Sexuality and Disability, Vol. 19, No.

2, Summer 2001 (䊚 2001)

The Myth of Asexuality: A Survey of Social and

Empirical Evidence
Maureen S. Milligan, M.Sc.1,2 and Aldred H. Neufeldt, Ph.D.1

Self-advocacy groups and individual authors have increasingly expressed con-

cern that persons with disabilities (PWD) are sexually disenfranchised by a
society that inaccurately perceives them as asexual beings. The purpose of this
paper is to evaluate the social and empirical foundations for the contention that
PWD are indeed viewed as asexual and examine whether there is cause for
ongoing concern and intervention. This review includes a consideration of the
implications for both clinical practice and future research as well. It is con-
cluded that despite significant gains in our biological and psychosocial under-
standing of sexuality in the context of disability, there remains much to be
accomplished to effect needed change in the areas of professional practice,
research, societal attitudes, and most importantly, in the lives of PWD.
KEY WORDS: disability; sexuality; review; intimate relationships.

INTRODUCTION

All too often, societal attitudes which give rise to handicapped status are
rooted in cultural myths and stereotypes that remain resistant to change (1).
Self-advocacy groups and individual authors have expressed concern that per-
sons with disabilities (PWD) are disenfranchised by a society that inaccurately
perceives them as asexual beings and therefore unsuitable as romantic partners
(e.g., 2–6). For most people, both with and without disabilities, sexuality and
its expression are a natural and important component of self-concept, emotional

1
Program in Clinical Psychology, University of Calgary, Calgary, Alberta, Canada.
2
Address correspondence to: Maureen S. Milligan, Program in Clinical Psychology, University of
Calgary, 2500 University Drive N.W., Calgary, Alberta, Canada T2N 1N4; e-mail:
msmillig噝ucalgary.ca.
91

0146-1044/01/0600-0091$19.50/0 䉷 2001 Human Sciences Press, Inc.

92 Milligan and Neufeldt

well-being, and overall quality of life (7). Physical and mental impairments
may significantly alter functioning, but do not eliminate basic drives or the
desire for love, affection, and intimacy (8,9). However, it is very difficult for
PWD to avoid internalizing social values and attitudes, which devalue them and
deny their sexual nature. In a self-fulfilling prophecy, actual and/or perceived
rejection may lead some PWD to retreat from intimacy and ergo, the adoption
of a nonsexual lifestyle (10).
The myth of PWD’s asexuality appears to be associated with two primary
lines of thinking. First, for people with physical disabilities, because of actual
or presumed sexual dysfunction, gratification opportunities are considered so
limited that sexual needs are either deemed to be absent or subjugated. Second,
although their sexual function is typically intact, individuals with intellectual
disabilities and/or psychiatric disorders are thought to have limited social judg-
ment, and therefore, lack the capacity to engage in responsible sexual relation-
ships. Historically, the latter rationale contributed to mass involuntary steriliza-
tion for persons with cognitive impairments such as traumatic brain injury or
mental retardation (11,12, Zola, 1987, as cited in 11), a strategy which appar-
ently continues to find ideological support amongst teachers and administrators
working with this population (13).
The purpose of this paper is to evaluate the social and empirical founda-
tion for the contention that PWD are viewed as asexual beings and examine
whether there is continued cause for concern. This meta-analysis is followed by
a consideration of implications for both clinical practice and future research.
Before proceeding, it is important to establish the parameters for this un-
dertaking. There are at least four broad types of disabilities (congenital, chronic
illness, traumatic injury, and psychiatric) that result in a wide array of cogni-
tive, affective, behavioral, motor and/or sensory impairments. This paper will
focus primarily, although not exclusively, on severe physical disabilities. With
regard to terminology, Trieschmann (14) has emphasized the important distinc-
tion between the three components of sexual function: sex drives (interest), sex
acts (behavior), and sexuality. She defines sexuality as “. . . the expression of a
sex drive, through sex acts, within the context of the personal identity of the
individual: the maleness and femaleness of the individual that is so heavily
influenced by past cultural learning, one’s self-image, and the expectations that
others have of the person” (p. 159). Trieschmann’s definition, adopted for this
paper, highlights the salience of the person-environment interaction which,
within a social model of disability, is the deemed source of handicap for PWD.

SOCIAL EVIDENCE

An abundance of anecdotal reports and other forms of social evidence

attest to the existence of a societal view that PWD are asexual beings; that they
The Myth of Asexuality 93

lack the desire, ability and/or capacity for sexual relationships (11,15,16). A
brief sampling of three major sources of this evidence will be provided through
an exploration of the personal narratives of PWD, cultural images, and the
historical absence of attention to matters of sexuality within professional reha-
bilitation settings.

Personal Narratives
How many lost years did I spend buying into the popular misconception that persons
with disabilities were asexual, almost as though a third gender? How many potential
relationships did I subvert out of fear of embarrassment? Too many—and I know I’m
not alone. (17, p. 19)

The most compelling and direct social evidence of the barriers created by a
myth of asexuality arises from the individual and collective accounts of PWD.
These personal testimonies, autobiographies and professional essays, found in
both the academic and popular literatures, have articulated the challenges in
attempting to negotiate a rewarding sexual life, not the least of which is being
dismissed by many nondisabled persons as inappropriate candidates for a sexual
relationship (e.g., 3,4,18).
By way of example, among other things, Ellen Stohl is a disability activist
with quadriplegia. Based on her personal experience and a review of the litera-
ture, Stohl (19) concludes: “The general perception of society is that people
with disabilities are asexual or androgynous. It is believed that people with
disabilities should put aside their sexual identities and focus on other aspects of
their lives such as work or religion” (p. 73). Although she purports her article to
be a literature review, it is based on few and very dated citations (the most
recent being 1980), with her conclusions appearing to be most heavily influ-
enced by the comments of other writers and her direct experience. Nonetheless,
her personal observations are telling as suggested in the following quotation:
“Socially I have been treated like anything but a woman—as a child, a disease,
an object of pity, or a supergimp. I am seen as a wheelchair first and a person
second” (Stohl, as cited in 20, pp. 26–27).
Individuals with congenital disabilities have described society’s paternalis-
tic attitudes towards them, reflected in their socialization from birth to assume a
disabled role that is essentially asexual (21,22,23). For example, Rousso (23)
has written about her experience as a woman (and psychologist) with cerebral
palsy. She grew up never expecting to date, have sex or get married. She admits
to having believed the myth that PWD, especially women, are asexual, and so
she kept her sexual fantasies to herself. In her clinical work with people with
cerebral palsy she has been struck by “. . . the lack of curiosity and knowledge
about the sexual aspects of their lives” (24, p. 99), which she attributes to
societal and family attitudes which conspire to thwart sexual development. It
seems that well-meaning parents and professionals, often in an effort to protect
94 Milligan and Neufeldt

