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How is disability understood? Anexamination of sociological approachesCarol Thomas aa University of Lancaster , UKPublished online: 01 Jul 2010.
To cite this article: Carol Thomas (2004) How is disability understood? An examination ofsociological approaches, Disability & Society, 19:6, 569-583, DOI: 10.1080/0968759042000252506
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Disability & Society, Vol. 19, No. 6, October 2004
How is disability understood?
An examination of sociological
approaches
Carol Thomas*
University of Lancaster, UK
This paper considers sociological understandings of what constitutes disability. Current meaningsof disability in both disability studies and medical sociology are examined and compared, usingselected articles from leading authors in each discipline as case studies. These disciplines are oftenrepresented as offering starkly contrasting approaches to disability, with their differences amount-ing to a disciplinary ‘divide’. It is argued that, on closer inspection, common ground can be foundbetween some writers in disability studies and medical sociology. It is suggested that this situationhas arisen because, in disability studies, the social relational understanding of disability developedby Vic Finkelstein and Paul Hunt in the 1970s has been lost over time, overshadowed by the riseto prominence of its offspring: the social model of disability. The paper concludes with somereflections on the need to revive a social relational understanding of disability.
Introduction
How much progress has been made in developing a sociology of disability? Judgingby the volume of books and papers claiming to examine disability sociologically onemight think that considerable advances have been made in the last thirty years. Thepublication of Sage’s tome Handbook of disability studies (Albrecht et al., 2001)appears to signal that a sociologically informed ‘disability studies’ has come of age.One must not, however, be fooled by appearances. While the quantity and scope ofpublications is to be celebrated as indicative of the seriousness with which disabilityis studied, we need to get beneath this to assess how much our understanding ofdisability has been enriched.
It is the nature of sociological understandings of what constitutes ‘disability’ thatis the subject of this paper, in other words, answers to the beguilingly simplequestion: what is disability? In Britain, many would assert that there remains amarked divide between two principal domains in the sociology of disability. The firstis associated with what this journal would recognize as ‘disability studies’ proper—
*Institute for Health Research, Lancaster University, Alexandra Square, Lancaster LA1 4YL, UK.Email: [email protected]
ISSN 0968-7599 (print)/ISSN 1360-0508 (online)/04/060569-15© 2004 Taylor & Francis LtdDOI: 10.1080/0968759042000252506
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an approach informed by the idea that disability is centrally structured by socialoppression, inequality and exclusion. The other, associated with medical sociology,or specifically its sub-genre the ‘sociology of chronic illness and disability’, isinformed by the idea that disability is caused by illness and impairment and entailssuffering and some social disadvantage. These contrasting approaches suggest thatthere is no unitary sociology of disability, but rather sociologies of disability thatcontinue to offer quite different perspectives on the nature of disability. There havebeen a few attempts to encourage dialogue across the disability studies and medicalsociology divide (Barnes & Mercer, 1996; Barnes et al., 2002), and some disabilitystudies writers have critiqued medical sociology at length (Oliver, 1990; Barnes etal., 1999; Thomas, 1999; Barnes & Mercer 2003). More often than not, however,these two arenas of the study of disability passively coexist rather than activelyengage with one another—as indeed is evident in the chapters in Albrecht et al.’s(2001) Handbook of disability studies.
This paper will not attempt to provide a comprehensive review of the literatureassociated with these two domains of sociology of disability, nor to explore with anythoroughness the richness of debate and theoretical difference within the parametersof each approach. Rather, it examines several of the defining features of how thesesociologies understand the nature of disability by focusing on a selection of recentpapers by notable authors on both sides of the divide; these serve as case studies.From disability studies, work by Vic Finkelstein (2001a, b) is drawn upon, and apaper by Tom Shakespeare and Nick Watson (2001) is used as an example of recentcritiques of the social model of disability. The perspective of medical sociology isexplored through papers by Michael Bury (2000) and Simon Williams (1999),leading writers in the sociology of chronic illness and disability. In selecting work bythese authors, the intention is not to achieve representativeness, but to use these casestudies as a means of examining prominent contemporary ideas about what consti-tutes disability.
