TOWARDS SOCIOLOGY OF DISABILITY
Prof. Dr. Nasir Sulman
Department of Special Education
University of Karachi
This article presents understandings of what constitutes disability from the point of view of Sociology. The Sociology of disability is associated with medical sociology, or specifically, it’s sub-group such as the ‘sociology of chronic illness and disability’. It is formed by the idea that disability is caused by illness and impairment, and brings about suffering and social disadvantages.
These kind of divergent approaches suggest that there is no unitary sociology of disability. But this discipline continues to offer quite different perspectives of the nature of disability. An attempt is made here to examine how these sociologies understand the nature of disability. In the following section, initially some of the sociological approaches through the 1960s and 1970s that analyzed disability as a form of social deviance and sickness and stigma have been outlined. Secondly, critique of sociology of disability by disability activists and academics is outlined.
a) Functionalist Analysis
Most of the sociological writings on disability are rooted in the works of Parsons and his analysis of sickness related behaviour. According to the functionalist approach, it is very significant for an individual to be healthy and to contribute to his/her society.
Consequently, sickness is treated as a form of deviant behaviour that must be controlled by the society. As outlined by Talcott Parsons (1951), sickness is similar to social deviance, since it causes a threat to the ‘normal’ role performance and wider economic productivity and efficiency. As a result, the society recognizes that the sick person cannot get better simply by an ‘act of will’ and she/he be allowed to withdraw temporarily from ‘normal’ social roles (Barnes and Mercer, 2003). In addition, the sick person must obtain medical confirmation of his condition and follow the suggested treatment in order to leave the sick role as soon as possible. However, the applicability of the sick role to the individual with disabilities received criticism (Sliver and Wortman, 1980).
- Firstly, as per this approach, the sick person is required to cooperate with rehabilitation professionals in order to achieve some degree of ‘normality’. This approach describes a hierarchical relationship where professionals identify the problems, needs and the capabilities of sick persons and prescribe appropriate ‘solutions’ ranging from health and social care to special educational provision (Finklestein, 1983).
- Secondly, it ignores social, economic and political factors.
- Thirdly, it denied the subjective interpretations of impairment from the perspective of the person concerned (Oliver, 1983).
The realization of impairment is acknowledged to involve some form of loss or ‘personal tragedy’. Thus, this kind of individualistic approach can be best understood as ‘personal tragedy theory’ (Barnes, 1990). According to this theory, if any sick person fails to achieve the expected rehabilitation goals, this failure can be explained with reference to the disabled people’s perceived inadequacy. But professional integrity remains intact, traditional wisdom and values are not questioned, and the existing social order remains unchallenged.
b) Symbolic Interactionism:
During the 1960s the central focus of the symbolic interactionists was analysis of social reaction towards disadvantaged minority groups such as people with impairments (Barnes and Mercer, 2003). In studying disability or health, they focused on the fact that the meaning social actors give to their impairment or illness or disease will affect their self-concept and relationships with others. They stressed the social construction of what is perceived as deviance in every day interaction:
“Social groups create deviance by making rules whose infraction constitutes deviance, and by applying those rules to particular people and labeling them as outsiders. From this point of view, deviance is not a quality of the act the person commits, but rather a consequence of the application by others of rules and sanctions to an „offender‟. The deviant is the one to whom the label has successfully been applied; deviant behaviour is behaviour that people so label” (Becker 1963).
One of the important studies of social reaction to difference was that of Lemert (1951) which distinguished between primary and secondary deviance. Lemert states that primary deviance occurs where social norms or rules are broken but there are no long lasting consequences. In contrast, secondary deviance generates a more important and enduring social reaction that is sufficient to produce a deviant identity and status.
Generally, the attribution of deviance to an individual with impairments is associated with ‘ascribed’ status (social position acquired by birth, for example, sex, caste, race, age and impairment) rather than ‘achieved’ status (social position acquired through one‘s own efforts, for example, a doctor, or an engineer) rule breaking. However, particular groups such as women, minority groups and people with disabilities excessively attract specific psychiatric labels such as ‘schizophrenia’ and depression respectively (Barnes and Mercer, 2003). Once applied, these kinds of labels such as ‘mental illnesses’ at least confirm and transform the public perception of an individual. At the same time, it is also very difficult to remove or challenge a medical label (Freidson, 1965).
