Based on a qualitative anthropological study of American mothers of infants and young children newly diagnosed with disability, this essay examines how mothers understand their children and define disability in relation to publicly available discourses of disability and identity. In seeking to improve their children’s opportunities in mainstream society, mothers appear to comply with the medical model. But over time and in the process of providing meaning to their experience, mothers retool models, drawing both on (...) the social and minority group models’ rejection of a problem-based definition of disability as inherently caused by impairment and on their own intimate engagement with impairment as an embodied experience. (shrink)

During recent decades various researchers from health and social sciences have been debating what it means for a person to be disabled. A rather overlooked approach has developed alongside this debate, primarily inspired by the philosophical tradition called phenomenology. This paper develops a phenomenological model of disability by arguing for a different methodological and conceptual framework from that used by the existing phenomenological approach. The existing approach is developed from the phenomenology of illness, but the paper illustrates how (...) the case of congenital disabilities, looking at the congenital disorder called cerebral palsy (CP), presents a fundamental problem for the approach. In order to understand such congenital cases as CP, the experience of disability is described as being gradually different from, rather than a disruption of, the experience of being abled, and it is argued that the experience of disability is complex and dynamically influenced by both intrinsic and extrinsic factors. Different experiential aspects of disability— pre-reflective, attuned and reflective aspects—are described, demonstrating that the experience of disability comes in different degrees. Overall, this paper contributes to the debates about disability by further describing the personal aspects and experience of persons living with disabilities. (shrink)

This paper challenges the view that there is one medical model of disability monolithically and oppressively imposed on disabled people. Because the presence of disability may be ambiguous in any given case, multiple actors, lay and professional, may invoke particular medical models of disability and advance competing claims about an individual’s disabilities and related needs. The literature for parents of disabled children is seen as a resource on which parents can draw in making claims (...) about their children’s disabilities and disability-related needs. Particular attention is given to the assumptions that this literature makes about the identity, resources and dispositions of the audience. Ultimately, these assumptions favor disability claims made by white, highly educated, upper-income parents. (shrink)

This chapter contains sections titled: Introduction Investing in Science: Child Health and U.S. Medicine in the Twentieth Century The Impact of Specific Medical Interventions The Changing Definition of ID The “Flynn Effect” and the Impact of Improved Public Health Conclusion References.

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical (...) class='Hi'>model of health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical (...) class='Hi'>model of health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical (...) class='Hi'>model of health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical (...) class='Hi'>model of health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

According to the World Health Organization, 15% of the global population lives with some form of disability, of whom 2% to 4% experience significant difficulties in functioning. Persons with impairment are the most neglected sector in society. This inquiry looks into the social and medical model in terms of analyzing the impact of the COVID-19 pandemic on persons with developmental disorder. The paper argues that the medical model is insufficient to account for the needs of (...) persons with disability. While the medical model requires that individuals with impairment should be given priority in terms of access to effective treatment, policies in the midst of public emergencies must be based on a comprehensive awareness of the social context of cognitive disability. (shrink)

The following paper examines the cyberpunk transhumanist graphic novel Transmetropolitan through the theoretical lens of disability studies to demonstrate how science fiction, and in particular this series, illustrate and can influence how we think about disability, impairment and difference. While Transmetropolitan is most often read as a scathing political and social satire about abuse of power and the danger of political apathy, the comic series also provides readers with representations of impairment and the source of disability as (...) understood by the Social Model of Disability (SMD). Focusing on the setting and fictional world in which Transmetropolitan takes place, as well as key events and illustration styling, this paper demonstrates that the narrative in this work encompasses many of the same theoretical underpinnings and criticisms of society’s ignorance of the cause of disability as the SMD does. This paper aims, by demonstrating how Transmetropolitan can be read as an allegory for the disabling potential of society as experienced by individuals with impairments, to prompt readers into thinking more creatively about how narratives, seemingly unconcerned with disability, are informed and can be understood via disability theory. (shrink)

The formal justice model proposed by Anita Silvers in Disability, Discrimination, and Difference emphasizes the social model of disability and the need for full equality of opportunity, and it suggests that a distributive model of justice that gives special benefits to individuals with disabilities is self-defeating. Yet in that work, Silvers allows an exception for the "profoundly impaired." In this paper, I show how the formal justice theory falls short when it comes to defining and (...) dealing with "profoundly impaired" individuals and explore the ways in which making the exception raises serious theoretical concerns for the grounding of the formal justice model. (shrink)

