Disability is the consequence of an impairment that may be physical, cognitive, intellectual, mental, sensory, developmental, or some combination of these that results in restrictions on an individual's ability to participate in what is considered "normal" in their everyday society. A disability may be present from birth or occur during a person's lifetime.
Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus, disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.
Disability is a contested concept, with different meanings for different communities. On the one hand, it may be used to refer to physical or mental attributes that some institutions, particularly medicine, view as needing to be fixed (the medical model); it may refer to limitations on participation in social life imposed on people by the constraints of an ableist society (the social model); or the term may serve to name a social identity claimed by people with disabilities in order to mark their shared goals and politics.
The contest over disability's definition arose out of disability activism in the U.S. and U.K. in the 1970s, which challenged how medical conceptions of human variation dominated popular discourse about disabilities and how these were reflected in common terminology (e.g., "handicapped," "cripple"). Debates about proper terminology as well as over appropriate models and their implied politics continue in disability communities and the academic field of disability studies. In many countries the law requires that disabilities be clearly categorized and defined in order to assess which citizens qualify for disability benefits.
|This section needs additional citations for verification. (February 2016) (Learn how and when to remove this template message)|
Contemporary understandings of disability derive from concepts that arose during the West's scientific Enlightenment; prior to the Enlightenment, physical differences were viewed through a remarkably different lens. During the Middle Ages, madness and other conditions (epilepsy, e.g.) were thought to be caused by demons; on the other hand, they were also thought to be part of the natural order, especially during and in the fallout of the Plague, which wrought impairments throughout the general population. In the early modern period there was a shift to seeking biological causes for physical and mental differences, as well as heightened interest in demarcating categories: for example, Ambroise Pare, in the sixteenth century, wrote of "monsters," "prodigies," and "the maimed." The European Enlightenment's emphases on knowledge derived from reason and on the value of natural science to human progress helped spawn the birth of institutions and associated knowledge systems that observed and categorized human beings; among these, the ones significant to the development of today's concepts of disability were asylums, workhouses, prisons, and clinical spaces in which medicine was practiced.
Contemporary concepts of disability are firmly rooted in eighteenth- and nineteenth-century developments. Foremost among these was the development of clinical medical discourse, which made the human body visible as a thing to be studied, manipulated, and transformed. These worked in tandem with scientific discourses that sought to classify and categorize and, in so doing, became methods of normalization. The concept of the "norm" developed in this time period, and is signaled in the work of the French statistician Alphonse Quetelet, who wrote in the 1830s of l'homme moyen – the average man. Quetelet postulated that one could take the sum of all people's attributes in a given population (such as their height or weight) and find their average, and that this figure should serve as a norm toward which all should aspire. This idea of a statistical norm threads through the rapid take up of statistics gathering by Western European states, Britain, and the United States during this time period, and it is deeply tied to the rise of eugenics. It also served as the soil out of which concepts of disability would gestate, since once a norm is defined, a set of other concepts – nonnormal; abnormal; normalcy – adhere around it. The circulation of these concepts is evident in the popularity of the freak show, where showmen profited from exhibiting people who deviated from those norms.
With the rise of eugenics in the latter part of the nineteenth century, such deviations were viewed as dangerous to the health of entire populations. With disability viewed as part of a person's biological make-up and thus their genetic inheritance, scientists turned their attention to notions of weeding such deviations out of the gene pool. Various metrics for assessing a person's genetic fitness arose – for example, IQ tests, still in use today – which were then used to deport, sterilize, or institutionalize those deemed unfit. At the end of the Second World War, with the horrible example of Nazi eugenics near at hand, eugenics faded from public discourse, and increasingly disability cohered into a set of attributes that medicine could attend to – whether through treatment, rehabilitation, augmentation, and so forth.
In the early 1970s, disability activists began to challenge not only how society treated people with disabilities but also the heavily medical approach to disability. Out of their work identifying how material barriers to access constituted conditions that functionally disabled them emerged what is today known as the social model of disability. Coined by Mike Oliver in 1983, this phrase distinguishes between the medical model of disability – under which an impairment needs to be fixed – and the social model of disability – under which the society that limits a person needs to be fixed.
