What is the difference between the medical and social models of disability and why does it matter?

Today’s guest author is Jennifer Litton Tidd.  Jennifer is a restraint and seclusion survivor, whose autistic child is also a restraint and seclusion survivor, a former team member, and still a fierce ally of AASR. She is also a multiply diagnosed neurodivergent person, who is co-founder of the Neurodivergent Liberation Coalition, an ND led, intersectional, neurodivergent rights group formed to build a coalition between many neurotypes to become more visible, to engage in political direct action, to educate, change minds and policies that impact neurodivergent people. NDLC believes when neurodivergents aren’t at the table, we’re probably on the menu, and we demand to write the menu. Neurodiversity is a liberation movement of our minds and bodies from the shackles of discrimination and erasure. #NothingAboutUsWithoutUs #LiberateNDs #endseclusion 

According to the social model of disability, ‘disability’ is socially constructed. Let me explain. 

To understand the social model, we must first understand the medical model of disability. In this model, ‘disability’ is a health condition dealt with by medical professionals, therapy, or treatment. We need to be repaired because we are broken. Disabled people are thought to be different from ‘what is normal.’ We are seen as abnormal. Disability is seen to be a problem with a person. From the medical model, a disabled person is in need of being fixed or cured. From this point of view, disability is a tragedy, and people “with” disabilities are to be pitied. We’re seen as so broken, common language insists we separate disabled people from our diagnoses with person-first language. I become a “person with disabilities,” to designate me as a human because being a “disabled person” allegedly denies me my humanity. The medical model of disability is all about what a person cannot do and cannot be. It sends the message to both society and the disabled person that our disabilities separate us, make us broken, or not whole. So stigmatized in fact, we have to distance ourselves from our disability in any sentence describing us.

On the more sinister side of the medical model, thinking is a disabled person being broken, hopeless, and not worth education or healthcare expenditure. The medical model dictates that disabled people need to be segregated, denied consent, bodily autonomy, or institutionalized. We are of lesser value, hence inalienable human rights do not apply to us. 

The social model sees ‘disability’ as the result of the interaction between people who are somehow impaired and an environment filled with physical, attitudinal, communication, and social barriers. It, therefore, carries the implication that the physical, attitudinal, communication, and social environment must change to enable disabled people to participate in society on an equal basis with others. We are as worthy of human rights as any other person. 

The medical model sees access and accommodations as “special needs,” a favor to disabled people, often a burden to abled people. It deems access as something for which disabled people must be grateful for special favors. It doesn’t acknowledge that abled people also often benefit from “disability accommodations.” We build ramps for access for wheelchair users, but a parent with a stroller, a pregnant or sick person, someone with a broken leg, or someone elderly who struggles with stairs, will also benefit from a ramp. We have cut-outs in curbs for people with mobility issues, but bike riders and rollerbladers also benefit from accommodations that allow access to the sidewalk for disabled people. 1 in 5 people are dyslexic, yet schools teach reading only how neurotypical people learn and exclude dyslexic people from access to an inclusion classroom. Neurotypicals can also learn to read using programs designed to accommodate dyslexic learners. Why not include everyone? 

Accommodations benefit all. 

Restraint and seclusion exist only because of entrenched medical model thinking. Restraint and seclusion come straight from institutions and prisons. The disabled person is broken, hence our rights to consent and bodily autonomy are denied and justified for our “safety.” Nobody in a restraint and seclusion culture is safe. Not those being restrained and secluded, those doing the restraining and secluding, nor those witnessing it. Restraint and seclusion are not accommodations. They deny a disabled person access to the education to which we are entitled, enshrined in the Individuals with Disabilities Education Act. (IDEA) Restraint and seclusion also violate the Americans with Disabilities Act, which guarantees disabled people equitable treatment to abled people. Disabled children are 13% of US schools, yet are 78% of seclusions, and 80% of restraints, a craven violation of the ADA. 

A social model perspective does not deny the reality of impairment, sickness, nor its impact on the individual, or a caretaker. However, it does challenge the physical, attitudinal, communication, and social environment to accommodate impairment as an expected incident of human diversity. Yes, not only is disability not “abnormal,” it’s a very normal part of the human condition. Very few people are born, live their entire lives, and die without experiencing disability. 

