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The medical and social models of disability discourse
This is an excerpt from Introduction to Adaptive Sport and Recreation by Robin Hardin & Joshua R. Pate.
By Justin A. Haegele and Cathy McKay
When medical professionals replaced religious leaders as the cognitive authority in society, it opened the door for a medical understanding of disability, particularly given the medical field’s ability to define, heal, and cure illness and injuries (Brittain, 2004). The medical model of disability defines disability as a medical problem that resides in the individual as a defect in or failure of a bodily system that is abnormal and pathological (Goodley, 2016).
The medical model defines disability as a medical issue: a defect in or failure of the body that society views as a problem.
Given the focus on the body, it is unsurprising that the medical model conceptualizes disability as a biological product and as an individual phenomenon that results in limited functioning that is viewed as a problem (Goodley, 2016). This can include structural or functional deficiencies caused by physical, sensory, affective, or cognitive issues (Haegele and Hodge, 2016). According to the medical model of disability discourse, limitations associated with having a disability are considered a product of an impairment. Those ascribing to this model believe that something is inherently disabling about impairments, and the challenges disabled people face are independent of wider sociocultural or political environments (Goodley, 2016).
Within this model, disability is viewed as being inherently negative and is therefore something that the medical community should intervene to help remediate or “fix” using psychological or medical interventions (Haegele and Hodge, 2016; Mitra, 2006). In this way, disability is conflated with the “sick role,” similar to illness, where medical personnel should help cure individuals’ disabilities so that they can function “normally” within society. Thus, to reduce disability and therefore gain independence, the medical community must help eradicate the cause of and “fix” impairments. Within this model, access to treatment or medical services to reduce disability is available only via referral by diagnosis, placing medical professionals and medical diagnoses in critical roles for disabled people. When disabilities cannot be eliminated or “fixed,” disabled people are often viewed as pitiful or in need of help or charity (Roush and Sharby, 2011).
Historically, the medical model has underpinned many aspects of research and practice in adaptive sport and recreation contexts. For example, many adaptive sport or recreation opportunities are restricted to those who have specific diagnoses, making medical professionals important gatekeepers to individuals’ involvement within sport or recreational opportunities. Classification systems within adaptive sport, which tend to group participants based on impairment severity, are also largely medically informed. In addition, medical model understandings of disability have influenced the language that we use when we talk about disabled people within these, and all, contexts. Medical model language generally centers on specific diagnoses (e.g., a person with cerebral palsy) and revolves around differences based on what is considered normal, acceptable, and valued compared to what is viewed as abnormal or devalued (Spencer et al., 2020) and is largely present in most adaptive sport and recreation research and practice. This language is well aligned with the normative nature of disability as conceptualized within discourse in the medical model of disability.
Another aspect is the persistent negative disability stereotypes common to the medical model and the way these beliefs can influence how disabled people experience sport and recreation. In this model, disability is discussed as a deficit, which focuses on a biophysical assumption of normality and creates a problematic normal and abnormal dichotomy (Haslett and Smith, 2020). This language can influence how people interact with and talk about disabled people, including in sport and recreation contexts, and can reinforce harmful and stigmatizing ideals about disability being undesirable (Spencer et al., 2020). For example, disabled athletes may find themselves being mocked or disregarded by others when expressing interests in exploring higher-level sport because of understandings that disabled people are limited and that high-level competition is not possible. These ideas can be attributed to the deficit-based definitions, language, and perceptions the medical model of disability discourse has established.
The Social Model of Disability Discourse
The social model of disability, sometimes considered a reaction to the medical model of disability discourse, has gained popularity among academics in adaptive sport and recreation contexts. According to Mitra (2006), there are at least nine versions of the social model of disability discourse. Many of these models share common assumptions of disability, and this chapter will discuss these similarities as conceptualized with the phrase the social model.
In the social model, disabled academics and advocates, as well as allies, supplant medical professionals as the cognitive authority. Social model advocates suggest that society imposes disability on individuals with impairments. That is, rather than impairments being inherently disabling, social model advocates suggest that the behaviors of those within society who do not take into account people who have impairments and exclude them from various aspects of community life are what disable them. Importantly, the terms impairment and disability are different concepts in the social model of disability, where the former refers to a biological phenomenon (e.g., physical, social, cognitive, emotional) and the latter refers to disadvantages or restrictions of activities caused by societal organizations or structures (Goodley, 2016; Haegele and Hodge, 2016). This is a critical distinction. Unlike the medical model’s stance that disabilities are inherently negative, it suggests that one’s body function does not limit their activities or abilities; society does (Roush and Sharby, 2011). Therefore, there is nothing inherently disabling about impairments, and impairments are considered neither positive nor negative. This distinction is important to remember. Exclusion and social isolation can both be a product of society’s inability, unwillingness, or failure to remove the barriers disabled people encounter or the perceptions toward them as being less able.
