Models of disability

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This category of models centre on different deficits held by disabled people, such as the medical model (a deficit in health) and the rehabilitation model (a deficit in employment).^[6]

The tragedy model views disability as an individual's misfortune. It is one of the most dominant conceptualizations of disability in Western society.^[7] It is generally an individualistic view of disability: each disability is an individual, personal tragedy.^[7]

The tragedy model is criticized for being ableist; it is associated with the view that living with a disability is worse than death.^[5] In the tragedy model, pity is seen as an appropriate response to disability, and used to justify infanticide and other murders of disabled individuals.^[5] The tragedy model underlies the supercrip stereotype: if a disabled person is seen as thriving, it is because they did so in spite of their disability.^[5]

The charity model positions disabled people as pitiable victims,^[8] and abled people who provide them with charity as beneficent saviours.^[9][10] This model is frequently combined with other deficit models, such as the tragedy and medical models.^[11][12]

This model is criticized by disabled people, as it centres the people who provide the charity,^[13] rather than those ostensibly being "helped".^[14] Disability acts as a means for abled people to feel good about themselves, through providing charity—without regard for whether this charity was wanted or effective.^[15][16]

The moral model of disability, also known as the religious model, views disability as a form of punishment for having a deficit in one's morality.^[2] In Judeo-Christian tradition, disability may be viewed as a punishment by God for having sinned;^[17] in Hindu tradition, disability may be understood as karma for misdeeds committed in one's past life.^[18] The moral model is characterized by a distrust of disabled individuals.^[19]

The moral model is frequently seen regarding disabilities where individuals' actions may have contributed to acquiring the disability, such as AIDS, type 2 diabetes, obesity, and addiction.^[2] Concerning addictions, the moral model is often contrasted with the medical model: addiction is less likely to be seen as a moral failing if one understands it instead as an involuntary, medical condition.^[20]

In the expert or professional model of disability, disability is a problem that requires expert professionals to identify and then prescribe a series of interventions.^[21] This model produces a power dynamic where an abled, authoritarian service provider acts on behalf of a passive, disabled client.^[11] At its extreme, disabled people are given no authority or autonomy over their care or everyday life.^[21] It has been described as a fixer/fixee relationship.^[21]

The medical model, also known as the normalization model,^[22] views disability as a medical disorder, in need of treatment and ultimately cure.^[12] Its endpoint is a world where disability no longer exists, as all disabilities have been "cured".^[12]

In the medical model, physicians are the primary authorities on disability.^[21] It is categorized as a deficit model, as it views disability as a deficit in health.^[6] It is also categorized as an individualistic model, in that disablement is a result of each individual's body/mind.^[12] The medical model has been heavily critiqued by the disability community, as many disabled people do not wish to be cured, and reject the deficit framing.^[6]

The rehabilitation model, also known as the functional limitations model,^[2] aims to "rehabilitate" disability through alterations both to the disabled individual and their environment.^[12] Like the medical model, it is categorized both as an individualistic model and as a deficit model,^[12] but instead of a deficit in health it is a deficit in employment.^[6] Unlike the medical model, the rehabilitation model does not aim to alter the underlying cause of a person's impairment; the focus instead is on functional capacity.^[2]

Unlike the medical model and the eugenic model, the goal is not to eliminate disability.^[12] The desired endpoint instead is to minimize the effects of disability in society.^[12] This model expects disabled people to conform as much as possible to society.^[19] Similar to the medical model, it places rehabilitation experts as the authorities on disability, rather than disabled people.^[6]

The technological model, also known as disability technoscience,^[15] aims to reduce the effect of disability through technological means.^[23][16] It is a subtype of the rehabilitation model which focuses specifically on how technology can reduce functional limitations. Unlike the rehabilitation model, it positions engineers and designers as the authorities on disability.^[15]

This model has been criticized by disability advocates for expecting disabled people to need complex, expensive technologies rather than implement changes in society.^[16] For example, why design a costly and likely unsafe "stair-climbing wheelchair" when instead building codes should be changed so ramps and elevators are provided?^[9] In their Crip Technoscience Manifesto, scholars Hamraie and Fritsch further critique the implication "that disabled people are not already making, hacking, and tinkering with existing material arrangements".^[15]

