Monday, 21 January 2013

Bio-medical vs social models of disability

Talking to Bill Penson this week about disability, I found myself trying to put forward something like Jerry Wakefield’s harmful dysfunction model as the best bet for a bio-medical model of disability. Bill’s basic objection was that it didn’t seem a promising way of capturing some of the important social features of disability, such as stigma. But I could imagine a bio-medical approach claiming that whilst those were important and unfortunate features, they were contingent effects of disability, not disability itself.

To rehearse familiar ground, such an approach has a key attraction. There is little hope of giving a merely statistically abnormal in the sense of unusual account of disability because it carries with it some notion akin to impairment. That notion suggests a normative or evaluative characterisation. But combined with the common neo-Humean view that norms and values are human inventions, merely subjective (even if intersubjective) features, that suggests that there could not be a science of impairment and hence disability. Now whilst it is true that the harmful dysfunction analysis does contain just such a value (harm), it also promises a central objective core condition: impairment requires biological dysfunction, cashed out through descriptive evolutionary theory.

I don’t think it is so descriptive. But let’s ignore that here.

What would be wrong with such analysis? Even if it seems to get the focus in the wrong place to some, because it is not an essentially social status, might it not captured the core idea: there is disability only where there is impairment and that that apparently normative notion reflects the biological norm of proper function?

One clue, which Bill suggested, comes from an analogy with the Deaf community: Deafness – if not deafness – can be claimed to be a cultural identity rather than a disability. It is a distinct form of subjectivity, a merely different (not impaired) take on being in the world. But the Wakefield position can accommodate this even if in a way which will not appeal to the Deaf. Deafness is a failure of biological function even if not, in the right context of community empowerment, a harmful one. Dysfunction is necessary but not sufficient, on this analysis, for disability.

But that suggests another question to ask. Is it really necessary? Do all disabilities require an impairment,  cashed out as failure of biological function? It may be that there is something more fundamental to disability than dysfunction and that dysfunction is just one way of partially filling this out.

So here is a thought which aims to capture the social dimension mentioned at the start, and stressed by Bill. Perhaps there can be disabilities where there is no dysfunction because they are purely socially constituted. This is following the idea that, to be disabled, something other than biology has to do the disabling. One is disabled by social context. (And thus, in a different context, it is not that one’s disability is ameliorated but rather expunged.)

So suppose that handedness played a much more important role in our artefactual and cultural life. All scissors were one way only. Driving and writing were virtually impossible in one chirality but fine the other. Handshakes were elaborate and required much one handed strength and dexterity (ho ho). We can now imagine a case where being one handed rather than another was not in itself functional or dysfunctional biologically. But it would be a grave disability to be of the minority handedness.

In such a case, there is something like ‘function’ playing a role. But it is an essentially social and relational version. If this is a possible approach it would explain why a biological dysfunctional approach would sometimes get the right answer but for merely derivative reasons. But we would need to work out in a generic account of what such social ‘functions’ and dysfunctions were.