Disability definitions and models

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Definitions and Models

The International Classification of Functioning, Disability and Health (ICF), produced by the World Health Organization, distinguishes between body functions (physiological or psychological, e.g. vision) and body structures (anatomical parts, e.g. the eye and related structures). Impairment in bodily structure or function is defined as involving an anomaly, defect, loss or other significant deviation from certain generally accepted population standards, which may fluctuate over time. Activity is defined as the execution of a task or action. The ICF lists 9 broad domains of functioning which can be affected:

• Learning and applying knowledge
• General tasks and demands
• Communication
• Mobility
• Self-care
• Domestic life
• Interpersonal interactions and relationships
• Major life areas
• Community, social and civic life.

(see also List of mental disorders)

The introduction to the ICF states that a variety of conceptual models has been proposed to understand and explain disability and functioning, which it seeks to integrate:

The medical model

The Medical Model of Disability

The medical model of disability sees the disabled person as the problem. We are to be adapted to fit into the world as it is.

If this is not possible, then we are shut away in some specialised institution or isolated at home, where only our most basic needs are met. © Self Direction Community Project 2000 - 2001[2]

The medical model views disability as a problem of the person, directly caused by disease, trauma, or other health condition which therefore requires sustained medical care provided in the form of individual treatment by professionals. In the medical model, management of the disability is aimed at "cure", or the individual’s adjustment and behavioral change that would lead to an "almost-cure" or effective cure. In the medical model, medical care is viewed as the main issue, and at the political level, the principal response is that of modifying or reforming healthcare policy.

The social model

Impairment and chronic illness exist and they sometimes pose real difficulties for us. The disability movement comprises those disabled people and supporters who understand that we are, regardless of our particular impairment, subjected to a common oppression by the non-disabled world. We are of the view that the position of disabled people and the discrimination against us are socially created. This has little to do with our impairments. As disabled people we are often made to feel it's our own fault that we are different. The difference is that some part, or parts, of our body or mind are limited in their functioning. This is an impairment. © Self Direction Community Project 2000 - 2001[3]

The social model of disability sees the issue of "disability" mainly as a socially created problem, and basically as a matter of the full integration of individuals into society (see Inclusion (disability rights)). In this model disability is not an attribute of an individual, but rather a complex collection of conditions, many of which are created by the social environment. Hence, in this model, the management of the problem requires social action, and thus, it is the collective responsibility of society at large to make the environmental modifications necessary for the full participation of people with disabilities in all areas of social life. The issue is both cultural and ideological, requiring individual, community, and large-scale social change. Viewed from this perspective equal access for people with impairment/disability is a human rights issue of major concern.

Other models

• The moral model (Bowe, 1978) refers to the attitude that people are morally responsible for their own disability, including, at one extreme, as a result of bad actions of parents if congenital, or as a result of practicing witchcraft if not. This attitude can be seen as a religious fundamentalist offshoot of the original animal roots of human beings, back when humans killed any baby that could not survive on its own in the wild (see Darwinism).

• The Expert/Professional Model has provided a traditional response to disability issues and can be seen as an offshoot of the Medical Model. Within its framework, professionals follow a process of identifying the impairment and its limitations (using the Medical Model), and taking the necessary action to improve the position of the disabled person. This has tended to produce a system in which an authoritarian, over-active service provider prescribes and acts for a passive client.

• The Tragedy/Charity Model depicts disabled people as victims of circumstance, deserving of pity. This and Medical Model are probably the ones most used by non-disabled people to define and explain disability. To counter this trend, disabled activists are fond of the slogan "PISS ON PITY".

• Social Adapted Model

• Economic Model

• Empowering Model