These two sets of authors will be considered separately in the next two sections,followed by a discussion examining whether there is overlap or common ground inthe understanding of disability. The case is made that despite the widespreadreference to a disciplinary divide there is evidence of common ground on whatconstitutes disability. It is suggested that this has arisen because, in disability studies,the focus on a social relational understanding of disability introduced by VicFinkelstein and Paul Hunt in the 1970s has dissipated over time, something that thisauthor laments. Ironically, this loss has occurred as a consequence of the success ofthe ‘social model of disability’—the offspring of the 1970s social relational conceptu-alization of disability. The social model holds that disability is the outcome of socialbarriers that restrict the activities of people with impairments. The concludingremarks reflect on the need to revive a social relational perspective in disabilitystudies.
Understanding disability: disability studies
Readers of a deconstructionist leaning may already be thinking that the positeddivide between disability studies and medical sociology might be a discursively
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constructed and imposed dualism. However, such a divide is real enough, bothconceptually and politically, as far as many within disability studies and medicalsociology are concerned (Barnes & Mercer, 1996; Thomas, 1999; Bury, 2000).From a disability studies viewpoint, what makes its disciplinary standpoint distinctis an explicit commitment to assist disabled people in their fight for full equality andsocial inclusion. This compares with medical sociology’s commitment to pursuesociological scholarship per se, or to inform policy-makers and professionals in thedisability services arena. Since the early 1990s, a considerable body of disabilitystudies literature has been produced, and its commitment to emancipatory goals isreflected in the first two papers to be considered, not least because these have beenmade accessible on the Internet as part of an archive of written materials for disabledpeople and their supporters1. These papers are the work of a founding member ofthe disabled people’s movement and disability studies in Britain, Vic Finkelstein(2001a, b).
Finkelstein: a founding attempt at a materialist perspective in disability studies
Finkelstein’s name is closely connected to the establishment of the social model ofdisability, though, as he reminds us, it was the sociologist Mike Oliver who took upthe ideas of UPIAS (Union of the Physically Impaired Against Segregation)—theorganisation of disabled people founded by Finkelstein and Paul Hunt, amongothers, in the mid-1970s—and encapsulated them in the notion of ‘the social modelof disability’ (Finkelstein, 2001a; Oliver, 2004). Oliver’s work in disability studies isseminal, and I have engaged with his ideas at length elsewhere (Thomas, 1999), butit is helpful to leave the idea of the social model aside for a while, and to focus onFinkelstein’s perspective on disability as recently expressed in his own words.
Reviewing the establishment of UPIAS, Finkelstein recounts that he and others,as disabled people, were faced with a stark choice: ‘you see disability fundamentallyas a personal tragedy or you see it as a form of social oppression’ (2001a, p. 5). Hewas clear that disability had to be interpreted in the second sense: ‘It is society thatdisables us and disabled people are an oppressed social group’ (2001b, p. 2). Thisperspective arose out of his attempt, with Hunt, to reflect theoretically upon thenature of the social treatment of disabled people in the 1970s, particularly in itswelfarist form: residential care, minimal benefits, exclusion from employment andthe educational mainstream, and blocks on access to the built environment. Theview that society disables people with impairments, and that it is this problematicsocietal response that constitutes disability, meant that disabled people’s politicalstruggle should be directed toward changing society and winning control over theirown lives. Thus it was a question of revolution rather than reform, or, in Finkel-stein’s terms, a question of an emancipatory strategy rather than a ‘compensatory’one.
Though impairment was seen as a prerequisite of disability (Finkelstein, 2001a,p. 8), at the heart of this social interpretation was a conceptual severing of any causalconnection between impairment and disability:
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Disability is something imposed on top of our impairments by the way we areunnecessarily isolated and excluded from full participation in society. Disabled peopleare therefore an oppressed group in society. (UPIAS, 1976, cited in Finkelstein, 2001b,p. 1)
It is important to recognise that, for Finkelstein, this separation did not mean thatliving with the effects of impairment posed no difficulties for disabled people. Whatit did mean was that these difficulties did not make up the substance of disability.Rather, such difficulties were, and should remain, private and personal matters:
The agreed UPIAS interpretation was that, although it may be a tragedy to have animpairment, it is oppression that characterises the way our society is organised so thatwe are prevented from functioning. In other words, at the personal level we may talkabout acquiring an impairment as a personal tragedy, but at the social level we shouldtalk about [how] the restrictions that we face are, and should be interpreted as, a crime.(Finkelstein, 2001b, p. 2)
Indeed, to speak metaphorically, Finkelstein (2001b, p. 4) particularly objects to thewashing of this personal dirty linen in public, and to any consequent diversion ofdisabled people’s energies away from the struggle to change society and toward anintrospective dwelling on experiences of either impairment or disability. In his view,any focus on ‘personal experiences’ is only acceptable if it is in the service ofgalvanising the broader struggle for social change.
