Medical vs social model of disability

Medical model:
From Independent Living and the Medical Model of Disability by Simon Brisenden (1986)

• disabled people's opinions not generally considered as valid as the opinion of medical 'experts'
• have to get to the real person inside the disability,
• not the disabled, but disabled people or people with disabilities,
• using the term 'the disabled' depersonalises and denies their right to be seen as unique,
• the terms 'the disabled',  'spina bifida', 'tetraplegic', 'muscular dystrophy', - terminology that throws away all the important things about disabled people (p2),
• mistaken belief that by asking questions about the nature of a person's disability then you can learn about their life - this assumes that the person is defined by their disability.  In reality, this way of educating med students helps to foster an image which is negative and disabling in itself, and all under the guise of an objective scientific enquiry. (p 3),
• term 'disabled' is used as a term to cover large group of people who have noting in common with each other except they function in an 'abnormal' manner (ie not exactly in the same way as those considered 'normal'),
• seen as abnormal because are different but in fact have a range of things they can or cannot do and a range of physical and mental abilities that are unique to them as individuals (like everyone else).  The only difference is the lens that they are viewed through, that it is focussed on inabilities,
• looked at as non-people with non-abilities, helpless individuals to be forced into a life constructed for them rather than as people with different abilities who can construct a life out of their different abilities,
• entirely defined by inabilities and therefore given the blanket label 'the disabled' which teaches a conditioned uselessness based on the making them believe they are a drain on society's resources rather than on actual physical or intellectual capabilities.  This teaches them to be passive and ignore that they may be able to contribute actively to society,
• labelling process leads to exclusion and being treated like morons or people from a different planet,
• if society was organised more equitably then the problems associated with being physically 'perfect', such as being able to walk, see and hear perfectly, speak distinctly and be intellectually dextrous, would disappear,'
• further disabled by buildings not designed to admit them,
• medical model sees people as 'patients' that need treating, too willing to medicate and hospitalise even if this doesn't improve quality of life,
• this model has in turn been passed on to other professionals and people with disabilities themselves which has lead to low expectations,
• this type of thinking ignores sociological and psychological aspects and that medication and hospitalisation is one of the most disabling factors,
• one way to break down the medical definition is to distinguish between a  disease (which has a physical manifestation that you can see) and a  disability (which doesn't).  Mental illness is more controversial when looking at whether it fits the definition of a disease,
• many disabilities are not diseases as they result from traumatic accidents and the definition is not appropriate when the disability is congenital, they are simply living their life the way they always have; it is part of who they are,
• there is no case where a disease related to a disability defines that person's life,
• independent living movement rejects the medical model as it contributes to placing them outside society and into institutions, they describe a place in society where they participate as equals with something to say and a life to lead,
• independence indicates that someone has control of their life and is choosing how to lead that life,
• most important factor is the amount of control they have over their life.

Definition of social vs medical model:

Goering (2015) stated that disability is 'a problem that exists in a person’s body and requires medical treatment.' (p. 1).  This is contrasted by the social model which makes a distinction between and impairment and a disability.  Disability is identified as a disadvantage that comes from a lack of fit between someone's body and the social environment. 

Social vs medical from Goering (2015):

• standard medical approach views disability as something that exists in a person's body and therefore the person needs fixing with treatment or care,
• medical model leads to people feeling excluded, undervalued, pressured to fit a norm and treated as if they were incapacitated,
• main disadvantage experienced stems from how they are made to feel unwelcome in the world (via physical structures, norms and social attitudes),
• impairment is understood as a non-standard state of the body whereas disability is a restriction of activity that is caused by social organisation that doesn't consider people's physical impairments and as a result means they are unable to participate in mainstream social activities,
• making this distinction illustrates that the disabling thing for people with impaired bodies are things that can be changed (eg presenting information in more than one way),
• social model focusses on paying attention to the attitudinal obstacles faced by those with non-standard bodies.  Other people's expectations can create additional disability by making it more difficult for them to feel good about themselves,
• social model has played an important role in promoting self-worth, identity and political organisation and has saved lives,
• people living with impairment can experience negative effects and may still want medical support to remove these negative effects,
• medical professionals must talk more candidly about negative impairment effects while also maintaining respect for the individuals and their right for full inclusion and also think more openly about how chronic illness fit in the distinction between disability and impairment,
• discussing negative effects of impairment was excluded form disability rights discussions because there was a worry about acknowledging it would undermine addressing disability discrimination and oppression,
• the social model asks us to question the ways in which disability is understood and to listen carefully to the people's experiences of living with impairment and to think creatively about how to include, accommodate and make things accessible,
• healthy (stable bodily conditions and medical needs are age appropriate)vs unhealthy (require medical treatment to be comfortable) disabled, 
• not all who live with an impairment may want to get rid of it and may value the perspective it has given them,
• ethical conditions for medical professionals:  first: impairments not always negative, listening to and engaging with people important, non-disabled frames of reference have their own limitations, second: even if the experiences of impairment are negative the reasons for this are different from what the non-disabled presume, third: even if the experiences are negative (and may be due to social barriers), they may not be overwhelmingly negative, fourth: be wary of fearing the impairment due to presumptions made,
• disability pride comes from our response to having an impairment or being disabled

A-ha moment:

Change the lens.  We all have a range of things we can and cannot do.  For example, as much as I would like to drum or play the piano, I don't have the hand/feet co-ordination (in the case of drumming) or the patience to practise (in the case of the piano) so does this make me disabled?  Potentially if you are looking through the lens of what is 'normal' and what is 'abnormal'.

So what have I learned from this?  The medical model is misleading and disabling.  We all have degrees of 'normal', whatever normal is.  A person isn't defined by their disability and should be looked at for the point of view of what they can achieve.

How does this impact me in my work?  It is important to know a person in order to be able to include them and this is why we talk to all people involved in the case.  Parents and the student themselves are the ones that know themselves the best and we should always consider them.

Wonderings:

How much do I contribute to the 'conditioned uselessness'?

How did I live the medical model in the unit ie client vs student?

Treatment of mental health by loading them up with meds.
What is the distinction between disability and impairment and why is it important?

References:

Brisenden, S. (1986). Independent living and the medical model of disability. Disability, Handicap & Society, 1(2), 173-178.

Goering S. (2015). Rethinking disability: the social model of disability and chronic disease. Current reviews in musculoskeletal medicine, 8(2), 134–138. https://doi.org/10.1007/s12178-015-9273-z