Do you need reading glasses to read? Your eyes cannot focus on the text, and the magnification in the glasses is an accommodation. Your ability to read is impaired, but accommodation makes a book accessible to you. How are glasses for a seeing person different from Braille for a Blind person? Why does one group find their accommodation at any drug store, but the other group has to fight for their accommodations? Why does a child who wears glasses have access to being educated with seeing children, but the only option for a Blind child is to be excluded into a more restrictive “special education” environment? 

Ever broken a bone? Your cast and crutches are accommodations, and suddenly accommodations for wheelchair users start making sense to you. Suddenly ramps, elevators, and curb cut-outs become a welcome way for you to access all you were able to do before breaking your leg. 

Have you been pregnant on bed-rest? Had the flu? Had a root canal? Impairment is common. Disability is normal. Yet for some reason, we don’t blink an eye at accommodating a temporary disability, but people born disabled are seen as broken, abnormal. We have to fight for access and accommodations. 

The social model seeks to change society to accommodate people living with impairment, either lifelong or temporary; it does not seek to change disabled people to accommodate society. It supports the view that disabled people have a right to be fully participating citizens on an equal basis with others. Whatever is needed to overcome access barriers is valuable and accommodated, because disabled people are valued and our accommodations are a human right, not a special need or favor. 

Some think the social model of disability and neurodiversity movements deny that many disabled or neurodivergent people need treatment, medication, or have struggles. This is false. There is a distinction. In the social model, the treatment must benefit the individual being treated, not sedate, change, or erase us to make us less burdensome. An example is behavioral compliance “therapy” for neurodivergent children. Does behavioral therapy make our lives easier and expand access as communication therapy does? Or is the “therapy” attempting to eradicate flapping hands, force us to stay seated, or force eye contact? These are goals that do not center the neurodivergent person, but the neurotypicals around us, hence are not expanding access or accommodating us. They are intended to force neurodivergents to accommodate neurotypicality. The world is built entirely around neurotypicality. We are already forced to navigate through what is difficult for us enough. The behaviors that need changing are those who seem resolutely opposed to what we are. We need acceptance, not to be forced to be something we aren’t.

The social model says that often our greatest struggles are the barriers created in a world built for, focused on, and that values only neurotypicality. 

The social model of disability is now the internationally recognized way to view and address disability. The UN Convention on the Rights of Persons with Disabilities (CRPD) marks the official paradigm shift in attitudes towards disabled people and approaches to disability concerns, access, and accommodations. 

Disabled people are not “objects” of charity, medical treatment, and social protection but “subjects” with rights, capable of claiming those rights, able to make decisions for our own lives based on our free and informed consent, and be active members of society. Disabled people have a right to personhood, to be treated with respect and dignity. 

Disabled people have rights: 

  • A right to healthcare. 
  • A right to access to communication modalities. 
  • A right to transportation access. 
  • A right to physical access to all buildings, public and private. 
  • The right to a fully accommodated inclusion education in the least restrictive environment. (That does not mean mainstreaming without accommodations. It means access to education and all accommodations and supports we require to progress in a classroom. Inclusion isn’t where a person’s desk is placed, but access through all appropriate supports.) 
  • We have a right to be asked questions and to collaborate on our access needs and what accommodations are required to guarantee the right to access an education. 
  • We have a right to be in an educational environment with teachers and staff who are knowledgeable in modern brain science and understand trauma-informed education. 
  • A right to access via accommodations to advanced placement courses, sports, and the arts to which typical children have access. 
  • We have a right to safety, bodily autonomy, and consent that dangerous restraints deny us. 
  • We have a right not to be excluded from our abled and other disabled cohorts because we are disabled.  
  • We have a right, as do typical children, to class sizes small enough that studies show make inclusion education possible and successful. 
  • We have a right not to be secluded alone in a solitary confinement cell for any reason. 
  • We have a right to not regress or lose time in school by being suspended for behavior that is because of our disability. 
  • We have a right not to be discarded by being expelled for our disability. 
  • We have a right to tolerance, acceptance, redemption, and safety, hence zero-tolerance policies have no place in schools. 
  • We have a right to equal protection, and every other fundamental enshrined constitutional right. 

Accommodations are a fundamental human right. Denying them is discrimination. Discriminating against disabled people is immoral and illegal.

President John F Kennedy once opined that when one person is diminished, we are all diminished. Disabled people without access are not broken. The society that far too often denies us access is broken and is harming us all. 

You can find them on Facebook at: 

Neurodivergent Liberation Coalition 
Twitter at @LiberateNDs 

Liberate Neurodivergents 

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