Another of Finkelstein’s objections, or disappointments, is that, over the years,too much has come to be invested in the social model of disability:
Sadly a lot of people have come to think of the social model of disability as if it werean explanation, definition or theory and many people use the model in a rather sterileformalistic way. (Finkelstein, 2001a, p. 6)
It’s like putting a model aeroplane together and placing it into a wind tunnel to gaininsight into how it functions under different conditions. The model will not explainhow an aeroplane flies. The social model does not explain what disability is. For anexplanation we would need a social theory of disability. (Finkelstein, 2001a, p. 11)
We are told that he and Paul Hunt never got round to developing such a theory,and that much work remains to be done. As a materialist, and as the author ofAttitudes and disabled people (Finkelstein, 1980), we can nonetheless discern thegeneral direction of his theoretical path: toward an analysis of ‘the material aspectsof social relations’ (Finkelstein, 2001a, p. 7) characteristic of market economies inindustrial and developing-world societies. Mike Oliver (1990), and particularlyBrendan Gleeson (1999), have begun to tackle this materialist agenda in theirwritings on the causal economic mechanisms that worked to generate disabilityduring the transition from feudalism to capitalism in the West. But this type of socialtheory of disability—what one might call a political economy of disability (Thomas,2003)—remains to be fully developed, in both its historical and contemporaryapplications.
It is fitting to have started this section with Finkelstein’s view on what constitutesdisability because the ‘social model’ to which it gave rise has become the principal
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point of reference in disability studies debates in Britain. The model now has analmost iconic status, and whether authors are for or against it their writings arealmost invariably in dialogue with it. In the minds of many in disability studies andpolitics, the social model of disability is conflated, or fused, with Finkelstein’smaterialist conceptualization of disability: they have become one and the same thing.It follows that, for critics, the faults found with the model are synonymous with thefaults of a materialist perspective.
Shakespeare and Watson: a postmodernist perspective in disability studies
We see this conflation at work in a recent paper by Tom Shakespeare and NickWatson (2001). They take the social model of disability as their point of departure,and the faults they find with it are identified with those of its Marxist/materialistfoundations. They propose its abandonment:
… we believe that the ‘strong’ social model itself has become a problem, and that itcannot be reformed. Our claim is that the British version of the social model hasoutlived its usefulness. Rather than developing piecemeal criticisms or supplyingalternative arguments to fill the gaps and compensate for the inadequacies of the socialmodel, it is time to put the whole thing to one side and start again. (Shakespeare &Watson, 2001, pp. 13–14)
In making this argument Shakespeare and Watson give exceptionally clear ex-pression to a growing section of opinion in disability studies. They draw on anincreasing number of criticisms of the social model from feminist, postmodernistand poststructuralist sources, though critics vary in their desire to reject, reform ordefend the social model of disability (Crow, 1996; Morris, 1996; Corker & French,1999).
Of most interest here is the way that Shakespeare and Watson articulate theconcept ‘disability’. At the core of their rejection of the social model is its conceptualseparation of impairment from disability and its assertion that people with impair-ment are disabled by society, not by their impairments. Their claim is that impair-ments do play some role in causing disability, that is, the body and embodied statesare of relevance to ‘being disabled’:
People are disabled both by social barriers and by their bodies. This is straightforwardand uncontroversial. The British social model approach, because it ‘over-eggs thepudding’, risks discrediting the entire dish. (Shakespeare & Watson, 2001, p. 17)
It is important to note that in this statement, and in others in their paper, the termdisability only makes sense if it is understood to mean restrictions of activity; theirargument is that such restrictions are ‘obviously’ caused both by social barriers andby impairment per se.
