Disability and Oppression

Disability and oppression

Black, Rita. 1994. "Diversity and Populations at Risk: People With Disabilities." The Foundations of Social Work Knowledge, Frederic G. Reamer. New York: Columbia.

Kirst-Ashman, K. K. 2000. "Empowerment of People With Developmental Disabilities in Community and Organizational Environments." Human Behavior, Communities, Organizations, and Groups in the Macro Social Environment: An Empowerment Approach, K. K. Kirst-Ashman. Belmont, CA: Brooks/Cole.

Asch, Adrienne and Nancy R. Mudrick. 1997. "Disability." Encyclopedia of Social Work, Editor Richard L. Edwards. Washington, D.C.: National Association of Social Workers.

Lecture:

In this lecture I’ll review the evolution of thinking about how to define and understand disability, utilizing the materials assigned for this class session and additional materials from the United Nations and the World Health Organization. The General Assembly established the foundation for the promotion and protection of human rights in 1948, when it proclaimed the Universal Declaration of Human Rights. Article 25 of the Declaration states that each person has "the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control".

In 1980, the World Health Organization adopted its International Classification of Impairments, Disabilities and Handicaps.

(Source: The United Nations and Disabled Persons: The First 50 Years

This document was prepared with a view to the upcoming United Nations Decade of Disabled Persons: 1983-1992.

The International Classification made a distinction between impairment, disability and handicap. These three concepts are defined by it as follows:

(a)Impairment is "any loss or abnormality of psychological, physiological, or anatomical structure or function". Impairments are .....at the level of the organ or ....body structure, [including] loss of a mental function. Examples are blindness, deafness, loss of sight in an eye, paralysis of a limb, amputation of a limb…..loss of speech, mutism.

(b)Disability is a "restriction or lack (resulting from an impairment) of ability to perform an activity....". Disability was seen as describing a “functional limitation or activity restriction caused by an impairment...... at the level of the person.” Examples of disabilities include difficulty seeing, speaking or hearing; difficulty moving or climbing stairs….

(c)A handicap is a "disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfilment of a role.....”. The document describes “these disadvantages are brought about through the interaction of the person with specific environments and cultures. Examples of handicaps include being bedridden or confined to home; being unable to use public transport; being socially isolated.”

These definitions were used by the World Programme of Action Concerning Disabled Persons:

(a) Prevention:

1. Primary prevention: aimed at preventing the onset of mental, physical and sensory impairments

2. Secondary prevention: preventing impairment, when it has occurred, from having negative physical, psychological and social consequences

(b) Rehabilitation:

1. Goal-oriented and time-limited process

A. Enabling an person with impairments to reach functional level,

B. Providing the individual with the tools to change her or his own life.

C. Measures intended to compensate for a loss of function or functional limitation

Access of all to the physical and cultural environment, housing and transportation, social and health services, educational and work opportunities, cultural and social life, including sports and recreational facilities, etc.
Kirst-Ashman argued that there are five characteristics of developmental disability:

1. Severe and chronic disability.

2. Onset before age 22

3. Disability likely to be permanent

4. Disability results in substantial functional limitations

5. Need for lifelong supplemental help and services

Her source for this classification were Encyclopedia of Social Work articles and legal definitions from federal law.

She classifies several kinds of developmental disabilities:

Cognitive disabilities

Cerebral Palsy

Epilepsy

Orthopedic problems

Hearing impairment

Visual impairment

Autism

Multiple Disabilities

Kirst-Ashman then outlines three principles which evolved during these years:

Normalization - people with disabilities have rights and every individual’s environment should be adjusted to ensure maximum social participation

Deinstitutionalization - Removal of any overly restrictive service environment

Individual program planning - individualized efforts to achieve the goal of “least restrictive environment”

Developmental model – persons with disabilities seen as CLIENTS whose changing needs over time are assessed

In the 1990’s, Kirst-Ashman outlined a shift to thinking in terms of:

Clients as consumers

Emphasis on consumer choice

Innovation (further individualization beyond stage-oriented or changing need oriented approaches)

Family support (both OF and BY significant others)

END of Kirst-Ashman material

Beginning of Rita Black notes:

People with Disabilities as members of a common population
Different disabling conditions > different service needs, BUT
Sharing of the common experience of disability

Passage of Americans with Disabilities Act, 1990

Included definition of person with a disability as linked to function limitations experienced by that person:

Physical or mental impairment limiting major life activity
Record of such impairment
Being regarded as having such impairment

Black cites LaPlante’s distinction between actions and activities. Let’s expand on this to help distinguish them:

Actions / Activity I / Activity II
Vocalization of words / Conversing via spoken language / Communicating without vocalization
Seeing with the eyes / Reading of a book via eyesight / Comprehending written material in another form
Walking with lower extremities / Ambulate: move from place to place / Transporting of self from place to place

A specific impairment that restricts specific actions does not necessarily disable Activity I, and a disability of Activity I does not necessarily disable Activity II.

Black cites Fine and Asch impotant point that feminist researchers have argued that just as there is a difference between sex and gender, there is a difference between impairment/disability and handicap (page 396).

