This is part 3 in a 6-part blog series aimed at helping you to understand Disability.
In the previous blog, I introduced the Eugenics model and looked at how this broad classification of ‘fit’ or ‘unfit’ has influenced how we understand Disability today.
In this blog, I am going to introduce you to the Medical model. I will attempt to explain how the medical view of disability affects how we work with and treat disabled people.
Summary: According to the Medical Model, a person has a disability.
This disability is a ‘problem’ in their body that needs to be fixed or managed by medicine and science in order to live a ‘normal’ life.
Medical model language: includes terms like normal, abnormal, the disabled, the blind, person with disabilities, able-bodied, handicapped, suffering from, special needs, needs, and wheelchair-bound.
The Medical Model of understanding disability was born out of the eugenicist framework, and it framework shapes lots of contemporary conversations and approaches to disability today.
While eugenicists thought that unfit characteristics — both social and physical — were hereditary in the body and should be removed from society, the Medical Model focuses specifically on perceived imperfections within the human body.
In this model, imperfections are understood as abnormalities that need to be improved or fixed by medicine.
The disability lives in that individual person’s body and is the reason that they may not live a ‘normal’ life – life without a disability.
This means normal is equated with not ‘having any disabilities’, while abnormal is equated with ‘having a disability’.
The Medical Model believes that disabilities are clinical and something that healthcare should support the person to lessen, fix or manage the impact of.
Thus science and medicine, medical professionals and the medical industry are perceived as the experts on disability.
The Framing of Need
The framing of need is key in the medical model because the aim is to make the disabled person normal, and the reason that they aren’t normal is that there is something wrong with their body. The individual therefore needs society to help them be normal.
The construct of need in the medical model, coupled with the designation of professionals as specialists on disabilities means that many services designed for disabled people are separate from non-disabled services in healthcare, social care, education and most other arenas.
This requires disabled people to be separated from non-disabled peers and services in order to access standard and support services.
Under the Medical Model, people are often perceived not as whole people, but as their impairments or medical conditions first… and all else second.
The perceived need associated with whatever impairment they have is seen as the fundamental aspect of their being that should be engaged with in health services, education services, welfare services, legal services, and often socially too.
The Medical Model is used widely in the modern world. It underpins most medical and healthcare services globally. It also shapes public policy. Even Work Capability Assessments (the assessment for disability and sickness benefits in the UK) is tested by an assessment of the things your body can and cannot do.
Interestingly, there’s growing evidence that these assessments bias against particular subsections of disabled people: poor people, women and people with mental health conditions — suggesting that eugenics-model thinking is still at play in Medical Model practice.
The Medical Model also exists in the education system, most visibly in the practice of special needs, special educational needs (SEN) and special educational needs and disabilities (SEND).
The construct of special needs fits the medical model in two ways; it suggests that disabled people need help and that said help necessitates specialist support. Additionally, the inclusion of disability in the SEND acronym implies that all disabled people need special educational support, even though many disabled people learn in the same way as their non-disabled peers.
The delivery of SEN/SEND support in schools is also often separated from mainstream education. While it might be true that a range of students — including disabled students — might need specific support in education, the construct of special needs is derived from medical-model thinking.
It is based on a philosophy of a normative form of education (usually called mainstream) and specialist support for people who need to learn in different ways. It seems to be failing many of the students it classifies as SEND who are more likely to be excluded, to be unemployed, to end up in prison, or to live in poverty.
In fact, we see similar patterns of eugenicist thinking in education as in social care.
In 2009/10, 84.2% of pupils who were permanently excluded had either Special Educational Needs, were eligible for Free School Meals or were Black Caribbean (or a combination therein) in the UK.
Medical Model in Practice
This leads us onto the ways that the medical model exists in attitudes as well as practice.
Societies and individuals recreate the construct of non-disabled as normal in latent and blatant ways regularly.
Language is one way that cultural ideas are practiced in unintentional ways.
A key word from the medical model lexicon was “handicapped”. There are various accounts of the etymology of the phrase, but simply it means that someone has a physical limitation.
Other Medical Model language includes phrases like “the handicapped” or “the blind” to refer to disabled or blind people as whole subsections of society, homogenous and other.
In response to this, many disabled people started to advocate for people first language where they would be seen as a person, where before they were seen as their impairment.
In that way they might be a person with a disability or a person with a visual impairment.
The phrase “able-bodied” is, although commonly used today, also derived from the Medical Model. In identifying people who aren’t disabled as able-bodied, we understand the opposite of disabled to be abled.
This both infers that disabled people aren’t able and also that disability is located in a person’s body, that disability is physical and that disability is visible.
This thinking is so commonplace that we often assume all disabled people are in wheelchairs or use mobility aids, and that disabled people are most often born disabled. In fact, only 8% of disabled people use a wheelchair and only 17% are born disabled.
Offshoots of the Medical Model
There are a number of models which branch off from the Medical Model, notable offshoots worth looking at are the tragedy or charity models.
These models view disability as tragic and something to be pitied. The charity model encourages non-disabled people to work to support and save disabled people from their personal tragedy of disability.
Often disability charities generate funds from supporters by using advertising that represents disabled people as worthy of pity and help in order to find cures or meet the needs of their disability.
However, in the 1970s and 80s, disabled people started responding to what they perceived was disempowering and infantilising attitudes towards them born of the Medical Model, and they started to develop and advocate for a new way of thinking: the Social Model.
This shifted the way we conceptualise disability from in the body to thinking of it as constructed by society.
This will be the focus of the next part in the blog series.