Different terms have been used for people with disabilities in different times and places. The euphemism treadmill and changing fashions have caused terms to rise or fall in popularity.
Disability or impairment are commonly used, as are more specific terms, such as blind (to describe having no vision at all) or visually impaired (to describe having limited vision).
Handicap has been disparaged as a result of false folk etymology that says it is a reference to begging. It is actually derived from an old game, Hand-i'-cap, in which two players trade possessions and a third, neutral person judges the difference of value between the possessions. The concept of a neutral person evening up the odds was extended to handicap racing in the mid-18th century. In handicap racing, horses carry different weights based on the umpire's estimation of what would make them run equally. The use of the term to describe a person with a disability—by extension from handicap racing, a person carrying a heavier burden than normal—appeared in the early 20th century.
Handicap replaced terms that are now considered insulting, such as crippled.
Impairment is the correct term to use to define a deviation from normal, such as not being able to make a muscle move or not being able to control an unwanted movement. Disability is the term used to define a restriction in the ability to perform a normal activity of daily living which someone of the same age is able to perform. For example, a three-year-old child who is not able to walk has a disability because a normal three-year-old can walk independently. Handicap is the term used to describe a child or adult who, because of the disability, is unable to achieve the normal role in society commensurate with his age and socio-cultural milieu. As an example, a sixteen-year-old who is unable to prepare his own meal or care for his own toileting or hygiene needs is handicapped. On the other hand, a sixteen-year-old who can walk only with the assistance of crutches but who attends a regular school and is fully independent in activities of daily living is disabled but not handicapped. All disabled people are impaired, and all handicapped people are disabled, but a person can be impaired and not necessarily be disabled, and a person can be disabled without being handicapped.
The American Psychological Association style guide states that, when identifying a person with an impairment, the person's name or pronoun should come first, and descriptions of the impairment/disability should be used so that the impairment is identified, but is not modifying the person. Improper examples are "a borderline", "an obsessive-compulsive man," or "a mentally ill person"; more acceptable terminology includes "a woman with Down syndrome" or "a man who has schizophrenia". It also states that a person's adaptive equipment should be described functionally as something that assists a person, not as something that limits a person, for example, "a woman who uses a wheelchair" rather than "a woman in/confined to a wheelchair."
A similar kind of "people-first" terminology is also used in the UK, but more often in the form "people with impairments" (such as "people with visual impairments"). However, in the UK, the term "disabled people" is generally preferred to "people with disabilities". It is argued under the social model that while someone's impairment (for example, having a spinal cord injury) is an individual property, "disability" is something created by external societal factors such as a lack of wheelchair access to the workplace. This distinction between the individual property of impairment and the social property of disability is central to the social model. The term "disabled people" as a political construction is also widely used by international organisations of disabled people, such as Disabled Peoples' International (DPI).
To a certain degree, physical impairments and diminishing mental states are almost ubiquitously experienced by people as they age. Aging populations are often stigmatized for having a high prevalence of disability. Kathleen Woodward, writing in Key Words for Disability Studies, explains the phenomenon as follows:
Aging is invoked rhetorically-at times ominously-as a pressing reason why disability should be of crucial interest to all of us (we are all getting older, we will all be disabled eventually), thereby inadvertently reinforcing the damaging and dominant stereotype of aging as solely an experience of decline and deterioration. But little attention has been given to the imbrication of aging and disability.
There is a global correlation between disability and poverty, produced by a variety of factors. Disability and poverty may form a vicious circle, in which physical barriers make it more difficult to get income, which in turn diminishes access to health care and other necessities for a healthy life. The World report on disability indicates that half of all disabled people cannot afford health care, compared to a third of non-disabled people. In countries without public services for adults with disabilities, their families may be impoverished.
There is limited research knowledge, but many anecdotal reports, on what happens when disasters impact people with disabilities. Individuals with disabilities are greatly affected by disasters. Those with physical disabilities can be at risk when evacuating if assistance is not available. Individuals with cognitive impairments may struggle with understanding instructions that must be followed in the event a disaster occurs. Those who are blind, hearing impaired, etc. may have difficulty communicating during the emergency. All of these factors can increase the degree of variation of risk in disaster situations with disabled individuals.