Shakespeare and Watson see the social model’s separation of impairment anddisability as related to a problematic reduction of impairment to the biological (seealso Hughes & Paterson, 1997; Hughes, 2002). Impairment, they argue, is notbiological but profoundly social, not least because: ‘The words we use and the
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discourses we deploy to represent impairment are socially and culturally determined’(Shakespeare & Watson, 2001, p. 18). In addition, and like other poststructuralistwriters (Corker, 1998; Corker & Shakespeare, 2002), these authors take issue withthe supposed modernist separation of ‘impairment’ and ‘disability’, something seenas representative of outdated dualistic, binary, thought:
Impairment and disability are not dichotomous, but describe different places on acontinuum, or different aspects of a single experience. It is difficult to determine whereimpairment ends and disability starts, but such vagueness need not be debilitating.Disability is a complex dialectic of biological, psychological, cultural and socio-politicalfactors, which cannot be extricated except with imprecision. (Shakespeare & Watson,2001, p. 22)
Thus disability—restricted activity—has to be understood as the product ofmultiple bio-psycho-social forces. This, it is argued, is what must inform a moreadequate theory of disability. To it must be added an understanding that everyone isimpaired, in varying degrees (Shakespeare & Watson, 2001, p. 24). This perspective,they claim, offers an important insight into human experience, and can be used asa springboard for dismantling socially constructed divisions between ‘the disabled’and the ‘normal’.
Understanding disability: medical sociology
In medical sociology, we find that the claim to the title ‘disability studies’ is notunique to writers and activists who coalesce around the social model of disability.The US sociologist, Gary Albrecht—chief editor of the Handbook of disability studies(2001)—claims it too. He describes how this title designates a much broader field ofstudy in the US (Albrecht, 2002), one that encompasses a range of social scientificand rehabilitative disciplines as well as the perspectives of disabled activists. InBritain, however, the disciplinary landscape is more compartmentalized, and thesociologists who engage with disability from a vantage point other than the socialmodel generally associate themselves with medical sociology, and specifically with‘the sociology of chronic illness and disability’. This section considers papers by twoauthors who fall into this category, Michael Bury (2000) and Simon Williams(1999), who have both critiqued the social model of disability. In each case, it istheir understanding of what constitutes disability that is of interest here.
Bury: disability is undoubtedly caused by impairment
Michael Bury is an authoritative figure in British medical sociology, and has writtenextensively on chronic illness and disability. The paper referred to here provides ahelpful overview of his thinking. Bury (2000) reasserts his view that disability iscaused, unquestionably and in the main, by impairment—whether impairment isassociated with disease, active pathology, genetic disorders, accident or trauma.
The denial of any causal relationship between illness, changes in the body, and
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disability comes up against the daily realities experienced by the chronically sick andthose who care for them, whether in the community or in health care systems … Thepoint needs to be stressed … that in any overview of disability in modern society,chronic illness remains its most significant cause … (Bury, 2000, p. 179)
Bury adheres to what he calls a socio-medical model of disability, one which— asin the ICIDH schema of which he was an architect2—defines disability as arestriction or lack of ability to perform an activity in a normal manner. Since, in hisview, the main cause of restriction of activity is illness or impairment it is notsurprising that, ‘Just as the prevalence of chronic illness rises with age, so too doesdisability’ (Bury, 2000, p. 179).
However, Bury does not deny that some restrictions of activity have social andcultural causes: ‘disability is also influenced by context and culture’ (2000, p. 178).Indeed, much of his paper is devoted to making the case that medical sociology haslong recognized the wider social setting in which disability occurs and is shaped, andthat it does not, therefore, individualize disability. He claims that his own earlierwriting focusing on the ‘meaning’ and ‘consequences’ of chronic illness bearswitness to this (Bury, 1988). Thus he understands disability to be both biologicallyand socially caused, though the more significant causal weight lies with the former;this gives rise to a conceptualization of disability that focuses on the interactionsbetween individuals and their social location. What he finds untenable in the socialmodel of disability is its denial, exemplified in his view in the writings of Mike Oliver(1996), that impairment has any causal connection to disability. Bury characterizesthis as an unhelpful ‘oversocialized’ and overly politicized view.