Black cites Fine and Asch’s critique of several major false assumptions of the social construction of disability(p. 409-410):

Disability is located solely in biology
Impairments directly cause disabilities
People with disabilities are victims
The disabilities people face are primary self-definition
People with disabilities all need help and support

END BLACK MATERIAL
ASCH and MUDRICK MATERIAL

The term disability has evolved to refer to three general areas (here revised from original, page 752):

Disability Impairments themselves
Disability as the functional consequences of impairments to which the person or their environment have not adapted so as to prevent a specific disability
Disability as by-product of maladaptive environment

Asch and Mudrick point out:

People with disabilities are often stigmatized
People with disabilities are “disadvantaged as much or more by discrimination as by physical limitations”
“Social workers must learn to distinguish between situations in which disability is and is not a client’s or a family’s principle concern”

END OF ASCH AND MUDRICK NOTES
ICIDH-2: International Classification of Functioning, Disability and Health. (

In 1980, the distinctions made by the International Classification of Impairments, Disabilities and Handicaps were considered extremely advanced. However, in preparation for the 54th World Health Assembly, the Final Draft off a new classification has been released for discussion (but not for clinical use.) The final version will be released after the process of consideration and approval by WHO’s governing bodies has been completed. The ICIDH-2 uses three concepts as umbrella terms:

Functioning: body functions, activities and participation
Disability: impairments, activity limitations, participation restrictions
Environmental factors that interact with all above

Functioning: body functions, activities and participation
Disability: impairments, activity limitations, participation restrictions
Environmental factors that interact with all above

These 3 terms replace the formerly used terms “impairment”, “disability” and “handicap”, and extend their meanings to include positive experiences. It would appear that BOTH the term handicap AND the term impairment were seen as having negative implications for how disability is socially constructed. As a result, impairment of body functions is placed within a broader context of overall functioning of the body (and its range of actions), as well as within the context of various possible activities and forms of participation. This functioning is then assessed with respect to what is the primary factor leading to a specific disability, which can include forms of disability embedded primarily in a specific impairment as well as those which are a result of restrictions imposed on the person with a disability by virtue of their not being adequate adaptations available due to various limitations or restrictions. Finally, the environmental factors which can affect functioning or disability are taken into consideration.

Each of these three terms is better understood in the context of definitions on page 163-164 of the document:

IMPAIRMENT

Impairment is a loss or abnormality of a body part (i.e. structure) or body function (i.e. physiological function). Physiological functions include mental functions. Abnormality here is used strictly to refer to a significant variation from established

statistical norms (i.e. as a deviation from a population mean within measured standard norms) and should be used only in this sense.

ACTIVITY AND ACTIVITY LIMITATIONS

Activity is the execution of a task or action by an individual. It represents the individual perspective of functioning. Activity limitations are difficulties an individual may have in executing activities. An activity limitation may range from a slight to a severe deviation in terms of quality or quantity in executing the activity in a manner or to the extent that is expected of people without the health condition.

PARTICIPATION AND PARTICIPATION RESTRICTIONS

Participation is a person's involvement in a life situation. It represents the societal perspective of functioning. Participation restrictions are problems an individual may experience in involvement in life situations. The presence of a participation restriction is determined by comparing an individual's participation to that which is expected of an individual

without disability in that culture or society.

FUNCTIONING

Functioning is an umbrella term for body functions, body structures, activities and participation. It denotes the positive aspects of the interaction between an individual (with a health condition) and that individual's contextual factors (environmental and personal factors).

DISABILITY

Disability is an umbrella term for impairments, activity limitations and participation restrictions. It denotes the negative aspects of the interaction between an individual (with a health condition) and that individual's contextual factors (environmental and personal factors).

CONTEXTUAL FACTORS

Contextual factors are the factors that together constitute the complete context of an individual’s life, and in particular the background against which health states are classified in ICIDH-2. There are two components of contextual factors: Environmental Factors and Personal Factors.

ENVIRONMENTAL FACTORS

All aspects of the external or extrinsic world that form the context of an individual’s life and, as such, have an impact on that person's functioning. Environmental factors include the physical world and its features, the human-made physical world, other people in different relationships and roles, attitudes and values, social systems and services, and policies, rules and laws.

BARRIERS

Barriers are environmental factors in a person’s environment that, through their absence or presence, limit functioning and create disability. These include aspects such as a physical environment that is inaccessible, lack of relevant assistive technology, negative attitudes of people towards disability, as well as services, systems and policies that are either nonexistent or that hinder the involvement of people with a health condition in all areas of life.

PERSONAL FACTORS

Personal factors are contextual factors that relate to the individual such as age, gender, social status, life experiences and so on, which are not currently classified in ICIDH-2 but which users may incorporate in their applications of ICIDH-2.

The World Health Organization document concludes, based upon the context of the above definitions:

“Disability is characterized as the outcome or result of a complex relationship between an individual’s health condition and personal factors, and of the external factors that represent the circumstances in which the individual lives. Because of this relationship, different environments may have a very different impact on the same individual with a given health condition. An environment with barriers, or without facilitators, will restrict the individual’s performance; other environments that are more facilitating may increase that performance. Society may hinder an individual's performance because either it creates barriers (e.g. inaccessible buildings) or it does not provide facilitators (e.g. unavailability of assistive devices).”

The preparation of this lecture has lead me to understand disability as a process, not a personal characteristic. Seen this way, disability is a process involving specific impairments that have lead to reduced range of action, leading in turn to functional limitations which, absent specific adaptations by the person or the environment, turn that functional limitation into a disability in personal and/or social functioning. Seen in this way, even “persons with disabilities” is inaccurate. Persons experiencing disabilities becomes another way of thinking about disability in our society.

Discussion questions:

Going back to the table on Actions and Activities, if a person is unable to engage in any of the listed actions, does the person have a disability? In other words, does a specific impairment or limitation constitute a disability?

Does the 1980 distinction between impairment, disability and handicap still have value?

Exercise: Words and affective phrases related to disability