In this paper, I defend a version of the medical model of disability, which defines disability as an enduring biological dysfunction that causes its bearer a significant degree of impairment. We should accept the medical model, I argue, because it succeeds in capturing our judgments about what conditions do and do not qualify as disabilities, because it offers a compelling explanation for what makes a condition count as a disability, and because it justifies (...) why the federal government should spend hundreds of billions of dollars, annually, on aid and accommodations for disabled people. After responding to a pair of objections Elizabeth Barnes has raised against the medical model, I contrast it with Guy Kahane and Julian Savulescu's welfarist account of disability, and with Barnes's own mere-difference view. Both of these accounts face serious challenges, although elements of Barnes's view can—and, in my opinion, should—be adopted by proponents of the medical model. (shrink)

The concept of social reproduction of sets of advantages and disadvantages together with that of status group, is used to explore the evidence and thinking presented in the Royal Commission on the Blind, the Deaf and Dumb, etc. regarding the education of children with disabilities in 1889. Even though the evidence was ambiguous, models for the education of children with disabilities were laid down. Integration into mainstream elementary schools was recommended for the blind. Recommendations for deaf children were divided in (...) allegiance with belief in the principles of either oralism or signing. The largest group numerically received the least attention in the Commission. The idea of feeble-minded children as a product of social, economic and educational circumstances had its champion but was overwhelmed by the acceptance of the doctrine of the innate characteristics of the child's mind identifiable by medical science. (shrink)

In Western industrialized countries, women report using health services, and certain medications, more often than do men. Often, analyses are based on data that exclude objective measures of morbidity and that come from cross-sectional surveys, which precludes the use of socioeconomic covariates that are endogenous to seeking care. Here, differences in objective cognitive and physical function, as well as differences in reporting on illness, propensity to seek care, and socioeconomic resources are expected to account for differences in care-seeking behaviour among (...) women and men. This model is applied to the question of medication use in Ismailia, Egypt, using two waves of survey data and in-home tests of physical function from 896 adults aged 50 years and older. The results show that women use medications more often than do men, and that differences between women and men in reported morbidity and disability, observed cognitive and physical function, and economic resources account for womens and men’s care-seeking behaviour in later life. (shrink)

This article presents an archaeological inquiry into the early histories of Quality of Life measures, and takes this as an occasion to rethink the concept of the ‘medical model of disability’. Focusing on three instruments that set the ground for the emergence of QoL measures, namely, the Karnofsky Performance Scale, and the classification of functional capacity as a diagnostic criterion for heart diseases and as a supplementary aid to therapeutic criteria in rheumatoid arthritis – I discuss how (...) medicine, throughout the emergence of QoL, began to expand its gaze beyond the confines of the body to what that body does in daily life. Building upon Armstrong et al.’s notion of ‘distal symptoms’ and Wahlberg’s idea of ‘knowledge of living’, I propose the notion of disabilitization to encapsulate this expansion of the clinical gaze, through which medicine has come to articulate diseases and their treatments in new ways, and in so doing, has inadvertently created disability as a new kind of knowledge category in itself – a category that is defined not through its reduction to mere pathology, but through its dispersal into everyday life. I present this concept not as a periodization, but as a provocative discontinuity with the totalizing history assumed within the medical model of disability, and in so doing, ask what, in fact, holds ‘the medical model’ together, and whether there might be other ways of understanding medicine’s complex relationship to disability than what the concept of the medical model allows us to envisage. (shrink)

Despite being assailed for decades by disability activists and disability studies scholars spanning the humanities and social sciences, the medical model of disability—which conceptualizes disability as an individual tragedy or misfortune due to genetic or environmental insult—still today structures many cases of patient–practitioner communication. Synthesizing and recasting work done across critical disability studies and philosophy of disability, I argue that the reason the medical model of disability remains so gallingly (...) entrenched is due to what I call the “ableist conflation” of disability with pain and suffering. In an effort to better equip healthcare practitioners and those invested in health communication to challenge disability stigma, discrimination, and oppression, I lay out the logic of the ableist conflation and interrogate examples of its use. I argue that insofar as the semiosis of pain and suffering is structured by the lived experience of unwelcome bodily transition or variation, experiences of pain inform the ableist conflation by preemptively tying such variability and its attendant disequilibrium to disability. I conclude by discussing how philosophy of disability and critical disability studies might better inform health communication concerning disability, offering a number of conceptual distinctions toward that end. (shrink)

