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Contra The Social Model Of Disability
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JUL 14, 2023
What is the Social Model Of Disability? I’ll let its proponents describe it in their own words (emphases and line breaks mine)
The Social Model Of Disability Explained (top Google result for the term):
Individual limitations are not the cause of disability. Rather, it is society’s failure to provide appropriate services and adequately ensure that the needs of disabled people are taken into account in societal organization.
Disability rights group Scope:
The model says that people are disabled by barriers in society, not by their impairment or difference.
The American Psychological Association:
It is [the] environment that creates the handicaps and barriers, not the disability.
From this perspective, the way to address disability is to change the environment and society, rather than people with disabilities.
Foundation For People With Learning Disabilities:
The social model of disability proposes that what makes someone disabled is not their medical condition, but the attitudes and structures of society.
University of California, San Francisco:
Disabilities are restrictions imposed by society. Impairments are the effects of any given condition. The solution, according to this model, lies not in fixing the person, but in changing our society.
Medical care, for example, should not focus on cures or treatments in order to rid our bodies of functional impairments. Instead, this care should focus on enhancing our daily function in society.
The Social Model’s main competitor is the Interactionist Model Of Disability, which says that disability is caused by an interaction of disease and society, and that it can be addressed by either treating the underlying condition or by adding social accommodations.
In contrast to the Interactionist Model, the Social Model insists that disability is only due to society and not disease, and that it may only be addressed through social changes and not medical treatments.
. . . this isn’t how the Social Model gets taught in real classrooms. Instead, it’s contrasted with “the Medical Model”, a sort of Washington Generals of disability models which nobody will admit to believing. The Medical Model is “disability is only caused by disease , society never contributes in any way, and nobody should ever accommodate it at all . . . ” Then the people describing it add “. . . and also, it says disabled people should be stigmatized, and not treated as real humans, and denied basic rights”. Why does the first part imply the second? It doesn’t matter, because “the Medical Model” was invented as a bogeyman to force people to run screaming into the outstretched arms of the Social Model.
If we ignore the tradition of teaching disability models this way, and contrast the Social Model with the Interactionist Model, it’s easy to see that the Social Model . . . kind of sucks? In fact, I’ve never heard anyone willing to defend the actual Social Model the way it’s taught in every course, written on every website, and defined by every government agency. Everyone says they mean the Interactionist Model. Yet somehow, the official descriptions still say that disability is only social and not related to disease, and that you may only treat it with accommodations and not with medical care.
All Models Are Wrong, Some Are Useful, Right?
Is it possible that people mean the Social Model and the Medical Model are both okay, and the truth lies somewhere in between? “All models are wrong, some are useful”, that kind of thing? I think this is an okay motte. But the topic is taught in a way that only occasionally nods to such a compromise; more often the Medical Model is condemned as outdated and bigoted, and the Social Model introduced as the new, acceptable version that people should use. Going back to our links, starting with The Social Model Explained:
A consequence of the medical model of disability is that people with disabilities often report feeling socially excluded, undervalued, and treated as if they are completely incapacitated or objects of pity [3]. But for many, the main disadvantage of living with a disability is less about their own body and more about society’s response to them. This response often comes in the form of an unwelcoming reception, in terms of social attitudes and institutional norms, as well as built physical environments that promote exclusion.
It is only when viewing disability through [the lens of the Social Model] that we can begin to change people’s perspectives on how everyday organizations and environments should be inclusively structured, and begin to actively counter the way disabled people are so commonly viewed in society: not as objects of medical treatment, charity, and tokenism or inspiration porn, but rather as full and equal members of society with human rights.
The medical model looks at what is ‘wrong’ with the person, not what the person needs. We believe it creates low expectations and leads to people losing independence, choice and control in their lives.
UCSF:
[The ideas of the Medical Model] convey notions of weakness, dependence, and abandonment. Sometimes, these messages take the form of treatments meant to normalize, but which do not improve our ability to function or participate in our chosen activities of daily living.
The Social Model calls for an end to discrimination and oppression against people with disabilities through education, accommodation, and universal design. This education will lead to changes in the way people think about disabilities. Ideally, these changes influence how architects incorporate universal design and accessibility features into building plans, how governments consider our rights and needs when passing new laws, how people with disabilities are included in education, and how clinicians approach the care of their patients with complex disabilities. By valuing a spectrum of abilities, we only add to our collective richness and diversity.
This isn’t “all models are wrong, some are useful”. The way the topic is commonly taught usually focuses on ways the Social Model is useful, and the Medical Model is wrong. Maybe this is a bravery debate. But since the Social Model is now the standard in classrooms, hospitals, and government agencies, maybe it’s time to come at the bravery debate from the other side.
I’m hammering this in because people really like saying nice things about the Social Model of Disability, and they really want to rescue it as saying or meaning something different than its explicit text. If this isn’t you, sorry for this long post which will continuously harp on this point.
But if you’re willing to keep reading, I want to explain why I think the people who invented and promoted the Social Model meant exactly what they said, not something weaker, and what they were trying to do with it.
Then I want to explain in more detail why I think the Social Model is wrong or at least incomplete.
