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Article Excerpt
Much of the way in which rehabilitation practitioners, educators, and researchers undertake their work is guided by the model of disability to which they subscribe (Harper, 1991; Tate & Pledger, 2003). Models of disability define disability, determine casual and responsibility attributions, influence professional practice, drive payment systems, and guide legislation (Dembo, 1982; Hahn, 1993; Nagi, 1969; Zola, 1989). Models of disability permeate every professional relationship in rehabilitation; these models also serve as the structure for rehabilitation and disability research development, providing the rationale for the funding of large studies. Further, every type of rehabilitation/disability resource allocation has its basis in a model of disability and agency policies and regulations trace their origins to a model of disability (Albrecht, 1981, 1992; Berkowitz, 1987; Bickenbach, 1993; Fox, 1993; Wolfensberger, 1972). Thus, the daily lives of people with disabilities, if and how they are educated, if and where they work, and their social and familial life, in large part are determined by models of disability. Perhaps, most important, models of disability exert a powerful influence on the public perception of disability and the public's response to people with disabilities. Consequently, models of disability have the capacity to shape the self-identity of those with disabilities (Conrad, 2004; Davis, 1997; Hannah & Midlarsky, 1987; Hulnick & Hulnick, 1989; Longmore, 1995; Nagi, 1969).
Surprisingly, the power of models of disability is rarely acknowledged or addressed; nor, are these models questioned or challenged (Gill, Kewman, & Brannon, 2003; Harper, 1991; Pledger, 2003). Indeed, most practitioners are only marginally aware that there are other models and that patients/clients/consumers may, and often do, subscribe to a different model. A therapeutic alliance, therefore, is difficult to establish if the professional and client define the disability differently and, as a result, envision different treatments and services. Most practitioners function in the way in which they have been educated and trained (Bauman & Drake, 1997; Bluestone, Stokes, & Kuba, 1996; Gill et al., 2003; Hogben & Waterman, 1997; Kemp & Mallinkrodt, 1996; Parsons, Hernandez, & Jorgensen, 1998). For example, if a practitioner has been trained to view disability as solely a clinical concept, he or she will conceptualize the necessary response to be clinical treatment.
Models of disability are the underlying structure for large, complex diagnostic/defining systems, such as the International Classification of Disabilities, Impairments, and Handicaps--2 (ICIDH-2) (WHO, 1993, 2001) and the Diagnostic and Statistical Manual IV--Text Revision (DSM-IV-TR, American Psychiatric Association, 2000) and the International Classification of Functioning, Disability, and Health (ICF, World Heath Organization, 2001). In turn, these diagnostic systems are used not only for clinical purposes but also for research development, and administrative and social planning. Diagnoses, therefore, have profound political, social, and financial consequences (Hahn, 1985; Smart, 2005b).
Models provide both casual and responsibility attributions; these attributions determine which academic disciplines study and teach the disability experience. If disability is viewed as only a medical concern, then the cultural, historical, social, and political aspects will not be taught in psychology, sociology, political, science, law, or history curricula. Moreover, most people with disabilities, after medical stabilization has been achieved, consider the social, cultural, and political aspects of the disability experience to be their most important concern (Bowe, 1980; Dembo, 1974; Smart, 2005a, 2005b). However, it is likely that there are few professionals, who possess the adequate background, training and clinical experience to provide these social, cultural, and family support services.
Despite the persuasive power and influence of models of disability and their very tangible results, these models are not reality or fact, but rather human-made representations of reality (Eisenberg, Griggins, & Duval, 1982; Smart, 2001). Each model, then, reflects the needs, values, and purposes of its definers and thus none is morally neutral (Clendinen & Nagourney, 1999; Kirk & Kuchins, 1992; Stone, 1984; Zola, 1993). All models are somewhat time-bound and culture-bound; different concepts of disability have historically led to different methods of dealing with disability and ways of responding to individuals who experience disabilities. Further, at present, there is no single model with the capability to describe and explain every aspect of the disability experience, probably due to the fact that disability is a complex, multivariate experience (Tate & Pledger, 2003). Stated differently, each model is reductionistic or incomplete, emphasizing some aspects of the disability experience and ignoring others (Bickenbach, Chatterji, Badley, & Ustin, 1999; Zola, 1989).
Thus, there are weaknesses and limits to each model of disability. Furthermore, the definitions, casual attributions, and interventions of each model conflict with their counterparts in the other models; however, adherents of one model often do not reject the viewpoints of other models. Nonetheless, each model is capable of change and, indeed, all models are required to make refinements and modifications. The evolutionary path of all models can be easily traced, often through reviewing their results.
In view of the power and influence of models of disability, a general overview of the models will provide insight into the rationale and evolutionary path of each, the weaknesses and strengths of each model and their results in four broad areas: legislation and policy, training and education, professional practice, and research. It is important to discuss all of these models in order to view the evolutionary path and to construct a basis upon which to make comparisons. To present a comparative overview, it is necessary to be somewhat brief, general, and broad. Accordingly, first a brief description of each of three models of disability will be presented. Secondly, the weaknesses and strengths of each model will be discussed. Finally, the diversity of these three models will be considered as broadening the definition and response to disability. All models have strengths and weaknesses and the vestiges of these models are deeply entrenched in the broader culture. Nonetheless, each model fills important needs.
Three Broad Models of Disability
Biomedical Model of Disability
Only the Moral/ Religious Model has a longer history than the Biomedical Model. The Biomedical Model has the prestige and authority of established academic areas of study and professions: science and medicine (Kerr & Myerson, 1987; Stone, 1984). In addition, the Biomedical Model has a great deal of scientific rigor and objectivity. Perhaps the greatest strength of this model is the ease with which its diagnostic/definitional system is understood by the general public. Because of the intuitive understanding of the general public, the Biomedical Model has had dominance in shaping the public's perception and attitude toward disability (Ferguson, Ferguson, & Taylor, 1992).
In the Biomedical Model, disability is thought to be pathology, disorder, dysfunction, or deformity that is located within an individual (Bickenbach, 1993). This has been termed the "pathology orientation" or "deficit orientation" (Wright, 1991)....
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