The charitable model of disability relates closely to the hegemonic medical model of disability (Hughes, 1998, p60). The medical model seeks to be dominant by claiming “expert” knowledge and discursively suggesting that disability is pathological. It views disability as a problem that is within the individual and requires classification, diagnosis and treatment by skilled professionals (Hughes, 1998, p73). The legal and medical discourses of disability literally give power to professionals to treat the “problem”. It suggests that able-bodiedness is the norm that must be aspired to, achieved through drug therapy and programmes of rehabilitation. Foucault (1972) identified this focus on the pathology alone as “the medical gaze” and Mason’s account, cited in Hughes (1998) highlights its dehumanising effects.
An extreme example of how a medical discourse of disability can have a significant impact on people’s lives is found within the development of eugenics (Hughes, 1998, p71). This “scientific” body of thought suggest that genetical defects make disabled people “lesser beings” and create a threat to the purity of “the racial stock”. This approach is extreme in that its policies attempt to restore normality by removing the “abnormal”, primarily through segregation and institutionalisation. This approach differs from much of the medical model in its emphasis on elimination as opposed to rehabilitation. Examples of this approach can be found in the Nazi compulsory sterilisation and euthanasia programmes that resulted in around 200,000 disabled people being killed. This construction is not only confined to history but has been resurrected in recent debate about genetic counselling (Hughes, 1998, p72).
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Although it offers different policy solutions to the problem of disability, eugenics still locates the difference within the individual, in the same way that the dominant orthodox medical discourse of the 1950s does. The orthodox medical model has informed the majority of social policy on disability, such as the Disability Discrimination Act (1995), and has provided solutions in the provision of disablement services that seek to respond to individual needs and offer support (Hughes, 1998, p76). As a result, these policies reaffirm disability as an individual problem and perpetuate its social difference from the accepted able-bodied norm.
A major challenge to this dominant discourse is the social model. It contests the naturalisation of able-bodiedness. It suggests that it is not the impairment that is disabling; rather that societal attitudes and environmental factors result in oppression of the disabled. They are excluded from participating in society because medicine defines disability as dependency and tragedy. In adopting this structural stance, the social model suggests that policies should address restructuring the physical environment and the legal discrimination of Rights (Hughes, 1998, p77).
One of the main aims of the social model has been to challenge the definition of “independence”. It has argued that independence is not linked to having capacity to participate within society without assistance but instead having the choice and control of how and when assistance is required (Hughes, 1998, p80). It suggests that specific policy intervention, based on the new language of Rights as opposed to welfare, is needed. This can be demonstrated by the policy of direct payments. This crucial legislation allowed disabled individuals to purchase their own care in the form of PA’s, as opposed to passively receiving it from carers. This helped to alleviate the notion of dependency. Explicitly making the disabled “employers” enables them choice and control to dictate exactly what they require. This is clearly illustrated by Jane Campbell’s account on the course DVD (The Open University, 2006). However, critics would argue that, whilst direct payments offer autonomy for articulate disabled individuals, it excludes the more severely disabled individuals that may not be able to fulfil the responsibilities of an employer. This model could create a subgroup of subordinate disabled people. Jane Campbell stresses that whilst Direct Payments have made some impact on issues of dependency, disabled people
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remain reliant on central government policy because Direct Payments are subject to government funding that could be withdrawn at any time. Although the disability movement has sought to reconstruct the group’s identity, it can be criticised for failing to recognise diversity within the group and denying difference of personal experience among disabled people (Morris, 1991, cited in Hughes, 1998, p85). The social model contests that disability is a natural problem and suggests it is a by-product of social factors. However, it is still a construction of difference and has consequence to the implementation of policy.
Another example of how the construction of social difference has consequence for social policy is in the construction of Race. This was accelerated by increasing numbers of immigrants into Britain after WW2 (Lewis, 1998, p104). Common sense assumptions based upon physical characteristics that categorised the “nation” as a homogenous group of people with a common cultural and “white” identity led to the construction of the immigrant minority as unnatural and as a consequence defined it as a problem (Lewis, 1998, p101).
To ensure that homogeneity was not disrupted central government acted to ensure that the minority was quickly absorbed into the host society. This became known as the Assimilationist phase (Lewis, 1998, pp105-110). A social policy used in this phase was “bussing”. Using dispersal and placing an upper limit on the number of minority children within schools ensured that native parents were appeased by attempts to control the “problem”. Boyle’s speech to the House of Commons illustrates further the construction of Race as a problem (Lewis, 1998, pp107-108). The very need for a speech and the sense of urgency with which it was delivered suggested a real cause for management. The long term implication constructed difference based entirely on race and nature and not a difference of ability in language. This suggests immutable permanence.
The Integrationist phase challenged the Assimilationist phase as ineffective (Lewis, 1998, p110). It maintained the need for cultural stability but called for tolerance of difference, so long as it didn’t conflict with the “norm”. This firmly constructed immigrants as “in” the nation but not “part” of it. It was characterised by a programme of teacher training in multicultural awareness.
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The changes in policy did little to accept the minority into the nation, instead it highlighted difference within “the unchanging culture of the school” (The Open University, 1978, pp80-81 cited in Saraga, p111).
As it became apparent that minority presence was here to stay and that there would be further generations “British Born”, language and the meanings ascribed were altered. “Immigrant” was replaced by “ethnic minority” and cultural difference replaced racial difference. This shift paved the way for debate about multiculturalism (Lewis, 1998, p111). This phase aimed to provide policies of equal opportunity to attend to the needs of ethnic minority children and ensure that ALL children were equipped for life within a cultural pluralist society, as outlined in the Swann Report, 1985 (Lewis, 1998, pp115-116). This contests the construction of the nation as “white”. However it still suggests that there is a difference through the implementation of policy (the Rampton Report) to address minority “needs” (Lewis, 1998, p114). The Institute of Race Relations imply instead that structural inequality found within education policy and wider society is the root cause of difference (Lewis, 1998, pp114-115). This reconstructs the problem as caused by social factors and suggests the implementation of anti-racist policy. Although, it must be argued, that the construction of anti-racism is not free from contestation. Some would suggest that this simply inverts the meaning of difference and positions “white” as being the problem (Burnage Report, cited in Lewis, 1998, p123).
So, to conclude, it is evident that how we construct difference has radical effects on the implementation of social policy. It is imperative that we should not be seeking to deny difference or confirm one construction as the truth. Instead understanding is achieved by looking at why meanings are attached to social issues and the effects that these meanings have on policy. Although there can be many challenges and contestation of constructions if it has been naturalised it becomes very difficult to challenge; the ideas are so deeply imbedded within society and institutionalised through policies used to address the “problem”. Ultimately power is given, to those defining the problem, over the course of people’s lives and their equality within society (Saraga, 1998, pp204-205).
Word Count (excl ref) 1709
References
Clarke, J and Cochrane, A (1998) “The Social Construction of Social Problems” in Saraga, E (Ed) Embodying the Social: Constructions of Difference, Routledge/The Open University.
Hughes, G (1998) “A Suitable Case for Treatment? Constructions of Disability” in Saraga, E (Ed) Embodying the Social: Constructions of Difference, Routledge/The Open University.
Lewis, G (1998) “Welfare and The Social Construction of Race” in Saraga, E (Ed) Embodying the Social: Constructions of Difference, Routledge/The Open University.
Saraga, E (1998) “Review” in Saraga, E (Ed) Embodying the Social: Constructions of Difference, Routledge/The Open University.
The Open University (2006) DVD, Programme 2, “Independent Living”, D218 Social Policy: Welfare, Power and Diversity, Milton Keynes, The Open University.
