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Humanities

Social and medical models of disability and mental health: evolution and renewal

Andrew J. Hogan
CMAJ January 07, 2019 191 (1) E16-E18; DOI: https://doi.org/10.1503/cmaj.181008
Andrew J. Hogan
Department of History, Creighton, University College of Arts and Sciences, Omaha, Neb.
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  • RE: Social model of disability must be a core competency in newly developing Competency by Design medical education programmes in Canada
    Jeff Nisker MD PhD FRCSC FCAHS
    Posted on: 23 January 2019
  • A call to recognize the value in disability
    Lesley A. Tarasoff
    Posted on: 10 January 2019
  • RE: Social and medical models of disability
    Dhastagir Sultan Sheriff
    Posted on: 09 January 2019
  • Posted on: (23 January 2019)
    Page navigation anchor for RE: Social model of disability must be a core competency in newly developing Competency by Design medical education programmes in Canada
    RE: Social model of disability must be a core competency in newly developing Competency by Design medical education programmes in Canada
    • Jeff Nisker MD PhD FRCSC FCAHS, Physician, researcher, educator, Western University

    Although I applaud Hogan’s article (1) for bringing the social model of disability to the attention of its extensive readership, as well as the need for more persons with disabilities to be able to attend medical school, the article is dismissive of the imperative that the social model of disability be prominent in all levels of medical education. The need for the social model of disability to replace the medical model has been called for by disability scholars for decades (2-4). Further, it has been emphasized that the social model and indeed all education promoting the health of persons with disabilities be designed and taught by persons with disabilities (2-4), honouring the concept “Nothing about us, without us” (5). This need was reinforced by our recent research interviewing Canadian women’s health physicians, whose transcripts displayed lack of knowledge of the legal rights of women with disabilities, and lack of understanding of how persons with disabilities see themselves and want to be seen (6). The physicians commented on their lack of any training in promoting the health of disabled persons, including no knowledge of the social model of disability (6). An immediate opportunity exists in Canada for “competency” in the health promotion of persons with disabilities to be included as a core “competency” in the newly developing “Competency by Design” undergraduate and postgraduate medical education programmes. Further, this competency should be based on the social...

    Show More

    Although I applaud Hogan’s article (1) for bringing the social model of disability to the attention of its extensive readership, as well as the need for more persons with disabilities to be able to attend medical school, the article is dismissive of the imperative that the social model of disability be prominent in all levels of medical education. The need for the social model of disability to replace the medical model has been called for by disability scholars for decades (2-4). Further, it has been emphasized that the social model and indeed all education promoting the health of persons with disabilities be designed and taught by persons with disabilities (2-4), honouring the concept “Nothing about us, without us” (5). This need was reinforced by our recent research interviewing Canadian women’s health physicians, whose transcripts displayed lack of knowledge of the legal rights of women with disabilities, and lack of understanding of how persons with disabilities see themselves and want to be seen (6). The physicians commented on their lack of any training in promoting the health of disabled persons, including no knowledge of the social model of disability (6). An immediate opportunity exists in Canada for “competency” in the health promotion of persons with disabilities to be included as a core “competency” in the newly developing “Competency by Design” undergraduate and postgraduate medical education programmes. Further, this competency should be based on the social model of disability, and be designed and taught by persons with disabilities.

    References

    1. Hogan AJ. Social and medical models of disability and mental health: evolution and renewal. CMAJ. 2019(191):E16-8.
    2. Oliver M. The Politics of Disablement: A Sociological Approach. New York, NY: St. Martin's Press, Inc.; 1990.
    3. Linton S. Claiming Disability: Knowledge and Identity. New York: New York University Press; 1998.
    4. Shakespeare T. Disability Rights and Wrongs. New York: Routledge; 2006.
    5. Charlton JI. Nothing About Us Without Us: Disability Oppression and Empowerment. Berkeley, California: Unviersity of California Press; 1998.
    6. Joseph M, Saravanabavan S, Nisker J. Physicians’ Perceptions of Barriers to Equal Access to Reproductive Health Promotion for Women with Mobility Impairment. Canadian Journal of Disability Studies. 2018;7(1).

