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Disability & Society
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How is disability understood? An
examination of sociological approaches
Carol Thomas
a
a
University of Lancaster , UK
Published online: 01 Jul 2010.
To cite this article: Carol Thomas (2004) How is disability understood? An examination of
sociological approaches, Disability & Society, 19:6, 569-583, DOI: 10.1080/0968759042000252506
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Disability & Society, Vol. 19, No. 6, October 2004
How is disability understood?
An examination of sociological
approaches
Carol Thomas
*
University of Lancaster, UK
This paper considers sociological understandings of what constitutes disability. Current meanings
of disability in both disability studies and medical sociology are examined and compared, using
selected articles from leading authors in each discipline as case studies. These disciplines are often
represented as offering starkly contrasting approaches to disability, with their differences amount-
ing to a disciplinary divide. It is argued that, on closer inspection, common ground can be found
between some writers in disability studies and medical sociology. It is suggested that this situation
has arisen because, in disability studies, the social relational understanding of disability developed
by Vic Finkelstein and Paul Hunt in the 1970s has been lost over time, overshadowed by the rise
to prominence of its offspring: the social model of disability. The paper concludes with some
reections on the need to revive a social relational understanding of disability.
Introduction
How much progress has been made in developing a sociology of disability? Judging
by the volume of books and papers claiming to examine disability sociologically one
might think that considerable advances have been made in the last thirty years. The
publication of Sages tome Handbook of disability studies (Albrecht et al., 2001)
appears to signal that a sociologically informed disability studies has come of age.
One must not, however, be fooled by appearances. While the quantity and scope of
publications is to be celebrated as indicative of the seriousness with which disability
is studied, we need to get beneath this to assess how much our understanding of
disability has been enriched.
It is the nature of sociological understandings of what constitutes disability that
is the subject of this paper, in other words, answers to the beguilingly simple
question: what is disability? In Britain, many would assert that there remains a
marked divide between two principal domains in the sociology of disability. The rst
is associated with what this journal would recognize as disability studies proper
*Institute for Health Research, Lancaster University, Alexandra Square, Lancaster LA1 4YL, UK.
Email: C.Thomas@lancaster.ac.uk
ISSN 0968-7599 (print)/ISSN 1360-0508 (online)/04/060569-15
2004 Taylor & Francis Ltd
DOI: 10.1080/0968759042000252506
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570 C. Thomas
an approach informed by the idea that disability is centrally structured by social
oppression, inequality and exclusion. The other, associated with medical sociology,
or specically its sub-genre the sociology of chronic illness and disability, is
informed by the idea that disability is caused by illness and impairment and entails
suffering and some social disadvantage. These contrasting approaches suggest that
there is no unitary sociology of disability, but rather sociologies of disability that
continue to offer quite different perspectives on the nature of disability. There have
been a few attempts to encourage dialogue across the disability studies and medical
sociology divide (Barnes & Mercer, 1996; Barnes et al., 2002), and some disability
studies writers have critiqued medical sociology at length (Oliver, 1990; Barnes et
al., 1999; Thomas, 1999; Barnes & Mercer 2003). More often than not, however,
these two arenas of the study of disability passively coexist rather than actively
engage with one anotheras indeed is evident in the chapters in Albrecht et al.s
(2001) Handbook of disability studies.
This paper will not attempt to provide a comprehensive review of the literature
associated with these two domains of sociology of disability, nor to explore with any
thoroughness the richness of debate and theoretical difference within the parameters
of each approach. Rather, it examines several of the dening features of how these
sociologies understand the nature of disability by focusing on a selection of recent
papers by notable authors on both sides of the divide; these serve as case studies.
From disability studies, work by Vic Finkelstein (2001a, b) is drawn upon, and a
paper by Tom Shakespeare and Nick Watson (2001) is used as an example of recent
critiques of the social model of disability. The perspective of medical sociology is
explored through papers by Michael Bury (2000) and Simon Williams (1999),
leading writers in the sociology of chronic illness and disability. In selecting work by
these authors, the intention is not to achieve representativeness, but to use these case
studies as a means of examining prominent contemporary ideas about what consti-
tutes disability.