a child with a disability from future rejection, vulnerability to sexual abuse, or

unwanted pregnancy, may avoid the topic of sex—“. . . better that he or she
remain a child” (24, p. 102).
A nonexhaustive sampling of recent national and provincial publications
by the Canadian Paraplegic Association (a self-help advocacy organization
serving 30,000 people living with SCI and other mobility impairments), and the
U.S. publication/website, New Mobility Magazine [online], reveals featured arti-
cles written by and for PWD addressing issues of sexuality. In true advocacy
spirit, these articles recount personal stories which, by example, seek to inspire
readers to resist internalizing the social messages PWD receive about their sex-
uality—or lack thereof (e.g., 17,25–28). In a recently published interview,
Carol Gill (a polio survivor, former clinical psychologist, researcher, and self-
described cultural revolutionist) challenges PWD, particularly women, to
“. . . purge themselves of their internalized oppression and devaluation of their
own status” (29).
Extending the social discourse, Hahn (30) has argued that, in general, the
source of negative attitudes towards PWD may be rooted not only in myths of
asexuality, but in an “existential anxiety” (the projected threat of potential per-
sonal loss of capabilities) or “aesthetic anxiety” (a fear of those whose traits fall
outside relatively narrow prescriptions of physical attractiveness), that non-
disabled people experience in their social interactions with PWD. Both anxi-
eties are purported to produce social discomfort and can result in discriminatory
behavior, an issue that will resurface later in this paper.

Popular Culture Images of PWD

Another source of social evidence, which supports a persistent societal

myth of asexuality, is to be found in popular culture images of PWD. Over
recent decades, mass media consumption has become the number one leisure
pursuit of the Canadian urban adult population (31). The ubiquitous presence of
the media in our everyday lives has contributed to its potency as an important
influence on attitude formation. In a recent comprehensive analysis of the his-
tory of physical disability in the cinema, Norden (5) argues persuasively that
the movie industry has created or perpetuated stereotypes of disability that are
so durable, pervasive and repetitious that they have come to represent unex-
amined truisms within our culture, despite their scant resemblance to actual
PWD. Not only have unrepresentative, unidimensional characterizations of
PWD informed mainstream society’s perceptions, but it appears they have also
infiltrated the self-perceptions of PWD themselves (5,30,32,33).
Particularly pertinent to this discussion are traditional cinematic narratives
based on re-enactments of the male Oedipal crisis. Characterizations of men as
The Myth of Asexuality 95

frustrated eunuchs may represent the biggest obstacle for filmmakers to over-
come if they are to provide relevant, realistic representations of men with phys-
ical disabilities (5). In a culture that emphasizes sex acts and performance, men
and women alike are often portrayed as axiomatically prohibited from participa-
tion in satisfying sexual relationships and destined to emotionally empty lives,
as exemplified in the recent films Passion Fish (34) and Breaking the Waves
(35).
The debate over whether the media reflects or directs societal attitudes will
not be resolved here. In the absence of direct personal experience and/or con-
tact with PWD, it could be expected that able-bodied viewers have little basis
from which to discern the representational validity of the media images they
consume. In this way, inaccurate and narrow portrayals of PWD as asexual
beings can be expected to contribute to both the construction and maintenance
of social barriers to inclusion.

Historical Context of Rehabilitation Programs

Before the 1970s, the clinical and empirical literatures were virtually silent
on the issue of sexuality and disability (36–38). This lack of investigative ef-
forts reflects a general failure of the social and behavioral sciences to recognize
sexuality as a relevant issue and problem for PWD (39). Historically, the topic
of sexuality was either avoided or considered unnecessary in the training of
rehabilitation professionals as “. . . it was automatically assumed that disabled
individuals were asexual and had no interest in sexual activity” (40, p. 199). In
her exhaustive review of the SCI literature, Trieschmann (14) stated with some
humor: “In the 1970s, the field of rehabilitation discovered sex . . .” (p. 161).
Prior to that, single people with traumatic SCI were routinely told by physicians
and other hospital staff they would likely never marry, never have a family, and
certainly would not have a sex life—so it was best just not to think about it.
For those who were married, the explicit or implicit message received from
professionals was to expect marital breakdown (41).
Certainly, as members of society, professionals are not immune to cultural
myths, stereotypes, and false assumptions about disability. With a retrospective
analysis it can be tempting to condemn the professional treatment of PWD.
However, as will be discussed below, there is evidence to suggest that in prac-
tice, despite rapidly advancing knowledge of sexual functioning (particularly in
the area of spinal cord injury (SCI)) and an emerging psychosocial literature,
vestiges of these same attitudes can be inferred from current clinical practice
(42).
Taken together, the personal testimonies, advocacy literature and historical
rehabilitation practices appear to attest to both PWD’s desire for a rewarding
96 Milligan and Neufeldt

sexual life and the need for realistic concern that societal attitudes present sig-
nificant obstacles to the achievement of this goal. This paper will now turn its
focus to an examination of the empirical literature.

