The following is a response to Professor Mike Oliver’s post of 5th June, 2015, with introduction by Dave Nicholls, “The Social model of Disability and Physiotherapy: Reflections from Mike Oliver.”
I was delighted to see some work from another non-physiotherapist on this site. While I am always excited to read posts by people who would change physical therapy from within, I think this must also take place in consultation with those across the floor, so to speak. I’d been getting lonely. I was especially interested to see someone as prominent as Dr. Oliver participate in the dialogue. If there is a unifying approach to disability in the field of disability studies, particularly (but not exclusively) in the Commonwealth states, it is the social model. Those for and against may disagree on what form, exactly, the social model takes, and a great many disagree on the benefits of the approach in isolation—but we can all agree it is required reading for critical disability studies. If you are teaching it, you talk about the social model. It is a fundamental point of reference for us all, one way or another.
On reading Dr. Oliver’s “Reflections”, I began to think about my own career as someone personally invested in doing disability studies, and as a participant in this wonderful collaborative network. In my time working with members in Toronto, Canada (not to mention my intercontinental Skype conversations with The Master) I have learned and thought a great deal about rehabilitation, and revised my earlier views on physical therapy, to which I have been subject and extremely suspicious throughout. These same conversations led to the revision of many of my viewpoints on the relationship of disability studies and medical practices, physical therapy included. I thought I might put some to paper—should my network colleagues care to read them: all the better. For the sake of brevity, they are twofold.
First, I have learned that disability studies and the rehabilitation sciences hold two very different understandings of what ‘the medical model’ is. Disability studies’ understanding is displayed well by Dr. Oliver.
My own thoughts on this are that both physiotherapists and doctors see their practice as placed within the individual model of disability and are constrained by seeing the body as a physical and mechanical entity which, when it is need of repair, falls within the domain of their own practice. Neither profession sees modifying physical, cultural, political and other barriers as something they should be involved in as practitioners (Oliver, 2015)
For disability studies, and particularly in Oliver’s The Politics of Disablement (1990), the individual model, or “individual tragedy model” and the medicalization of disability, is the cultural and institutional dominance of medical expertise over disability-as-individual-problem. This model, or “individual tragedy theory” obscures the problematic barriers that I—and every other disabled person—experience on a daily basis. It implies “methodological individualism […] seeing the problems that disabled people face as being caused by their individual impairments” (Oliver, 1992, p. 108). The causal mis-attribution of the exclusion of disabled persons to their medical problems, this Oliver calls the “ideology of individualism” (1990). Central here is a methodological division between disability as a social and material outcome and impairment, particular medical issues. Ideally, disability studies is concerned about the former, medicine about the latter.
In a recent roundtable held at the University of Toronto, I was surprised to hear that physical therapists, too, opposed the medical model. “Is this even possible?” I thought. Yes: but only because it is defined very differently. The medical model is one that reduces disability (for Oliver: impairment) to pathological organ states, rather than individual function. Function extends past organic malfunction and the pathologists’ understanding of disease, looking instead to the way that disability manifests in the operation within the lived environment (I may be amalgamating the PT and OT purviews here, please suffer my ignorant blasphemy). I am disabled at the physiotherapist, but the cardiologist only sees cardiomyopathy. Now, I doubt that anyone doing the social model, or almost any other sort of disability studies, would buy this redefinition. Yes, we would say, perhaps we are not looking to disability as a merely organic problem, but it is still medical and individual through and through. It is, notwithstanding this expanded view, a technical problem in need of solution, and bodies, not barriers, are the primary emphasis. On the other hand, I think a great many physiotherapists would dispute the fact that they ignore barriers entirely, both within the network and without. If we are to work together, we must bridge this gap—or at least stop talking past one another.
My second thought relates to this conceptual bridge, about working together. Professor Oliver’s work, particularly his “Changing the Social Relations of Research Production” (op cit.) is not only about criticizing the status quo. Following the most famous thesis on Feuerbach: “the point is to change it” (Marx in Marx & Engels, 1968, p. 30). Oliver hints at this as well in the “Response”.
Changing the social relations of physiotherapeutic practice would entail physiotherapists giving up or, at least, sharing some of their power and placing their skills and knowledge at the disposal of disabled people. (Oliver, 2015, n.p.).
This, for me, presents the greatest promise of the Critical Physiotherapy Network. It is for this reason that I eagerly read the posts on the site, regardless of the author’s profession, and I think many of you share this enthusiasm. I do not want to speak for Oliver here, but reflecting on his work, particularly the 1992 paper, here he would want—at least I assume he would want—disabled persons at the fore of the research agenda, outlining what methods employed and in what direction future work takes place. We would have to expand the above definition of function to include functional environment (if it does not already) and the gains of the research would have to be shared more equitably. This meets, I think, the “reciprocity, empowerment and gain” criteria in the CPN post.