These two sets of authors will be considered separately in the next two sections,
followed by a discussion examining whether there is overlap or common ground in
the understanding of disability. The case is made that despite the widespread
reference to a disciplinary divide there is evidence of common ground on what
constitutes disability. It is suggested that this has arisen because, in disability studies,
the focus on a social relational understanding of disability introduced by Vic
Finkelstein and Paul Hunt in the 1970s has dissipated over time, something that this
author laments. Ironically, this loss has occurred as a consequence of the success of
the social model of disabilitythe offspring of the 1970s social relational conceptu-
alization of disability. The social model holds that disability is the outcome of social
barriers that restrict the activities of people with impairments. The concluding
remarks reect on the need to revive a social relational perspective in disability
studies.
Understanding disability: disability studies
Readers of a deconstructionist leaning may already be thinking that the posited
divide between disability studies and medical sociology might be a discursively
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How is disability understood 571
constructed and imposed dualism. However, such a divide is real enough, both
conceptually and politically, as far as many within disability studies and medical
sociology are concerned (Barnes & Mercer, 1996; Thomas, 1999; Bury, 2000).
From a disability studies viewpoint, what makes its disciplinary standpoint distinct
is an explicit commitment to assist disabled people in their ght for full equality and
social inclusion. This compares with medical sociologys commitment to pursue
sociological scholarship per se, or to inform policy-makers and professionals in the
disability services arena. Since the early 1990s, a considerable body of disability
studies literature has been produced, and its commitment to emancipatory goals is
reected in the rst two papers to be considered, not least because these have been
made accessible on the Internet as part of an archive of written materials for disabled
people and their supporters
1
. These papers are the work of a founding member of
the disabled peoples movement and disability studies in Britain, Vic Finkelstein
(2001a, b).
Finkelstein: a founding attempt at a materialist perspective in disability studies
Finkelsteins name is closely connected to the establishment of the social model of
disability, though, as he reminds us, it was the sociologist Mike Oliver who took up
the ideas of UPIAS (Union of the Physically Impaired Against Segregation)the
organisation of disabled people founded by Finkelstein and Paul Hunt, among
others, in the mid-1970sand encapsulated them in the notion of the social model
of disability (Finkelstein, 2001a; Oliver, 2004). Olivers work in disability studies is
seminal, and I have engaged with his ideas at length elsewhere (Thomas, 1999), but
it is helpful to leave the idea of the social model aside for a while, and to focus on
Finkelsteins perspective on disability as recently expressed in his own words.
Reviewing the establishment of UPIAS, Finkelstein recounts that he and others,
as disabled people, were faced with a stark choice: you see disability fundamentally
as a personal tragedy or you see it as a form of social oppression (2001a, p. 5). He
was clear that disability had to be interpreted in the second sense: It is society that
disables us and disabled people are an oppressed social group (2001b, p. 2). This
perspective arose out of his attempt, with Hunt, to reect theoretically upon the
nature of the social treatment of disabled people in the 1970s, particularly in its
welfarist form: residential care, minimal benets, exclusion from employment and
the educational mainstream, and blocks on access to the built environment. The
view that society disables people with impairments, and that it is this problematic
societal response that constitutes disability, meant that disabled peoples political
struggle should be directed toward changing society and winning control over their
own lives. Thus it was a question of revolution rather than reform, or, in Finkel-
steins terms, a question of an emancipatory strategy rather than a compensatory
one.
Though impairment was seen as a prerequisite of disability (Finkelstein, 2001a,
p. 8), at the heart of this social interpretation was a conceptual severing of any causal
connection between impairment and disability:
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572 C. Thomas
Disability is something imposed on top of our impairments by the way we are
unnecessarily isolated and excluded from full participation in society. Disabled people
are therefore an oppressed group in society. (UPIAS, 1976, cited in Finkelstein, 2001b,
p. 1)
It is important to recognise that, for Finkelstein, this separation did not mean that
living with the effects of impairment posed no difculties for disabled people. What
it did mean was that these difculties did not make up the substance of disability.
Rather, such difculties were, and should remain, private and personal matters:
The agreed UPIAS interpretation was that, although it may be a tragedy to have an
impairment, it is oppression that characterises the way our society is organised so that
we are prevented from functioning. In other words, at the personal level we may talk
about acquiring an impairment as a personal tragedy, but at the social level we should
talk about [how] the restrictions that we face are, and should be interpreted as, a crime.