EMPIRICAL EVIDENCE

The physiological aspects of sexual functioning after SCI has been an area
of considerable research interest, particularly within the medical literature.
However, until recently the psychosocial aspects of sexuality have received far
less attention (38). In the past decade, interest in the topic of sexuality and
disability has begun to rapidly expand. By way of illustration, a recent literature
search of PsycINFO (1984–1999) using the key words “sexuality and disabil-
ity” revealed a total of 158 citations, of which 89% (141/158 articles) were
dated 1990 or later. Much of this literature consists of commentaries, literature
reviews, or didactic articles based on clinical observations, however, a growing
number of empirical investigations are beginning to address the subjective and
interpersonal aspects of sexual experience for PWD.
There is scant direct empirical support for the contention that PWD are
literally considered to be asexual by society. In a rare, and now very dated,
investigation of public and rehabilitation center staff attitudes toward the sexual
functioning of men with SCI, Wada and Brodwin (43) found that both groups
assumed that “. . . once an individual is confined to a wheelchair, his sex life is
over” (p. 21). The authors noted their findings were particularly disturbing in
that staff working directly with PWD also assumed a “universal impotence
myth” (p. 20). The investigators called for education to dispel the ignorance,
which contributes to this belief.
There is indirect evidence from a variety of sources which suggests that
PWD are, at least to some degree, perceived and treated as asexual beings. In
an often-cited paper, Hahn (4) provided one of the first analyses of the social
difficulties, which may impact on sexual relationships involving PWD. Draw-
ing on his training as a social scientist and his personal experience as a polio
survivor, Hahn’s review of the literature led him to conclude that “. . . for some
undetermined portion of the nondisabled population, the barriers against sexual
relationships with disabled persons almost amount to a taboo which few are
willing to defy” (p. 224). The author argued that stigmatization effectively ren-
ders PWD asexual and largely confined to the realm of platonic relationships
with the nondisabled population. Since that provocative paper, an increasing
number of converging empirical investigations have reported findings, which
are directly or indirectly supportive of Hahn’s reasoned lament. These bodies of
work will be briefly summarized below.
The Myth of Asexuality 97

Attitude Research

Research focused on attitudes towards PWD has suggested that the stig-
matizing effects of disability can lead to negative appraisals and reduced social
acceptance, avoidance behaviors and/or rejection by the nondisabled population
(44–46). PWD have been found to be more readily accepted as co-workers and
casual friends than as dating or marital partners (10,14,47,48). Furthermore, it
appears a fairly stable preference hierarchy of disability acceptability can be
discerned across a wide range of samples, with severe disabilities (e.g., quadri-
plegia, cerebral palsy, multiple sclerosis) consistently ranked lower than less
visibly disabling conditions (e.g., epilepsy, deafness) (47,49). Potential explana-
tions for able-bodied individuals’ expressed desire for greater social distance as
the level of intimacy increases include not only notions of asexuality, but also
social discomfort, expectations of stigmatization of the self by others based on
the reduced social worth of PWD, or aesthetic aversion (3,4,47,50,51). Cer-
tainly the extensive work of Fichten and her colleagues (e.g., 52–55), has at-
tested to the interactional awkwardness and distress nondisabled individuals
often experience in the presence of peers with visible physical disabilities.
A few investigators have examined nondisabled persons’ attitudes towards
specific sex acts and sex behaviors. These reports suggest sex acts involving
PWD are viewed more negatively than when these same behaviors are consid-
ered in the context of nondisabled persons (56,57). Wolfe (13) found greater
disapproval for sex acts involving individuals with severe (IQ ⬍ 40) as op-
posed to moderate (IQ 40–55) mental retardation, which is not particularly
surprising given inherent concerns related to the issue of consent of persons
with profound intellectual disabilities. At this time there are simply too few
studies from which to draw anything but the most tentative of conclusions re-
garding this substantive topic.
Generally, when considering the conclusions that might be drawn from this
body of literature it is important to keep in mind that attitudes, as measured in
studies, are often based on hypothetical situations (analogue studies), and do
not necessarily predict actual future behavior. As Yuker (58) points out, atti-
tudes may also be expected to show considerable variance across contexts. Fur-
thermore, the ubiquitous problem of heavy reliance on college student samples
is manifest in the attitude literature and limits the generalizability of obtained
results.

Intimate Relationships

Although the investigation of intimate relationships in the context of dis-

ability remains a surprisingly neglected topic of research, there is evidence to
98 Milligan and Neufeldt

suggest that PWD are significantly disadvantaged in the pursuit of satisfying

romantic/sexual relationships.3 Although the literature is relatively sparse, many
investigators and authors have reported that PWD experience difficulty finding
partners and achieving satisfaction in this area of their lives (10,14,48,59). Few
studies have employed able-bodied comparison groups, thereby limiting conclu-
sions. A recent exception is a landmark study conducted by Rintala et al. (67).
Rintala and her colleagues (67) undertook a large (N ⳱ 900) exploratory
investigation of dating issues for women with physical disabilities. Results of
the study indicated that women with disabilities were “. . . less satisfied with
their dating frequency, perceived more constraints on attracting dating partners,
and identified more societal and personal barriers to dating” (p. 239) as com-
pared to women without disabilities. The most significant perceived societal
barriers to dating were physical obstacles in the environment which limited the
women’s ability to socialize, and other peoples’ assumption the women were
unable to engage in sexual intercourse and/or surprise to find a woman with a
disability might be interested in sexual intimacy.
One indicator of success in forging romantic relationships is marital status.
Consistent with the above-noted findings, recent quantitatively based investiga-
tions of the marital status of individuals with SCI indicate they are significantly
less likely to marry, at least in the short term, and more likely to divorce than
the general population (69–72). These findings are congruent with qualitative
inquiries and clinically-based reports which have concluded the sequelae of
SCI, in combination with its stigma inducing properties, can impose significant
social barriers to both the initiation and stability of romantic/sexual relation-
ships (4,10,46,73–76).
A number of investigations have also generated evidence that men and
women with disabilities, even when they are involved in a relationship, may
perceive that they are viewed as unattractive, and in some way asexual. Even in
the absence of overt signs of rejection, PWD often feel sexually unattractive
(23,48,64,77–80). Particularly in the case of traumatic onset of physical disabil-
ity, it is not surprising to find PWD can experience prominent body image
distress (22,77) which interacts with social discrimination presumably rooted in
cultural values which reflect the worship of youth, physical fitness and beauty.
Despite the stated obstacles, it appears that PWD’s sexual interest often remains
high, although sexual activity may not keep pace and this can be a source of
considerable sexual dissatisfaction (9,62,79–81).
Empirical findings in the sexuality and disability literature are not all nega-
tive, for many PWD do report satisfaction with their romantic/sexual lives,
however, not surprisingly, this may be related to having a spouse or partner
(70,71,81–88). Unfortunately, couples where one partner has a disability can

3
It is important to emphasize that the majority of investigations have been conducted with the SCI
population.
The Myth of Asexuality 99

face considerable family opposition to the relationship as well as explicit and

implicit social disapproval (3,63,85).
As stated earlier, professionals are also vulnerable to cultural myths and
attitudes towards disability, and despite their best intentions, academics are no
exception. Data does not speak for itself and researchers bring their personal
values and beliefs to the interpretation process. For example, Neumann (89)
found that 60% of his sample of able-bodied women with SCI partners consid-
ered physical attractiveness in a sexual partner as being important to them and
that their partners were indeed attractive. The author speculated that perhaps
low levels of prior sexual experience in the women “. . . allowed them to find a
spinal cord injured partner genuinely attractive” (p. 291). The implicit message
in this analysis is that somehow there must have been some deficit in the
women that contributed to apparently unexpected findings. Other examples of
this kind of bias can be found (e.g., 40) and in this way the empirical literature
provides some social evidence of a negative bias toward the sexuality of PWD.

