Disability and Impairment

Although the term disability sounds somewhat clinical, during the early twenty-first century, its significance in everyday experience has become an area of politicization. Disability has shifted from being considered in terms of biophysical limitation and a medical problem, to the product of interactions between individuals and their surroundings, and as such, has engendered a new paradigm of focused social and cultural research. Research on disability tends to be influenced by two main approaches. On the one hand, disability studies draw on accounts of the experience and politics of disability and productively use the analytical tools of social geography and sociology to examine and explain the social oppression of disabled people. On the other, cultural studies draw on theories about the social construction and production of the human body to examine how 'damaged bodies' become the site of power (Williams, 1999). These two broad approaches are beginning to converge in research that argues for analysis of not only how disability is a social and cultural product but also of how the experiences of those who are considered disabled affect their everyday lives. Consequently, many disability researchers, who are also activists, argue that disability research must begin with the voices of those who are disabled.

Keywords Biomedical Model of Disability; Biophysical Norms; Disability; Dramaturgical Model; Eugenics; Impairment; Social Categorization; Social Model of Disability

Day to Day Social Interaction > Disability & Impairment

Overview

Although the term disability sounds somewhat clinical, during the early twenty-first century, its significance in everyday experience has become an area of politicization. Disability has shifted from being considered in terms of biophysical limitation and a medical problem, to the product of interactions between individuals and their surroundings, and as such, has engendered a new paradigm of focused social and cultural research. Research on disability tends to be influenced by two main approaches. On the one hand, disability studies draw on accounts of the experience and politics of disability and productively use the analytical tools of social geography and sociology to examine and explain the social oppression of disabled people. On the other, cultural studies draw on theories about the social construction and production of the human body to examine how 'damaged bodies' become the site of power (Williams, 1999). These two broad approaches are beginning to converge in research that argues for analysis of not only how disability is a social and cultural product but also of how the experiences of those who are considered disabled affect their everyday lives. Consequently, many disability researchers, who are also activists, argue that disability research must begin with the voices of those who are disabled.

Social Categorization

What is a normal body and normal bodily performance? This is, in part, the question that implicitly informs Erving Goffman's dramaturgical model of interaction, introduced in The Presentation of Self in Everyday Life (1971), which explores what makes it possible to enter into and participate in social encounters. The dramaturgical model emphasizes that in social encounters, people give, receive, and manage information, most of which is non-verbal and directed toward performances. Performances are possible through roles that operate as organized frameworks that allow people to make sense of encounters. People (or actors) seek to maximize or minimize the visibility of bodily and facial information depending on the impressions they seek to present. Successful encounters require managing visual and expressive information—such as gestures, facial expressions, and other physical cues like clothing, hairstyle, and jewelry—and acquiring control over the human body (or doing body work). For the symbolic interactionist, the body and the face literally 'speak' according to assumptions about what is acceptable for bodies to do in public spaces and to expectations about what bodies should do. Therefore, as long as we present ourselves in correspondence with what is expected of us, we can expect a degree of predictability and stability in social encounters.

To investigate the social categorization of young people with disabilities in the twenty-first century, Chatzitheochari and Butler-Rees (2022) explored the contextual meaning of the disabilities and impairments of thirty-five individuals using semi-structured interviews. Social class, which impacts the location and quality of the school the individual may attend, mitigated the prevalence of stigmatization of their disability. Additionally, not all disabilities elicit the same amount of stigma—dyslexia was most commonly accommodated and normalized, while individuals with severe autism or those with physical disabilities experienced much more stigmatization. However, the amount of support and resources available to the individual, the less social challenges they experienced, exemplifying the disadvantage that low-income individuals with disabilities face (Chatzitheochari, & Butler-Rees, (2022). To fully understand the link between social categorization and stigmas concerning disabilities, longitudinal studies are needed.

Bodily Betrayals & Stigma

However, we are not always able to control the rhythms and functions of the body, especially when there is an element of physical impairment that has the potential to jeopardize the dependability of our bodies. "Discontinuities of social interaction" (Williams & Bendelow, 1998, p. 59) occur through bodily betrayals—belching, farting, dribbling, incontinence—that have the potential to undermine the integrity of social encounters by damaging self- and social-identity. They do so because they draw attention to bodily differences and to categorizations of normal and deviant.

Goffman argues that societies develop physical, or corporeal, attributes considered ordinary or normal for members of particular social categories. Such attributes develop historically via requirements for economic productivity (Paterson & Hughes, 2000) and via the array of stylized images in consumer culture that reproduce ideas about aesthetic normality. For instance, consumer culture bombards us with images of celebrities who are paraded as the embodiment of physical perfection. Indeed, though we may take for granted the norms associated with how bodies physically work and function, these norms are a product of specific, social, and historical circumstances and processes, in particular, the development of scientific medicine.