This article puts forth a novel framework for understanding conceptions of disability using six models of disability: the “Social,” “Medical,” “Tragedy,” “Affirmative,” “Minority” and “Universal” models. It analyzes these models as three opposed pairs, each pertaining to a distinct aspect of the multifaceted experience of disability: (1) the cause of disabled people’s social disadvantage and exclusion; (2) the effect of impairment on individuals’ quality of life and well-being; (3) the dichotomy or lack thereof between disabled and (...) nondisabled people. The article argues that although each model is incompatible with its opposed pair, it is compatible with the remaining four models, in the sense that there is no contradiction in holding the views associated with these models at the same time. It therefore concludes that conceptions of disability are best understood as clusters of views on disability that are associated with compatible models. (shrink)

This article puts forth a novel framework for understanding conceptions of disability using six models of disability: the “Social,” “Medical,” “Tragedy,” “Affirmative,” “Minority” and “Universal” models. It analyzes these models as three opposed pairs, each pertaining to a distinct aspect of the multifaceted experience of disability: (1) the cause of disabled people’s social disadvantage and exclusion; (2) the effect of impairment on individuals’ quality of life and well-being; (3) the dichotomy or lack thereof between disabled and (...) nondisabled people. The article argues that although each model is incompatible with its opposed pair, it is compatible with the remaining four models, in the sense that there is no contradiction in holding the views associated with these models at the same time. It therefore concludes that conceptions of disability are best understood as clusters of views on disability that are associated with compatible models. (shrink)

Both the medical model and the social model of disability have substantial drawbacks for the project of creating better lives for people with disabilities; the first denies the value of difference and the effects of discrimination, and the second denies any place for prevention and cure. Using fictional and non-fictional parental narratives of Fetal Alcohol Syndrome, this article argues that a third model–a morphological model of disability–can best help us think about respectfully and (...) effectively intervening in disability. (shrink)

Disability has been traditionally understood as a medical condition. However, people with disabilities have claimed in recent decades for a dephatologized social model of disability—i.e. the functi...

The neurocentric worldview that identifies the essence of the human being with the material brain has become a central paradigm in current academic discourse. Israeli researchers also seek to understand educational principles and processes via neuroscientific models. On this background, the article uncovers the central role that visual brain images play in the learning-disabilities field in Israel. It examines the place brain images have in the professional imagination of didactic-diagnosticians as well as their influence on the diagnosticians' clinical attitudes. It (...) relies on two theoretical fields: sociology and anthropology of the body and sociology of neuromedical knowledge. The research consists of three methodologies: ethnographic observations, in-depth interviews, and rhetorical analysis of visual and verbal texts. It uncovers the various rhetorical and ideological functions of brain images in the field. It also charts the repertoire of rhetorical devices which are utilized to strengthen the neuroreducionist messages contained in the images. (shrink)

Is there such a thing as a social conception of disability? Recently two writers in this journal have suggested not only that there is a coherent social conception of disability but that all non-social conceptions, or “medical models” of disability are fatally flawed. One serious and worrying dimension of their claims is that once the social dimensions of disability have been resolved no seriously “disabling” features remain. This paper examines and rejects conceptions of disability (...) based on social factors but notes that physical and mental conditions which disadvantage the individual have social dimensions. (shrink)

This chapter articulates how people understand “microaggression” and offers a clarifying augmentation of that account. It attempts to define disability, and then talk through how analysis connects with the very few discussions of microaggressions within the context of disability. The chapter introduces the case of “Disabled But Not Really.” It leverages previous analysis to show how microaggressions’ mixed legibility is crucial to their role in maintaining an epistemology that polices disability in general and disabled people in particular. (...) The chapter discusses the ramifications this has for future analysis of both microaggressions and disability. It highlights the specific challenges faced by persons at the junction of multiple oppressed identities. Ontologically, the commitment is the rejection of the medical model of disability where “disabilities are just particular kinds of bodily malfunction”. The focus within that ontological analysis is primarily concerned with the social/political consequences of disability. (shrink)

