Medical Model
The medical model is rooted in medical science and an interpretation of disablement as an illness that can be diagnosed and an attempt to cure it. Further to this Connolly (2001, p158) attributes the “large scale institutionalisation of disabled people throughout the nineteenth and twentieth centuries”, to the medical model.
It is grounded in the personal tragedy view of disablement which presumes that the goal of disabled people is to be normal and to therefore seek the intervention of professionals “experts” to try and bring them as close as possible to normal. A non-tragedy view by disabled people would likely be considered by non-disabled people as a false show of bravery or a lack of acceptance of their condition (Swain et al, 2004). French and Swain in Swain et al (2004, p.35) state “the most intrusive, violating and invalidating experiences, for disabled people, emanate from the policies, practices and interventions which are justified and rationalised by the personal tragedy view of disability and impairment. That is why they believe, the abortion of impaired foetuses or the compulsory sterilisation of people with learning disabilities that is practiced in many parts of the world is barely challenged. They believe that at the heart of this is a belief that due to their impairments, disabled people cannot possibly ever be happy, fulfilled or enjoy an adequate quality of life. They argue that the reason for this may be the view that being disabled is abnormal, especially in a society, which believes that disabled people want to be “normal.”
Social Model
Drake (1999) challenges the indication that normality depends on a specific level of functioning and wonders whether society serves the needs of all its members equally (social justice), without considering their functioning and concludes that it does not and from the social model perspective the result for those members that are not served equally is disablement, this is supported by Barnes et al (1999) who see social justice as being at the heart of disability theory. Drake (1999, p.36) postulates that only “a policy model that secures the equal rights and equality of opportunity for disabled people can affirm and secure their citizenship. Such an outcome depends on the aims, scope, and capacity to bring about social and environmental change of the disability policies in place.
The social model is believed to have its roots within the fields of psychology and sociology and sees disability as a social construction brought about by the way disabled and non disabled people interact, which creates disadvantage and exclusion. The result being a view of disabled people by society as a deviant group, while at the same time society tries to minimise the deviance by working to a policy of assimilation of disabled people, which tends to devalue their identity (Connolly, 2001; Swain et al, 2004). Further to this Swain et al (2004, p.287) believe that “the social model of disability provides an emancipatory way of conceiving the relationship between the individual and society and of the importance of socio-economic conditions and relations in terms of understanding the position and experiences of disabled people in society”.
Political Model
According to Bennie cited by Connolly (2001) a political model defines disability, as being something that people experience and not what they have. Disability therefore is seen as the consequences arising from living with impairment, in a society that does not take disabled people into account. The political perspective embraces the idea that there are irreconcilable differences within society and these are brought on by conflict between those with power and resources and those without.
Connolly (2001, p.159) believes Resolution, will only come about through “fundamental changes to the structure, organisation, and dominant values of society.” The political perspective is one where disabled people are able to “assert their right to define issues and problems on their own terms, and to determine a course of action that might lead to changes and structures that operate in their interests.” (Bennie cited by Connolly, 2001; Hahn cited by Oliver and Barnes, 1998asd). Drake (1999) refers to the domination of those with power and resources on those without, hence society’s failure to take account of disabled people.
Drake (1999) argues that “governments formulate and implement policies, in part to give concrete expression to their ideologies, values and beliefs, and each administration creates and promotes policies that resonate with its own particular understanding of disability.” Further to this he believes that how a government views disability will have an effect on the shaping of laws and institutions as well as the quality of life that disabled people can enjoy. While some governments will place disability at the heart of the legislative process others may deal with it in a piecemeal fashion such as ensuring the provision of health but leaving out other services that may be just as pertinent, and yet other governments may leave the disabled to fend for themselves as best as they can (Drake, 1999).
Connolly (2001) believes that the policies guiding health and disability in New Zealand have significantly changed in the last decade and not really for the better. Further to this key pieces of legislation governing changes in health, welfare and disability sectors such as the Health and Disability Services Act (1993) have not always been welcomed with open arms by disabled people. For example according to Connolly (2001) disabled people criticised the decision by government to move the responsibility for policy, funding and services from the Ministry of Social Development (welfare sector) to the Ministry of Health (health sector), based on issues of resource provision, mode of service delivery and rights to services. Such a move also seemed to vindicate the medical model view in New Zealand, and this is supported by Munford and Sullivan (1997) who believe that the restructuring of the welfare state during this decade and the changes in the mode of service delivery that ensued has had the result of negatively impacting on people who were already marginalized. For example while the Ministry of health seems to embrace the social model of disability in their definition of disability, there is a marked contradiction in terms of their actions especially as far as the needs assessment is concerned, where eligibility for funding is assessed using the medical model (Ministry of Health, 2001;Munford and Sullivan, 1997).
Conclusion
Where do we put our focus? Is it on trying to change the individual through care, treatment and therapy, as per the medical model of disability, or on trying to change the disabling impact of society itself. Drake (1999, p.14) sees the medical and social models as representing “two fundamentally different ways of understanding disability”. While he does not specifically identify the existence of a political model, Drake (1999) believes that the decision of which model is used in a given society depends on those in power at a given time. Luke cited by Drake (1999, p.16) proposes the “three dimensional analysis of power” and postulates that “the third dimension of power involves the imposition of a prevailing and all-pervasive ethos by a dominant social force upon a subordinate one”. By this he claims that the environment that is created by the dominant group is such that the subordinate group does not see themselves as disadvantaged but see it as natural. According to Oliver cited by Swain et al (2004, p. 286) the social model of disability rests upon the UPIAS 1976, which states, “ In our view it is society which disables physically impaired people. Disability is something imposed on top of our impairment by the way we are unnecessarily isolated and excluded from full participation in society. Disabled people therefore believe themselves to be an oppressed group in society.” This view challenges the medical model of disability, distinguishing between the impairments that people have and the barriers to social integration.
REFERENCES
Barnes, C. M., Mercer, G., Shakespear,T. (1999). Exploring Disability; A Sociological Introduction. UK, Blackwell Publishers.
Connolly, M. (2001). New Zealand Social Work; Contexts and Practice. Australia, Oxford University Press.
Drake, R.F. (1999). Understanding Disability Policies. UK, Macmillan Press.
Munford,R. and Sullivan, M.(1997)Social Theories of Disability; The Insurrection of Subjugated Knowledges. Dunmore Press, Palmerston North.
Oliver, M. and Barnes, C. (1998) Disabled People and Social Policy. New York, Addison Wesley Longman.
Oliver, M. and Sapey, B. (2nd Edition). (1999). Social Work With Disabled People Basingstoke, Macmillan.
Swain, J., French, S., Cameron, C. (2003). Controversial Issues in a Disabling Society. Buckingham, Open University Press.
UPIAS(1976) Fundamental Principles of Disability. London, UPIAS.
Swain, J., French, S., Barnes, C., Thomas, C. (2nd Edition) (2004). Disabling Barriers - Enabling Environments. London, Sage Publications.
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