The Historical Development of Biophysical Norms

Biophysical norms associated, for instance, with height, weight, movement, gestures, and physical capacity to be economically productive, are a fundamental part of the assumptions we make about the physical appearance and capacities of people. Historical analysis suggests that such norms, developed through industrialization processes, which had the effect of displacing people with physical limitations from spaces associated with economic production. While pre-industrial, agrarian economic spaces did not preclude people with bodily impairments from economic participation, industrial times created confined spaces for economic production—factories, mines, shipyards—that privileged or demanded specific physical abilities and characteristics (such as the ability to use mechanized equipment, which required repetitive, regimented, standardized, and routine movements). As a consequence, certain groups became less useful for capitalism—the sick, the mad, the impaired—and were effectively segregated in another kind of confined social space, such as the workhouse and the asylum (Gleeson, 1999). A consequence of this environmental segregation was the increasing social invisibility of people with bodily impairment. Even though such groups could be seen in nineteenth century cities hawking goods or begging, they were viewed as deviant, dissident bodies (Gleeson, 1999) that were a topic of visual intrigue and display.

The physical requirements for economic productivity and the assumptions of normalcy on which they were increasingly based were shored up by biomedical and scientific discourses. The development of clinical medicine was, itself, dependent on access to and examination of the human body. It grew rapidly from the eighteenth century, as the number of hospitals expanded and provided a new kind of space in which people gathered and were available for examination and inspection (Turner, 1987). The opportunity to examine bodies provided medical practitioners with material that was interpreted, measured, and assessed in ways that built up a basis for making statistical comparisons between bodies (Nettleton, 1992). Observations of and comparisons between bodies helped to establish biophysical averages and norms, such as developmental/age-linked height and weight (Armstrong, 1995). Commonly used statements such as 'isn't he tall for his age?' or 'what a big girl she is,’ draw attention to norms. These kinds of statements measure what one sees against an implicit assumption about the appropriate height associated with a particular age and, thereby, both draw on and reinforce prevailing biophysical norms. These norms reinforce a distinction between normal and deviant bodies, which, in turn, depends on a view of the human body as a self-evident object (Seymour, 1998).

Further Insights

The Biomedical Model of Disability

The body, as defined within the biomedical model, is viewed as a relatively stable, predictable, objective entity. It is seen as a complex biochemical machine that can be fixed by medical intervention (Freund & McGuire, 1999) and that has a relatively well-defined natural history and clear boundaries between normal and abnormal (or deviant). Consequently, biophysical difference, or impairment, within this model is viewed as a deviation from the benchmark of the idealized, healthy body and is itself viewed as disability. That is, loss of the ability to walk through spinal cord damage is what makes a person disabled, and not, for instance, that the built environment is designed for people who are able to walk. Indeed, biomedical discourses of biophysical normality influenced the design of built environments by having a standing, walking, and physically able body in mind (Kruse, 2003).

Until the mid-twentieth century, impairment was equated with disability and research was largely oriented toward finding clinical solutions to common problems that impaired people experienced, explorations of people's experience of rehabilitation interventions and of 'managing' impairment in the context of, for instance, employment (e.g., Pinder, 1995). However, this approach was increasingly challenged as people with impairments argued that disability was less a biophysical experience than a cultural and social experience. Indeed, a BBC radio show (no longer in existence) called Does He Take Sugar? highlighted this experience through experiential stories that told (in Goffmanesque terms) of how able-bodied people were often unable to speak directly to people with some kind of visible impairment (or symbol of impairment, such as a wheelchair or cane). The biomedical model of disability reduces disability to individual impairment and treats it as a bodily and personal tragedy that assumes the dependency of those experiencing impairment. Such a model focuses on bodies that are damaged and perpetuates an understanding of people with impairment as a problem for society (Morris, 1993). These insights led to the development of the disability movement in the 1980s and to an analytic distinction between impairment and disability, in which the latter may be seen as a problem in society.

