AQA Unit 2 Sociology of Health (5)

Disability

This unit is concerned with how able-bodied society views and

interprets the condition of disability. As you shall see, there are
generally two broad perspectives on disability; the biomedical model
which interprets disability from a medical or scientific point of view, and
the social construction model which has mainly been put together by
disabled sociologists such as Oliver, Shakespeare and Barnes. You will
have began this unit by looking at Finkelstein’s disabled village – what
point do you think Finkelstein is making about the experiences of
disabled people in the UK?

One particularly interesting area where ideas about health and the
body overlap is the topic of disability. According to Friedson (1965),
the commonsense perception of disability is that disabled people have
some impediment that prevents them from operating ‘normally’. Best
(2005) notes that disability is defined as the inability to fully take part
in activities that the majority take-for-granted such as washing or
dressing oneself, walking, driving, etc.

In other words, it is assumed that disabled people have some

physical or mental impairment that prevents them from operating
‘normally’ such as the loss of a limb or limbs, paralysis, a physically
degenerative disease such as motor neurone disease or MS, blindness,
Down’s syndrome etc.

This view of disability is established in the law. Under the Equality Act

of 2010 people are disabled if they have a physical or mental
impairment that has a ‘substantial’ and ‘long-term’ negative effect on
their ability to do normal daily activities. ‘Substantial’ means more
than minor or trivial, e.g. not being to work or get dressed without
help. ‘Long-term’ means this condition has lasted 12 months or more

The biomedical approach to disability

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These commonsense and legal definitions of disability originate with
the biomedical model of disability which assumes that there exists an
ideal normal and healthy body and therefore disability is abnormal
because physical and mental impairments reduce a person’s ability to
lead a normal life. The biomedical model tends to define disability as a
form of long-term chronic illness. Moreover, the biomedical model
works on the assumption that disability leads to around-the-clock
dependence on others – doctors and carers (who are often family
members). Disability is often presented by the biomedical model as a
‘tragedy’ and consequently the idea that the disabled deserve society’s
pity and charity is strongly embedded in culture and media
representations. It is also often assumed that the individual disabled
person has to be ‘helped’ to come to terms with the physical and
psychological problems that they allegedly face.

The social construction approach to disability

Oliver (1996) is critical of the biomedical approach to disability

because it assumes that there exists a clear definition of the ‘normal’
body, and a ‘normal’ range of activities associated with it. Oliver
argues there is no such thing as a ‘normal’ body. He points out that
not everyone is able to do everything as well as others – for example,
run, catch or throw a ball – yet society does not describe those who
are less able as being ‘disabled’. Society accepts these differences as
part of the normal range of human abilities. Shakespeare suggests
that bodies should be viewed as part of a continuum with fit able-
bodied people at one end of the continuum and the severely disabled
who are usually bedridden at the other end. In between these two
extremes, Shakespeare points out that there are a range of abilities
and impairments.

According to both Oliver and Shakespeare, it is how the lack of some

of these abilities and impairments are interpreted by society that is
important. This is because the lack of some abilities and the
possession of some type of impairment are defined by society as a
social problem, deviant (in the abnormal sense) and consequently the
individual who lacks the ability or who has the impairment is labelled
as ‘inferior’ compared with an able-bodied individual. In this sense,

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Shakespeare and Oliver argue that people with impairments are not
disabled by their bodies. Rather they are disabled by society’s
reactions to their bodies.

The social constructionist approach to disability, then, focuses on how

the individual is disabled by society rather than by their physical or
mental impairment. It sees disability as a social construction, i.e. as a
product of society and is very critical of the biomedical model for
failing to recognise the social barriers that prevent the disabled from
participating in the same social activities as the able-bodied. Oliver
refers to these social barriers which are made up of prejudicial
attitudes and stereotypes about the disabled as well as a range of
discriminatory actions as ‘disableism’.

Understanding the concept – disability

Disability refers to the social barriers resulting from the prejudice and
discrimination of the able-bodied which prevent people with
impairments ability to perform ordinary tasks.

The origins of disability as a stigmatised identity

If disability is a socially constructed concept, how did it come to be a

negative or stigmatised identity? According to Finkelstein (1980), the
modern idea of the dependent disabled person is largely the
result of industrialization and the introduction of machinery.
People with impairments were excluded from this type of work and
came to be viewed as a burden. The rise of the medical profession in
the early 19th century led them to become labelled as sick and in need
of care.