The social model suggests that society imposes disability on individuals who have impairments.
Unlike the deficit thinking medical model language perpetuates, the social model of disability suggests that impairment be considered a form of diversity, like gender, sexual orientation, race, or ethnicity, that offers a unique perspective that should be valued and celebrated (Goodley, 2016). Therefore, rather than attempting to “fix” disabled individuals, advocates of the social model suggest that solutions should be focused on societal change. Social model thinkers suggest that societal change, and the associated change in attitude toward disabled people, could be the impetus to reduce many problems typically associated with disability. The overarching message of the social model is a call to move society from one that discriminates against those with impairments to one of social inclusion.
The social model of disability also has language considerations that influence the way in which we talk about disability. Rather than using a person-first language model (such as person with a disability), social model thinkers tend to use an identity-first language model (such as disabled person) to refer to persons who are oppressed, or disabled, by society. As noted earlier, in the social model, people do not have disabilities but rather are actively disabled by society. Given conceptual differences between impairment and disability, social model thinkers may also use alternative language such as person with an impairment or person experiencing disability; however, these terms are much less commonplace than the phrase disabled person. Persons interacting with disabled people should also be mindful of the language preferences of those within specific disability communities. For example, communities of autistic or neurodivergent people have recently reclaimed their impairment-related language and tend to present in ways that are consistent with social model thinking. According to Spencer and colleagues (2020), “such terms frame the ways their minds work as neutral or positive human variations and frame their social and medical treatment as forms of oppression, eugenics, and genocide” (p. 137). That is, the reclamation of autism-related terminology is aligned with the idea that autism should not be considered a detrimental feature of the human experience. Rather, differences associated with autism are considered positive or neutral features. These beliefs and preferences appear well aligned with social model thinking and, unsurprisingly, social model language.
While social model thinking may represent progressive thinking in several ways, it is not without its criticisms. One notable criticism is related to attempts to separate impairment from disability completely, which does not fully account for the lived experiences of disabled people. This thought has led some to propose the social relational model of disability, which suggests that disability is imposed on top of restrictions that are caused by one’s impairment (Reindal, 2008, 2009), therefore taking into consideration both the biomedical restrictions of impairment and societal restrictions of disability. The social model has also been criticized as being idealistic and monolithic, in that it considers only one form of an individual’s identity (i.e., their disability) without exploring the implications of other oppression they may face associated with additional identity markers (e.g., racism, sexism, transphobia). To better understand how these identities interact to inform experiences, readers may consider exploring research and scholarship associated with intersectionality, which provides a lens through which we can understand how differences among disabled people (e.g., racial, cultural, ethnic differences) interact to influence experiences within society.
The Charlottesville Cardinals: Wheelchair Basketball Team and Disability Sport Advocates
The Charlottesville Cardinals wheelchair basketball team was formed in early 1980 by six local athletes in the Charlottesville, VA, area. Our team was created to provide disabled athletes an opportunity for exercise and competitive recreation and to educate the general public concerning the capabilities of individuals with disabilities. Since our formation, over 700 disabled athletes have participated with the Cardinals, and we have played in front of over 175,000 people across the United States, Canada, and Puerto Rico. In addition to competitive recreation, we are proud to have a reputation of developing highly skilled athletes. We have been perennially ranked among the top 20 teams in the country for over 20 years and are very proud of our commitment to skill development and high-level competition. Our team was initially sponsored by the Therapeutic Recreation Program of the City of Charlottesville. Later, a local center for independent living, the Independence Resource Center, became our key sponsor.
As an organization and team, we strive to advocate for societal change related to approaching disability as one of the many forms of diversity. Our players identify not only as disabled but also as White, Black, and Brown; as he, she, and their; and as adolescent, adult, and older adult. We work tirelessly to advance social inclusion through community and school engagement efforts, hoping that our stories and experiences will allow those with whom we engage to better understand and value our diverse abilities. Our engagement includes school presentations where we demonstrate wheelchair basketball and play against a faculty or student team; school visits where we teach and lead lessons on the skills of wheelchair basketball; and community demonstrations at parades and festivals. We also partner with a variety of universities in Virginia, as well as up and down the East Coast, to advance programming related to disability sport and disability etiquette. Our hope is that our community and school-based advocacy efforts allow for students and community members to broaden their perspectives on disability. This broadening includes learning and growing as inclusive members of organizations and schools, coming to know and understand the power that sport can play in changing our communities and our society, and advancing attitudes toward disability.
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