The Social Model of Disability

This critique led to a distinction between a biomedical model of disability and a social model of disability, in which the former is linked to expert, professional and scientific understandings of disability and the latter to emancipatory, political approaches that are critical of how society—especially capitalist society—turns impairment into disability (Buder, & Perry, 2021). The social model of disability has been termed the intellectual expression of the disability movement (Oliver, 1996). It emphasizes the importance of the lived experience of disability, the ways that communities attribute social meanings to impairment (Bury, 2000) and how people with impairment can be disabled by imagery and prejudice. The model makes an important distinction between the terms (Buder, & Perry, 2021). While impairment refers to some loss of physiological or anatomical capacity, the term disability registers the repercussions of impairment and the difficulties a person might encounter while engaging with the physical, built, social, and cultural environment. The term disability reflects not only the ways that people with impairments are typically isolated and excluded from full social participation (Oliver, 1996) but also that Western standards of disability are not universal. Whether impairment becomes disability depends on the social and cultural contexts in which it occurs or is acquired (Buder, & Perry, 2021). For instance, Freund and McGuire (1999) draw attention to the example of inhabitants of Martha's Vineyard, Massachusetts, in the 1940s in the United States, a large proportion of whom were deaf. Sign language was known and used by both those who were deaf and those whose hearing was not impaired. The former group was not viewed as separate from the wider community because it formed such a significant part of it.

A social model of disability has been central to the analysis of the extent to which physical and social environments are disabling. Within this model, disabilities transpire when society fails to provide adequate services and accommodate physical impairment (Buder, & Perry, 2021) or denotes such impairment as in need of special arrangements (Nettleton, 1995). A social model of disability developed from and has been important to the disability rights movement in the Anglophone world (especially in the U.S.) and its emphasis on the acquisition of citizenship entitlements. Though disability is not a homogenous term within the social model of disability, as Nettleton (1995) observes, such categorization has been used in ways that have had transformative potential. It has worked as a rallying identity for the disability rights movement and its calls for equality.

Similarly, researchers drawing on the writings of Michel Foucault note that the body is not biophysically intransigent but is a malleable phenomenon that is defined through discourses and specialist knowledge about normality (especially biomedical discourses) that establish definitions of normality through systematic classification of distinctions and differences between bodies. Bodies are labeled through such processes and social hierarchies are created in ways that make clear not all bodies are created equal (Blaikie et al., 2003). Consequently, some researchers who adopt this perspective argue that disability can only be understood in relation to ideas about what it means to be able-bodied (defined biomedically), in ways that perpetuate disability as a form of 'otherness.'

Both social perceptions and visual images have the potential to disable those who are the subjects of imagery (Shakespeare, 1994) in ways that accentuate the 'otherness' through which disability is defined. For instance, in the nineteenth century, so-called "freak shows" in the U.S. and Europe offered a paying public 'opportunities' to view a range of 'bodily otherness' made anomalous by virtue of their visual difference (Thomson, 1996). In the contemporary period, makers of visual images, such as photographers, similarly use their craft to create images that accentuate the physical impairment of their subjects in order to draw attention to their 'freakishness' and 'otherness' (see Hevey, 1992 for a critique of the ethics here). And advertising images produced by commercial agencies for disability or health promotion campaigns may use iconography that reinforces the stigma associated with physical impairment. Wang's research (1992) on accident and injury prevention campaigns in the U.S. show how the notion that physical impairment through accident is intolerable and similar criticisms have been made of campaigns to promote social awareness of multiple sclerosis in the UK ("Flesh and Blood," 1991).

Impairments can be found in all societies, but whether the status of disability is conferred upon impairment depends on the responses and social arrangements of the communities in which they occur. Such conferment occurs via a process of social categorization on the basis of both physical appearance and physical function that may be stigmatizing in their consequences (Zola, 1993). Moreover, Tom Shakespeare (1994) observes, "people with impairment are disabled, not just by material discrimination, but also by prejudice. This prejudice is not just interpersonal, it is also implicit in cultural representation, in language, and in socialization" (p. 298). Disabled people are "dustbins for disavowal:" people project onto them "their fear of death, their unease at their physicality and mortality" (p. 298). This projection is perhaps no more intense than in the arena of modern genetics.

Viewpoints

The Biomedical Model & Genetics

The biomedical model sees physical abnormalities as problematic and as something to be cured by a doctor (Buder, & Perry, 2021) or sorted through medical or surgical intervention or diagnosis via genetic testing. People are increasingly exposed to genetic tests that claim to determine our susceptibility to various diseases (for example, breast cancer), or to assess our DNA profiles so that we can follow tailored health and fitness programs. Some researchers have observed that the logical consequence of a model that strives for methods and means to eliminate diseases that contribute to physical impairment is that the world would be a better place without disabled people. Indeed, some researchers (e.g., Kerr & Shakespeare, 2002) have argued that modern genetic practice has been shaped by eugenics. For instance, 'family completion' practices such as prenatal diagnostic techniques (e.g., amniocentesis) to test for congenital impairment, such as down syndrome, or embryo selection on the basis of desired characteristics might be viewed in these terms. Their views stem from feminist and disability perspectives of the new genetics, emphasizing how the ideas of choice and autonomy are quickly trounced by proponents of genetic testing. For these authors, genetic screening and prenatal testing for disability leads to prejudice against and a decrease in services for disabled people and they challenge readers to consider why genetic screening is seen as a 'solution to the problem of disability' (Steinbock, 2003).