Similarly, one of the classic studies of Goffman (1963) provides responses to stigma or a ‘spoiled identity’ including ‘abominations of the body’, with illustrations such as those described as ‘deformed’, ‘deaf’, ‘crippled’, ‘blind’ and ‘mentally-ill’.
Goffman’s interest in ‘undesired differentness’ focuses on how individuals with impairments, manage their ‘spoiled identity’ in everyday social interaction. For him, application of stigma is the outcome of situational considerations and social interactions between the ‘normal’ and the ‘abnormal’. He acknowledges stages such as ‘passing’ (hiding the stigma), and ‘covering’ (reducing its significance) strategies to avoid humiliation and social sanctions. These include repeated and often painful medical and surgical procedures to make the individual ‘more normal’ or less likely to attract a critical public gaze (Barnes and Mercer, 2003). The only other option for a stigmatized person is ‘withdrawal’ from social interaction. In addition, behaviour and negative attitude may be extended to other family members as ‘courtesy stigma’ (Goffman, 1963).
c) Conflict Perspective
The Conflict theory focuses on political, economic, and social forces that influence health and the health care delivery system. Among these issues which are of interest are those such as how race, class, and gender inequalities influence health and health care; power relations between doctors and other health care workers; the dominance of the medical model of health care; and the role of profit in the health care system (Barnes and Mercer, 2003).
From this perspective, the social construction of disability took their prompt from Mills (1963) who argued that the definition of social problems must be located within wider material and political contexts, including the power relations and conflicts between dominant and subordinate classes (Conrad and Schineider, 1980). Historically, there was a change in the people‘s perception of social deviance rooted in religious criteria of ‘badness’ towards medical judgments of ‘sickness’.
The medicalization of disability established the arrival of an orthodox medical profession, with state-legitimated control of the health and care services. With rapid growth of medical professionals, the lives of disabled people have been unevenly affected (Barnes and Mercer, 2003). It is most obvious in studies of mental illness that include a full-blown critique of a self-serving professional for exploiting its power of labeling and collaborating in a wider process of social control.
In brief, despite these significant perspectives and the sociological questions that disability raises, sociology has remained silent on the issues of disability. In addition, the analysis of disability has been theoretically and methodologically inadequate. This is mainly due to that fact that sociology has accepted almost without a question the legitimacy of bio-medical or individualistic approach to disability. Moreover, the field of sociology has been dominated by medical sociologists who focused mainly on measurements of impairment and the experience of ‘chronic illnesses’ rather than the experience of disability, as perceived by disabled people. Thus, the discipline as a whole has contributed significantly to the continued marginalization of the people with impairments (Thomas, 1998). Therefore, the early studies regarding the discipline of disability grew without much support from well-developed sociological critique of disabled bodies or bodies with impairments as carriers of meaning history and social spaces.
This discussion has demonstrated that hitherto sociological analyses of disability have been theoretically and methodologically inadequate. The main reason for this is that sociology, in common with the other major contemporary disciplines, has accepted almost without question the legitimacy of the individualistic, biomedical approach to disability. following the work of the early role theorists and interactionists – who never managed to move beyond the shadow of Parsons’ analysis of sickness related behaviour – the field has been dominated by medical sociologists who have chosen to concentrate upon measurements of impairment and the experience of ‘chronic illness’ rather than the experience of disability as perceived by disabled people. Until very recently this partial and essentially ‘non-disabled’ reading of the phenomenon has succeeded in precluding a meaningful evaluation of the economic, political and cultural forces which created and continue to create disability in modern society. Thus the discipline as a whole has contributed significantly to the continued marginalization of the disabled population.
However, this remarkable situation has been resolved by disabled people themselves in the form of the international disabled people’s movement and a small but committed group of disabled and non-disabled researchers. In the face of formidable environmental and ideological opposition from a variety of sources they have transformed perceptions of disability by drawing upon disabled people’s individual and collective experiences; something which sociology and the research establishment has hitherto consistently failed to do. The outcome of which is that disability is no longer considered simply a medical problem effecting only a minority of the population but is increasingly perceived as one of the major socio/political phenomena of our time with implications for society as a whole. Clearly, it is an issue which is as central to mainstream sociological discourse and analysis as class, gender, race and sexuality. It is an indication of the discipline’s intellectual stagnation and methodological decay over the last fifteen or so years that sociologists have only just begun to realize this.
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