The History and Evolution of Disability Models

Published January 15, 2021

A few decades ago, people who were diagnosed with a disability were pigeonholed into a category and often set on a course over which they had little control. A blind person might be sent to a boarding school to live with other blind people; those with major physical and cognitive disabilities were often sent to sanitariums or worse, jails and poorhouses. These institutions were often overpopulated, underfunded and engaged in questionable treatments such as overmedication and sterilization. To be disabled was to be seen as useless and hopelessly dependent on others.

At the turn of the twentieth century, however, the conversation began to change. Legislators and disability advocates began talking about people with disabilities in terms of usefulness and productivity. They suggested that with proper support, people with disabilities could be productive and empowered to lead independent lives. New approaches were developed to define disability by medical, legal and social viewpoints. This became the dominant approach in the latter half of the twentieth century and community-based support programs replaced institutionalization.

Today, disability is no longer simply defined by a lack of function, but a complex mix of personal and environmental factors. A person with hearing loss, for example, is no longer shunned to a facility for the deaf, but presented with an array of options for amplification (or lack thereof), communication methods like spoken word or sign language and educational settings with accommodations for them. A deaf person may fit the medical model for a hearing disability but may not personally identify as disabled, since she exists in an environment that provides appropriate support for her needs.

There are different ways to define disability as it relates to individuals and the world around them. Where disability was once simply defined by a lack of function in the body, it now encompasses a much more complex mix of factors.

Medical model of disability

In the medical model of disability, a lack of function in the body is equal to a reduced quality of life. The disability is viewed as a defect that the medicine must fix (or cure) to help the individual be happy and healthy.

By treating disability the same as other pathologies, such as cancer, the implication is that disability is sick or abnormal, and that those affected are assumed to be unhappy with their inability to be “healthy.” If an individual is unable to walk, for example, the medical model focuses on identifying the root cause and possible solutions for making that person walk.

This viewpoint has often been criticized for creating stigmatization, impoverishment, and institutionalization of many individuals with disabilities. The medical model has also come under fire for focusing on costly and sometimes unnecessary interventions (such as surgery or drugs) instead of simpler inclusionary practices like universal design and social inclusion. In other words, instead of trying to force an individual to walk (which may not be physically possible), some argue the focus should be on creating an environment in which that person doesn’t have to walk in order to get to the same places as everyone else.

Social model of disability

The social model describes disability in relation to the environment of the person with the disability. Instead of focusing on the function of the body, the social model identifies barriers in the environment, such as derogatory attitudes, social isolation or physical exclusion of people with disabilities.

Mike Oliver, a pioneer of the social model of disability in the 1980s, based the model on his belief that it is not individual limitations that are the cause of the problem. Rather, it is society’s failure to provide appropriate services and adequately ensure that the needs of disabled people are considered. The model gained steam over the next three decades as society shifted from trying to “fix” an individual with a disability and instead created best practices for equity, like universal design and social inclusivity.

Though the social model has given rise to outcomes like the Americans with Disabilities Act, it is not the be-all, end all. Some feel the social model paints disability with a broad brush, ignoring individual differences and instead lumping together all disabilities into one demographic category with a standardized set of solutions. They assert that there are variations within each category of disability that should influence the way society responds. Within the deaf community, for example, there are conflicting viewpoints on the value of hearing aids and cochlear implants, teaching deaf children to speak versus teaching them sign language and whether it is better for television shows to provide closed-captioning or a picture-in-picture box with sign language interpreters.

Individual-environment model of disability

In 1980, the World Health Organization (WHO) designed a new concept of disability that considered the medical and social model alongside other factors. The result, known as the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) and later the International Classification of Functioning, Disability, and Health (ICH), considers at the individual at three levels:

  • Body Functions and Structures refers to body parts, or individual variations in physical and cognitive function and structure.
  •  Activities and Participation considers difficulties people have in executing activities or problems they experience in life situations as a result of their body function and structure.
  •  Environmental Factors relate to physical, social, and attitudinal factors in people’s lives that serve as barriers or facilitators of their ability to function.

 These factors are scored on a scale of 0 to 9, with 0 being “no impairment” or “no barrier” and increasingly higher numbers in proportion to the impact on daily functioning and activities. By using this model, the ICF aims to describe individuals not as either disabled or not disabled but by their individual levels of health, capacity and performance. Many people credit the ICF with helping further advance the view of disability from a defect to a natural variation in humanity and a societal responsibility to create inclusive spaces for all.

Today, the Individual-Environment model has given rise to several movements around people with disabilities, including greater acceptance of neurodiversity, which is the view that brain differences such as autism, Tourette Syndrome and ADHD are normal variations in human behavior, not disabilities. Some historically mainstream practices to change, “fix” or “cure” people - such as lobotomy and electroshock therapy - are now viewed as barbaric.  Some people even argue that other involuntary practices, such as cochlear implants for deaf infants who cannot consent to the surgery, should follow suit.

Disability models should not be seen as a series of mutually exclusive viewpoints, with one superior to others or replacing the models before them. Instead, they are a reflection of how society evolves in its thinking about disability. Disability models are a useful framework to gain an understanding of the history of disability – and more importantly, how to move forward into an inclusive, accessible and equitable society for all.