ABSTRACT
From the preceding two chapters, my position has become evident. Rather than setting medical model versus social model, I think it is more fruitful to distinguish reductionist accounts and multi-factorial accounts, and I favour the latter. Existing perspectives have benefits and weaknesses. Chronic illness perspectives in medical sociology offer helpful empirical evidence exploring how the impact of illness or impairment affects a person’s sense of self and their relations with others but fail to situate disability in wider economic and political structures (Thomas, 2007). Materialist disability studies highlight how social barriers disable people with impairments but fail to account for impairment, either as personal experience or as causal explanation for disadvantage. This, together with its crude dichotomies, makes it hard to operationalise ‘strong’ social model approaches in social research. Cultural disability studies tell us that dichotomies are unhelpful, and draw attention to how cultural and historical variations differ in ways of classifying and describing impairment, and explore psychological explanations for why impairment is threatening to nondisabled people (Shildrick, 2012). However, they lack a strong political commitment, and this approach too is hard to operationalise in social research. In this chapter, I want to sketch how an alternative social approach to disability might reconcile different factors, avoid the perils of either biological or social or cultural determinism, and serve as the basis for a progressive politics. I am unashamedly eclectic and pragmatic in my theoretical allegiances,
finding a plurality of approaches beneficial in the analysis of disability. For example, feminism offers the concept of the personal being political and exciting work on the feminist ethic of care. The work of Nancy Fraser (1995, 2000) and Axel Honneth (1995) has proved powerful in
analysing the demands of radical social movements, and exploring the inter-personal dimensions of oppression. Most recently, Andrew Sayer’s book Why Things Matter to People (Sayer, 2011) does an excellent job of articulating why social science cannot be divorced from normative ethics. Like Sayer, I find the Aristotelian virtue ethics approach to be particularly fruitful, together with the work of Amartya Sen (1992) and Martha Nussbaum (2006) on the capabilities approach. I find the critical realist perspective to be the most helpful and
straightforward way of understanding the social world, because it allows for complexity. Critical realism means acceptance of an external reality: rather than resorting to relativism or extreme constructionism, critical realism attends to the independent existence of bodies which sometimes hurt, regardless of what we may think or say about those bodies. Roy Bhaskar, in his seminal work outlining the realist theory of science, asserts: ‘Things exist and act independently of our descriptions, but we can only know them under particular descriptions’ (Bhaskar, 1975: 250). In other words, critical realists distinguish between ontology (what exists) and epistemology (our ideas about what exists). They believe that there are objects independent of knowledge: labels describe, rather than constitute, disease. In other words, while different cultures have different views or beliefs or attitudes to disability, impairment has always existed and has its own experiential reality. Cultural sensitivity is required, but relativism is corrosive (Bickenbach, 2009). In disability research, strong statements from the critical realist perspec-
tive have been made by Simon Williams (1999) and Berthe Danermark (Danermark and Gellerstedt, 2004), and more recently by Nick Watson (2012). Each seeks to avoid arguments over medical model versus social model perspectives by demanding an analysis that gives weight to different causal levels in the complex disability experience. For example, Williams concludes: ‘Disability … is an emergent property, located, temporally speaking, in terms of the interplay between the biological reality of physiological impairment, structural conditioning (i.e. enablements/ constraints) and socio-cultural interaction/elaboration’ (1999: 810). Whereas Danermark and Gellerstedt suggest:
This implies that injustices to disabled people can be understood neither as generated by solely cultural mechanisms (cultural reductionism) nor by socio-economic mechanisms (economic reductionism) nor by biological mechanisms (biological reductionism). In sum, only by taking different levels, mechanisms and contexts into account, can disability as a phenomenon be analytically approached.