SUMMARY OF EVIDENCE

There is considerable social evidence, from a variety of sources, which

indicates that society does treat PWD as asexual beings. In particular, an in-
creasingly vocal constituency of PWD has expressed frustration at the social
barriers to full participation in life, particularly in the taboo area of sexuality. A
survey of the empirical literature suggests that although there is virtually no
direct test of the hypothesis that society literally views PWD as asexual, there is
considerable evidence to support Hahn’s (4) contention that PWD are hand-
icapped as sexual partners: that they are considered “damaged goods” (48, p. 849)
and therefore less sexually marketable than their able-bodied peers. The current
literature in the area of disability and intimate relationships remains in its infancy
and therefore precludes firm conclusions. Only speculative explanations can be
offered for an apparent romantic/sexual relationship disadvantage for PWD.
Societal views of PWD as asexual is one possibility, however, issues related to
aesthetics, stigmatized social status, economic disadvantage and/or social isola-
tion and attendant loss of opportunity to meet potential partners cannot be ruled
out. Whatever the contributing factors are, it seems apparent that for many PWD,
the result is often both stigmatization and sexual marginalization.

PARADIGM SHIFTS?

Despite the discouraging evidence presented thus far, if one adopts a pro-
cess orientation, there is reason to be optimistic that both the knowledge base
and societal attitudes towards PWD are improving, albeit slowly. Particularly
100 Milligan and Neufeldt

considering there was virtual silence on the subject of sexuality and disability
until a little over two decades ago, the growing interest which is reflected
within the psychosocial and popular literatures is encouraging.
Investigators, clinicians, and PWD have drawn professional attention to
the importance of sexuality to both the emotional adjustment and general func-
tioning of PWD—an acknowledgment that reflects considerable progress from
a time when PWD were not considered to have a legitimate or real interest in
sexual activity. The very existence of this journal provides further evidence of
ongoing and expanding interest in this topic. This literature is increasingly fo-
cused towards the psychological and interpersonal aspects of sexuality, signify-
ing a move away from almost exclusive attention to physical capacity and sex
acts (38,78). As well, modest evidence suggests a deficit model is not the only
theoretical framework which guides theory building in the area of sexuality and
disability. For example, work to develop wellness models of sexual health and
explore positive attitudes towards PWD represent a qualitative shift in orienta-
tion (32,39). Also, researchers, informed by the lived experience of disability
and presumably sensitized to salient issues, appear to be playing an important
role in the quality of investigations which are placing an increasing emphasis
on understanding and articulating the experience of PWD.
Self-help advocacy agencies and PWD have become vocal on the topic of
sexuality and disability, as discussed above. For example, in the United States,
the impetus for the formation of The Western New York Association for Sexu-
ality and Disability in 1989 was to specifically address “society’s misconcep-
tions that people with disabilities are asexual” and to “advocate for the sexual
rights of persons with disabilities” (2, p. 286). Through a focus on education,
training and counseling for individuals with developmental disabilities and their
families, as well as consultative work with community agencies and programs,
the association strives to promote positive attitudes towards sexuality.
Within the social arena, new cultural images of PWD are slowly emerging.
An “insider perspective” has begun to challenge distorted and narrow cinematic
portrayals of PWD and will hopefully enlighten audiences. Filmmakers with
disabilities have used their personal experience to present multidimensional
characterizations of PWD, including their sexuality. Films like The Waterdance
(90), written and directed by Neal Jiminex and based partially on his own
rehabilitation experience after a SCI, have provided rarely seen images of PWD
actively involved in romantic and sexual relationships. In general, the increas-
ing visibility of PWD in advertisements, television dramas, and other media
formats, engaging in everyday activities, could be expected to impact positively
on societal attitudes towards PWD by providing evidence of similarity rather
than emphasizing difference. Whether this kind of progress will have an impact
on societal views of sexuality and disability, of course, remains to be seen.
The virtual explosion of the Internet has also provided unprecedented op-
The Myth of Asexuality 101

portunity for PWD, who have access to quality information on issues of sexu-
ality through website postings by researchers, rehabilitation hospitals, service
agencies, advocacy groups and others with disabilities. In addition, chat rooms
connect PWD with each other and nondisabled people, and in this way technol-
ogy may be a valuable tool to overcome social and architectural barriers that
have restricted the participation of persons with severe physical disabilities. The
growing use of computers and on-line services is even beginning to impact the
way that research is conducted, both generally and in the area of sexuality and
disability (91–93).
Even with these positive trends in the evolution of sexuality in the context
of disability, considering the social and empirical evidence presented earlier, it
is obvious that there is much work that remains to be done to change societal
attitudes towards PWD.

Clinical Implications

Given a professional awareness of the sexual difficulties facing many

PWD, it is incumbent upon clinicians working with the disabled population to
intervene. By not directly addressing issues of sexuality, or de-emphasizing
their importance, professionals can endanger the physical and psychological
well-being of adults and adolescents. In the absence of sex education, children,
adolescents and young adults are placed at increased risk for sexually-transmit-
ted disease, pregnancy, and/or sexual molestation (12,24). Similarly, for adults,
the importance of sexual information and counseling is reflected in findings that
emotional well-being, as well as social and marital adjustment, may be related
to sexual satisfaction, although the nature of these relationships is currently
unknown (62,66,94).
Typically, psychosocial interventions are targeted towards individuals and
groups who are in distress. In the case of sexuality and disability, despite recog-
nition of the larger problem of societal attitudes, most approaches described
within the literature continue to focus on intervening with the PWD, sometimes
including their partners. An ecological perspective would argue that this strat-
egy is only addressing half the problem. Community based programs that focus
on prevention, consultation, and public awareness campaigns about sexuality
and disability are needed. However, to date, these approaches have been the
focus of few articles. Rather, efforts have primarily been directed towards
PWD.
Despite pervasive rhetoric within the literature that urges the delivery of
comprehensive sexual information and counseling programs to PWD, there ap-
pears to be a significant discrepancy between program description and service
delivery. Although some rehabilitation settings have implemented comprehen-
102 Milligan and Neufeldt