Bury does acknowledge that advocates of the social model have had a significantimpact on wider social and sociological thinking about disability. He positions thesocial model alongside another influential sociological approach to chronic illness,advanced by Arthur Frank (1995). In opposition to the legacy of Parsonian soci-ology which constructed the patient as passive, Frank and like-minded sociologistsare seen to have drawn attention to the agency exercised by people with longstand-ing illness: they become ‘wounded storytellers’. Patients and people living withillness are constructed as active creators of new selves and life trajectories in a‘remission society’ (Frank, 1995), opening up the possibility that illness experiencesinvolve positive as well as negative outcomes. In Bury’s view, a sociology of disabilityhas to chart a trajectory between these influential perspectives on disability, that is,between the social model and the Frankian paradigm:
The mid-range, between a wounded storyteller and an overly politicised conceptionwould, as [Irving] Zola suggests, seem to offer the best way forward. (Bury, 2000,p. 182)
Williams: corporeal realities
In a paper proposing that a critical realist theoretical perspective has much to offermedical sociology, Simon Williams (1999) illustrates his case with an examinationof the disability debate. This allows him an opportunity to present his well-rehearsed
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argument that sociology must ‘bring the body back in’ (see Williams & Bendelow,1998).
On one side of the disability debate, in Williams’ view, is the work of medicalsociologists like Bury who are influenced by interactionist perspectives, a seam ofresearch in which:
… key concepts and insights have been advanced, including the biographically disrup-tive nature of chronic illness, the importance of narrative reconstruction, the nego-tiation of selfhood and identity, as well as the positive actions which people take in theface of their adversity: responses which, analytically, may be referred to as coping,strategy and style (Bury 1991). (Williams, 1999, p. 801)
On the other side of the debate, he claims, is the work of scholars in disabilitystudies, proponents of the social model, who have attempted to:
… ‘write the body out’ completely from the biology/society equation… Writers such asOliver (1990) reject [the ICIDH] in favour of an approach in which disability itself, farfrom being a result of limitations caused by impairment or physical trauma, is insteadseen as a form of ‘social oppression’. (Williams, 1999, p. 803)
Williams shares Bury’s view that such a position is untenable, but critiques it onthe grounds that it entails a problematic denial of the social significance of ‘thebody’, something that he thinks sociology guilty of more generally (see Williams &Bendelow, 1998). Interestingly, Williams (1999, p. 804) borrows from critical voiceswithin disability studies itself (Crow, 1996; Hughes & Paterson, 1997) to make thepoint that the social modelist denial of the causal link between illness/impairmentand disability is a form of essentialism:
Disability [Studies] theorists, in short, like their sociological counterparts of yesteryear,seem to be suffering from a peculiar form of what Spelman (1988), in the context ofWestern feminist thought, has appositely termed ‘somatophobia’: one involving an‘overly drawn’ view of society itself.
He suggests that critical realism offers a fruitful way of bridging the dividebetween the conceptualizations of disability utilized by sociologists of chronic illnessand those advanced by key disability studies writers. From a critical realist stance:
The nub of the problem here, and the issue to which any serious critique of a socialmodel of chronic illness and disability must necessarily return, is the conflation of theontological with the epistemological. (Williams, 1999, p. 805)
Critical realism is believed to set up a powerful challenge to postmodernist and otherconstructionist and relativist variants of sociology because it refuses to collapse theontological into the epistemological, and thus avoids the ‘epistemic fallacy’—that is,the idea that nothing ‘real’ can exist because, tautologically, all we can know are ourideas about it. Rather, critical realism gives the body ontological autonomy:
The body in short, diseased or otherwise, is a real entity, no matter what we call it orhow we observe it. It also, like all other social and natural domains, has its ownmind-independent generative structures and causal mechanisms. (Williams, 1999,p. 806)
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Williams goes on to argue that if one accepts that there is an independently ‘real’biological body, constituting a pre-discursive causative force, then one can challengeall of the following: postmodernist social reductionism, biological reductionism, andthe ‘one-sided social determinism’ evident in the social model’s denial of the effectsthat illness and impairment have on restrictions of social activity. Thus disability,from a critical realist, perspective, can be understood as follows:
Disability… is an emergent property, located, temporally speaking, in terms of theinterplay between the biological reality of physiological impairment, structural conditioning(i.e. enablements/constraints), and socio-cultural interaction/elaboration. (Williams, 1999,p. 810, author’s emphasis).
It follows that, like Bury, Williams sees great merit in the ICIDH schema becauseit understands disability to be restrictions of activity produced by the interactionbetween impairment and specific societal contexts.