The privation theory of evil (PTE) states that evil is the absence of some good that is supposed to be present. For example, if vision is an intrinsic good, and if human beings are supposed to have vision, then PTE implies that a human being’s lacking vision is an evil, or a bad state of affairs. The mere-difference view of disability (MDD) states that disabilities like blindness are not inherently bad. Therefore, it would seem that lacking sight is not (...) a bad state of affairs. Thus PTE and MDD seem to be in tension. This essay discusses that apparent tension and explains how it might be resolved without doing violence to either view. Given the prominence of PTE in the history of Christian theology, and the wide support for MDD among disability theorists, it is worth finding a way to harmonize these two views. (shrink)

Disability laws are crucial in ensuring a life of dignity for persons with disabilities. However, they remain limited and ineffective in the absence of adequate knowledge and awareness of the experiences with disability. The limitedness of disability laws has been spoken of in cases where the full realization of rights is subject to technological, philosophical, and market dynamics. In many cases, the law is also weakened by negative cultural beliefs and social perceptions of disability. And then (...) there are cases where disability laws perpetuate or tolerate oppression and violence. Despite their limitedness, disability laws offer normative content to facilitate engagement and critique for reform. In terms of what disability laws ‘ought’ to be, scholars write, that they should be about disabled people and the meanings provided by them. This objective has and can be fulfilled with the aid of disability studies that go beyond the inquiries of law with the right kind of research tools to theorize and re-theorize concepts and meanings about disability. Disability studies, in other words, represent the living conditions of disabled persons and the questions of how disability and/or impairment should be defined. This chapter examines the interaction between disability law and disability studies through the prism of the Convention on the Rights of Persons with Disabilities (CRPD). While discussing the models of disability (medical, social, human rights, and relational-community models) and agendas for reforming the CRPD, the chapter highlights the importance of new concepts and approaches. Further, the potential of disability laws, CRPD in particular, has been discussed keeping in mind the application of its core principles across different sectors (with a special focus on the Marrakesh treaty and copyright laws). (shrink)

In the author's dual identities of Disney fanatic and philosopher of disability, he was as delighted as a five‐year‐old on their first trip to the Magic Kingdom to see the progress that Disney had made in Finding Dory by depicting what philosophers call the social model of disability. In contrast to the social model of disability, people often see the medical model, in which disability is understood as an individual problem to be (...) remedied through medical treatment or charity. Not to get too far ahead of themselves, but Dopey from Snow White is a perfect illustration of a character with a disability portrayed in terms of the medical model. Keep pondering that while people consider a darker side to the Finding Dory disability paradise, one that reveals it is only a wonderful world for those who can speak. (shrink)

Tom Shakepeare is an eminent, and somewhat controversial, contributor to disability studies. As he outlines, part of the explanation for his controversial status within that field stems from his engagement with disciplines outside it, including genetics and bioethics. For many in the field of disability studies, no genuine engagement should be sought with scholars in genetics or bioethics because—so the party line goes—these areas of study are inherently opposed to disability rights and otherwise pose genuine threats to (...) the status of disabled people. The present volume is unlikely to do much to reduce his controversial status.The book is divided into three parts. The first presents a detailed criticism of the social model with some, more positive, proposals concerning how disability is best conceived. The second part—perhaps the one that will be of most interest to JME readers—concerns bioethical issues in disability . The final part focuses on themes such as care, charity, intimacy and the role of the non-disabled in “the world of disability”.The main reason why this book is unlikely to reduce Shakespeare’s controversial status is that its central theme is a sustained attack on the so-called and widely held “social model” of disability. According to this model, the causes of disability lie in the social environment, not within the individual. So, change the social environment in appropriate ways, and disability disappears. Shakespeare illustrates the various ways in which this model is analytically flawed and has had a negative effect upon disability studies, research and the lives of disabled people. …. (shrink)