(Finkelstein, 2001b, p. 2)
Indeed, to speak metaphorically, Finkelstein (2001b, p. 4) particularly objects to the
washing of this personal dirty linen in public, and to any consequent diversion of
disabled peoples energies away from the struggle to change society and toward an
introspective dwelling on experiences of either impairment or disability. In his view,
any focus on personal experiences is only acceptable if it is in the service of
galvanising the broader struggle for social change.
Another of Finkelsteins objections, or disappointments, is that, over the years,
too much has come to be invested in the social model of disability:
Sadly a lot of people have come to think of the social model of disability as if it were
an explanation, denition or theory and many people use the model in a rather sterile
formalistic way. (Finkelstein, 2001a, p. 6)
Its like putting a model aeroplane together and placing it into a wind tunnel to gain
insight into how it functions under different conditions. The model will not explain
how an aeroplane ies. The social model does not explain what disability is. For an
explanation we would need a social theory of disability. (Finkelstein, 2001a, p. 11)
We are told that he and Paul Hunt never got round to developing such a theory,
and that much work remains to be done. As a materialist, and as the author of
Attitudes and disabled people (Finkelstein, 1980), we can nonetheless discern the
general direction of his theoretical path: toward an analysis of the material aspects
of social relations (Finkelstein, 2001a, p. 7) characteristic of market economies in
industrial and developing-world societies. Mike Oliver (1990), and particularly
Brendan Gleeson (1999), have begun to tackle this materialist agenda in their
writings on the causal economic mechanisms that worked to generate disability
during the transition from feudalism to capitalism in the West. But this type of social
theory of disabilitywhat one might call a political economy of disability (Thomas,
2003)remains to be fully developed, in both its historical and contemporary
applications.
It is tting to have started this section with Finkelsteins view on what constitutes
disability because the social model to which it gave rise has become the principal
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How is disability understood 573
point of reference in disability studies debates in Britain. The model now has an
almost iconic status, and whether authors are for or against it their writings are
almost invariably in dialogue with it. In the minds of many in disability studies and
politics, the social model of disability is conated, or fused, with Finkelsteins
materialist conceptualization of disability: they have become one and the same thing.
It follows that, for critics, the faults found with the model are synonymous with the
faults of a materialist perspective.
Shakespeare and Watson: a postmodernist perspective in disability studies
We see this conation at work in a recent paper by Tom Shakespeare and Nick
Watson (2001). They take the social model of disability as their point of departure,
and the faults they nd with it are identied with those of its Marxist/materialist
foundations. They propose its abandonment:
we believe that the strong social model itself has become a problem, and that it
cannot be reformed. Our claim is that the British version of the social model has
outlived its usefulness. Rather than developing piecemeal criticisms or supplying
alternative arguments to ll the gaps and compensate for the inadequacies of the social
model, it is time to put the whole thing to one side and start again. (Shakespeare &
Watson, 2001, pp. 1314)
In making this argument Shakespeare and Watson give exceptionally clear ex-
pression to a growing section of opinion in disability studies. They draw on an
increasing number of criticisms of the social model from feminist, postmodernist
and poststructuralist sources, though critics vary in their desire to reject, reform or
defend the social model of disability (Crow, 1996; Morris, 1996; Corker & French,
1999).
Of most interest here is the way that Shakespeare and Watson articulate the
concept disability. At the core of their rejection of the social model is its conceptual
separation of impairment from disability and its assertion that people with impair-
ment are disabled by society, not by their impairments. Their claim is that impair-
ments do play some role in causing disability, that is, the body and embodied states
are of relevance to being disabled:
People are disabled both by social barriers and by their bodies. This is straightforward
and uncontroversial. The British social model approach, because it over-eggs the
pudding, risks discrediting the entire dish. (Shakespeare & Watson, 2001, p. 17)
It is important to note that in this statement, and in others in their paper, the term
disability only makes sense if it is understood to mean restrictions of activity; their
argument is that such restrictions are obviously caused both by social barriers and
by impairment per se.