Research studies have consistently found discrimination against individuals with disabilities during all phases of the disaster cycle. The most common limitation is that people cannot physically access buildings or transportation, as well as access disaster-related services. The exclusion of these individuals is caused in part by the lack of disability-related training provided to emergency planners and disaster relief personnel.
The International Classification of Functioning, Disability and Health (ICF), produced by the World Health Organization, distinguishes between body functions (physiological or psychological, such as vision) and body structures (anatomical parts, such as the eye and related structures). Impairment in bodily structure or function is defined as involving an anomaly, defect, loss or other significant deviation from certain generally accepted population standards, which may fluctuate over time. Activity is defined as the execution of a task or action. The ICF lists 9 broad domains of functioning which can be affected:
In concert with disability scholars, the introduction to the ICF states that a variety of conceptual models has been proposed to understand and explain disability and functioning, which it seeks to integrate. These models include the following:
The medical model views disability as a problem of the person, directly caused by disease, trauma, or other health conditions which therefore requires sustained medical care in the form of individual treatment by professionals. In the medical model, management of the disability is aimed at a "cure," or the individual’s adjustment and behavioral change that would lead to an "almost-cure" or effective cure. In the medical model, medical care is viewed as the main issue, and at the political level, the principal response is that of modifying or reforming healthcare policy.
The social model of disability sees the issue of "disability" as a socially created problem and a matter of the full integration of individuals into society. In this model, disability is not an attribute of an individual, but rather a complex collection of conditions, many of which are created by the social environment. Hence, the management of the problem requires social action and it is the collective responsibility of society at large to make the environmental modifications necessary for the full participation of people with disabilities in all areas of social life. The issue is both cultural and ideological, requiring individual, community, and large-scale social change. From this perspective, equal access for someone with an impairment/disability is a human rights issue of major concern. Some says that Medical humanities is a fruitful field where the gap between the medical and the social model of disability might be bridged. Recently, the social model of disability has come under criticism. While recognizing the importance played by the social model in stressing the responsibility of society, many scholars, especially Tom Shakespeare, point out the many limits of the model, and urge the need for a new model that will overcome the "medical vs. social" dichotomy.
The social construction of disability is the idea that disability is constructed by social expectations and institutions rather than biological differences. Highlighting the ways society and institutions construct disability is one of the main goals of this idea. In the same way that race and gender are not biologically fixed, neither is disability.
Around the early 1970s many sociologists, notably Eliot Friedson, began to argue that labeling theory and social deviance could be applied to disability studies. This led to the creation of the social construction of disability theory. The social construction of disability is the idea that disability is constructed as the social response to a deviance from the norm. The medical industry is the creator of the ill and disabled social role. Medical professionals and institutions, who wield expertise over health, have the ability to define health and physical and mental norms. When an individual has a feature that creates an impairment, restriction, or limitation from reaching the social definition of health, the individual is labeled as disabled. Under this idea, disability is not defined by the physical features of the body but by a deviance from the social convention of health.
Social construction of disability would argue that the medical model of disability's view that a disability is an impairment, restriction, or limitation is wrong. Instead what is seen as a disability is just a difference in the individual from what is considered "normal" in their society.
In contexts where their differences are visible, persons with disabilities often face stigma. People frequently react to disabled presence with fear, pity, patronization, intrusive gazes, or disregard. These reactions can, and often do, exclude persons with disabilities from accessing social spaces along with the benefits and resources these spaces provide. Disabled writer/researcher Jenny Morris describes how stigma functions to marginalize persons with disabilities:
“Going out in public so often takes courage. How many of us find that we can't dredge up the strength to do it day after day, week after week, year after year, a lifetime of rejection and revulsion? It is not only physical limitations that restrict us to our homes and those whom we know. It is the knowledge that each entry into the public world will be dominated by stares, by condescension, by pity and by hostility.”