Oliver (1990) takes Finkelstein’s analysis further, by suggesting that

the medical profession not only imposed the label of sickness,
abnormality and dependency on people with impairments, but also
helped to construct the dominant way in which able-bodied people
view and treat people with impairments. Oliver notes that people are

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encouraged to see the impaired individual in terms of their personal
misfortune facing problems very specific to them rather than as
members of a wider minority group which shares a common
experience of inequality and discrimination. According to Oliver, this
draws attention away from the fact that impairment is turned into
disability by the wider economic, physical and social environment that
discriminates against disabled people.

Stigma and disability

Stigma is an important term in helping sociologists to understand how

people with disabilities are excluded from social activities. The concept
was first used in sociology by Erving Goffman (1963), who suggested
that certain groups of people are defined as ‘discredited’ because of
they possess characteristics that are seen as ‘negative’. They are
negatively labelled and treated as problematic because they exhibit
social and physical characteristics which differ from the general norm.

Understand the concept - Stigma refers to the situation whereby some

people have this label placed upon them because they have a social
characteristic seen as somehow making them different and possibly
inferior. People with impairments are different from the able-bodied
norm and consequently they are often subjected to stigma (or
disableism) in the form of social prejudice and active discrimination
which makes it difficult for them to lead the sorts of independent and
active lifestyles led by their able-bodied peers.

Evaluation Question: How do you react to people with

disability? Do you treat them differently than other people? If
you do, why?

Types of disableism – prejudice

The social constructionist argument argues that the last civil rights
battle (now that women, ethnic minority people and gay people have
achieved equal rights) is the one currently being fought by people with
impairments. It is argued that this group are unable to enjoy the same
opportunities as able-bodied people – they do not share the same civil

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or human rights. This is because they face constant prejudice and
discrimination.

Sociologists note that myths and negative stereotypes about disability

are held by able-bodied people that act as cultural barriers and
contribute to their lack of status and consequently the inequalities
people with impairments experience on a daily basis. These myths etc
which many people with impairments reject include:

 A person’s disability defines who they are as an

individual. This means that people with impairments are often
labelled according to their condition or limitations. It is assumed
that they cannot carry out particular tasks. Moreover, as a result
of this, some able-bodied people may find it awkward to interact
with and have normal social relations with the physically or
mentally impaired. For example, during interaction with an
impaired person in a wheelchair, the able-bodied may be
embarrassed by the impairment and therefore ignore or seek not
to mention the ‘obvious’ disability. They may also spend most of
the time conversing and interacting with the carer rather than
the person in the wheelchair. Research by Aiden and
McCarthy (2014) reported that two-thirds of the British public
feel uncomfortable talking to disabled people whilst one fifth of
18-34 year-old males admit that they have actually avoided
talking to a disabled person because they were unsure how to
communicate with them.

 People with disabilities are brave, courageous,

superhuman and inspirational for living with their
disability. George Covington, a writer who is blind notes,
“We’re seen as inspirational, and inspiration sells like hotcakes.
My disability isn’t a burden: having to be so damned
inspirational is” (quoted on www.togetherwerock.com).

 People with disabilities are special and should be treated

differently.

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  Disabled people are a burden on the able-bodied. Aiden
and McCarthy’s research found that 13 per cent of able-bodied
people think of disabled people as getting in the way most or
some of the time whilst 76 per cent of their sample believed that
disabled people were in need of constant care.
 People with disabilities cannot lead a full and productive
life. Aiden and McCarthy’s research found that over a third of
able-bodied people believed that disabled people are not as
productive as everyone else.

 Adult disabled people are not capable of loving physical

sexual relationships.

There is some evidence that some of these prejudicial social attitudes

held by the able-bodied are probably rooted in negative media
representations of the disabled. For example, Longmore (1987)
found that disabled people tend to be represented on television either
as evil, dangerous and monster-like or as objects of pity or charity.
Cumberbatch and Negrine (1992) argue that media representations
of the disabled rarely present them as ‘people who just happen to
have a disability’ whereas until fairly recently events such as the
Paralympics were ignored altogether by television or impaired athletes
were treated as ‘heroic’ in terms of their success in overcoming their
physical disadvantages.

Types of disableism – discrimination

It is claimed by Oliver that a number of different types of

discrimination are practiced against the physically and impaired which
result in them being disabled by society. These include:

1. A general failure to consider and include the needs of the

impaired when designing and building the physical
environment. The social constructionist argument argues that
lack of accessibility to shops, public transport, public toilet,
football stadiums and so on is the real cause of disability
because much of society’s social space has been designed only
with the able-bodied in mind. However, there are now signs that

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 physical environments like new shopping centres and schools are
now being designed with the impaired in mind too.