sive sexual health programs,4 a significant proportion of PWD (approximately

50%) report receiving little or no sexual information and/or counseling related
to their disability, and of those who do, only 50% report satisfaction with the
quality of the service provided. Furthermore, it appears women are twice as
likely as men not to receive any sexual education or counseling (68,95). Two
primary professional issues which need to be addressed are inadequate profes-
sional training and staff/patient resistance to involvement in sexuality counsel-
ing, as they appear to represent obstacles to service delivery.
Effective training of professionals working within interdisciplinary reha-
bilitation settings is critical. To date few opportunities in this specialized field
have existed (68,96,97). Tepper (97) only recently published what appears to be
the first description of an in-service education curriculum for training health
care professionals. There is a need to develop effective interdisciplinary training
programs if rehabilitation staff are to be expected to understand and manage the
sexual health care needs of PWD (97).
For training to be effective, the staff resistance that has been observed in
clinical settings will need to be addressed (15). Discomfort discussing issues
pertaining to sexuality and countertransference reactions to disability, if not
addressed, may interfere with staff training programs. Additionally, particularly
in the context of serious traumatic injury (e.g., brain/stroke/SCI) with extensive
medical, functional and psychological sequelae to treat and ever-shortening hos-
pital stays, pressure on staff may result in issues related to sexuality being
relegated a low priority. Political and fiscal considerations may also impact
implementation of education and/or counseling on sexuality issues. Tepper (97)
emphasizes the importance of institutional support for the provision of a com-
prehensive program of sexual health care and appropriate levels of training in
human sexuality for staff. Although the increasing availability of print and au-
diovisual resources can be utilized to reduce some of the pressure on staff, it is
unlikely that factual information will suffice as an intervention.
It is not only staff who may demonstrate resistance to addressing sexual
issues. Despite evidence that there is considerable interest in receiving informa-
tion and counseling about altered sexual functioning (79,80), particularly with
traumatic injury, PWD may demonstrate resistance which will require health
care professionals to do more than make mere overtures to discuss these issues.
On the other hand, attention to sexual issues must be balanced against an over-
emphasis on this subject and sensitivity to a needs hierarchy which may dictate
the primacy of other issues. The input of PWD should be sought to achieve this
balance.
In summary, if clinicians are to do their part to contribute to adjustment

4
The British Columbia Rehabilitation Society staffs clinicians dedicated solely to the comprehensive
sexual health care needs of their clientele (97).
The Myth of Asexuality 103

and improve the quality of life for PWD, then attention to issues of sexuality
must move beyond professional rhetoric. To enable clinicians and rehabilitation
counselors to deliver effective sexual health care interventions, both institu-
tional commitment to programs and staff training, as well as empirically based
knowledge as to what constitutes effective intervention are critical.

Research Implications

Given the paucity of investigations in the area of sexuality and the disabil-
ity, the need for further research is self-evident. Exploratory qualitative investi-
gations targeted to eliciting the experiences of PWD should be a priority to
enhance our understanding of both the personal and social barriers that face
PWD in the domain of sexuality. This paper has emphasized the importance of
considering the issue of sexuality and disability within a social context. As
sexual expression almost always occurs within an interpersonal context, the
virtual absence of reports that have involved partners/spouses is particularly
unfortunate and this perspective should be sought. As well, investigations of
PWD who have been successful in finding satisfaction in their intimate lives is
required and would be particularly informative in determining what factors fa-
cilitate romance and sexual expression. When salient variables have been iden-
tified, hypothesis-testing approaches will be more meaningful.
Further investigation of nondisabled persons’ attitudes towards PWD is
also needed. At present we have only a limited understanding of the important
antecedents of these attitudes, the correlates of positive and negative attitudes,
and the interaction between information, contact and attitudes. Investigations,
which focus on specific disabilities, are needed (58). As well, the contribution
of PWD to interpersonal transactions and outcomes has received little attention
to date and warrants further study (98).
A general criticism of past research has been a tendency to focus on dis-
ability as a defining variable of PWD, to the neglect of potentially salient indi-
vidual personality and attitudinal characteristics (99). Additionally, the investi-
gation of static variables (e.g., age-of-onset, sex, degree of impairment) while
informative and useful for theory building, ultimately lead to findings that are
not amenable to intervention. If a major goal of research efforts is to intervene
to improve access to sexual satisfaction and participation in intimate relation-
ships for PWD, then it is critical that studies focus on conditions and variables
which are potentially amenable to change (100), for example, social skills, sex-
ual information, interpersonal expectations, etc.
To date the sexuality and disability literature has been primarily dominated
by investigations of men with SCI. Issues that present for persons with physi-
cal, psychiatric and intellectual disabilities are very different and there is a
104 Milligan and Neufeldt

conspicuous need to expand research investigations across the spectrum of dis-

abilities. As well, attention to the differential experiences of men and women
has been neglected. In the case of SCI investigations, because women represent
approximately 20% of the SCI population, and the sexual sequelae of injury
have been deemed less consequential (based on a stereotyped passive role),
their specific concerns and issues have historically been ignored.
Finally, research has a critical role to play in designing efficacious and
effective sexual counseling/intervention and professional training programs.
Some of the questions that need to be addressed relate to content, format,
method of service delivery, timing of interventions, modality, etc. Systematic
investigations to assess outcome and compare the effectiveness of programs
will be needed. To date these areas have not been addressed.

