Before the discussion reaches the point to examine the origins and nature of the concepts of inclusion and exclusion it may be vital to start with an overview on some definitions and models that may help to explain the complexity of disability.
The following table provides the image that has been given to people with disabilities and to people without disabilities. Johnstone (2001) uses the term of able bodied and disabled. A sense of pity, fear and charity characterize the disabled whereas able bodied appear ‘normal’, ‘good’ and ‘decent’.
Source: Johnstone (2001)
Two models of disability will be introduced the medical / individual and the social model. The medical model of disability encourages explanations in terms of the features of an individual’s body whereas a social model encourages explanations in terms of characteristics of the way society it organized.
The medical model was grounded on ‘illness model’ by Parson (1951, in Quinn, 1997:xix). This model equates disability with chronic illness, gives a sick role to the individual focused on dysfunction. Oliver (1990) observes that the medical model conserves the notion of impairment as abnormality in function, disability as not being able to perform an active considered normal for a human being and handicap as the inability to perform a normal social role.
In 1980 the World Health Organization suggested a classification of impairments, disabilities, and handicaps as follows:
Impairment: Any temporary or permanent loss or abnormality of a body structure or function, whether physiological or psychological. An impairment is a disturbance affecting functions that are essentially mental (memory, consciousness) or sensory, internal organs (heart, kidneys), the head, the trunk or the limbs.
Disability: A restriction or inability to perform an activity in the manner or within the range considered normal for a human being, mostly resulting from impairment.
Handicap: This is the result of an impairment or disability that limits or prevents the fulfillment of one or several roles regarded as normal, depending on age, sex, and social and cultural factors. (Barbotte, 2001)
The above definitions appear of a negative nature and are associated with disadvantage and as Oliver (1990) calls it personal tragedy.
Disabled people who feel that the individual model does not provide an adequate explanation for their exclusion from mainstream society have worked out the social model with the support of disabled people in academic circles. It is argued that their problems are not caused by their impairments but by the way society is organized (Oliver, 1990).
In the social model of disability there is a distinction between ‘impairment’ and ‘disability’ Impairment is defined as ‘the lack of all or part of a limb, or having a defective limb, organism or mechanism of the body’. Disability is ‘disadvantage or restriction of activity caused by a contemporary social organization which takes little or no account of people who have a physical impairment and thus excludes them from the mainstream of social activities’ (Union of Physically Impaired Against Segregation (UPIAS), 1976: 3-4, in Stalker, 1999).
The social models points to material constrains and barriers within society as the source of disability, rather than a person’s impairment. Barriers can be prejudice and stereotypes, inflexible organizational procedures and practices, inaccessible information, inaccessible buildings and inaccessible transport.
The following table provides a summary of the main characteristics of the models discussed.
Source: Rieser (2000) adapted from Barton, L. (2001: 139)
The social model has been criticized by writes within the disability movement. For example French (1993) and Crow (1996) point out that it neglects the implications of impairment and the interaction between impairment and disability.
The way conceptualizations of disability are shaped influence policy responses. For instance, policies based on the medical model tend to place emphasis on benefits. On the other hand policies based on the social model tend to draw attention on policies such as including disabled people in employment.
In this essay the view that both models explanations contribute to understanding disability is taken. However, it can be argued that explanation of disability as taxonomy of medical and biological problems has grown and expanded to include characteristics of disability as a service or social problem.
In the late 1960s a new perception around disability issues emerged supported by disabled academics and disabled people themselves. During the 1980s the Disability movement emerged. Marx & McAdam, (1994) define social movement as ‘organised efforts to promote or resist change in society that rely, at least in past, on non – institutionalized forms of political action’ (in Campbell & Oliver, 1996:22). Disabled people’s movement intended to have positive implications for the creation of an inclusionary society. It had a significant impact on promoting new political changes, changes in public opinion, human rights, civil right and citizenship, together with empowerment, consciousness raising and education (Dowse, 2001).
Having had a brief insight in understanding disability, now the discussion will move on to present an insight into the concepts of exclusion and inclusion.
Two major concepts can be identified which characterize the approaches adapted to disability policies in UK; the concept of exclusion and the concept of inclusion. Each will be analyzed in terms of its origins, development and possible future shifts. Throughout history disabled people have experienced exclusion and inclusion depending on a combination of economic, social, political, ideological, moral and cultural forces.