    Show Less
    Competing Interests: None declared.
  • Posted on: (10 January 2019)
    Page navigation anchor for A call to recognize the value in disability
    A call to recognize the value in disability
    • Lesley A. Tarasoff, Postdoctoral Research Fellow, University of Toronto Scarborough

    It was a pleasure to read Hogan’s article on the social and medical models of disability in the most recent issue of the CMAJ. As someone who does work at the intersections of public health, disability studies, gender studies, and psychology, I was delighted to see Hogan’s eloquent summary of the history of the medical and social models of disability include the perspectives of some feminist disability scholars. What Liz Crow and other feminist disability scholars (1-3) argue is for was an embodied, relational understanding of disability, wherein disability is understood as simultaneously material or physical (i.e., in or of our bodies) and shaped by social interactions, discourses, and the environment around us (i.e., experienced through our bodies).

    I found this to be the case in my own research on the pregnancy and motherhood experiences of women with physical disabilities (4-5). For women with physical disabilities, disability, while experienced as limiting and even frustrating in many ways, was also experienced as a sort of blessing in the perinatal period.

    "I thought pregnancy was the hard part and it really wasn’t. It was easier than [I expected]. All the able-bodied women that I knew were complaining. … I had it [morning sickness] but I wasn’t awful… I think in part because I’ve been dealing with physical limitations for so long, I was like, 'this is it?' I think a lot of able-bodied women are like 'ugh, I don’t have control over...

    Show More

    It was a pleasure to read Hogan’s article on the social and medical models of disability in the most recent issue of the CMAJ. As someone who does work at the intersections of public health, disability studies, gender studies, and psychology, I was delighted to see Hogan’s eloquent summary of the history of the medical and social models of disability include the perspectives of some feminist disability scholars. What Liz Crow and other feminist disability scholars (1-3) argue is for was an embodied, relational understanding of disability, wherein disability is understood as simultaneously material or physical (i.e., in or of our bodies) and shaped by social interactions, discourses, and the environment around us (i.e., experienced through our bodies).

    I found this to be the case in my own research on the pregnancy and motherhood experiences of women with physical disabilities (4-5). For women with physical disabilities, disability, while experienced as limiting and even frustrating in many ways, was also experienced as a sort of blessing in the perinatal period.

    "I thought pregnancy was the hard part and it really wasn’t. It was easier than [I expected]. All the able-bodied women that I knew were complaining. … I had it [morning sickness] but I wasn’t awful… I think in part because I’ve been dealing with physical limitations for so long, I was like, 'this is it?' I think a lot of able-bodied women are like 'ugh, I don’t have control over my body now and all the sudden I have to pee 5 times in the night.' I know what that’s like already, so it wasn’t really shocking to me to have the limitations, in terms of what I could do. You have to go with it and make adjustments. I think if you are able-bodied, you might have a harder time with that because you are just used being able to do whatever you want to do, whenever you want to do it." (4) - Woman with a lumbar spinal cord injury.

    When understanding disability from a medical model perspective, people with disabilities are considered to be inherently defective and “unruly” and marginalized as a result; they are undesirable unless they are treated or cured. My research however shows that there is value in the “unruly” disabled body and there is much to learn from the experiences of often-marginalized bodies.

    As the above quotation suggestions, women with physical disabilities may be better able to adapt to or even embrace the bodily changes associated with pregnancy given their experiential knowledge of living with a disabled body, a body that is not always controllable. The pregnancy experiences of women with physical disabilities may challenge the notion that a lack of bodily control during pregnancy (and in general when experienced by people without disabilities) is only negative or detrimental. From my interviews with women with physical disabilities, I found that during pregnancy, the embodied experience of disability can be appreciated, and offers a re-imagination of the “unruly” body. The embodied experience of disability may serve as resource or an opportunity for others to draw on should they experience a significant bodily change, whether it be pregnancy, injury, illness, or aging. In other words, as feminist disability scholar Alison Kafer1 has argued, “rethinking our cultural assumptions about disability… will benefit all of us.”

    With growing populations of older people and people with comorbid conditions, discussions among health care providers and between health care providers and their patients (both disabled and non-disabled) about the various understandings of disability and the value that disability might bring is vital now more than ever.