Shakespeare and Watson see the social models separation of impairment and
disability as related to a problematic reduction of impairment to the biological (see
also Hughes & Paterson, 1997; Hughes, 2002). Impairment, they argue, is not
biological but profoundly social, not least because: The words we use and the
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574 C. Thomas
discourses we deploy to represent impairment are socially and culturally determined
(Shakespeare & Watson, 2001, p. 18). In addition, and like other poststructuralist
writers (Corker, 1998; Corker & Shakespeare, 2002), these authors take issue with
the supposed modernist separation of impairment and disability, something seen
as representative of outdated dualistic, binary, thought:
Impairment and disability are not dichotomous, but describe different places on a
continuum, or different aspects of a single experience. It is difcult to determine where
impairment ends and disability starts, but such vagueness need not be debilitating.
Disability is a complex dialectic of biological, psychological, cultural and socio-political
factors, which cannot be extricated except with imprecision. (Shakespeare & Watson,
2001, p. 22)
Thus disabilityrestricted activityhas to be understood as the product of
multiple bio-psycho-social forces. This, it is argued, is what must inform a more
adequate theory of disability. To it must be added an understanding that everyone is
impaired, in varying degrees (Shakespeare & Watson, 2001, p. 24). This perspective,
they claim, offers an important insight into human experience, and can be used as
a springboard for dismantling socially constructed divisions between the disabled
and the normal.
Understanding disability: medical sociology
In medical sociology, we nd that the claim to the title disability studies is not
unique to writers and activists who coalesce around the social model of disability.
The US sociologist, Gary Albrechtchief editor of the Handbook of disability studies
(2001)claims it too. He describes how this title designates a much broader eld of
study in the US (Albrecht, 2002), one that encompasses a range of social scientic
and rehabilitative disciplines as well as the perspectives of disabled activists. In
Britain, however, the disciplinary landscape is more compartmentalized, and the
sociologists who engage with disability from a vantage point other than the social
model generally associate themselves with medical sociology, and specically with
the sociology of chronic illness and disability. This section considers papers by two
authors who fall into this category, Michael Bury (2000) and Simon Williams
(1999), who have both critiqued the social model of disability. In each case, it is
their understanding of what constitutes disability that is of interest here.
Bury: disability is undoubtedly caused by impairment
Michael Bury is an authoritative gure in British medical sociology, and has written
extensively on chronic illness and disability. The paper referred to here provides a
helpful overview of his thinking. Bury (2000) reasserts his view that disability is
caused, unquestionably and in the main, by impairmentwhether impairment is
associated with disease, active pathology, genetic disorders, accident or trauma.
The denial of any causal relationship between illness, changes in the body, and
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How is disability understood 575
disability comes up against the daily realities experienced by the chronically sick and
those who care for them, whether in the community or in health care systems The
point needs to be stressed that in any overview of disability in modern society,
chronic illness remains its most signicant cause (Bury, 2000, p. 179)
Bury adheres to what he calls a socio-medical model of disability, one which as
in the ICIDH schema of which he was an architect
2
denes disability as a
restriction or lack of ability to perform an activity in a normal manner. Since, in his
view, the main cause of restriction of activity is illness or impairment it is not
surprising that, Just as the prevalence of chronic illness rises with age, so too does
disability (Bury, 2000, p. 179).
However, Bury does not deny that some restrictions of activity have social and
cultural causes: disability is also inuenced by context and culture (2000, p. 178).
Indeed, much of his paper is devoted to making the case that medical sociology has
long recognized the wider social setting in which disability occurs and is shaped, and
that it does not, therefore, individualize disability. He claims that his own earlier
writing focusing on the meaning and consequences of chronic illness bears
witness to this (Bury, 1988). Thus he understands disability to be both biologically
and socially caused, though the more signicant causal weight lies with the former;
this gives rise to a conceptualization of disability that focuses on the interactions
between individuals and their social location. What he nds untenable in the social
model of disability is its denial, exemplied in his view in the writings of Mike Oliver
(1996), that impairment has any causal connection to disability. Bury characterizes
this as an unhelpful oversocialized and overly politicized view.