CONCLUSIONS

Although arguably less prevalent today than decades ago, it seems that
society continues to deny or ignore the sexuality of PWD. Social and empirical
evidence continues to attest to discriminatory attitudes and significant disadvan-
tage in forging and/or maintaining sexual relationships. For an as yet unknown
percentage of PWD, the experience of an essentially nonsexual status in society
can be a source of considerable dissatisfaction. Despite significant social gains
in terms of PWD’s greater visibility and integration into our communities, and
increasing public awareness of issues related to environmental access through
the removal of architectural barriers, it would appear that physical barriers are
easier to change and often less oppressive than social ones (24).
Despite widespread agreement within the literature that sex education and/
or sexual counseling needs for PWD must be addressed and constitute an im-
portant focus for any holistic rehabilitation program, professional rhetoric has
been slow to translate into the delivery of comprehensive services to PWD.
When sexual issues have been addressed, they have often been treated super-
ficially (68,97).
Why are societal attitudes so resistant to change? This question is not
easily answered for our understanding of the psychosocial consequences of liv-
ing with a disability, and the forces which shape societal attitudes, is far from
complete. One possible problem relates to the nature of discourse on the issue
of sexuality and disability. If there is any merit in the charge that academics talk
amongst themselves, this assessment also appears to be true for PWD. Self-
advocacy publications provide a valuable forum for PWD to share information,
communicate with peers, influence the attitudes of others with disabilities, and
mobilize activism. Writers in this context call for peers to reject the myth of
asexuality and avoid internalizing the messages they receive from society as to
The Myth of Asexuality 105

their unsuitability as mates and sexual partners. Instead, PWD are encouraged
to show initiative and take risks in the pursuit of sexual/intimate relationships.
However, the general population typically does not read these literatures, and
therefore are not persuaded by new knowledge or personal narratives. Rather,
attitudes towards the sexuality of PWD are most likely influenced by cultural
images and ideologies, personal values, and direct personal experience with
PWD.
As is the case for most oppressed and/or minority groups, it appears that
the voice of PWD will continue to be the major challenge to societal attitudes
and cultural myths. It seems PWD must not only deal with issues of handicap
in their day-to-day lives, but the burden to resist internalizing prejudicial soci-
etal attitudes and beliefs, develop a positive sense of self, and educate others
about their experience, will continue to fall primarily on their shoulders as well.
Social policy will ultimately be unhelpful in matters of sexuality5 —we cannot
legislate access to romantic relationships.
Professionals can best serve PWD in this process by expanding the knowl-
edge base and developing interventions that will foster positive expectations
and attitudes in PWD towards their own sexuality. As well, an important role
for clinicians/rehabilitation counselors will be to assist PWD in developing the
confidence and skills they require to meet the social challenges to negotiating a
satisfying sexual life. There is much to be done. As Tilley (1998) recently
observed: “Inclusion does not just mean building a ramp” (p. 91).

ACKNOWLEDGMENTS

During the preparation of this article, M.S. Milligan was supported by The
Alberta Paraplegic Foundation (Rick Hansen Neurotrauma Initiative Grants).
This support is gratefully acknowledged.

REFERENCES

1. Neufeldt AH: Appearances of disability, discrimination and the transformation of rehabilita-

tion service practices. In Cross-cultural Rehabilitation: An International Perspective, R.L.
Leavitt (ed). Toronto, W.B. Saunders, 1999, pp. 25–36.
2. Caruso, SM, Baum RB, Hopkins D, Lauer M, Russell S, Meranto E, Stisser K: The develop-
ment of a regional association to address the sexuality needs of individuals with disabilities.
Sex Disability 15:285–291, 1997.
3. Gill CJ: Dating and relationship issues. Sex Disability 14:183–189, 1996.
4. Hahn H: The social component of sexuality and disability: Some problems and proposals. Sex
Disability 4:220–233, 1981.
5
Social policy is helpful in removing environmental barriers to increase accessibility to the social
spheres and thereby encourage interaction between PWD and the nondisabled population; facilitat-
ing the opportunity to change societal attitudes.
106 Milligan and Neufeldt

5. Norden MF: The Cinema of Isolation: A History of Physical Disability in the Movies. New
Brunswick, NJ, Rutgers University Press, 1994.
6. Tilley CM: Sexuality in women with physical disabilities: A social justice or health issue? Sex
Disability 14:139–151, 1996.
7. Felce D, Perry, J: Quality of life: The scope of the term and its breadth of measurement. In
Quality of Life for People with Disabilities (2nd ed), R Brown (ed). Cheltenham, UK, Stanley
Thornes, 1997, pp. 56–71.
8. Medlar TM: Sexual counseling and traumatic brain injury. Sex Disability 11:57–71, 1993.
9. Nosek MA, Rintala DH, Young ME, Howland CA, Foley CC, Rossi D, Chanpong G: Sexual
functioning among women with physical disabilities. Arch Phys Med Rehabil 77:107–115,
1996.
10. Yoshida KK: Intimate and marital relationships: An insider’s perspective. Sex Disability
12:179–189, 1994.
11. DeLoach CP: Attitudes toward disability: Impact on sexual development and forging of inti-
mate relationships. J Appl Rehabil Counseling 25(1):18–25, 1994.
12. Whitehouse MA, McCabe MP: Sex education programs for people with intellectual disability:
How effective are they? Educ Training Ment Retard Dev Disabilities 32(2):229–240, 1997.
13. Wolfe PS: The influence of personal values on issues of sexuality and disability. Sex Disabil-
ity 15:69–90, 1997.
14. Trieschmann RB: Spinal Cord Injuries: Psychological, Social, and Vocational Rehabilitation
(2nd ed), New York, Demos, 1988.
15. Burlink K, Tarvydas VM, Maki DR: Human sexuality and disability: A holistic interpretation
of rehabilitation counseling. J Appl Rehabil Counseling 25:10–16, 1994.
16. Farrow J: Sexuality counseling with clients who have spinal cord injuries. Rehabil Counseling
Bull 33:251–259, 1990.
17. Webster J: Lost time: Sex after SCI. Spinal Columns 11(3):25–26, Winter 1997. (Available
from Canadian Paraplegic Association [Alberta], 噛305, 11010-101 Street, Edmonton, AB
T5H 4B9)
18. Corbet B: Bully pit: Freak love. New Mobility [online], February, 1998. (Available: http://
www.newmobility.com/query/magazine)
19. Stohl E: Sexuality and disability: Uncovering the real life obstacles. SCI Psychosoc Process
2/3:73–74, 1996.
20. Kroll K, Klein EL: Enabling Romance: A Guide to Love, Sex, and Relationships for the
Disabled (and the people who care about them), Bethesda, MD, Woodbine House, 1995.
21. Mona LR, Gardos PS, Brown RC: Sexual self views of women with disabilities: The relation-
ship among age-of-onset, nature of disability and sexual self-esteem. Sex Disability 12:261–
277, 1994.
22. Romeo AJ, Wanless R, Arenas S: A profile of psychosexual functioning in males following
spinal cord injury. Sex Disability 11:269–276, 1993.
23. Rousso H: Sexuality and a positive sense of self. In Women with Physical Disabilities:
Achieving and Maintaining Health and Well-Being, D Krososki, M Nosek, M Turk (eds).
Baltimore, Paul H. Brookes, 1996, pp. 109–116.
24. Rousso H: Special considerations in counseling clients with cerebral palsy. Sex Disability
11:99–108, 1993.
25. DeCock HJ: Life with a spinal cord injury: Is it the pits? Spinal Columns 11(2):30, 1996.
(Available from Canadian Paraplegic Association (Alberta), 噛305, 11010-101 Street, Edmon-
ton, AB T5H 4B9).
26. Dobbs J: The road to intimacy. New Mobility [online], October, 1997. (Available: http://
www.newmobility.com/query/magazine)
27. The dating game. Caliper L11(4):28–29, Spring, 1998. (Available from Canadian Paraplegic
Association, 1101 Prince of Wales Drive, Suite 230, Ottawa, Ontario K2C 3W7).
28. Sexual turning points. New Mobility [online], June, 1997. (Available: http://www.new
mobility.com/query/magazine)
29. In search of a new aesthetic. New Mobility [online], November, 1998. (Available: http://
www.newmobility.com/query/magazine)
30. Hahn H: Can disability be beautiful? In Perspectives on Disability, M Nagler (ed). Palo Alto,
Ca, Health Markets Research, 1990, pp. 310–319.
The Myth of Asexuality 107