This paper is prompted by the charge that the prevailing Western paradigm of medical knowledge is essentially Cartesian. Hence, illness, disease, disability, etc. are said to be conceived of in Cartesian terms. The paper attempts to make use of the critique of Cartesianism in medicine developed by certain commentators, notably Leder (1992), in order to expose Cartesian commitments in conceptions of disability. The paper also attempts to sketch an alternative conception of disability — one partly inspired (...) by the work of Merleau-Ponty. In particular, three key Cartesian claims are identified and subjected to criticism. These are as follows: (a) The claim that the body is an object, (b) what is termed here ‘the modularity thesis’, and (c) the claim that the body cannot be constitutive of the self (i.e. since the soul/mind/brain is). In opposition to these claims, it is argued that the body is properly viewed as a subject; that there are neither purely mental, nor purely physical disabilities; and that selves are constituted, at least in part, by their bodies. (shrink)

This essay identifies and intervenes in the limitations of both the social and the medical models of disability in the postcolonial context, suggesting that those limitations may apply to theorizations of disability more broadly. It suggests that Bessie Head's novel A Question of Power, which represents mental illness and disability without positing a stable etiology for them, illustrates the inapplicability of these ways of thinking about disability under instances of extreme precarity. As such, Head offers (...) a test case for how mental illness and disability writ large might be theorized without the suppositions implicit to the liberal subject. (shrink)

Aristotle is oftentimes viewed through a strictly philosophical lens as heir to Plato and has having introduced logical rigor where an emphasis on the theory of Forms formerly prevailed. It must be appreciated that Aristotle was the son of a physician, and that his inculcation of the thought of other Greek philosophers addressing health and the natural elements led to an extremely broad set of biologically- and medically-related writings. As this article proposes, Aristotle deepened the fourfold theory of the elements (...) with anatomic and physiologic observations. In books like History of Animals, Parts of Animals, and the lost Anatomai, he actively dissected organisms and recorded his findings. The corpus of medically-related literature Aristotle developed had a direct influence on subsequent Greek thinkers, including Galen, and on Medieval Islamic and modern Western practitioners such as William Harvey. Aristotle's ideas continue to influence modern medical thinkers in Europe and America through both his interpretation by European philosophers gaining the attention of medical humanists, and his writings' enduring impact on medical researchers balancing scientific with more personalistic approaches to medicine. (shrink)

Against the medical and social models of disability are two newer proposals. Elizabeth Barnes’ Minority Body proposes that it is the bodies which are advocated for and included in the disability rights movement which are rightfully called “disabled.” Savulescu and Kahane’s Welfarist approach proposes that disability is intrinsically tied to the effects of bodily states on welfare. They put the need for a consistent and relatively simple normative theory above accounting for standard case judgements about who (...) is and is not disabled or looking at all to membership of the disabled community. I argue that Barnes’ theory offers the best response to issues with the dominant models of disability. Further, I argue that the Welfarist theory operates in a space removed from the wishes and lived experiences of disabled people – separating ‘disability’ from activism entirely – to its detriment. Doing so compromises its explanatory power, over-generalizes the concept and prevents the insertion of meaningful boundaries. Barnes’ ‘solidarity thesis’ soundly conceptualizes disability whilst making room for activist voices. The centering of activist projects makes it stronger. (shrink)

Disability studies can be of great value to medical education first, by placing the medical paradigm in the broad context of a sequence of ways of understanding and responding to disability that have emerged in the last two thousand years or so; second, by reminding medical professionals that people with disabilities have suffered as well as profited from medical treatment in the last two hundred years; finally, by providing access to a distinctive point of (...) view from which the experience of disability looks very different than it may from the outside. (shrink)

In this article, I argue for historical epistemology as a methodology for critical disability studies by examining Foucault’s archaeology of cure in History of Madness. Although the moral, medical, and social models of disability frame disability history as an advancement upon moral and medical authority and a replacement of it by sociopolitical knowledge, I argue that the more comprehensive frame in which these models circulate—the “models framework”—requires the more nuanced approach that historical epistemology offers. In (...) particular, the models framework requires greater use of epistemology as an analytical tool for understanding the historical construction of disability. Thus, I turn to Foucault’s History of Madness in order to both excavate one particular archaeological strand in the text—the archaeology of cure—and to demonstrate how this narrative disrupts some of the key assumptions of the models framework, challenging DS to consider the epistemological force of non-medical fields of knowledge for framing disability and procedures for its cure and elimination. I conclude by arguing that DS must develop historical epistemological methodologies that are sensitive to the complex overlays of moral, medical, and social knowledge, as well as attend to the social construction of scientific and biomedical knowledge itself. (shrink)