Additionally, facing stigma can cause harm to psycho-emotional well-being of the person being stigmatized. One of the ways in which the psycho-emotional health of persons with disabilities is adversely affected is through the internalization of the oppression they experience, which can lead to feeling that they are weak, crazy, worthless, or any number of other negative attributes that may be associated with their conditions. Internalization of oppression damages the self-esteem of the person affected and shapes their behaviors in ways that are compliant with nondisabled dominance. Ableist ideas are frequently internalized when disabled people are pressured by the people and institutions around them to hide and downplay their disabled difference, or, "pass." According to writer Simi Linton, the act of passing takes a deep emotional toll by causing disabled individuals to experience loss of community, anxiety and self-doubt. The media play a significant role in creating and reinforcing stigma associated with disability. Media portrayals of disability usually cast disabled presence as necessarily marginal within society at large. These portrayals simultaneously reflect and influence popular perception of disabled difference.
There are distinct tactics that the media frequently employ in representing disabled presence. These common ways of framing disability are heavily criticized for being dehumanizing and failing to place importance on the perspectives of persons with disabilities.
Inspiration porn refers to portrayals of persons with disabilities in which they are presented as being inspiring simply because the person has a disability. These portrayals are criticized because they are created with the intent of making able-bodied viewers feel better about themselves in comparison to the individual portrayed. Rather than recognizing the humanity of persons with disabilities, inspiration porn turns them into objects of inspiration for a nondisabled audience.
The supercrip trope refers to instances when the media report on or portray a disabled individual who has made a noteworthy achievement but center on the person's disabled difference rather than what they actually did. They are portrayed as awe-inspiring for their ability to be exceptional in spite of their condition. This trope is widely used in reporting on disabled sports as well as in portrayals of autistic savants. Persons with disabilities denounce these representations as reducing people to their condition rather than viewing them as full people. Furthermore, supercrip portrayals are criticized for creating the unrealistic expectation that disability should be accompanied by some type of special talent, genius, or insight.
Characters in fiction that bear physical or mental markers of difference are frequently positioned as villains within a text. Lindsey Row-Heyveld notes that it isn’t difficult to figure out, for instance, “that villainous pirates are scraggly, wizened, and inevitably kitted out with a peg leg or hook hand, whereas heroic pirates look like Johnny Depp.” The use of disabled difference to evoke fear in audiences perpetuates the view that persons with disabilities are a threat to public interests and well-being.
One of the key ways that people with disabilities have resisted marginalization is through the creation and promotion of the social model in opposition to the medical model. By doing this they shift criticism away from their bodies and various impairments towards the social institutions that oppress them. Disability activism that demands a wide variety of grievances be addressed, such as lack of accessibility, poor representation in media, general disrespect, and lack of recognition, can be said to originate from a social model framework. Furthermore, embracing disability as a positive identity by becoming involved in disability communities and participating in disability cultures can be an effective way to combat internalized oppression and challenge dominant narratives about disability.
The experiences that disabled people have navigating social institutions vary greatly as a function of what other social categories they may belong to. The categories that intersect with disabled difference to create unique experiences of ableism include, but aren’t limited to, race and gender.
Disabled individuals who are non-white generally have less access to support and are more vulnerable to violent discrimination. For example, in the United States people of color who are mentally ill are more frequently victims of police brutality than their white counterparts. Camille A. Nelson, writing for the Berkeley Journal of Criminal Law, notes that for “people who are negatively racialized, that is people who are perceived as being non-white, and for whom mental illness is either known or assumed, interaction with police is precarious and potentially dangerous.”
The marginalization of disabled difference can leave persons with disabilities unable to actualize what society expects of gendered existence. This lack of recognition for their gender identity can leave persons with disabilities with feelings of inadequacy. Thomas J. Gerschick of Illinois State University describes why this denial of gendered identity occurs:
"Bodies operate socially as canvases on which gender is displayed and kinesthetically as the mechanisms by which it is physically enacted. Thus, the bodies of people with disabilities make them vulnerable to being denied recognition as women and men."
To the extent that women and men with disabilities are gendered, the interactions of these two identities lead to different experiences. Disabled women face a sort of “double stigmatization” in which their membership to both of these marginalized categories simultaneously exacerbates the negative stereotypes associated with each as they are ascribed to them. As Rosemarie Garland-Thomson puts it, “Women with disabilities, even more intensely than women in general, have been cast in the collective cultural imagination as inferior, lacking, excessive, incapable, unfit, and useless.”