31. Brolley DY, Anderson SC: Advertising and attitudes. In Perspectives on Disability, M Nagler
(ed). Palo Alto, Ca, Health Markets Research, 1990, pp. 147–150.
32. Schwartz HD: Further thoughts on a “sociology of acceptance” for disabled people. Soc Pol-
icy 19(2):36–39, 1988.
33. Sheridan C: A Physical Challenge for the Media: The Effects of Portrayals of Wheelchair
Users [online]. Available at http://www.youknow.com/disability/portrayals.html) 1996.
34. Green S, Renzi M (Producers), Sayles J (Director): Passion Fish [Film], 1992.
35. Von Trier L (Director): Breaking the Waves [Film], Denmark, October Films, 1996.
36. Berkman AH, Weissman R, Frielich, MH: Sexual adjustment of spinal cord injured veterans
living in the community. Arch Phys Med Rehabil 59:29–33, 1978.
37. Cole S: Foreward. In Ducharme SH, Gill, KM: Sexuality after Spinal Cord Injury, Baltimore,
Paul H. Brookes, 1997.
38. Willmuth ME: Sexuality after spinal cord injury: A critical review. Clin Psychol Rev 7:389–
412, 1987.
39. Nosek MA, Howland CA, Young, ME, Georgiou D, Rintala DH, Foley CC, Bennett JL, Smith
Q: Wellness models and sexuality among women with physical disabilities. J Appl Rehabil
Counseling 25(1):50–58, 1994.
40. Robillard K, Fichten CS: Attributions about sexuality and romantic involvement of physically
disabled college students: An empirical study. Sex Disability 6:197–212, 1983.
41. Vargo FA: Adaptation to disability by the wives of spinal cord males: A phenomenological
approach. J Appl Rehabil Counseling 15(1):28–32, 1984.
42. Ducharme S, Gill KM: Sexual values, training and professional roles. In The Psychological
and Social Impact of Disability (3rd ed), RP Marinelli, AE Dell Orto (eds). New York,
Springer, 1991, pp. 201–209.
43. Wada MA, Brodwin MG: Attitudes of society toward sexual functioning of male individuals
with spinal cord injury. Psychol 12(4):18–22, 1975.
44. Anderson RJ, Antonak RF: The influence of attitudes and contact on reactions to persons with
physical and speech difficulties. Rehabil Counselling Bull 35:240–247, 1992.
45. Gething L: Judgements by health professions of personal characteristics of people with a
visible physical disability. Soc Sci Med 34:809–815, 1992.
46. Wright BA: Physical Disability: A Psychosocial Approach (2nd ed). New York: Harper &
Row, 1983.
47. Olkin R, Howson LJ: Attitudes toward and images of physical disability. J Soc Behav Pers
9(5):81–96, 1994.
48. Phillips M: Damaged goods: Oral narratives of the experience of disability in American cul-
ture. Soc Sci Med 30:849–857, 1990.
49. Strohmer DC, Grand SA, Purcell MJ: Attitudes toward persons with a disability: An examina-
tion of demographic factors, social context, and specific disability. Rehabil Psychol 29:131–
145, 1984.
50. Fichten CS, Goodrick G, Amsel R, McKenzie SW: Reactions toward dating peers with visual
impairments. Rehabil Psychol 36:163–178, 1991.
51. Gordon ED, Minnes PM, Holden RR: The structure of attitudes toward persons with a disabil-
ity, when specific disability and context are considered. Rehabil Psychol 35:79–90, 1990.
52. Fichten CS: Self, other, and situation-referent automatic thoughts: Interaction between people
who have a physical disability and those who do not. Cognitive Ther Res 10:571–588, 1986.
53. Fichten CS, Amsel R: Trait attributions about college students with a physical disability:
Circumplex analyses and methodological issues. J Appl Soc Psychol 16:410–427, 1986.
54. Fichten CS, Robillard K, Judd D, Amsel R: College students with physical disabilities: Myths
and realities. Rehabil Psychol 34:243–257, 1989.
55. Fichten CS, Robillard K, Tagalakis V, Amsel R: Causal interaction between college students
with various disabilities and their nondisabled peers: The internal dialogue. Rehabil Psychol
36:3–20, 1991.
56. Haring M, Meyerson L: Attitudes of college students toward sexual behavior of disabled
persons. Arch Phys Med Rehabil 60:257–260, 1979.
57. Scotti JR, Slack BS, Bowman MA, Morris TL: College students’ attitudes concerning the
sexuality of persons with mental retardation: Development of the Perceptions of Sexuality
Scale. Sex Disability 14:249–263, 1996.
108 Milligan and Neufeldt