Bury does acknowledge that advocates of the social model have had a signicant
impact on wider social and sociological thinking about disability. He positions the
social model alongside another inuential sociological approach to chronic illness,
advanced by Arthur Frank (1995). In opposition to the legacy of Parsonian soci-
ology which constructed the patient as passive, Frank and like-minded sociologists
are seen to have drawn attention to the agency exercised by people with longstand-
ing illness: they become wounded storytellers. Patients and people living with
illness are constructed as active creators of new selves and life trajectories in a
remission society (Frank, 1995), opening up the possibility that illness experiences
involve positive as well as negative outcomes. In Burys view, a sociology of disability
has to chart a trajectory between these inuential perspectives on disability, that is,
between the social model and the Frankian paradigm:
The mid-range, between a wounded storyteller and an overly politicised conception
would, as [Irving] Zola suggests, seem to offer the best way forward. (Bury, 2000,
p. 182)
Williams: corporeal realities
In a paper proposing that a critical realist theoretical perspective has much to offer
medical sociology, Simon Williams (1999) illustrates his case with an examination
of the disability debate. This allows him an opportunity to present his well-rehearsed
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576 C. Thomas
argument that sociology must bring the body back in (see Williams & Bendelow,
1998).
On one side of the disability debate, in Williams view, is the work of medical
sociologists like Bury who are inuenced by interactionist perspectives, a seam of
research in which:
key concepts and insights have been advanced, including the biographically disrup-
tive nature of chronic illness, the importance of narrative reconstruction, the nego-
tiation of selfhood and identity, as well as the positive actions which people take in the
face of their adversity: responses which, analytically, may be referred to as coping,
strategy and style (Bury 1991). (Williams, 1999, p. 801)
On the other side of the debate, he claims, is the work of scholars in disability
studies, proponents of the social model, who have attempted to:
write the body out completely from the biology/society equation Writers such as
Oliver (1990) reject [the ICIDH] in favour of an approach in which disability itself, far
from being a result of limitations caused by impairment or physical trauma, is instead
seen as a form of social oppression. (Williams, 1999, p. 803)
Williams shares Burys view that such a position is untenable, but critiques it on
the grounds that it entails a problematic denial of the social signicance of the
body, something that he thinks sociology guilty of more generally (see Williams &
Bendelow, 1998). Interestingly, Williams (1999, p. 804) borrows from critical voices
within disability studies itself (Crow, 1996; Hughes & Paterson, 1997) to make the
point that the social modelist denial of the causal link between illness/impairment
and disability is a form of essentialism:
Disability [Studies] theorists, in short, like their sociological counterparts of yesteryear,
seem to be suffering from a peculiar form of what Spelman (1988), in the context of
Western feminist thought, has appositely termed somatophobia: one involving an
overly drawn view of society itself.
He suggests that critical realism offers a fruitful way of bridging the divide
between the conceptualizations of disability utilized by sociologists of chronic illness
and those advanced by key disability studies writers. From a critical realist stance:
The nub of the problem here, and the issue to which any serious critique of a social
model of chronic illness and disability must necessarily return, is the conation of the
ontological with the epistemological. (Williams, 1999, p. 805)
Critical realism is believed to set up a powerful challenge to postmodernist and other
constructionist and relativist variants of sociology because it refuses to collapse the
ontological into the epistemological, and thus avoids the epistemic fallacythat is,
the idea that nothing real can exist because, tautologically, all we can know are our
ideas about it. Rather, critical realism gives the body ontological autonomy:
The body in short, diseased or otherwise, is a real entity, no matter what we call it or
how we observe it. It also, like all other social and natural domains, has its own
mind-independent generative structures and causal mechanisms. (Williams, 1999,
p. 806)
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How is disability understood 577
Williams goes on to argue that if one accepts that there is an independently real
biological body, constituting a pre-discursive causative force, then one can challenge
all of the following: postmodernist social reductionism, biological reductionism, and
the one-sided social determinism evident in the social models denial of the effects
that illness and impairment have on restrictions of social activity. Thus disability,
from a critical realist, perspective, can be understood as follows:
Disability is an emergent property, located, temporally speaking, in terms of the
interplay between the biological reality of physiological impairment, structural conditioning
(i.e. enablements/constraints), and socio-cultural interaction/elaboration. (Williams, 1999,
p. 810, authors emphasis).
It follows that, like Bury, Williams sees great merit in the ICIDH schema because
it understands disability to be restrictions of activity produced by the interaction
between impairment and specic societal contexts.