2. There is evidence that employers are reluctant to employ

people with impairments, e.g. they are six times more likely
to be refused job interviews. As a result, people with
impairments are disabled in that they are more likely than able-
bodied people to be excluded from well-paid jobs and to be
economically disadvantaged. People with impairments are
disabled by society because they disproportionately experience
unemployment, low wages and poverty.

3. The government has been accused of disabling the

impaired by introducing ‘work capability assessment’
tests for those receiving Employment and Support
Allowance (ESA). Disability charities have criticised these
‘fitness for work’ tests as unfair to those with impairments
because they are allegedly finding such people fit for work when
they are not. Benefits are cut off if that person is seen to be not
actively seeking work, therefore, disabling the impaired by
throwing them further into poverty.

4. Aiden and McCarthy’s research data showed that 28 per

cent of disabled people reported being stared at whilst 35
per cent had been talked to in a patronising way. Moreover,
20 per cent reported that people treated them as if they were a
nuisance whilst 40 per cent felt that able-bodied people did not
understand their needs. Finally, nearly a third of the sample
suggested that the general public needed to change their
attitudes towards the disabled.

5. There is evidence that people with impairments are disabled by

bullying, i.e.’ hate crimes’ in both care homes and in wider
society. In 2011, it was estimated that 8 in 10 children with
impairments had been the victims of bullying by able-bodied
children. According to the official criminal statistics, there were
1,985 recorded incidents of disability hate crime in the UK in
2013-14.

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The concept of ‘master status’

When people with impairments are negatively labelled, the label

becomes what Goffman calls a ‘master status’. This means that the
label completely dominates the way the person is treated, and any
other positive attributes that they have may be seen as less important.
For example, the person who is unable to walk unaided is simply seen
as ‘wheelchair-bound’ rather than as an intelligent, articulate man or
woman with a personality.

Goffman points out that often individuals with impairments may come
to accept and internalize this master status and see themselves solely
in terms of their dependent disabled status. In other words, they may
respond to the constant assumption that they are helpless and
dependent by developing low social esteem and worth. A self-
fulfilling prophecy therefore results. Some people with physical and
mental impairments may become disabled in terms of their mind-set
as a result of being constantly treated and judged in terms of their
impairment rather than as an individual.

A classic study which illustrates this self-fulfilling prophecy very well is

Scott’s (1969) study of blind people. After observing the interaction
between medical professionals and blind people in the USA, Scott
argued that the blind developed a ‘blind personality’ because they
internalized the experts’ view that they should be experiencing
psychological problems in adjusting to their loss of sight. Part of this
process also involved ‘learned helplessness’, i.e. that they should learn
to rely on sighted people for help. In other words, they became
helpless and dependent because the experts expected that behavior.

The disabled identity and resistance

Recent sociological studies suggest that people with impairments are

more likely to resist those definitions and labels that stress
dependence and helplessness. For example, Olney and Kim (2001)

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argue that the impaired people in their study felt positive about their
bodies despite their awareness that the able-bodied negatively
evaluated them. They generally rejected medical and media labels of
their condition and consequently had a very positive self-image.

The social model of disability argues that more positive disabled

identities should be promoted stressing independence, choice and
autonomy for people with impairments. They believe that the state
should invest in an impaired-friendly social environment and should
more actively address the prejudice and discrimination which results in
disableism. There is evidence that people with impairments are
themselves addressing politicians directly through the setting up of
self-help groups such as the Black Triangle Campaign in order to
challenge the types of disabled stereotyping documented on this
guide.

Critiques of the social model of disability

Critiques of the social model of disability have recently appeared.

These argue that sociologists cannot ignore the fact that physical and
biological factors such as pain, mental impairment, being bedbound
and so on, do negatively impact on how some people with impairments
experience social life and can make that life unpleasant and difficult. In
other words, not all people with impairments can lead active and
independent lifestyles and this has nothing to do with labels,
stereotypes, the physical environment etc. This group of people is
quite simply disabled by their impairment.

Conclusion

This chapter has demonstrated that defining health and illness is not a
straightforward business. How people define health and illness and
how they respond to symptoms differs according to a range of social
influences. The medical profession’s main approach to health, illness
and disease is a scientific one but this has been challenged for a
number of convincing reasons by sociologists and alternative health
practitioners. Furthermore, some sociologists have argued that in
order to understand how society views health and illness that research

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should focus on how the human body has come to be seen as a health
project in recent years by people wishing to project a healthy identity.
Finally no examination of the body can ignore the debate about
disability and what constitutes a ‘normal’ body. Disabled sociologists
have raised interesting questions as to whether people are disabled by
their impairment or whether instead they are disabled by society’s
prejudices and actions.

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