58. Yuker HE: Variables that influence attitudes toward people with disabilities: Conclusions from
the data. J Soc Behav Pers 9(5):3–22, 1994.
59. Bozzacco V: Long-term psychosocial effects of spinal cord injury. Rehabil Nurs 18:82–87,
1993.
60. Carlson CE: Conceptual style and life satisfaction following spinal cord injury. Arch Phys
Med Rehabil 60:346–352, 1979.
61. Krause JS: Life satisfaction after spinal cord injury: A descriptive study. Rehabil Psychol
37:61–70, 1992.
62. Mackelprang RW, Hepworth DH: Sexual adjustment following spinal cord injury: Empirical
findings and clinical implications. Arete 15(1):1–13, 1990.
63. Miller S, Morgan M: Marriage matters: For people with disabilities too. Sex Disability 3:203–
211, 1980.
64. Pearson V, Klook A: Sexual behavior following paraplegia: An exploratory study in Hong
Kong. Disability Handicap Soc 4:285–295, 1989.
65. Povolny MA, Kaplan SP, Marme M, Roldan G: Perceptions of adjustment issues following a
spinal cord injury: A case study. J Appl Rehabil Counseling 24(3):31–34, 1993.
66. Ray C, West J: Social, sexual and personal implications of paraplegia. Paraplegia 22:75–86,
1984.
67. Rintala DH, Howland CA, Nosek MA, Bennett JL, Young ME, Foley CC, Rossi CD, Chan-
pong G: Dating issues for women with physical disabilities. Sex Disability 15:219–242, 1997.
68. Tepper MS: Sexual education in spinal cord rehabilitation: Current trends and recommenda-
tions. Sex Disability 10:15–31, 1992.
69. Brown JS, Giesy B: Marital status of persons with spinal cord injury. Soc Sci Med 23:313–
322, 1986.
70. DeVivo MJ, Fine PR: Spinal cord injury: Its short-term impact on marital status. Arch Phys
Med Rehabil 66:501–504, 1985.
71. DeVivo MJ, Hawkins LN, Richards JS, Go BK: Outcomes of post-spinal cord injury mar-
riages. Arch Phys Med Rehabil 76:130–138, 1995.
72. DeVivo MJ, Richards, JS: Community reintegration and quality of life following spinal cord
injury. Paraplegia 30:108–112, 1992.
73. DeLoach C, Greer BG: Adjustment to Severe Disability: A Metamorphosis. New York,
McGraw-Hill Books, 1981.
74. Lemon MA: Sexual counseling and spinal cord injury. Sex Disability 11:73–97, 1993.
75. Oliver M, Zarb G, Silver J, Moore M, Salisbury V: Walking Into Darkness: The Experience of
Spinal Cord Injury. London, MacMillan Press, 1988.
76. Vash CL: The Psychology of Disability. New York, Demos, 1981.
77. Kettl P, Zarefoss S, Jocoby K, Garman C, Hulse C, Rowley F, Corey R, Sredy M, Bixler E,
Tyson K: Female sexuality after spinal cord injury. Sex Disability 9:287–295, 1991.
78. Richards E, Tepper M, Whipple B, Komisaruk BR: Women with complete spinal cord injury:
A phenomenological study of sexuality and relationship experiences. Sex Disability 15:271–
283, 1997.
79. White MJ, Rintala DH, Hart KA, Fuhrer MJ: Sexual activities, concerns and interests of
women with spinal cord injury living in the community. Am J Phys Med Rehabil 72:372–378,
1993.
80. White, MJ, Rintala DH, Hart KA, Young ME, Fuhrer MJ: Sexual activities, concerns and
interests of men with spinal cord injury. Am J Phys Med Rehabil 71:225–231, 1992.
81. Kreuter M, Sullivan M, Siosteen A: Sexual adjustment and quality of relationships in spinal
paraplegia. Arch Phys Med Rehabil 77:541–547, 1996.
82. Crewe NM, Athelstan GT, Krumberger J: Spinal cord injury: A comparison of preinjury and
postinjury marriages. Arch Phys Med Rehabil 60:252–256, 1979.
83. Crewe NM, Krause JS: Marital relationships and spinal cord injury. Arch Phys Med Rehabil
69:435–438, 1988.
84. El Ghatit AZ, Hanson RW: Marriage and divorce after spinal cord injury. Arch Phys Med
Rehabil 57:470–472, 1976.
85. Milligan MS, Neufeldt AH: Postinjury marriage to men with spinal cord injury: Women’s
perspectives on making a commitment. Sex Disability 16:117–132, 1998.
The Myth of Asexuality 109

86. Simmons S, Ball SE: Marital adjustment and self-actualization in couples married before and
after spinal cord injury. J Marriage Fam 46:943–945, 1984.
87. Siosteen A, Lundqvist C, Blomstrand C, Sullivan L, Sullivan M: Sexual ability, activity,
attitudes and satisfaction as part of adjustment in spinal cord-injured patients. Paraplegia
28:285–295, 1990.
88. Walters AS, Williamson GM: Sexual satisfaction predicts quality of life: A study of adult
amputees. Sex Disability 16:103–115, 1998.
89. Neumann RJ: The forgotten other: Women partners of spinal cord injured men, a preliminary
report. Sex Disability 2:287–292, 1979.
90. Hurd GA, Cantin M (Producers), Jiminez N, Steinberg M (Directors): The Waterdance [Film].
No Frills Film Production, 1992.
91. Gardos PS, Mona LR: The use of computers and on-line services in conducting sexuality
research with people who have physical disabilities. Sex Disability 12:251–259, 1994.
92. Hewson CM, Laurent D, Vogel CM: Proper methodologies for psychological and sociological
studies conducted via the Internet. Behav Res Methods Instrum Comput 28:186–191, 1996.
93. Schmidt WC: World-wide web survey research: Benefits, potential problems, and solutions.
Behav Res Methods Instrum Comput 29:274–279, 1997.
94. David A, Gur S, Rozin R: Survival in marriage in the paraplegic couple: Psychological study.
Paraplegia 15:198–201, 1977–78.
95. Donohue J, Gebhard P: The Kinsey Institute/Indiana University Report on sexuality and spinal
cord injury. Sex Disability 13:7–85, 1995.
96. Ducharme S: From the editor. Sex Disability 15:125–126, 1997.
97. Tepper MS: Providing comprehensive sexual health care in spinal cord injury rehabilitation:
Implementation and evaluation of a new curriculum for health care professionals. Sex Disabil-
ity 15:131–165, 1997.
98. Shurka E, Siller J, Dvonch P: Coping behavior and personal responsibility as factors in the
perception of disabled persons to the nondisabled. Rehabil Psychol 27:225–233, 1982.
99. Fine M, Asch A: Disability beyond stigma: Social interaction, discrimination, and activism. J
Soc Issues 44:3–21, 1988.
100. Kerr N, Bodman DA: Disability research methods: An argument for the use of Galileian
modes of thought in disability research. J Soc Behav Pers 9(5):99–122, 1994.