    References
    1. Kafer A. Feminist, queer, crip. Bloomington & Indianapolis (IN): Indiana University Press; 2013.
    2. Thomas C. Female forms: experiencing and understanding disability. Buckingham (England): Open University Press; 1999.
    3. Wendell S. (1996). The rejected body: feminist philosophical reflections on disability. New York (NY): Routledge; 1996.
    4. Tarasoff LA. A qualitative study of embodiment among women with physical disabilities during the perinatal period and early motherhood. Unpublished doctoral dissertation. Toronto (ON): University of Toronto; 2018.
    5. Tarasoff LA. “We don't know. We've never had anybody like you before”: Barriers to perinatal care for women with physical disabilities. Disabil Health J. 2017;10(3):426-33.

    Show Less
    Competing Interests: None declared.
  • Posted on: (9 January 2019)
    Page navigation anchor for RE: Social and medical models of disability
    RE: Social and medical models of disability
    • Dhastagir Sultan Sheriff, Professor, Independent Research Worker

    Disability whether it is physical or mental is both a social and medical phenomenon. Yet it requires that society addresses this issue with clarity and inclusiveness. Disability must not become a political slogan or a project for non-governmental social organizations (NGOs). It does not end with giving tools or aids to these people. They are part of the society and need to be included in the community without social discrimination and bias. They must be given equal opportunities in available resources of economic and social emancipation. It is known some of the greatest scientific minds and intellectuals have some form of disability. Therefore, the physical disability in certain cases bring the best out of the individual and providing a platform for their abilities is one of the social responsibilities of the society. It is vividly explained by the following statement:
    “the failure of a structured social environment to adjust to the needs and aspirations of citizens with disabilities rather than from the inability of the disabled individual to adapt to the demands of society.” (Hahn, H. 1986:128)
    When it comes to mental health though it is included in some states as a disability, there is a wide gap between the policies and execution of that policy with respect to mental health issues. Still in many countries mentally compromised individuals are considered as outcasts, isolated or sometimes confined or chained like inhuman beings. The mental health policies of...

    Show More

    Disability whether it is physical or mental is both a social and medical phenomenon. Yet it requires that society addresses this issue with clarity and inclusiveness. Disability must not become a political slogan or a project for non-governmental social organizations (NGOs). It does not end with giving tools or aids to these people. They are part of the society and need to be included in the community without social discrimination and bias. They must be given equal opportunities in available resources of economic and social emancipation. It is known some of the greatest scientific minds and intellectuals have some form of disability. Therefore, the physical disability in certain cases bring the best out of the individual and providing a platform for their abilities is one of the social responsibilities of the society. It is vividly explained by the following statement:
    “the failure of a structured social environment to adjust to the needs and aspirations of citizens with disabilities rather than from the inability of the disabled individual to adapt to the demands of society.” (Hahn, H. 1986:128)
    When it comes to mental health though it is included in some states as a disability, there is a wide gap between the policies and execution of that policy with respect to mental health issues. Still in many countries mentally compromised individuals are considered as outcasts, isolated or sometimes confined or chained like inhuman beings. The mental health policies of the government must be inclusive , provide healthy shelter, medical facilities and societal acknowledgement of their part in society.
    My personal experience is that my father accepted my mentally compromised mother as his partner, provided and met all her needs, protected from social stigma and gave her the status of a wife. (Sheriff, D.S. 1992)
    There is no model that can take address all the needs of these segment of population. Yet the most important model is a humanitarian model that treats them as humans who need our attention, recognition and help.

    1.Hahn, H. (1988). The politics of physical differences: disability and discrimination. Journal of Social Issues, 44 (1) 39-47

    2.D.S. Sheriff, Lesson from my father. American J Med, 1992;93;4, :441–442

    Show Less
    Competing Interests: None declared.
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Social and medical models of disability and mental health: evolution and renewal
Andrew J. Hogan
CMAJ Jan 2019, 191 (1) E16-E18; DOI: 10.1503/cmaj.181008

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Social and medical models of disability and mental health: evolution and renewal
Andrew J. Hogan
CMAJ Jan 2019, 191 (1) E16-E18; DOI: 10.1503/cmaj.181008
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