The biopsychosocial model was developed by mental health practitioners to recognize how the interactions between biological, psychological, and social factors can influence the outcome of any given medical condition.^[24][25]

The model has been critiqued by both disability and medical communities as the psychological element is often overemphasized in clinical practice.^[24][26] For example, the biopsychosocial model has been used by physicians to dismiss myalgic encephalomyelitis and medically unexplained symptoms as psychosomatic in nature without adequate investigation to somatic causes nor consideration of social determinants of health.^[27]

Disability advocates have criticized the biopsychosocial model as victim-blaming.^[24] According to Inclusion London, the biopsychosocial model treats the primary cause of unemployment amongst disabled people not due to workplace discrimination but instead due to the disabled individuals themselves having negative attitudes and behaviours about work.^[28] If a disabled person becomes depressed because they repeatedly encounter workplace discrimination, and stop applying for jobs, the biopsychosocial model places the onus on the disabled person for not having tried hard enough.^[28]

The economic model understands disability as a deficit to the economy.^[17] The model uses the lens of economic analysis to quantify the effect of disability on economic productivity,^[17] such as through the Disability-adjusted life year. The value of a disabled person is hence reduced to their ability to contribute to capitalism,^[2] and is criticized for being dehumanizing and disconnected from the broader sociological forces.^[17][1]

It is similar to the rehabilitation model for its focus on how disability prevents people from working. However, where the rehabilitation model focuses on qualitative, social functioning; the economic model focuses on quantitative, financial impact.^[8]

Although the economic model can be applied on an individual basis, the financial impact of disability is more often evaluated with respect to employers and nation-states.^[8] Indeed, this model is often invoked in policy-making in Western countries.^[17][1]

The bureaucratic model of disability, also known as the compliance model, treats disability as a question of legal compliance for institutions.^[29][30] Disabled people are understood deserving of special exceptions to rules, but only if the disabled person has the exact requisite paperwork to prove their worthiness.^[31][32]

The end goal of this model is to shield institutions from legal liability.^[29] Disabled people are hence seen as a deficit in rule-following.^[30] This model is used by disability advocates to criticize how bureaucratic accommodations for disabled people are often one-size-fits-all, rigid, ineffective, and inaccessible to many who need them.^[29][30]

The eugenic model argues that the human race should take an active role in selectively breeding for desirable physical and mental characteristics.^[14][33] In the eugenic model, people are categorized as fit or unfit. Its end goal is a population composed solely of those who are "fit",^[33] and has been used as justification for mass-sterilization and mass-murder of those seen as unfit.^[34]

In the eugenic model, disability is not merely an individual deficit but a threat to the collective gene pool.^[34] Eugenic thought was built upon a misunderstanding of evolution: genetic variation is important for a species' evolution and resilience.^[35] In contrast, the evolutionary model understands disability as contributing positively to the gene pool.^[35]

Disability activists and scholars stress that eugenic thought remains alive and active in society.^[14] For example, the COVID-19 pandemic brought to light how common it is for abled people to see disabled lives as expendable, such as through the common refrain that "only the old and sick will die"^[36] and medical rationing policies that explicitly discriminate against disabled people.^[37]

Similar reports are found of disabled people treated as expendable with regard to climate change and disaster preparedness, and have been termed "Climate Darwinism".^[38] Certain environmentalist discourses which focus on fixing "overpopulation" (rather than over-consumption) are criticized for often implying the "solution" is to rid the world of degenerate (disabled) people.^[39][40]

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The affirmation model, also known as the affirmative model and the identity model,^[41][17] centres the benefits of being disabled.^[7] It is a direct rejection of the tragedy model of disability. This model was developed by disabled people and positions disabled people as authorities on disability.^[7]

The concept of Deaf Gain refers to how losing one's hearing also gains one a place in the Deaf community.^[42] Many Deaf people take pride in Deaf culture and the unique features of signed languages.^[42]

Similarly, the so called "Neurodiversity" movement has advanced an affirmative model of disabilities such as Autism. Many autistic people view their autism positively and claim to not be in need of cure.^[43] Events such as Autistic Pride Day celebrate autism as a positive identity.

