsychosocial Models

Other understandings of disability have been identified including the Charitable Model, which is self-explanatory, and also the Biopsychosocial Model . This later understanding was championed and developed by private health care companies in the United States and takes disability away from the Social Model and back to an individualistic, quasi-medical and psychological approach, putting the responsibility back on the individual disabled people. There is a lot of emphasis within this understanding on the disabled person’s attitude, which are perceived as mainly negative and lacking motivation especially with regard to employment. By putting the onus back on the disabled individual, rather than on society, one could argue that this Model is profit motivated.

The Affirmative Model

In 2000, an article by John Swain and Sally French entitled Towards an Affirmative Model understanding of disability was published in the journal Disability and Society. The authors proposed a new model of disability drawing upon the spirit of the disability arts movement and the whole notion of disability pride.

Their starting point was that even if the Social Model was put into practice and all the barriers around were removed to give equal access to employment, inclusive education, public transport, housing, leisure, information and so on, it would still be possible for impairment to be seen as a personal tragedy and for disabled people to be regarded and treated as victims of misfortune.

If the Social Model was disabled people’s political response to the Medical Model , Swain and French’s idea was for a new model which addressed the personal tragedy model of disability.

Practical Application of the Social Model Understanding

It’s worth remembering that the Social Model approach to disability is not set in stone and wasn’t designed to be a perfect theory. It does however reflect disabled people’s real life experiences and offers a radical approach to ending the exclusion of disabled people from mainstream society. It also doesn’t require disabled people to change who they are or be ‘cured’ in order to enjoy the same rights and opportunities that non-disabled people enjoy.

So, how can the Social Model understanding of disability be used in practice? Having previously identified that it helps us recognise barriers that make life harder for disabled people, it follows that removing these barriers creates equality and offers disabled people more independence, choice, and control of their lives.

It should also be recognised that by removing barriers and making a service more accessible, it will also benefit society as a whole, not just disabled people. For example, better physical access will benefit people with prams, push-chairs and those using delivery trucks etc., whereas clearer, more accessible communication benefits everyone.

Crippen has also produced a pdf booklet which you are invited to download via the following link

Landscape – Understanding the Models of Disability

I also appreciate Prof David Bolt’s Tripartite Model of Disability…see more here https://www.academia.edu/44050558/Not_Forgetting_Happiness_by_David_Bolt

That is a very interesting article which explains clearly what has been going on.

Spot on. It was really interesting to read your article and get an insight into what’s really going on with the disabled artist. Thank you.

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Social Model vs Medical Model of disability

The social model vs the medical model of disability.

Social model of disability

The social model of disability says that disability is caused by the way society is organised, rather than by a person’s impairment or difference. It looks at ways of removing barriers that restrict life choices for disabled people. When barriers are removed, disabled people can be independent and equal in society, with choice and control over their own lives.

Disabled people developed the social model of disability because the traditional medical model did not explain their personal experience of disability or help to develop more inclusive ways of living.

(An impairment is defined as the limitation of a person’s physical, mental or sensory function on a long-term basis.)

Changing attitudes to disabled people

Barriers are not just physical. Attitudes found in society, based on prejudice or stereotype (also called disablism ), also disable people from having equal opportunities to be part of society.

Medical model of disability

The social model of disability says that disability is caused by the way society is organised. The medical model of disability says people are disabled by their impairments or differences.

Under the medical model, these impairments or differences should be ‘fixed’ or changed by medical and other treatments, even when the impairment or difference does not cause pain or illness.

The medical model looks at what is ‘wrong’ with the person and not what the person needs. It creates low expectations and leads to people losing independence, choice and control in their own lives.

Social model of disability: some examples

• A wheelchair user wants to get into a building with a step at the entrance. Under a social model solution, a ramp would be added to the entrance so that the wheelchair user is free to go into the building immediately. Using the medical model, there are very few solutions to help wheelchair users to climb stairs, which excludes them from many essential and leisure activities.
• A teenager with a learning difficulty wants to work towards living independently in their own home but is unsure how to pay the rent. Under the social model, the person would be supported so that they are enabled to pay rent and live in their own home. Under a medical model, the young person might be expected to live in a communal home.
• A child with a visual impairment wants to read the latest best-selling book to chat about with their sighted friends. Under the medical model, there are very few solutions but a social model solution ensures full text audio-recordings are available when the book is first published. This means children with visual impairments can join in with cultural activities on an equal basis with everyone else.