Medicalization and Disability SOC 162 PDF

MEDICALIZATION AND DISABILITY SOC 162 10/17/2023 Agenda ▪ Review medicalization ▪ Models of disability ▪ Social construction of impairment and disability ▪ Role of medicine in creating and maintaining disability as a category ▪ De-medicalized visions of disability ▪ Hayes, Jeanne and Elizabeth "...

MEDICALIZATION AND DISABILITY SOC 162 10/17/2023 Agenda ▪ Review medicalization ▪ Models of disability ▪ Social construction of impairment and disability ▪ Role of medicine in creating and maintaining disability as a category ▪ De-medicalized visions of disability ▪ Hayes, Jeanne and Elizabeth "Lisa" M. Hannold. 2007. "The Road to Empowerment: A Historical Perspective on the Medicalization of Disability.” Journal of Health and Human Services Administration 30(3): 352-377. Review: Medicalization ▪ A process by which a nonmedical problem becomes defined and/or treated as a medical problem. ▪ Disability, including ADHD diagnoses, are often uncritically thought of as medical issues requiring medical intervention. Models of Disability ▪ What is “disability”? ▪ 2 prevailing models of disability (Oliver 1990): 1. Biomedical model of disability: • Individual pathology • Seen as something inherently negative to be fixed/treated. • Rooted in the rise of capitalism and development of wage labor. • Facilitated by the medical profession. 2. Social model of disability: • Distinction between “impairment” and “disability” • Both are socially-constructed, socially-relative, and unevenly distributed across groups. • Seen as a form of oppression built upon an impairment. • Exists external to the individual. • Theorized by disabled scholars (notably Michael Oliver, Colin Barnes, and Vic Finkelstein) during the early disability rights movement. Disability as a Relative Social Construct ▪ What is an impairment in one context is not necessarily an impairment in another. • E.g., attention deficit and deafness ▪ Whether an impairment leads to disability is dependent on social context. ▪ Nora Groce’s historical study on hereditary deafness in pre-industrial Martha’s Vineyard, where most people could sign, demonstrated that deafness need not always result in disability, i.e. exclusion from mainstream society or social inequality. ▪ Because impairments occur unevenly across society, disability disproportionately affects marginalized groups. • E.g., war, environmental hazards, food security Creation of the “Disabled” Category ▪ Where do our modern, medicalized notions of disability come from? • Mainly, industrial labor standards. ▪ In pre-industrial societies, disabled people were not necessarily excluded from the production process or segregated from mainstream society (Oliver 1990). ▪ Not all could perform standardized factory labor, which was fast-paced and rigid. ▪ This led to the separation of people whose labor could not conform from the rest of the “able-bodied” workforce. Creation of the “Disabled” Category (Cont.) ▪ Stratified at the bottom of the labor market, disabled people were seen as a social problem. ▪ Their exclusion from the labor market led to segregation and exclusion from other institutions as well, including education. ▪ Institutions like workhouses, sanitariums, and asylums responded to the “problem” of disabled people. These institutions largely housed those with intellectual and developmental impairments (Oliver, 1990). ▪ Doctors defined criteria who qualified as disabled and often oversaw control of the institutions created to contain disabled people. Institutionalization of Disability ▪ Institutions effectively contained disabled populations from the general public in inhumane, unsanitary, and abusive conditions. ▪ Asylums often followed the construction of land-grant universities, where the residents were often the subjects of studies. Mass graves have been discovered on the grounds of such institutions (Dolmage 2017). ▪ Geraldo Rivera’s exposé of the Willowbrook State Hospital in Upstate New York was a catalyst for the deinstitutionalization movement. • https://www.youtube.com/watch?v=AURYfGI I4d8 • https://www.youtube.com/watch?v=qOtdmc 7tVuk Eugenics and Disability ▪ A pseudo-science, meaning “good genes.” ▪ Concerned with solving social problems through the genetic “purity” of populations. ▪ The eugenics movement rose to global prominence in the early 20th century. ▪ Methods included sterilization and, at its worst, euthanasia. ▪ Was considered a part of standard medical education until the mid-20th century. Rehabilitation and Disability ▪ World War I produced disability globally on a massive scale. ▪ The post-war era produced the birth of rehabilitation as we know it, through which injured veterans attempted to “return to normal” and re-integrate into society (Striker 2019). ▪ While rehabilitation can yield many benefits, some disabled people report experiencing attempts at achieving ablebodied norms as oppressive or paternalistic. • E.g., unwanted prosthetics and cochlear implants/aural rehabilitation Disability Rights Movement Timeline ▪ Similarly, the return of large numbers of injured WWII veterans from combat eventually led to a strong disability rights movement. ▪ Independent Living Movement begins in Berkeley during the 1960’s. ▪ The Rehabilitation Act of 1973 ▪ Mainly applied to organizations receiving federal funds. ▪ Americans with Disabilities Act (ADA) passed after the Capitol Crawl in 1990. ▪ Expanded rights to almost all organizations along with better enforcement. ▪ Yet, inequalities by ability persist. • Hayes and Hannold suggest that the medical profession has played a role in perpetuating inequalities. De-Medicalization of Disability ▪ In part, the disability rights movement and sub-movements have worked to de-medicalize disability and disabled people. ▪ Manifestations of de-medicalized disability: • • • • Disability pride movement Disability art Disability sport Sign Language ▪ These manifestations demonstrate disability constructed on disabled people’s terms. Hayes and Hannold – “The Road to Empowerment…” ▪ 3 ways medicine “contributes to the oppression of people with disabilities” (Hayes and Hannold 2007): 1. Maintenance of a “medical/knowledge power differential” • Doctors are powerful experts with the valuable ability to diagnose • Often control much of disabled people’s lives, including access to services. 2. Reinforcement of the sick role • Stigmatization • Perpetually “ill” and in need of treatment • However, there’s often only so much “healing” that can be done 3. Objectification of people with disabilities • Cast as passive recipients • Create dependency Discussion ▪ Do disabled people create a dilemma for medicine? ▪ What is the role of medicine for disabled people? ▪ Where should medical boundaries lie in the case of disabled people?