Finally, I want to propose an alternative (a fleshed-out version of what I called the Interactionist Model above)
What Would It Mean To Take The Social Model Literally?
I think the Social Model was invented and promoted by people who took it literally and wanted it to be adopted, not by people who meant some much weaker more common-sense version.
The Social Model Of Disability came out of the same 60s/70s cultural current that gave us Thomas Szasz’s claim that mental disorders are fake. Szasz was thinking of examples like the stigmatization of homosexuality; he (understandably) preferred to think of homosexuality being a perfectly fine alternate-way-of-being that society just had to learn to accommodate. But he took it too far – and then Bryan Caplan took it even farther – and claimed that all mental disorders were just alternate-ways-of-being that society had to change to accommodate. There’s no such thing as drug addiction; people just voluntarily choose to use drugs. Society stigmatizes that choice by casting it as a disease where the person can’t control their drug use. But this is no more true than thinking of playing baseball as a disease where people can’t control their baseball use. Instead, society should admit that using drugs is fine.
Likewise, depression is just a voluntary choice to stay in bed with the windows closed and moan about the bitterness of life – which is no worse of a lifestyle than being an artist or a baseball player. Since society would prefer people be chipper and hard-working, it calls this a “disease” to stigmatize people who do it, and to pressure them to get “treatment”.
Nowadays this perspective has been abandoned by everyone except a few holdouts, Bryan Caplan, and the Scientologists; maybe it’s hard to take it seriously. But put yourself in the shoes of a 1970s radical. Your stereotype of psychiatric treatment, which wasn’t entirely false, would have been cops taking gays / LSD users / eccentrics, locking then up in horrible state-run hospitals for months, and treating them with strong drugs or electroshock therapy or lobotomies. You’d never met a schizophrenic, but you believed Gregory Bateson and Thomas Szasz’s report that they were just cool eccentric people who didn’t abide by society’s artificial rules. You and your comrades had just won a great victory in getting the medical establishment to de-list homosexuality as a mental disorder, and – sure enough – the problem had been society’s persecution of gays, not the “disorder” itself. Drunk with victory, you might see the arc of history pointing to the complete liberation of all categories of supposedly “mentally ill”. So why not the supposedly “physically ill” too? Why not liberate everybody?
Into this climate came the Union Of The Physically Impaired Against Segregation, a group of disabled Marxists led by former South African anti-apartheid activist Vic Finkelstein. They set out to recast the condition of the disabled in the language of radical activism. Finkelstein wrote:
We don’t want [compensation] for being oppressed! We want people to stop oppressing us! The logic of these different perspectives is very simple. The former interpretation of disability places us in a permanently dependent relationship to able-bodied society for handouts – what we called state charity. The latter approach says that the able-bodied society’s got to change, it’s an oppressive society.
In order to push his point that all disability was the result of oppression, he redefined medical conditions like blindness or paraplegia as “impairments”, and said there was “no causal connection between impairment and disability” – only society persecuting people with impairments by forcing them into the “disabled” role. These ideas eventually got dubbed The Social Model Of Disability.
To support his point, he gave various examples. Lord Nelson, who was blind in one eye, was a great Admiral. But in his own day, disabled people were banned from the Navy. This couldn’t because their disability prevented successful naval service, or Nelson’s victories would have been impossible. It must have been because of state discrimination.
This makes sense, but it’s a cherry-picked example. Someone in a wheelchair would flounder in a submarine, where space is at a premium and corridors are very narrow. Submarines big enough to be wheelchair-accessible would be extraordinarily expensive and unwieldy. Was Finkelstein suggesting the Navy needed to retrofit its submarines this way? I can’t find any non-cherry-picked examples like this in his writing, and I don’t know what he would have thought of them.
Why I Disagree With The Social Model
Society isn’t really the sole cause of all disability.
A blind person, marooned on a desert island untouched by society, is worse off than a sighted person on the same desert island. Here the problem is clearly caused by the blindness, not by any social response to it.
There’s no reason to call the blindness an “impairment” and say that it only becomes a problematic “disability” once society oppresses you for it. It’s a disability even on a society-less desert island.
Likewise, a blind person can’t drive a car. This is partly a result of society banning them from having a driver’s license, but this shouldn’t be considered “oppression”. Blind people are prohibited from having driver’s licenses for great reasons that almost everyone, including most blind people themselves, can support. Their blindness itself, totally separate from any social response to it, makes it hard for them to drive a car. There’s no reason to call the blindness an “impairment” and say that it only interferes with driving after society oppresses them. The fundamental nature of not being able to see makes driving – an inherently sight-requiring activity – harder.
A social model partisan might respond that it was Society that failed to provide adequate bus routes. So if a blind person’s inability to drive prevents them from traveling, this is still Society’s fault.
I would respond in two ways: first, even granting this, the blind person’s inability to drive remains due to their blindness, not society. The Social Model explicitly says that all impairments only become disabilities in response to society’s choices. I only need to find one counterexample to prove its universal statement wrong.
But second, society’s failure to provide adequate bus routes is better considered a failure to resolve the disability, not the cause of it.