Assistive Technology is a generic term for devices and modifications (for a person or within a society) that help overcome or remove a disability. The first recorded example of the use of a prosthesis dates to at least 1800 BC. The wheelchair dates from the 17th century. The curb cut is a related structural innovation. Other examples are standing frames, text telephones, accessible keyboards, large print, Braille, & speech recognition software. People with disabilities often develop personal or community adaptations, such as strategies to suppress tics in public (for example in Tourette's syndrome), or sign language in deaf communities.
As the personal computer has become more ubiquitous, various organizations have formed to develop software and hardware to make computers more accessible for people with disabilities. Some software and hardware, such as Voice Finger, Freedom Scientific's JAWS, the Free and Open Source alternative Orca etc. have been specifically designed for people with disabilities while other software and hardware, such as Nuance's Dragon NaturallySpeaking, were not developed specifically for people with disabilities, but can be used to increase accessibility. The LOMAK keyboard was designed in New Zealand specifically for persons with disabilities. The World Wide Web consortium recognised a need for International Standards for Web Accessibility for persons with disabilities and created the Web Accessibility Initiative (WAI). As at Dec 2012 the standard is WCAG 2.0 (WCAG = Web Content Accessibility Guidelines).
The Paralympic Games (meaning "alongside the Olympics") are held after the (Summer and Winter) Olympics. The Paralympic Games include athletes with a wide range of physical disabilities. In member countries organizations exist to organize competition in the Paralympic sports on levels ranging from recreational to elite (for example, Disabled Sports USA and BlazeSports America in the United States).
The Paralympics developed from a rehabilitation programme for British war veterans with spinal injuries. In 1948, Sir Ludwig Guttman, a neurologist working with World War II veterans with spinal injuries at Stoke Mandeville Hospital in Aylesbury in the UK, began using sport as part of the rehabilitation programmes of his patients.
The disability rights movement aims to secure equal opportunities and equal rights for people with disabilities. The specific goals and demands of the movement are accessibility and safety in transportation, architecture, and the physical environment; equal opportunities in independent living, employment, education, and housing; and freedom from abuse, neglect, and violations of patients' rights. Effective civil rights legislation is sought to secure these opportunities and rights.
The early disability rights movement was dominated by the medical model of disability, where emphasis was placed on curing or treating people with disabilities so that they would adhere to the social norm, but starting in the 1960s, rights groups began shifting to the social model of disability, where disability is interpreted as an issue of discrimination, thereby paving the way for rights groups to achieve equality through legal means.
On December 13, 2006, the United Nations formally agreed on the Convention on the Rights of Persons with Disabilities, the first human rights treaty of the 21st century, to protect and enhance the rights and opportunities of the world's estimated 650 million disabled people. As of April 2011, 99 of the 147 signatories had ratified the Convention. Countries that sign the convention are required to adopt national laws, and remove old ones, so that persons with disabilities will, for example, have equal rights to education, employment, and cultural life; to the right to own and inherit property; to not be discriminated against in marriage, etc.; and to not be unwilling subjects in medical experiments. UN officials, including the High Commissioner for Human Rights, have characterized the bill as representing a paradigm shift in attitudes toward a more rights-based view of disability in line with the social model.
In 1976, the United Nations began planning for its International Year for Disabled Persons (1981), later renamed the International Year of Disabled Persons. The UN Decade of Disabled Persons (1983–1993) featured a World Programme of Action Concerning Disabled Persons. In 1979, Frank Bowe was the only person with a disability representing any country in the planning of IYDP-1981. Today, many countries have named representatives who are themselves individuals with disabilities. The decade was closed in an address before the General Assembly by Robert Davila. Both Bowe and Davila are deaf. In 1984, UNESCO accepted sign language for use in education of deaf children and youth.
In the United States, the Department of Labor's new (2014) rules for federal contractors, defined as companies that make more than $50,000/year from the federal government, require them to have as a goal that 7% of their workforce must be people with disabilities. In schools, the ADA says that all classrooms must be wheelchair accessible. The U.S. Architectural and Transportation Barriers Compliance Board, commonly referred to as the Access Board, created the Rehabilitation Act of 1973 to help offer guidelines for transportation and accessibility for the physically disabled.