The end goal of the affirmation model is a world where disabled people have a collective identity which is a source of positive self-image and pride.^[17]

The social model views disablement as being caused by societal ableism.^[12] Disability is differentiated from impairment: impairment is the physical limits of one's bodymind, whereas disability is caused by society. For example, being born unable to hear is an impairment. But what is actually disabling is that society does not widely use any signed languages, and transcription/captioning are often unavailable.^[44]

In a social environment where using a signed language is ubiquitous, deafness stops being disabling.^[45] Prior to colonization, many Native American cultures routinely used signed languages such as Plains Indian Sign Language, and did not have a conceptualization of disability which included deafness.^[46]

The social model is usually contrasted directly with the medical model of disability.^[5] Whereas the medical model views disability as a problem caused within the individual, the social model views disability as a problem with the society in which the individual lives. The social model, like the affirmation model, was created by disabled activists.^[12]

The end goal of the social model is a world where disabled people enjoy unrestricted social participation.^[5] All barriers for disabled participation have been removed through universal design in the built environment, widespread use of signed languages, Universal Design for Learning in teaching, universal access to support workers who are paid fair wages, and so on.^[47][48]

The social model has been criticized for being overly reductionist.^[49] Some disabilities, such as ME/CFS, involve physical pain or fatigue, and as such do not neatly fit in the conventional social model of disability.^[49]

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The human rights model, also known as the rights model,^[50] views disabled people as inherently worthy of human rights and dignity.^[17] Disabled people should have the same rights as every one else in society, and should have legal protections from discrimination.^[8] It is contrasted with the charity model.^[51] With its focus on personal liberties, rights, and autonomy, this model is rooted in philosophical liberalism.

The human rights model has been criticized as it focuses on reforming the existing social system, rather than enacting fundamental social change.^[50] For example, the human rights model aims to prevent legal discrimination in disabled people owning private property, and does not question the legitimacy of land ownership in settler colonial nations.^[50]

The human rights model aims for disabled individuals to have complete autonomy over decisions affecting their lives.^[51] Unlike the social model, the human rights model recognizes that some disabled people experience chronic pain and/or fatigue that they wish to have treated or cured.^[17] The human rights model asserts all disabled people have a right to patient-centred medical treatment which respects their bodily autonomy, and respects that some disabled people may use this right to have their disability cured.^[1]

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The cultural model of disability, also known as the social construction model and the critical disability studies (CDS) model,^[1] understands both disability and impairment as categories generated by academic knowledge, cultural media, and everyday discourse.^[13] This model focuses on the social forces which shape and reinforce the category of "disability".^[17] This model uses a post-structural sociocultural lens to examine how the boundaries of disability shift across cultures and times.^[6] Its end goal is to decode and deconstruct the unstated assumptions about disability.^[6]

Unlike the social model, the cultural model views both "impairment" and "disability" as social constructions—and troubles the idea that these concepts may be easily separated.^[13]

In the radical model, disability as a category is socially constructed, and was created for the purposes of capitalism and white supremacy.^[12] The radical model acknowledges that disabled people do not, in practice, control the definition of disability, and so "disability" is anyone who has been identified by the relevant political powers as disabled.^[14]

The radical model, like the cultural model, pays attention to the social forces that shape the category of disability. It also views "impairment" and "disability" to be equally socially constructed.^[12] The radical model focuses on the intersectional aspects of how disability is socially constructed.^[52] For example, how the modern concept of intelligence was created by race science to position Black people as inherently feeble-minded^[34] and hence disabled. Which in turn is important for understanding how special education in the United States was expanded after Brown v Board as a means to maintain racial school segregation.^[53]

The radical model posits that disability cannot be neatly separated from other categories of oppression such as class, race, ethnicity, sexual orientation, and gender.^[52] It shifts the focus from disability rights to disability justice.^[52]

The radical model posits there is nothing inherently wrong with disabled people: Deaf people are a linguistic minority, certain groups of disabled people think differently, people with mobility disabilities move differently, et cetera.^[14]

The end goal of the radical model is a world without kyriarchy. The radical model is explicitly anti-capitalist, anti-racist, anti-colonial, feminist, and queer liberationist.^[52] Politically it is often associated with socialism and anarchism.^{[citation needed]}