Suppose I assault a passerby on my street. What caused this assault? Most people would say I did. Although potentially the police could have prevented the assault by stationing an officer on my street, who might have seen the assault and responded to it, we wouldn’t typically say “the police caused the assault”. We would say “I caused the assault, and the police failed to prevent it.”
Or suppose a paraplegic person wants to climb Everest, but can’t. Why not? Most people would say “Because climbing Mt. Everest in a wheelchair is inherently hard.” Although you could sort of say “because Society has not yet built a wheelchair ramp all the way up Mt. Everest”, this would be a weird and unnatural way of thinking about things, as if for some reason society had a duty to build a wheelchair ramp up Mt. Everest but refused out of spite.
Another way of thinking about this might be: paraplegia inherently, with no causal contribution from society, makes it impossible to climb Mt. Everest without a $1 trillion wheelchair ramp. Society has chosen not to spend 1% of world GDP building a wheelchair ramp up Everest. This is not an oppressive decision, it’s an extremely good decision that everyone would agree with. The natural way of thinking about this – “The paraplegic is disabled by their medical condition, and society has elected not to resolve this disability” survives this scenario; the Social Model – “the paraplegic has an impairment which by itself is no problem, but society is oppressing them” – doesn’t.
(if you’re hung up on Mt. Everest being natural, or un-climb-able even by most abled people, then replace this example with a wheelchair lift on a man-made hiking trail up a gently sloping hill. Or consider for example a spaceship. Before people invented spaceships, blind people couldn’t be astronauts, because nobody could be astronauts; going to space was just fundamentally difficult. Then people invented spaceships that could be piloted by sighted astronauts, but couldn’t be piloted by blind people. The invention of spaceships didn’t make blind people any less able to go to space than they were before; it requires a very strange contortion to think of the natural order of things as blind people as inherently destined to be astronauts, with society taking this away from them. So I think the most natural way of describing this is “being blind makes it hard to pilot a spaceship”, not “being blind has no relationship to piloting a spaceship, but NASA has chosen to deprioritize the needs of blind people in its spaceship design, which is what prevents blind people from going to space”)
The Social Model goes on to say that it’s only okay to treat disability with accommodation, not with medical cures (if you’re going to object that it doesn’t say this, please read the quoted statements from proponents above). But this is morally abhorrent. It requires that we refuse to treat blind people whose sight could be restored with simple ten-minute cataract surgery, that we deny antidepressants to depressed people, or that we never operate on people in chronic pain.
And there are some things Society will never be able to accommodate. My grandmother was blind for the last 30 years of her life. Society did a great job accommodating her – special kudos to the Library of Congress, which sends all blind people free audiobooks. Still, she could never see a sunset, or a rainbow, or a beautiful artwork. She didn’t want some kind of social revolution. She just wished she could see again.
What Is The Alternative To The Social Model?
Rejecting the Social Model doesn’t mean accepting the straw-man Medical Model.
Medicine, and especially psychiatry, already uses the Biopsychosocial Model for various purposes. It acknowledges that conditions (eg depression) can be caused by an interaction of biological factors (eg genes), psychological factors (eg trauma), and social factors (eg an abusive relationship). Some conditions are 99% biological and only 1% psychosocial; others are the reverse, but we expect most to be some combination of those things.
This isn’t an exact match for a model of disability; the Biopsychosocial Model is most often used to explain the causes of illness, not how it impairs people. Still, I think there is a close enough analogy that it could be easily extended to disability.
The Biopsychosocial Model, unlike the Social Model or the straw-man Medical Model, emphasizes biology and social conditions alike. It allows either treating impairments medically or accommodating them socially, depending on what the patient prefers and what society is willing to change. It already has a good reputation among doctors and medical ethicists.
The literal content of the Social Model of Disability as it’s usually presented is nonsense, but it’s attractive because it contains a useful insight: some conditions can be either life-ruining or completely fine, depending on how society accommodates them. A Biopsychosocial Model could continue to provide this insight, while jettisoning the less defensible elements.
Together, We Can Reach Entirely New Levels Of Disagreeing With Bryan Caplan About Mental Illness
The Social Model of Disability is similar to the Caplan model of mental illness.
Caplan says that we shouldn’t medicalize certain conditions, because it’s possible in theory for individuals to overcome them, so they must just be choosing not to so, so it’s all their fault.
The Social Model says that we shouldn’t medicalize certain conditions because it’s possible in theory for Society to accommodate them, so they must just be choosing not to, so it’s all their fault.
Both models are slightly wrong about some empirical facts, but mostly just reshape the empirical facts they do have into weird galaxy-brained contortions meant to cast blame rather than shed light.
But the Caplan Model is one weird economist’s hobbyhorse, and the Social Model is promoted in hospitals, universities, and government agencies. As much as I personally enjoy dunking on the former, the latter seems of more immediate concern.
Disabled people are understandably concerned that without the Social Model, people would lose track of the importance of providing accommodations. I think the Biopsychosocial Model can avoid the incoherence of the Social Model while continuing to emphasize this important point.
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