Discussion: sociologies of disability
Differences and similarities
Despite the frequently referred to divide between disability studies and medical
sociology (Barnes & Mercer, 1996), this review of selected papers from both
disciplines has revealed some agreement between Shakespeare, Watson, Bury and
Williams. These authors agree that the social model of disability is fundamentally
awed because it denies the impact of impairment on disability. More precisely, they
agree that impairment and chronic illness have direct causative effects on the daily
restrictions of activity that constitute disability. As we have seen, Shakespeare and
Watson argue that impairments are disabling, and Bury believes it to be nonsensical
to deny any causal relationship between chronic illness/impairment and disability.
Williams agrees and, like Shakespeare and Watson, sees such a denial as stemming
from a more general and mistaken sociological tendency to leave the body out of
account. In fact, there appears to be little to formally differentiate Burys and
Williams approval of the ICIDH schema, and Shakespeare and Watsons statement
that impairment and disability describe different places on a continuum if one
leaves aside fundamental issues of epistemology and ontology. But, of course,
Shakespeare and Watsons arguments against the social model arise from postmod-
ernist ideas while Williams and Burys objections to it are generated by theoretical
perspectives opposed to postmodernism and poststructuralism (see also Bury,
1997).
It is Finkesteins position that stands out as distinct: disability is a form of social
oppression, and disability is not caused by impairment. But we also know that for
Finkelstein the social model of disabilityinspired by a disability as social op-
pression stanceis not an explanation, denition or theory of disability, and that
too much has been invested in it. Thus he too is critical of the social model, but
defends absolutely its disability as oppression foundations and its political
signicance.
Shakespeare, Watson, Bury and Williams do nonetheless part company on the
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578 C. Thomas
decisive question of oppression. Shakespeare and Watson, as writers and activists in
disability studies, agree with Finkelstein that disabled people are indeed oppressed,
though they cannot accept that this is all there is to disability: they see a role for
impairment in shaping the restrictions of activity in disabled peoples lives. In
contrast, medical sociologists like Bury and Williams have never recognised that a
form of social oppression is in play. They agree that social processes and forces
shape the experience of disability, but they go no further than the ICIDHs stance
on handicap: that impaired people might also experience social disadvantage.
Clearly, there remains a divide between those who acknowledge that disabled people
are socially disadvantaged and those who see them as oppressed.
In summary: Finkelstein propounds the view that disability is entirely socially
imposed, and amounts to a form of social oppression. Shakespeare and Watson
argue that disability is caused both by impairment and social exclusion, the latter
being more signicant and amounting to social oppression. Bury and Williams
believe that disability is caused both by impairment and social disadvantage, but see
impairment as by far the more signicant cause; they ignore (rather than explicitly
refute) suggestions that a form of social oppression is at work.
The social relational versus restricted activity understanding of disability
In my view, what really stamps Finkelsteins understanding of disability as distinc-
tive is its social relational character, making it a new form of social oppression
associated with the relationships, at both macro and micro social scales, between the
impaired and the non-impaired. Thus, in the 1970s, Finkelstein and Hunt were
attempting to completely redene what disability meant. As we have seen, they
wrote about disability as something imposed on top of our impairments (Finkel-
stein 2001b, p. 1), and by implication, emergent from the immediate day-to-day
restrictive impacts that those impairments inevitably have on activities. The UPIAS
Fundamental principles document (UPIAS, 1976) stated that disability was
the disadvantage or restriction of activity caused by a contemporary social organisation
which takes no or little account of people who have [ ] impairments and thus
excludes them from the mainstream of social activities. (cited in Oliver, 1996, p. 22)
This denition clearly associates disability with those restrictions of activity caused
by the societal response to people with impairments. It does not assert that all
restrictions of activity are socially caused. For Finkelstein, and indeed for Oliver
(1996), the tragedy of living with impairment and illness, and of dealing with their
immediate limiting effects, is to be relegated to the realm of the private and
personal or the personal experience of impairment (Oliver, 2004) . Finkelstein has
consistently argued that what disabled people must make public are the many social
exclusions that constitute disability.
