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Evolving Definitions of Disability

There has been a long struggle between competing conceptual models or approaches to defining disability: the medical model versus the social model. A new international definition takes the best of both models and offers a different framework for thinking about disability and minimizing negative impacts. This new model is called the biopsychosocial model and it provides the basis for the new approach to understanding disability.

The Medical Model

• Located disability as a problem within the person caused by disease, trauma or other health condition that required medical intervention to cure or "fix" the person.
• Many people with disabilities rejected the medical model as it focused on changing the person.
• They also resisted the idea that a diagnosis was a useful or meaningful measure of any individual’s experience.

The Social Model

• Evolved as a reaction to the medical model and replaced the medical model’s focus on disability as residing in the person.
• Focused on disability as a "social construction," recognizing that one does not experience disability in isolation but in relation to the attitudes and behavior of others.
• Disability was not just a condition of the person but the result of a set of circumstances, many of them at the societal level.
• Progress shifted from a focus on "fixing" the person with a disability to "fixing" the social situation through collective action.
• At the political level, it emphasized human rights as a political framework for understanding disability. The social model is the perspective of the Americans with Disabilities Act (ADA).

The Biopsychosocial Model

We have reached a new evolutionary stage in our understanding of disability. The United Nation’s World Health Organization (WHO) developed the 2001 International Classification of Functioning, Disability and Health (ICF) after ten years of deliberation and negotiation. 191 member states voted to approve it and it is beginning to reshape thinking about disability worldwide. The new ICF definition of disability, referred to as the biopsychosocial model, evolves from the social model and incorporates the familiar notion that anyone might become disabled.

Background

Among the catalysts for the new model are:

• changing patterns in the distribution of disability in the population including evidence that socio-economic status puts people at risk for a higher proportion of congenital abnormalities, illnesses and injuries that can lead to disability
• the emergence of new disabilities,
• disproportionate concentrations of disability among:
  • people in poverty,
  • people that lack access to quality preventions and interventions,
  • people that are exposed to additional external or lifestyle risk factors,
• the prevalence of disability related to an aging world population.

Overview

The new definition of disability builds upon both the medical model and the social model of disability and takes what is true about each without repeating the mistake of over-simplifying a complex human experience. The ICF intends a synthesis of biological, individual and social perspectives they call a “biopsychosocial” model.

• The biopsychosocial model of disability focuses on functioning at the level of the whole person in a social context. The person is more or less disabled based on the intersection between herself and the many types of environments within which she interacts.
• One is more or less disabled based on whether the physical, information, communication and the social and policy environments are accommodating and welcoming of variation in ability.
• The new definition emphasizes function over diagnosis and establishes equity between physical and mental types of functional limitation.
• The WHO "mainstreams" the experience of disability as an ordinary part of experience for all people.
• It is a powerful conceptual framework for minimizing disabling experiences for all women who seek access to services and other supports.

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