Discussion: sociologies of disability
Differences and similarities
Despite the frequently referred to ‘divide’ between disability studies and medicalsociology (Barnes & Mercer, 1996), this review of selected papers from bothdisciplines has revealed some agreement between Shakespeare, Watson, Bury andWilliams. These authors agree that the social model of disability is fundamentallyflawed because it denies the impact of impairment on disability. More precisely, theyagree that impairment and chronic illness have direct causative effects on the dailyrestrictions of activity that constitute disability. As we have seen, Shakespeare andWatson argue that impairments are disabling, and Bury believes it to be nonsensicalto deny any causal relationship between chronic illness/impairment and disability.Williams agrees and, like Shakespeare and Watson, sees such a denial as stemmingfrom a more general and mistaken sociological tendency to leave the body out ofaccount. In fact, there appears to be little to formally differentiate Bury’s andWilliams’ approval of the ICIDH schema, and Shakespeare and Watson’s statementthat impairment and disability describe different places on a continuum —if oneleaves aside fundamental issues of epistemology and ontology. But, of course,Shakespeare and Watson’s arguments against the social model arise from postmod-ernist ideas while William’s and Bury’s objections to it are generated by theoreticalperspectives opposed to postmodernism and poststructuralism (see also Bury,1997).
It is Finkestein’s position that stands out as distinct: disability is a form of socialoppression, and disability is not caused by impairment. But we also know that forFinkelstein the social model of disability—inspired by a ‘disability as social op-pression’ stance—is not an explanation, definition or theory of disability, and thattoo much has been invested in it. Thus he too is critical of the social model, butdefends absolutely its ‘disability as oppression’ foundations and its politicalsignificance.
Shakespeare, Watson, Bury and Williams do nonetheless part company on the
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decisive question of oppression. Shakespeare and Watson, as writers and activists indisability studies, agree with Finkelstein that disabled people are indeed oppressed,though they cannot accept that this is all there is to disability: they see a role forimpairment in shaping the restrictions of activity in disabled people’s lives. Incontrast, medical sociologists like Bury and Williams have never recognised that aform of social oppression is in play. They agree that social processes and forcesshape the experience of disability, but they go no further than the ICIDH’s stanceon ‘handicap’: that impaired people might also experience social disadvantage.Clearly, there remains a divide between those who acknowledge that disabled peopleare socially disadvantaged and those who see them as oppressed.
In summary: Finkelstein propounds the view that disability is entirely sociallyimposed, and amounts to a form of social oppression. Shakespeare and Watsonargue that disability is caused both by impairment and social exclusion, the latterbeing more significant and amounting to social oppression. Bury and Williamsbelieve that disability is caused both by impairment and social disadvantage, but seeimpairment as by far the more significant cause; they ignore (rather than explicitlyrefute) suggestions that a form of social oppression is at work.
The ‘social relational’ versus ‘restricted activity’ understanding of disability
In my view, what really stamps Finkelstein’s understanding of disability as distinc-tive is its social relational character, making it a new form of social oppressionassociated with the relationships, at both macro and micro social scales, between theimpaired and the non-impaired. Thus, in the 1970s, Finkelstein and Hunt wereattempting to completely redefine what ‘disability’ meant. As we have seen, theywrote about disability as something imposed ‘on top of our impairments’ (Finkel-stein 2001b, p. 1), and by implication, emergent from the immediate day-to-dayrestrictive impacts that those impairments inevitably have on activities. The UPIASFundamental principles document (UPIAS, 1976) stated that disability was
‘the disadvantage or restriction of activity caused by a contemporary social organisationwhich takes no or little account of people who have [ … ] impairments and thusexcludes them from the mainstream of social activities’. (cited in Oliver, 1996, p. 22)
This definition clearly associates disability with those restrictions of activity causedby the societal response to people with impairments. It does not assert that allrestrictions of activity are socially caused. For Finkelstein, and indeed for Oliver(1996), the ‘tragedy’ of living with impairment and illness, and of dealing with theirimmediate limiting effects, is to be relegated to the realm of the ‘private andpersonal’ or the ‘personal experience of impairment’ (Oliver, 2004) . Finkelstein hasconsistently argued that what disabled people must make public are the many socialexclusions that constitute disability.