Thus disability is not equated with, nor dened by, restrictions of activity per se,
as it clearly is for Shakespeare, Watson, Bury and Williams. Rather, the attempt is
made to completely redene the meaning of disability, laying a foundation for the
concept disablism to come into being on a par with concepts like sexism, racism and
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How is disability understood 579
homophobia. Put another way, once the term disability is ring-fenced to mean
forms of oppressive social reaction visited upon people with impairments, there is no
need to deny that impairments and illness cause some restrictions of activityin
whole or in part.
Shakespeare, Watson, Bury and Williams understanding of disability does not
involve such a radical redenition. They stick with the commonplace meaning of
disability in contemporary cultureas not being able to do things and as restricted
activity. It is this adherence to a commonplace understanding of disability that
underpins their refusal to deny that impairment and illness have direct disabling
effects by limiting activity.
The loss of the original social relational understanding of disability
As history tells us, Finkelstein and Hunts bold attempt at a redenition of disability
as a social category was of enormous signicance for disabled people in the UK and
beyond. It inspired the social model of disability. But it is the runaway success of the
social model that gave rise to some of the conceptual difculties concerning what
disability is that we now face in disability studies. I would argue that the social
relational qualities of Finkelsteins and Hunts understanding of disability were
diluted, even lost, once its offspringthe social model of disabilitycame to the
forefront.
This is because the social model has only ever presented a simplied version of
social relational thinking. It has encouraged thinking in shorthandto assert, for
example, that disability equates with social barriers, or more precisely, that disabil-
ity equates with restricted activity caused by social barriers (see Oliver, 1996). It is
only a short distance, and one that has been commonly travelled, from these blunt
social modellist assertions to the proposition that all restrictions of activity are
caused by social barriers. It is then easy to slide into making logical counter
assertions such as this: impairment does not cause restrictions of activity because the social
model tells us that ALL restrictions of activity are caused by social barriers.
In this way, adherence to the social model of disability has come to be equated,
in the minds of many in the disabled peoples movement and some in disability
studies, with the position that impairments and chronic illness do not cause any
restrictions on activity. This is an impoverished version of the early UPIAS under-
standing of disability. It has lost the original social relational specicity injected by
Finkelstein and Hunt. But it is this impoverished version that has become the focus
of argument and critique, not least for Shakespeare, Watson, Bury and Williams. It
is a straw person, easy to reject on the grounds that it is untenable to deny that
impairment and illness cause some restrictions of activity. The unfortunate result is
that debates about disability have come to revolve around what does or does not
cause limitations of activity (see also the extended discussion in Thomas, 1999).
The assumptions common to Shakespeare, Watson, Bury and Williams on the
question of impairment/illness and disability is a consequence of this loss of a social
relational understanding of what constitutes disability. None start out from a social
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580 C. Thomas
relational understanding of disabilitydisability as a form of social oppression. And
all share in, and critique, the impoverished understanding of disability that is lodged
in the social model of disability: that disability is restricted activity.
Concluding remarks
This paper has examined sociological understandings of what constitutes disability,
using some recent papers in disability studies and medical sociology as case study
material. The argument has been advanced that despite the frequently reported
divide between these disciplines there is, on closer inspection, some evidence of
common ground on what constitutes disability: Shakespeare, Watson, Bury and
Williams can all agree that impairment plays a role in causing the restricted activity
that constitutes disability, and can agree that the social model of disability is awed
because it denies this causal linkage. These authors are by no means alone in holding
these views, either within disability studies or medical sociology. In contrast,
Finkelsteins position that disability is a form of social oppressionremains
distinct.
It has been argued that the success of the offspring of Finkelsteins 1970s UPIAS
social relational understanding of disabilitynamely, the social model of disability
has, ironically, been responsible for creating the conditions of possibility for this
convergence across the disability studies and medical sociology divide. This is
because the social model has allowed a commonplace cultural understanding of
disabilitythat disability equates with, or is dened by, restrictions of activityto
reassert itself. Writers such as Shakespeare, Watson, Bury and Williams utilize this
understanding of disability themselves and make common cause in their opposition
to the social model because it has become synonymous with the view that impairment
does not cause disability because all restrictions of activity [i.e. disability] are caused by
social barriers. What has been obscured by the shadow of the social model of
disability is the pioneering social relational understanding of disability to be found
in the original UPIAS formulations. That is, what has been lost is an understanding
that disability only comes into play when the restrictions of activity experienced by
people with impairment are socially imposed, that is, when they are wholly social in
origin. Such a social relational view means that it is entirely possible to acknowledge
that impairments and chronic illness directly cause some restrictions of activity. The
point is that such non-socially imposed restrictions of activity do not constitute
disability
3
.
