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Four Models of Disability
About the Author
Michael Gerald, PhD, is a licensed Clinical Mental Health Counselor and Certified Rehab Counselor. He is currently employed as an Assistant Professor in Rehabilitation Counseling at Utah State University (USU) in Logan, UT. Michael has provided clinical mental health services as a Crisis Counselor, Substance Abuse Counselor, Correctional Mental Health Provider, and Private Practice Mental Health.
Michael has received compensation from Coloplast to provide this information.
Often when we think about or discuss disability, medical conditions, or chronic illness we tend to think of diagnoses. “What do you have?” So, to speak. According to the Americans with Disabilities Act (ADA, 1990) a disability is defined by: the presence of a physical, cognitive, intellectual, or psychiatric condition (or a combination); pervasive impairment in social and occupational functioning; and the potential for experiencing prejudice, discrimination, stigma, and reduced opportunities as a result. The level of impairment an individual with a disability experiences has to do with a combination of their internal resources, their environment, and the course of the medical condition/chronic illness/disability itself. Models of Disability provide a set of guiding assumptions, concepts, and propositions about the nature of phenomena or human experience. Models of Disability help us to explain why or how a disability may be impacting someone. Models of Disability further provide: definitions of disability; the location of the problem; who is responsible for solving it; what the needs are of a person with a disability; policies that may be beneficial in mitigating disability; and who will study and work with persons with disability.
In the present article, I will describe four Models of Disability: Biomedical; Environmental; Functional; and Sociopolitical or Social.
The Biomedical Model is perhaps the most prevalent and readily understood of the models of disability and it is the foundation of the field of medicine. In the Biomedical Model the “problem” of disability lies within the individual and represents some pathology that needs to be cured, usually (although not always) by a healthcare provider. For example, a person with Inflammatory Bowel Disease (IBD) may receive prescription drug treatment for their Crohn’s Disease as well as surgical removal of parts of their bowel in order ameliorate symptoms and restore functioning. Medical supplies, such as ostomy pouches and flanges, certainly are born out of the Biomedical Model of disability. The Biomedical Model, of all the models, has the most objective standards for diagnosis and causal attribution, and has provided persons with disabilities with treatments, surgical options, and other techniques for restoring functioning. However, it is often criticized by persons with disabilities for: not taking the individual’s environment into account; objectifying persons with disabilities and their bodies; and relieving society of any responsibility for disability.
The Environmental and Sociopolitical Models of disability share some similarities in their definition of the problem and interventions to improve functioning for persons with disabilities. The Environmental Model of disability places the “problem” of disability in the individual’s physical environment and postulates the environment can cause, define, or exacerbate disability. Mitigation, therefore, of the consequences of disability requires addressing disabling, unresponsive, or insensitive environments. Curb cutouts for persons who use a wheelchair, grab bars in a bathroom for persons with limited coordination or mobility, or crossing signals that chirp for persons with visual impairments are all examples of environmental adaptations that can help promote functioning in persons with disabilities. The Sociopolitical, or Social, Model of disability views prejudice and discrimination (or attitudes) as causing disability. The “problem” of disability, therefore, lies in discriminatory attitudes of society and its unwillingness to provide equal access for persons with disabilities. The Social Model of disability was the inspiration for the Americans with Disabilities Act of 1990 (ADA) and Centers for Independent Living (CIL). For persons with bowel/bladder dysfunction and resultant ostomies, stigmatizing attitudes towards ostomies can negatively impact adjustment to ostomy surgery, as those attitudes may inhibit their employer from making accommodations or their school from believing they can continue their education.
The Functional Model defines disability in terms of the functional capacity that is affected by a given disability or diagnosis. For instance, a professional pianist who loses a finger is likely to experience much more functional impairment due to the loss than a professional soccer player. Disability, therefore, is mostly determined based on an individual’s functional capacities, their roles and responsibilities, and their environment. The Functional Model approaches treatment of disability and its consequences through adaptive technology, vocational training, and tailored job placement. For persons undergoing ostomy surgery, their level of functioning is impacted depending upon their lifestyle. Someone who is active, exercises a lot, may want to utilize products that allow them to maintain that level of activity, such as belly bands or smaller pouches.
In summary, our models of disability help us as practitioners to identify how a disability may be impacting someone’s life and what interventions would be best suited to mitigate those consequences. Persons with ostomies may not need more surgery or new medication, they may simply need better access to their environments. Persons with ostomies may not need new equipment, they may need help advocating against prejudicial attitudes regarding their ostomy.
For me, personally, as a person with an ostomy, I have always relied on the Functional Model of Disability (even before I knew what that was!) to guide me. What do I want to do? What are my limitations? What could I do to make that possible? My ostomy is permanent, I cannot change that, but in order to work and exercise how I want I can control my diet, how I maintain my pouch, what supplies I bring with me, how much I sleep, and so on and so forth. When working with persons with ostomies, asking questions about what people want to be doing rather than simply asking what is wrong can help better point us toward effective solutions. ●