Despite my very apologetic introduction, dancing around the issue as polite Canadians must do, I have some unresolved questions about the social model’s application in isolation from some other ways of doing disability research. I will post them in terms of this potential collaborative project. The social model approach tended to oppose research frameworks that took the individual as their focus. Prominent here is the “stigmatization” and “deviance” framework, popularized by another Canadian, Erving Goffman. Oliver many and other thinkers (Barnes & Mercer, 2003, off the top of my head) have expressed that the symbolic-interactionist framework reduces disability to deviant identity, and does not provide us a causal account of how the stigmatized individual ends up as such, or how we might go about eliminating this problem. Please permit a long quote from The Politics of Disablement, as I do not want to misrepresent Dr. Oliver’s position:
while stigma may be an appropriate metaphor for describing what happens to individual disabled people in social interactions, it is unable to explain why this stigmatisation occurs or to incorporate collective rather than personal responses to stigma. […] Thus, disabled people have not found stigma a helpful or useful concept in developing and formulating their own collective experience of disability as social restriction. To begin with, it has been unable (so far) to throw off the shackles of the individualistic approach to disability with its focus on the discredited and the discreditable. In addition, its focus on process and interpersonal interactions ignores the institutionalised practices ingrained with social relations (in the sociological sense [rather than in the face-to-face encounter—T.A.]). And finally, therefore, they have preferred to reinterpret the collective experiences in terms of structural notions of discrimination and oppression rather than the interpersonal ones of stigma and stigmatisation (Oliver, 1990, pp. 66-68).
Here I a skeptical. I am not skeptical that much of the stigma literature has ignored the structural problems of disablement (for it surely has), but I feel as though the way that Goffman himself incorporated it is certainly up to the task. Goffman’s Interaction Ritual makes this point extremely clear in an unfortunately androcentric remark, while he tries to eschew a solely psychological focus on the interactant: “Not, then, men and their moments. Rather moments and their men” (Goffman, 1967, p.3)
Why should critical physiotherapy (let along disability studies) care about any of this? I would like to propose a shift to the phenomenological work done in our ranks. I doubt that Oliver would have a more favourable view of phenomenology than of Goffman—though again, I may be wrong. It shares many of the points of contention established in the quote from the 1990 book. But here I think that the individualist emphasis, from both first person and third person viewpoints, is extremely important to the kind of work needed to do “emancipatory physiotherapy practice” (phrase borrowed from Trede, 2012). I have used my own experience of physical therapy demonstrate how the medicalization manifests not only in the institutional sense, as in governments using medical frameworks to distribute resources, but also how individual lives and experiences become coded in various measures used in the clinical setting. Consider here the Functional Independence Measure (Keith, et al., 1987) and the Patient Specific Functional Scale (Stratford et al., 1995). In the application of these measures, much of the experience of disability—and I use disability intentionally—is abstracted from its social and material setting, and applied a numerical value. Here it is not the medical model, I think, that needs to be rejected, but rather a particular form of medical modeling. We can come up with better models, but only if persons like myself can interrogate the nuts and bolts of the process, and only do so by relying on personal experience. If we are to do disability studies of rehabilitation, we cannot do so solely through an emphasis on barriers. There is much more to my existence as a disabled person than my exclusion. Much of this existence, especially at the clinical level, is of sociological importance. If the Stigma literature, too, helps me do this, it is useful.
With this said, there are many aspects of the phenomenological perspectives as they are employed in the critical literature that I would change. This desire for change aligns with the threefold emancipatory criteria Oliver cites in his post. While many of these studies have applied phenomenological theory in their reformulation of questionnaires, for example, they still reproduce the same researcher-subject relationship, as do the scales I have cited in the previous paragraph. They often used to shape the respondent into a case for study, an object, rather than an equal participant in the research enterprise. Here a memory of an old university instructor comes to mind. He was from Tanzania. Reflecting on the colonial experience, he taught us about the German versus the British approaches to colonial rule. The Germans said: “do this or we’ll shoot you”. The British said: “do this, for the love of the empire, for providence, for the glory of…”—you get the idea. He preferred the latter. Either way the cost of negligence was the same, but at least the Germans got to the point quickly so you could go about your day. In both cases, the power imbalance remained firmly in place.
In sum, and to return to the point of this post—the social model is a crucial component of disability studies history, its practice past and present, and many of the policy frameworks in place to this day. Its emphasis on barrier removal is of crucial importance to all disabled persons and all those who would help them live decent lives. Though I worry about the costs of a strict appeal only to the social model writing in isolation, these lessons are of crucial importance for the collaborative, emancipatory project that led me to this group. Onward!
Barnes, C., & Mercer, G. (2003). Disability. Cambridge: Polity.
Goffman, E. (1967). Interaction Ritual: Essays on Face-to-Face Behaviour. New York: Pantheon.
Keith, R. A., Granger, C. V., Hamilton, B. B., & SHerwin, F. S. (1987). The Functional Independence Measure: A New Tool for Rehabilitation. Advances in Clinical Rehabilitation, 1, 6–18.
Marx, K., & Engels, F. (1968). Karl Marx and Frederick Engels: Selected Works. New York: International Publishers.
Oliver, M. (1990). The Politics of Disablement. London: MacMillan.
Oliver, M. (1992). Changing the Social Relations of Research Production? Disability, Handicap & Society, 7, 101–114.
Stratford, P., Gill, C., Westaway, M., & Binkley, J. (1995). Assessing Disability and Change on Individual Patients: A Report of a Patient Specific Measure. Physiotherapy Canada, 47.
Trede, F. (2012). Emancipatory physiotherapy practice. Physiotherapy Theory and Practice, 28, 466–473.
 To introduce myself to the other members of the network: I am not a physiotherapist, rather a postdoctoral fellow at the University of Toronto’s Ontario Institute for Studies in Education (the teachers’ college). I have a PhD in Sociology, and am diagnosed with Becker Muscular Dystrophy. Dave has decided to extend me membership to the group, and I have worked with Dr. Barbara Gibson and Dr. James Shaw in the past.