Theoretical Models of Disability

Introduction

There are a number of different theoretical models that we use to understand disability. What are the most common models that you are likely to come across?

1. The Medical Model
2. The Social Model
3. The Functional Solutions Model
4. The Biopsychosocial Model
5. The Economic Model
6. The Society Identity or Cultural Affiliation Model
7. The Charity Model

What are the basic concepts behinds each of these models, as well as their strengths and weaknesses? Which of these models best align with the principles of accessibility and universal design? What are some practical examples of these models in our lives?

The Medical Model

Under the medical model of disability, disabilities arise from various biological impairments or diagnosable health conditions. The medical model emphasizes individuals’ impairments and limitations and is often concerned with “healing” the person or mitigating their impairments through professional medical care.

Strength: In clinical, medical settings, this way of understanding disability can help make sure that patients get the health care they need.​ The medical model of disability can also be used for legal purposes, such as clearly determining who qualifies for certain benefits.

Weakness: The medical model over-emphasizes the individual and overlooks the fundamental roles that society and environments play in creating disability. Additionally, if people’s disabilities don’t meet strict definitions, those people might not qualify for medical care or other benefits. Also, medical interventions can be a great deal of hassle for a person with a disability, as well as incredibly costly.

We see the medical model in action when someone with a disability is diagnosed by a medical professional with a health condition and then offered treatment or a cure for their condition through the health care system.

The Social Model

The social model of disability emphasizes mismatches between individuals’ capabilities and the demands of their environment. While under the medical model, disabilities are created by various impairments, under the social model, people are disabled when their environment is not designed to meet their needs. In this case, impairments don’t directly cause disability. Instead, people are disabled by poorly designed environments. Adherents to the social model of disability typically won’t deny that people have various impairments, medical conditions, or differing abilities that can present challenges. However, under the social model, those challenges on their own don’t cause a disability. Instead, the mismatch between a person’s abilities and their environment creates a disability, not an impairment in and of itself.​

Strength: The social model forces us to think about the roles we all play in creating (or preventing) disability. By creating accessible environments (physical, virtual, and social), we can greatly improve the experiences of people with various impairments or limitations. Likewise, when we fail to do so, it’s on us. In this way, the social model helps remove barriers for and end stigmas against people with disabilities.

For these reasons, I think the social model of disability aligns closely with the principles of accessibility and universal design. Relatedly, when we design our shared environments to be accessible to people with disabilities, we also benefit all sorts of other people and use cases. This trait of universal design is known as the curb-cut effect. We added curb-cuts on sidewalks for the benefit of people with disabilities, but many other people use curb-cuts as well, for things like bicycles or heavy luggage. When you approach disability from the social perspective, you also benefit people with situational limitations.

Weakness: If you look at disability strictly from the social model, you may overlook other aspects of disability, such as the biological or the cultural.

We see the social model in action when buildings are designed to be wheelchair accessible or when websites are designed to work with assistive technologies such as screen readers or switch controls. By carefully and inclusively creating our built environments, we can include rather than disable people.

The Functional Solutions Model

The functional socials model of disability looks at disability as a practical problem to be solved, often through innovative assistive technologies or adaptive strategies.

The functional solutions model somewhat aligns with the ideals of accessibility, as it is concerned with finding ways to increase access and independence for people with disabilities. However, I think the functional solutions model best aligns with the field of assistive technology (how do you come up with a solution to begin with?), and the social model best aligns with the field of accessibility (how can you scale those solutions throughout society?).

Strength: This model of disability is focused on helping people with disabilities in practical, direct ways and supporting them to be more independent.

Weakness: This view can be too narrow or myopic at times, overlooking the role of broader social change. (Yes, it’s super cool that some wheelchairs can climb stairs, but also, why didn’t we build a ramp?) Additionally, many functional solutions (assistive technologies) are prohibitively expensive.

We see the functional solutions model in action when an engineer create new assistive technologies or when we 3D-print braille dice.

Biopsychosocial Model

The biopsychosocial model is probably the most complicated, nuanced framework for understanding what disability is. This model is the basis for the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), a framework which is often used by occupational therapists.

I understand the biopsychosocial model as a perspective that incorporates and integrates the medical, functional solutions, and social models. This model recognizes that disability is “a complex phenomena that is both a problem at the level of a person’s body, and a complex and primarily social phenomena. Disability is always an interaction between features of the person and features of the overall context in which the person lives.” Under this model, disability arises both from a person’s health conditions as well as contextual factors, such as their environment.

What does that mean in practice? Biological impairments are real things, which merit professional medical treatment and care. Those impairments create activity limitations, difficulties an individual may have in performing certain tasks. To help with these limitations, an individual may be given assistive technology, adaptive strategies, personal assistance, or rehabilitation therapy. Because of their impairments or activity limitations, an individual may also experience participation restrictions, problems participating in everyday life situations. To help with these restrictions, we need universal design, anti-discrimination laws, and general social inclusion.

Strength: This model is nuanced and can be used to address disability from a variety of levels. It can also be applied to both prevention and intervention. Like the medical model, the biopsychosocial model can be used to create definitions and qualifications for legal purposes.

Weakness: It’s a little complicated to wrap your head around at first. It may also overlook the insights of the social identity/cultural affiliation model.

We can see the biopsychosocial model in action when an occupational therapist (OT) helps someone learn to use an assistive technology and later when the OT advocates for web accessibility.

The Economic Model

The economic model is concerned with how disability impacts an individual’s ability to work. By extension, this model may also be used by employers to analyze “productivity” or by the state to plan welfare programs.

Strength: This model is sensitive to the reality that many people with disabilities are unemployed and require social assistance.

Weakness: This approach to disability overlooks many other aspects of disability and can also create a stigma against people with disabilities, labeling them as “needy.”

We see the economic model in action when an employer wonders if someone with a disability would be “as productive” as someone without or when people creating welfare systems assume people with disabilities require economic support.

The Social Identity or Cultural Affiliation Model

People with disabilities often have similar life experiences to each other, experiences that others in society may not understand. The social identity or cultural affiliation model of disability pays attention to how people with disability can have a shared culture and take pride in their membership in this group.

Strength: This model encourages people to accept their disabilities and view them as a point of pride. It can lead not only to self-empowerment but also to political power for people with disabilities.

Weakness: For some people with disabilities, it is not easy to accept their disabilities or take pride in it. There are many different types of disabilities, and not everyone with a disability identifies as being in the same social group.

We see this model in action when Deaf individuals showcase Deaf pride and create or support Deaf culture.

The Charity Model

Under the charity model, disabilities are viewed as tragic or unfortunate, and people with disabilities may be viewed as inspirational for living with their impairments. Relatedly, people with disabilities are viewed as needing assistance, and providing that assistance is seen as morally laudable.

Strength: This perspective inspires people to donate time and money to support people with disabilities.

Weakness: This perspective objectifies people with disabilities, turning them into “inspiration porn.” This model can also perpetuate ableism and existing inequalities, as it applauds people who donate without necessarily challenging them to make society more equal and accessible.

We see this model in action when nonprofits attempt to fundraise by emphasizing the hardships of living with a disability.