Critical reflection on the importance of shaping disability-friendly - or disability-inclusive - congregations has enjoyed increasing attention in the field of practical theology in recent years. Moreover, the development of disability theology is a testament to the fact that practical theologians and the wider church community have taken serious notice of the realities and experiences of people with disabilities in our time. Nevertheless, even before the task of engaging in theological reflection from a disability perspective commences, (...) it is necessary that theologians acquaint themselves with the various models of disability that shape people's perceptions and ideas about people with disabilities. Guided by the principles of the interpretive task of practical theological investigation and cognizant of the importance of models of disability in shaping perceptions regarding people with disabilities, this article seeks to provide a brief overview of nine of the most dominant models of disability that are prevalent in our time. We shall utilise the typological approach to theoretical analysis in order to outline the basic characteristics of the various models. (shrink)

The diagnosis of idiopathic short stature refers to children who are considerably shorter than average without any identified medical reason. The US Food and Drug Administration authorised marketing of recombinant human growth hormone for ISS in 2003, while the European Medicines Agency refused it in 2007. This paper examines the arguments for these decisions as detailed in selected FDA and EMA documents. It combines argumentative analysis with an approach to policy analysis called ‘What’s the problem represented to be’. It (...) argues that the FDA presents its approval as an argument for equity of access to the treatment, describing short stature as a potential disadvantage, and assuming that height normalisation is a clinically meaningful result. The EMA, instead, refuses marketing authorisation with an argument that there is an imbalance of risks and benefits, describing ISS as a healthy condition, and arguing that hGH should provide some psychosocial and/or quality of life benefits to children with ISS other than height gain. This paper then discusses how these arguments could be read through different models of disability, particularly through the medical model of disability and the relational, experiential, and cultural understandings of disability. (shrink)

Assumptions about obesity—e.g., its connection to ill health, its causes, etc.—are still prevalent today, and they make up what I call the medical model of fatness. In this paper, I argue that the medical model was established on the basis of insufficient evidence and has nevertheless continued to be relied upon to justify methodological choices that further entrench the assumptions of the medical model. These choices are illegitimate in so far as they conflict with (...) both the epistemic and social aims of obesity research. I conclude the paper with a partial solution to these epistemic and social shortcomings. (shrink)

Chronic pain is one of the most disabling medical conditions globally, yet, to date, we lack a satisfying theoretical framework for research and clinical practice. Over the prior decades, several frameworks have been presented with biopsychosocial models as the most promising. However, in translation to clinical practice, these models are often applied in an overly reductionist manner, leaving much to be desired. In particular, they often fail to characterize the complexities and dynamics of the lived experience of chronic pain. (...) Recently, an enactive, affordance-based approach has been proposed, opening up new ways to view chronic pain. This model characterizes how the persistence of pain alters a person’s field of affordances: the unfolding set of action possibilities that a person perceives as available to them. The affordance-based model provides a promising perspective on chronic pain as it allows for a systematic investigation of the interactive relation between patients and their environment, including characteristic alterations in the experience of their bodies and the space they inhabit. To help bridge the gap from philosophy to clinical practice, we unpack in this paper the core concepts of an affordance-based approach to chronic pain and their clinical implications, highlighting aspects that have so far received insufficient attention. We do so with an analogy to playing video games, as we consider such comparative illustration a useful tool to convey the complex concepts in an affordance-based model and further explore central aspects of the lived experience of chronic pain. (shrink)

The medical and social model of disability is discussed and debated among researchers, scholars, activists, and people in general. It is common to hold a mixed view and believe that some disabled people suffer more from social obstacles and others more from medical problems inherent in their bodies or minds. Rachel Cooper discusses possible ‘test environments’, making explicit an idea which likely plays an implicit part in many disability discussions. We place or imagine placing the (...) disabled person in a range of different environments. If there is a relevant test environment in which they do fine, their problem was societal/external; if there is not, it was medical/internal. Cooper admits that deciding on the appropriate range of test environments is an ethical and political question. In this chapter, I argue that we often ought to widen our scope when discussing psychiatric disabilities. (shrink)