Thus disability is not equated with, nor defined by, restrictions of activity per se,as it clearly is for Shakespeare, Watson, Bury and Williams. Rather, the attempt ismade to completely redefine the meaning of disability, laying a foundation for theconcept disablism to come into being on a par with concepts like sexism, racism and
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homophobia. Put another way, once the term ‘disability’ is ring-fenced to meanforms of oppressive social reaction visited upon people with impairments, there is noneed to deny that impairments and illness cause some restrictions of activity—inwhole or in part.
Shakespeare, Watson, Bury and Williams’ understanding of disability does notinvolve such a radical redefinition. They stick with the commonplace meaning ofdisability in contemporary culture—as ‘not being able to do things’ and as ‘restrictedactivity’. It is this adherence to a commonplace understanding of disability thatunderpins their refusal to deny that impairment and illness have direct disablingeffects by limiting activity.
The loss of the original social relational understanding of disability
As history tells us, Finkelstein and Hunt’s bold attempt at a redefinition of disabilityas a social category was of enormous significance for disabled people in the UK andbeyond. It inspired the social model of disability. But it is the runaway success of thesocial model that gave rise to some of the conceptual difficulties concerning whatdisability is that we now face in disability studies. I would argue that the socialrelational qualities of Finkelstein’s and Hunt’s understanding of disability werediluted, even lost, once its offspring—the social model of disability—came to theforefront.
This is because the social model has only ever presented a simplified version ofsocial relational thinking. It has encouraged thinking in shorthand—to assert, forexample, that disability equates with ‘social barriers’, or more precisely, that disabil-ity equates with ‘restricted activity caused by social barriers’ (see Oliver, 1996). It isonly a short distance, and one that has been commonly travelled, from these bluntsocial modellist assertions to the proposition that ‘all restrictions of activity arecaused by social barriers’. It is then easy to slide into making logical counterassertions such as this: impairment does not cause restrictions of activity because the socialmodel tells us that ALL restrictions of activity are caused by social barriers.
In this way, adherence to the social model of disability has come to be equated,in the minds of many in the disabled people’s movement and some in disabilitystudies, with the position that impairments and chronic illness do not cause anyrestrictions on activity. This is an impoverished version of the early UPIAS under-standing of disability. It has lost the original social relational specificity injected byFinkelstein and Hunt. But it is this impoverished version that has become the focusof argument and critique, not least for Shakespeare, Watson, Bury and Williams. Itis a ‘straw person’, easy to reject on the grounds that it is untenable to deny thatimpairment and illness cause some restrictions of activity. The unfortunate result isthat debates about disability have come to revolve around what does or does notcause limitations of activity (see also the extended discussion in Thomas, 1999).
The assumptions common to Shakespeare, Watson, Bury and Williams on thequestion of impairment/illness and disability is a consequence of this loss of a socialrelational understanding of what constitutes disability. None start out from a social
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relational understanding of disability—disability as a form of social oppression. Andall share in, and critique, the impoverished understanding of disability that is lodgedin the social model of disability: that disability is restricted activity.
Concluding remarks
This paper has examined sociological understandings of what constitutes disability,using some recent papers in disability studies and medical sociology as case studymaterial. The argument has been advanced that despite the frequently reporteddivide between these disciplines there is, on closer inspection, some evidence ofcommon ground on what constitutes disability: Shakespeare, Watson, Bury andWilliams can all agree that impairment plays a role in causing the restricted activitythat constitutes disability, and can agree that the social model of disability is flawedbecause it denies this causal linkage. These authors are by no means alone in holdingthese views, either within disability studies or medical sociology. In contrast,Finkelstein’s position —that disability is a form of social oppression—remainsdistinct.
It has been argued that the success of the offspring of Finkelstein’s 1970s UPIASsocial relational understanding of disability—namely, the social model of disability—has, ironically, been responsible for creating the conditions of possibility for thisconvergence across the disability studies and medical sociology divide. This isbecause the social model has allowed a commonplace cultural understanding ofdisability—that disability equates with, or is defined by, restrictions of activity—toreassert itself. Writers such as Shakespeare, Watson, Bury and Williams utilize thisunderstanding of disability themselves and make common cause in their oppositionto the social model because it has become synonymous with the view that impairmentdoes not cause disability because all restrictions of activity [i.e. disability] are caused bysocial barriers. What has been obscured by the shadow of the social model ofdisability is the pioneering social relational understanding of disability to be foundin the original UPIAS formulations. That is, what has been lost is an understandingthat disability only comes into play when the restrictions of activity experienced bypeople with impairment are socially imposed, that is, when they are wholly social inorigin. Such a social relational view means that it is entirely possible to acknowledgethat impairments and chronic illness directly cause some restrictions of activity. Thepoint is that such non-socially imposed restrictions of activity do not constitute‘disability’3.
