As we wage the fight of our lives against Tory government attacks on disabled people, it may seem that discussing “models” of disability is an irrelevance, a distraction, a waste of time.
But the approach we use to understand disabled people’s position in capitalist society makes a big difference. Understanding oppression lays the foundation for an effective struggle for liberation.
There are several “models” used to describe disability. The two most prominent are the medical and the social models.
In short, the medical model sees the person’s physical or mental impairment as the problem, and therefore focuses on what a person can not do. The solution it offers is treatment, cure or, failing that, managing the person as an incomplete or defective human being who needs pity, care and decisions made on his/her behalf.
The social model, in contrast, distinguishes between impairment and disability. Impairment is the shortfall in full bodily or mental functioning; disability is the obstruction that society places in the way of an impaired person’s equal participation. Barriers may be physical eg. steps; use of limited means of communication eg. print but not Braille; attitudes and prejudices; financial and social disadvantage and stress.
For example, a wheelchair user attempts to enter a building but is confronted by steps. The medical model regards the person’s impairment as the problem; the social model says that although this is an impairment, the disability is the lack of an alternative to the steps. The medical model would either leave the person outside, or perhaps lift him/her up the steps; the social model would have installed a ramp or lift already.
The medical model has a long history, while the social model was devised by disability rights activists within the last half-century as a challenge to it.
Industrial production caused physical injury on a large scale; imperialist war caused still more. The victims of these, together with other impaired people, have long been treated as objects of pity, whose only hope lay in either a medical cure or dependence and charitable care. The consequence of this has been to disable people, consigning them to institutions or to poverty and social exclusion.
The 1960s and 70s saw a surge in liberation struggles — anti-war protests, feminism, gay liberation, workers’ struggles, and the black civil rights movement. A disability rights movement also grew. Activists spoke out against discrimination and set up Independent Living Centres in several countries.
By the mid-70s, socialists in this movement were outlining a distinction between impairment and disability. This became the foundation of the social model of disability. It turned the medical model on its head, and provided a tremendous boost to the confidence and assertiveness of the disability movement. It is a liberatory approach.
The social model, and the movement behind it, has achieved significant progress. Pitiful images of crippled kids on charity collection boxes are being left in the past. The UN Declaration on the Rights of Persons with Disabilities takes a social model approach, having been drafted by representatives of disabled people’s organisations.
However, even where there has been progress in our legal rights, it is often based on, and therefore limited by, the medical model. The UK’s disability discrimination legislation, incorporated in the 2010 Equality Act, requires a person to prove that they are disabled and therefore entitled to the limited rights contained in the Act by showing what they can not do. It is an individualistic and demeaning process focused on a person’s shortcomings rather than on the barriers that society places in their way.
A social model approach would require organisations to identify barriers and remove them rather than relying on individuals to plead for special treatment. The last Labour government nudged UK legislation in a social model direction by introducing the Equality Duty in 2006, obliging public sector bodies to challenge discrimination and promote equality, but the 2010-15 Tory/LibDem coalition government weakened the Duty to the point of practical uselessness.
Attitudes based on the medical model of disability help to maintain and condone the continuing inequality and marginalisation experienced by disabled people.
If the blame lies with the impairment, then there is a logic to blame the impaired person, especially if it can be portrayed as self-inflicted or “all in the mind”. Even if it is not their fault, or a cover for their idleness, then the medical model suggests that what we need is pity rather than the removal of obstacles. In “tough economic times”, pity — or at least, the money to give it practical expression — becomes a luxury society can no longer afford. Disabled people become scroungers, a burden, the “undeserving poor” of the Victorian era.
The social model of disability is not in itself a Marxist theory. Indeed, it is a model — an approach, a way of understanding, a guide to action — rather than strictly a ‘theory’ at all. It is, however, consistent with Marxism.
There are some criticisms of the social model, in particular that it disregards the genuinely significant impact of impairment, and that it fails to address other oppressions alongside disability. However, its strength is that it describes disability in a materialist way, in the context of the society in which impaired people live. That [capitalist] society causes many impairments and causes discrimination and disadvantage even where it does not cause impairment.
By focusing on material, social barriers, the social model offers the prospect of removing them and achieving equality and liberation through self-organisation and struggle. To paraphrase Marx, disabled people have thus far had to deal with an oppressive society; the point, however, is to change it.
• The TUC Disabled Workers’ Committee’s guidance, Trade Unions and Disabled Members: Why the social model matters, can be downloaded here.