This article reviews the contributions of the UN Convention on the Rights of Persons with Disabilities to the progressive development of both international human rights law and global health law and governance. It provides a summary of the global situation of persons with disabilities and outlines the progressive development of international disability standards, noting the salience of the shift from a medical model of disability to a rights-based social model reflected in the CRPD. Thereafter, the (...) article considers the Convention's structure and substantive content, and then analyzes in specific detail the particular contributions of the Convention to health and human rights law and global health governance. It concludes with an exploration of the potential implications of the CRPD's innovations for some of the most pressing issues in global health governance, including the Convention's contributions to the principle of participation in decision-making. (shrink)

This article addresses the precarious place of transgender and gender non-cis persons in relation to their discrimination-protections in recent legal, medical, and ethical policies in the United States. At present, there exists a contradiction such that trans persons are considered "pathological" enough that they are included in the latest iteration of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) as "gender dysphoric," but they are not included in the category of "disabled" under the Americans with Disabilities Act (ADA). (...) As such, trans persons in America are subject to the stigma of pathology (albeit with medical treatment) without the full protections of the ADA. By contrast, transgender and non-cis-gender Americans find their queer cohorts who are HIV-positive to be fully protected by the ADA. We ask whether transgender and non-cis-gender persons should embrace their (already pathologized) personhood as a disability. Sometimes "choosing disability" affords more rights than it deploys stigma. (shrink)

The rhetoric of the social model of disability is presented, and its basic claims are critiqued. Proponents of the social model use the distinction between impairment and disability to reduce disabilities to a single social dimension—social oppression. They downplay the role of biological and mental conditions in the lives of disabled people. Consequences of denying biological and mental realities involving disabilities are discussed. People will benefit most by recognizing both the biological and the social dimensions of (...) disabilities. (shrink)

Biomedical science has been remarkably successful in explaining illness by categorizing diseases and then by identifying localizable lesions such as a virus and neoplasm in the body that cause those diseases. Not surprisingly, researchers have aspired to apply this powerful paradigm to addiction. So, for example, in a review of the neuroscience of addiction literature, Hyman and Malenka (2001, p. 695) acknowledge a general consensus among addiction researchers that “[a]ddiction can appropriately be considered as a chronic medical illness.” Like (...) other diseases, “Once addiction has taken hold, it tends to follow a chronic course.” (Koob and La Moal 2006, p. ?). Working from this perspective, much effort has gone into characterizing the symptomology of addiction and the brain changes that underlie them. Evidence for involvement of dopamine transmission changes in the ventral tegmental area (VTA) and nucleus accumbens (NAc) have received the greatest attention. Kauer and Malenka (2007, p. 844) put it well: “drugs of abuse can co-opt synaptic plasticity mechanisms in brain circuits involved in reinforcement and reward processing”. Our goal in this chapter to provide an explicit description of the assumptions of medical models, the different forms they may take, and the challenges they face in providing explanations with solid evidence of addiction. <br>. (shrink)

abstract Emerging from the political activism of disabled people's movements and mainly theorised by the scholar Michael Oliver, the social model of disability is central to current debates in Disability Studies as well as to related perspectives on inclusive education. This article presents a philosophical critique of the social model of disability and outlines some of its theoretical problems. It argues that in conceptualising disability as unilaterally socially caused, the social model presents a (...) partial and, to a certain extent, flawed understanding of the relation between impairment, disability and society, thus setting a framework that needs clarifications and extensions and presents limits to the achievement of its own aim of inclusion. This article concludes by suggesting that, despite its theoretical limits, the social model acts as a powerful and important reminder to face issues of inclusion as fundamental, moral issues. (shrink)

In this paper, we offer a new account of disability. According to our account, some state of a person's biology or psychology is a disability if that state makes it more likely that a person's life will get worse, in terms of his or her own wellbeing, in a given set of social and environmental circumstances. Unlike the medical model of disability, our welfarist approach does not tie disability to deviation from normal species’ functioning, (...) nor does it understand disability in essentialist terms. Like the social model of disability, the welfarist approach sees disability as a harmful state that results from the interaction between a person's biology and psychology and his or her surrounding environment. However, unlike the social model, it denies that the harm associated with disability is entirely due to social prejudice or injustice. In this paper, we outline and clarify the welfarist approach, answer common objections and illustrate its usefulness in addressing a range of difficult ethical questions involving disability. (shrink)