In my view, a social relational understanding of disability is sorely needed within
disability studies. It needs to be rediscovered and reasserted. My preferred denition
of disability does this; it is an adaptation, or modernization, of the UPIAS formu-
lation, as follows:
Disability is a form of social oppression involving the social imposition of restrictions
of activity on people with impairments and the socially engendered undermining of
their psycho-emotional wellbeing (Thomas, 1999, p. 60).
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How is disability understood 581
In this social relational denition, disability only comes into play when the restrictions
of activity experienced by people with impairment are socially imposed, that is, when
they are wholly social in origin. This means that it is entirely possible to acknowledge
that impairments and chronic illness directly cause some restrictions of activitybut
such non-socially imposed restrictions of activity do not constitute disability. Such
non-socially imposed restrictions might be better captured by the concept impair-
ment effects (see Thomas, 1999)but space does not permit this point to be
pursued here.
If this kind of social relational understanding of disability could be adhered to
within disability studies, that is, if the commonplace view that disability equates with
restrictions of activity could be broken away from, then there would be no need for
futile and time-wasting disputes about whether or not impairment or chronic illness
cause some restrictions of activity. We can say, Yes, of course impairment causes
some restrictions of activitybut these are not what is of interest in studying and
combating disability. Disability is a form of social oppression on a par with other
forms of oppression in our society associated with gender, race, class, and sexuality.
But perhaps this loss of the social relational understanding of disability has been
a small price to pay for the advances that have been made by disabled people in the
name of the social model of disability? My answer, which may seem surprising in the
light of the argument outlined above, would be a resounding yes, it has been a small
price to pay. The social advances achieved by oppressed groups are always of much
greater signicance than any loss in the clarity of ideas along the way. The social
model remains, and should continue to remain, in place as a powerful organizing
principle, a rallying cry, and a practical tool (Oliver, 2004) for the disabled peoples
movement. However, within disability studiesthe academic wing of this move-
mentthere is an urgent need to rediscover a social relational understanding of
disability, and to recognise that the crude equation of disability with restricted
activity is a completely inadequate starting point. This means acknowledging the
limited nature of the social model of disability for academic purposes, recognising,
as Finkelstein (2001a, p. 6) and Oliver (2004) have done, that it is not an expla-
nation, denition or theory of disability, and should not be mistaken or used as a
substitute for these. In my view, a social relational understanding of disability offers
fertile ground for theoretical, empirical, and policy-related work in disability studies.
Put another way, a social relational understanding of disability provides a rm
foundation for an enriched sociology of disability, deploying a range of theoretical
perspectives. It is in this direction that we should be travelling, a direction that takes
us away from fruitless debates ensnared in restricted activity denitions of disability
and hooked up in supposed pros and cons of the social model of disability.
Achieving clarity and consistency on a social relational conceptualization of
disability within disability studies would illuminate the real divide between it and
medical sociologya divide associated with the fact that, to date, medical sociolo-
gists have not been prepared to acknowledge that disability is associated with social
oppression or systematic social exclusion. Medical sociologists have adopted the
rather mealy-mouthed stance that there is some social disadvantage involved in
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582 C. Thomas
disabled peoples lives. If disability studies were to challenge medical sociology on
this question then a series of potentially productive sociological debates could be
opened up between these disciplines on how to theorize disability.
Notes
1. This is The Disability Archive UK, set up by the Centre for Disability Studies, University
of Leeds, UK.
2. The ICIDH is the International Classication of Impairments, Diseases and Handicaps,
developed for the WHO by Philip Wood, Elizabeth Bradley and Mike Bury in the 1970s
(see Wood, 1980). The WHO is currently revising this schema.
3. The use of the term non-socially imposed restrictions of activity is an attempt to present
the argument forcibly. Impairment effects are, of course, socio-biological in naturebut
that is another story (see Thomas, 1999).
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