The social oppression of disabled people was established in ancient world of Greece and Rome. This approach was reinforced in the eighteenth and nineteenth centuries in UK. Initially social policy excluded disabled people from mainstream British society through the development of separate facilities.
Oliver (1990) suggests that ‘social policy for disabled people in Britain has been dominated by professional interests and concerns, characterized as constraining rather than empowering through out the later half of the twentieth century’. Indeed in late twentieth century social policy, legislation and services have tended to exclude disempower and immiserate disabled people rather than include and empower them.
Within the rise of industrialization disabled people were regarded as a burden. These is because many were unable to take on heavy physical labour required in factories and therefore were unable to contribute to the economy. Under the Elizabethan system (Poor Law Relief) waged labour made distinction between the ‘able-bodied’ and ‘non-able bodied’ poor as issues on labour mobility arose.
According to the social model the existence of disabling barriers have not encouraged inclusion into society.
Disability policy remained within the concept of exclusion till the end of Second World War.
After the Second World War the new welfare policies in Britain ‘were designed to treat all citizens as part of a more inclusive national order and in so doing to recognize state responsibility for caring for those who were in some way prevented from active economic participation’ (Giddens 1996:65).
Till the 1960s people with learning disabilities lived in large, grim isolated institutions. In the 1960s and 1970s a series of scandals brought change. De – institutionalization was a movement away from institutions. The follow up from de – institunalization was to transfer patients to a new life in the community. Such thinking aimed to include disabled people in the ordinary life and promoted by the social movement (1980s) (Twigg, 2003).
The social movement had major impact in civil rights legislation. Disability Discrimination Act 1995 is the first piece of legislation underpinning disabled people’s rights in UK as well as an important step towards full civil rights. In addition the Community Care Act (Direct Payments) 1996 is significant in British social policy as enables local authorities to provide disabled people with appropriate funding to employ their own helpers or personal assistants. This has been illegal since the National Assistance Act 1948 (Campbell and Oliver, 1996). The orientation of this legislation appears to promote the concept of inclusion.
Inclusion fits with links of normalization and quality of life. The strategy of normalization is to reduce social stigma and make people valued in society. Further it aims to change society’s perceptions of disabled people (Armstrong, 2002). Instead of pointing out what disabled people cannot do it is supported under normalization to promote what they are able to do. Thus focusing on abilities instead of disabilities.
The thinking about inclusion in Britain was influenced in the early 1990s from North America. It promoted intentional building of relationships, person-centred planning.
The following table provides a summary of the shift from exclusion to inclusion.
The above discussion shows that the political of disability as a form of social, cultural and patriarchal oppression emerged in a slow pace. Since 1998 the study of disability has been established as an area of study. Degree programmes and research from universities indicates that there is a growing interest in this field. It is very likely then that further developments may occur.
First of all changes in definitions may emerge. The area had been challenged by academics that are disabled themselves and influence thinking towards the social model. The social model is maybe to be developed further and improve its context.
The year 2003 was dedicated on disabled people by the European Union. European Union appears to adopted explanations and definitions leaning towards the social model.
Further developments seem to continue on inclusion in terms of equal rights and entitlements to empower the position of disabled people in today’s society.
Self advocacy appears to be the new emerging area It has been brought forward in the 2001 white paper Valuing People and rests on new labour’s modernization principle. Self-advocacy involves more than just talk…it implies the intent to produce change in one’s life (Wertheimer, 1988:3, in Armstrong, 2002).
Conclusions
From the evidence given the conceptualizations reflect fundamental interests and such interests appear to have implications. It appears that the medical model is rooted in biology and thus serves the interests of the medical profession as well as of those political groups supporting it. From the intellectual point of view appears limited for responding to the problems of disability. Disability is a complex area. It can be argued that conceptualizations on exclusion and inclusion modify disability.
The exclusion of disabled people has allowed traditional individualized medical approaches to disability based upon personal tragedy theory. To define the realities of the experiences of impairment, and to structure the development of policy responses to disabled people. The more recent sociological analyses of disability with emphasis on barriers approach to disability referred to as the social model of disability.
The conceptual development from inclusion to exclusion is to continue further in the context of civil rights and citizenship. Also self-advocacy is promoting representation of the views of people with disabilities. Expressing their views on how the society they live in is responding to their needs does this and to what extend they feel included in it.
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