The Power of Models of Disability
Smart, Julie F., The Journal of Rehabilitation
Much of the way in which rehabilitation practitioners, educators, and researchers undertake their work is guided by the model of disability to which they subscribe (Harper, 1991; Tate & Pledger, 2003). Models of disability define disability, determine casual and responsibility attributions, influence professional practice, drive payment systems, and guide legislation (Dembo, 1982; Hahn, 1993; Nagi, 1969; Zola, 1989). Models of disability permeate every professional relationship in rehabilitation; these models also serve as the structure for rehabilitation and disability research development, providing the rationale for the funding of large studies. Further, every type of rehabilitation/disability resource allocation has its basis in a model of disability and agency policies and regulations trace their origins to a model of disability (Albrecht, 1981, 1992; Berkowitz, 1987; Bickenbach, 1993; Fox, 1993; Wolfensberger, 1972). Thus, the daily lives of people with disabilities, if and how they are educated, if and where they work, and their social and familial life, in large part are determined by models of disability. Perhaps, most important, models of disability exert a powerful influence on the public perception of disability and the public's response to people with disabilities. Consequently, models of disability have the capacity to shape the self-identity of those with disabilities (Conrad, 2004; Davis, 1997; Hannah & Midlarsky, 1987; Hulnick & Hulnick, 1989; Longmore, 1995; Nagi, 1969).
Surprisingly, the power of models of disability is rarely acknowledged or addressed; nor, are these models questioned or challenged (Gill, Kewman, & Brannon, 2003; Harper, 1991; Pledger, 2003). Indeed, most practitioners are only marginally aware that there are other models and that patients/clients/consumers may, and often do, subscribe to a different model. A therapeutic alliance, therefore, is difficult to establish if the professional and client define the disability differently and, as a result, envision different treatments and services. Most practitioners function in the way in which they have been educated and trained (Bauman & Drake, 1997; Bluestone, Stokes, & Kuba, 1996; Gill et al., 2003; Hogben & Waterman, 1997; Kemp & Mallinkrodt, 1996; Parsons, Hernandez, & Jorgensen, 1998). For example, if a practitioner has been trained to view disability as solely a clinical concept, he or she will conceptualize the necessary response to be clinical treatment.
Models of disability are the underlying structure for large, complex diagnostic/defining systems, such as the International Classification of Disabilities, Impairments, and Handicaps--2 (ICIDH-2) (WHO, 1993, 2001) and the Diagnostic and Statistical Manual IV--Text Revision (DSM-IV-TR, American Psychiatric Association, 2000) and the International Classification of Functioning, Disability, and Health (ICF, World Heath Organization, 2001). In turn, these diagnostic systems are used not only for clinical purposes but also for research development, and administrative and social planning. Diagnoses, therefore, have profound political, social, and financial consequences (Hahn, 1985; Smart, 2005b).
Models provide both casual and responsibility attributions; these attributions determine which academic disciplines study and teach the disability experience. If disability is viewed as only a medical concern, then the cultural, historical, social, and political aspects will not be taught in psychology, sociology, political, science, law, or history curricula. Moreover, most people with disabilities, after medical stabilization has been achieved, consider the social, cultural, and political aspects of the disability experience to be their most important concern (Bowe, 1980; Dembo, 1974; Smart, 2005a, 2005b). However, it is likely that there are few professionals, who possess the adequate background, training and clinical experience to provide these social, cultural, and family support services. …