Beyond the Social Model

The social model of disability, in contrast to the biomedical model, claims that impairment alone—physical or biological deficit—is insufficient to label a person disabled. Rather, physical, social, and cultural environments do the work of disabling by creating barriers that oppress and exclude people with impairments from full social participation. Yet, while this model has been welcomed by researchers to confront the ways that bodies are measured and defined against socially constructed and culturally specific standards of normality, some (e.g., Paterson & Hughes, 2000) have argued that this model has the potential to render the physical (material) body invisible, precisely because the emphasis on physical and social environments over bodily experiences obscures the active constitution of the body (as disabled) through social interactions and exchanges. Indeed, the concept of disability is viewed as problematic in the sense that it perpetuates a binary opposition between normal and deviant (Fox, 1993).

Accordingly, while the social model of disability provided some early purchase on the politics of disability (especially in the British context), it has become, critics claim, a weak tool that overemphasizes the social and cultural production of disability at the expense of the material difficulties that disabled people experience daily. Shakespeare (2006), for instance, has argued that removing physical and cultural barriers may not be enough to help some of the disabilities that people experience. Accordingly, he has suggested that critical realism is a more relevant model for thinking about and dealing with disability, in that it acknowledges both interactional and structural factors in the construction and experience of disability. Such an approach, claims Shakespeare, acknowledges the real, everyday problems associated with impairment, but does not assume that impairment is identity defining.

Post-structuralist and critical realism models of disability help to conceptualize disability as an ongoing process of negotiation and interaction with others and emphasize how personal experiences of disability and what it means to be categorized as disabled might differ according to gender, race, and class (Thomas, 1999). Disability rights activists depended on the category of disability to highlight the exclusions of a disparate group of people and to establish an appreciation of their needs in the interests of equality. However, post-structuralist and critical realism approaches suggest that the processes of normalization, and, by association, stigmatization that construct the binary opposites of able-disabled may only be surmounted when society is able to consider all bodily abilities and visual appearances as part of a continuum of difference (Annandale, 1998).

One commentator, a linguist, has remarked that in the U.S., the term 'disabled' has become so fraught that it cannot be spoken or written, only 'inferred', as people struggle to find a non-offensive, neutral term to describe and capture what is means to have a physical impairment and the ways that society and culture can be disabling (Aronoff, 2007). At the very least these debates highlight how central are physical norms and notions of bodily perfection to the visible appearance and experience of the body and people's responses to it in everyday social interactions.

Terms & Concepts

Biomedical Model of Disability: Linked to expert, professional and scientific understandings of disability as the inevitable consequence of impairment.

Biophysical Norms: Ideas about physical attributes informed by the requirements of industrial economic productivity and underwritten by statistics and medical discourse.

Disability: The social and political difficulties that may be experienced through impairment.

Dramaturgical Model: A framework for explaining how individuals, social groups, and institutions manage information, by engaging in performances, to present particular impressions to those with whom they interact.

Eugenics: Social practice that uses the science of genetics to control human hereditary characteristics.

Impairment: Loss of physiological or anatomical capacity.

Social Categorization: A social process through which people are sorted into groups based on ideas about normalcy and deviancy.

Social Model of Disability: Linked to emancipatory, political approaches that are critical of how society (especially capitalist society) turns impairment into disability and attributes social meanings to impairment.

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Suggested Reading

Aron, L., & Loprest, P. (2012). Disability and the education system. Future of Children, 22, 97–122. Retrieved October 25, 2013, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=75184693

Barnes, C., Mercer, G. & Shakespeare, T. (2010). Exploring disability: A sociological introduction (2nd ed.). Polity Press.

Howson, A. (2016). The body in society: An introduction (2nd ed.). Polity Press.

Kanter, A. S. (2011). The law: What's disability studies got to do with it; or, an introduction to disability legal studies. Columbia Human Rights Law Review, 42, 403–479. Retrieved October 25, 2013, from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=59948134

Shakespeare, T. (2014). Disability rights and wrongs (2nd ed.). Routledge.