In the UK, the Department for Work and Pension is a government department responsible for promoting disability awareness and among its aims is to increase the understanding of disability and removal of barriers for people with disabilities in the workplace. According to a news report, a people survey conducted in the UK shows a 23% increase in reported discrimination and harassment in the workplace at The Department for Work and Pension. The survey shows the number of reports for discrimination due to disability was in majority compared to discrimination due to gender, ethnicity or age. DWP received criticism for the survey results. As a department responsible for tackling discrimination at work, the DWP results may indicate room for improvement from within. A DWP spokesperson said the survey results do not necessarily indicate an increase in the number of reports, but rather reflecting the outcomes of efforts to encourage people to come forward.
|This section needs additional citations for verification. (February 2010) (Learn how and when to remove this template message)|
Political rights, social inclusion and citizenship have come to the fore in developed and some developing countries. The debate has moved beyond a concern about the perceived cost of maintaining dependent people with disabilities to finding effective ways to ensure that people with disabilities can participate in and contribute to society in all spheres of life.
In developing nations, where the vast bulk of the estimated 650 million people with disabilities reside, a great deal of work is needed to address concerns ranging from accessibility and education to self-empowerment, self-supporting employment, and beyond.
In the past few years, disability rights activists have focused on obtaining full citizenship for the disabled.
There are obstacles in some countries in getting full employment; public perception of disabled people may vary.
Disability abuse happens when a person is abused physically, financially, verbally or mentally due to the person having a disability. As many disabilities are not visible (for example, asthma, learning disabilities) some abusers cannot rationalize the non-physical disability with a need for understanding, support, and so on.
As the prevalence of disability and the cost of supporting disability increases with medical advancement and longevity in general, this aspect of society becomes of greater political importance. How political parties treat their disabled constituents may become a measure of a political party's understanding of disability, particularly in the social model of disability.
Disability benefit, or disability pension, is a major kind of disability insurance that is provided by government agencies to people who are temporarily or permanently unable to work due to a disability. In the U.S., disability benefit is provided in the category of Supplemental Security Income. In Canada, it is within the Canada Pension Plan. In other countries, disability benefit may be provided under social security systems.
Costs of disability pensions are steadily growing in Western countries, mainly in Europe and the United States. It was reported that, in the UK, expenditure on disability pensions accounted for 0.9% of gross domestic product (GDP) in 1980; two decades later it had reached 2.6% of GDP. Several studies have reported a link between increased absence from work due to sickness and elevated risk of future disability pension.
A study by researchers in Denmark suggests that information on self-reported days of absence due to sickness can be used to effectively identify future potential groups for disability pension. These studies may provide useful information for policy makers, case managing authorities, employers, and physicians.
Private, for-profit disability insurance plays a role in providing incomes to disabled people, but the nationalized programs are the safety net that catch most claimants.
Estimates of worldwide and country-wide numbers of individuals with disabilities are problematic. The varying approaches taken to defining disability notwithstanding, demographers agree that the world population of individuals with disabilities is very large. For example, in 2012, the World Health Organization estimated a world population of 6.5 billion people. Of those, nearly 650 million people, or 10%, were estimated to be moderately or severely disabled.
In the United States, Americans with disabilities constitutes the largest and most inclusive minority. According to the U.S. Census Bureau, as of 2010, there were some 56.7 million disabled people, or 19% (by comparison, African Americans are the largest racial minority in the U.S., but only constitute 12.6% of the U.S. population).
There is widespread agreement among experts[who?] in the field that disability is more common in developing than in developed nations. The connection between disability and poverty is thought to be part of a "vicious cycle" in which these constructs are mutually reinforcing.
Nearly 8 million European men were permanently disabled in World War I. About 150,000 Vietnam veterans came home wounded, and at least 21,000 were permanently disabled. As of 2008, there were 2.9 million disabled veterans in the United States, an increase of 25 percent over 2001.
After years of war in Afghanistan, there are more than 1 million disabled people. Afghanistan has one of the highest incidences of people with disabilities in the world. An estimated 80,000 Afghans are missing limbs, usually from landmine explosions.