In my view, a social relational understanding of disability is sorely needed withindisability studies. It needs to be rediscovered and reasserted. My preferred definitionof disability does this; it is an adaptation, or modernization, of the UPIAS formu-lation, as follows:
Disability is a form of social oppression involving the social imposition of restrictionsof activity on people with impairments and the socially engendered undermining oftheir psycho-emotional wellbeing (Thomas, 1999, p. 60).
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In this social relational definition, disability only comes into play when the restrictionsof activity experienced by people with impairment are socially imposed, that is, whenthey are wholly social in origin. This means that it is entirely possible to acknowledgethat impairments and chronic illness directly cause some restrictions of activity—butsuch non-socially imposed restrictions of activity do not constitute ‘disability’. Suchnon-socially imposed restrictions might be better captured by the concept ‘impair-ment effects’ (see Thomas, 1999)—but space does not permit this point to bepursued here.
If this kind of social relational understanding of disability could be adhered towithin disability studies, that is, if the commonplace view that disability equates withrestrictions of activity could be broken away from, then there would be no need forfutile and time-wasting disputes about whether or not impairment or chronic illnesscause some restrictions of activity. We can say, ‘Yes, of course impairment causessome restrictions of activity—but these are not what is of interest in studying andcombating disability’. Disability is a form of social oppression on a par with otherforms of oppression in our society associated with gender, race, class, and sexuality.
But perhaps this loss of the social relational understanding of disability has beena small price to pay for the advances that have been made by disabled people in thename of the social model of disability? My answer, which may seem surprising in thelight of the argument outlined above, would be a resounding yes, it has been a smallprice to pay. The social advances achieved by oppressed groups are always of muchgreater significance than any loss in the clarity of ideas along the way. The socialmodel remains, and should continue to remain, in place as a powerful organizingprinciple, a rallying cry, and a practical tool (Oliver, 2004) for the disabled people’smovement. However, within disability studies—the academic wing of this move-ment—there is an urgent need to rediscover a social relational understanding ofdisability, and to recognise that the crude equation of disability with restrictedactivity is a completely inadequate starting point. This means acknowledging thelimited nature of the social model of disability for academic purposes, recognising,as Finkelstein (2001a, p. 6) and Oliver (2004) have done, that it is not an expla-nation, definition or theory of disability, and should not be mistaken or used as asubstitute for these. In my view, a social relational understanding of disability offersfertile ground for theoretical, empirical, and policy-related work in disability studies.Put another way, a social relational understanding of disability provides a firmfoundation for an enriched sociology of disability, deploying a range of theoreticalperspectives. It is in this direction that we should be travelling, a direction that takesus away from fruitless debates ensnared in ‘restricted activity’ definitions of disabilityand hooked up in supposed pros and cons of the social model of disability.
Achieving clarity and consistency on a social relational conceptualization ofdisability within disability studies would illuminate the real divide between it andmedical sociology—a divide associated with the fact that, to date, medical sociolo-gists have not been prepared to acknowledge that disability is associated with socialoppression or systematic social exclusion. Medical sociologists have adopted therather mealy-mouthed stance that there is some ‘social disadvantage’ involved in
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disabled people’s lives. If disability studies were to challenge medical sociology onthis question then a series of potentially productive sociological debates could beopened up between these disciplines on how to theorize disability.
Notes
1. This is ‘The Disability Archive UK’, set up by the Centre for Disability Studies, Universityof Leeds, UK.
2. The ICIDH is the International Classification of Impairments, Diseases and Handicaps,developed for the WHO by Philip Wood, Elizabeth Bradley and Mike Bury in the 1970s(see Wood, 1980). The WHO is currently revising this schema.
3. The use of the term ‘non-socially’ imposed restrictions of activity is an attempt to presentthe argument forcibly. Impairment effects are, of course, socio-biological in nature—butthat is another story (see Thomas, 1999).
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