Contra Scott Alexander in “Contra the Social Model of Disability”
Scott Alexander recently wrote this post, which seems to misunderstand the “Social Model” of disability in a way that is very familiar to me and frustrating:
As a deaf person who’s worked with disability rights activists, I’ve spent some time thinking about this, and I have some criticisms to offer. Mainly, the Medical Model of Disability is not as absent from many people’s thinking as he claims. I’ll examine his definition and try to provide a better one that shows how even in his writing there are elements of the medical model. In addition, the Social Model of Disability is not as poor a model as he makes it out to be.
Regarding the Medical Model, Alexander says this:
[When taught, the Social Model is] contrasted with “the Medical Model”, a sort of Washington Generals of disability models which nobody will admit to believing. The Medical Model is “disability is only caused by disease , society never contributes in any way, and nobody should ever accommodate it at all . . . ” Then the people describing it add “. . . and also, it says disabled people should be stigmatized, and not treated as real humans, and denied basic rights”. Why does the first part imply the second? It doesn’t matter, because “the Medical Model” was invented as a bogeyman to force people to run screaming into the outstretched arms of the Social Model.
Of course, nobody believes what Alexander has written here, because it is a bogeyman he invented. The only part of his description of the Medical Model that seems accurate is “disability is only caused by disease” and that the rest is showing real elements of society that are explained by a social model of disability in a way that “disability is only caused by disease” does not. The fact is that disabled people are stigmatized, not treated as real humans, and denied basic rights, and this has nothing to do with their actual ability and everything to do with how they are perceived by society. This is something that many people have not thought about and it is worth introducing them to this concept.
To further support the claim that many people see disability from the lens of “disability is only caused by disease” I want to point out the many examples of medical-model-type thinking I see in Alexander’s post. Let me first try to state the supporting assumptions of the medical model. I think it goes something like this:
Having an ability is objectively better than not having that ability
Disability is not having an ability that most people have
Given 1 and 2, the right response to disability is to treat it like an illness or injury: as a problem to be solved.
I find that there are pretty clear examples of medical model thinking in Alexander’s writing:
A blind person, marooned on a desert island untouched by society, is worse off than a sighted person on the same desert island. Here the problem is clearly caused by the blindness, not by any social response to it.
And:
The fundamental nature of not being able to see makes driving - an inherently sight-requiring activity - harder.
And:
My grandmother was blind for the last 30 years of her life… she could never see a sunset, or a rainbow, or a beautiful artwork.
As a deaf person, I’ve heard this sentiment expressed many times: “how sad it must be to live without music”, or “how challenging it must be to communicate with hearing folks.” In many cases, these takes are just wrong: I play the cello, Beethoven was famously deaf, and deaf folks commonly report being asked how they are able to drive. Although I am not myself blind, I’d guess that blind folks are perfectly capable of enjoying sunsets:
Imagine a blind person and her sighted friend enjoying a sunset. The breeze that had been uncomfortably hot is now rapidly cooling. They hear the evening bugs and frogs singing their evening songs. The smell freshly mown grass wafts over the nearby pond. Its not until the sighted friend leans over and says “You don’t know what you’re missing” that she has any reason to feel dissatisfied.
But even when the takes are right, as in “blindness makes it harder to drive” they often overestimate the effect that it has on quality of life. People are adaptable, and if they can’t do something the straightforward way, then they tend to find creative ways to do the things they want to do. There are folks with missing limbs that have scaled Mount Everest. In addition to adaptability, disabled folks sometimes find there are benefits to having their disability — I take my hearing aids out at night and I can sleep through sounds that most people can’t. In general, silence is under-valued.
I’d like to tackle the second assumption listed above, “disability is not having an ability that most people have.” First of all, this doesn’t work, even on its own terms. Aphantasia is not usually thought of as a disability (even though it is defined by lacking an ability most people have), whereas only 35% of people have 20/20 vision so it is not the case that “most people” have it.
But there’s a more serious issue here, which is that this ignores the identity that disabled folks tend to develop after a living with a disability, especially if they know others with disabilities. This disabled identity is crucial to many folks’ concept of themselves and if you gave them a magic pill to fix their disability they wouldn’t take it on the basis that it wouldn’t really be them anymore if they didn’t have the disability.
An important concept in deaf culture is “deaf gain” which is used in contrast to “hearing loss.” In essence, the deaf community feels that their contributions are valuable to society: sign languages are beautiful, among many other contributions. Treating deafness as a loss is simply not accurate to how those who develop a deaf identity see their disability.
Lastly, I would like to address Alexander’s contention that the social model argues against treating disability with medical care:
The Social Model goes on to say that it’s only okay to treat disability with accommodation, not with medical cures (if you’re going to object that it doesn’t say this, please read the quoted statements from proponents above). But this is morally abhorrent. It requires that we refuse to treat blind people whose sight could be restored with simple ten-minute cataract surgery, that we deny antidepressants to depressed people, or that we never operate on people in chronic pain.
Although Alexander tries to head off this criticism, I think that in fact Social Model does not say a disabled person shouldn’t ever treat their disability with medicine but that a disabled person shouldn’t have to treat their disability with medicine in order to be accepted in society. The decision to get medical treatment for a disability is not a straightforward one for many people and the social model argues there’s nothing wrong with deciding against it. As an example, I am deaf and have made a well-thought-out decision not to get a cochlear implant. But if there’s people living with disabilities, they still deserve to be fully included in society. Alexander uses this example:
Or suppose a paraplegic person wants to climb Everest, but can’t. Why not? Most people would say “Because climbing Mt. Everest in a wheelchair is inherently hard.” Although you could sort of say “because Society has not yet built a wheelchair ramp all the way up Mt. Everest”, this would be a weird and unnatural way of thinking about things, as if for some reason society had a duty to build a wheelchair ramp up Mt. Everest but refused out of spite.
[…]
(if you’re hung up on Mt. Everest being natural, or un-climb-able even by most abled people, then replace this example with a wheelchair lift on a man-made hiking trail up a gently sloping hill. Or consider for example a spaceship. […] I think the most natural way of describing this is “being blind makes it hard to pilot a spaceship”, not “being blind has no relationship to piloting a spaceship, but NASA has chosen to deprioritize the needs of blind people in its spaceship design, which is what prevents blind people from going to space”)
I would fully assert that everyone who uses a wheelchair should have access to man-made hiking trails up gently sloping hills (in sufficiently resourced parks). It is not very hard or expensive to pave a trail through the woods, and also benefits folks who do not use wheelchairs but may have other mobility difficulties: elderly folks with canes etc. This is a normal societal thing (unlike the examples Alexander favors: desert islands and Mt. Everest and spaceships) that everyone should have access to.
In summary, unlike the approach Alexander sometimes takes to “steel man” the positions he argues against, this article argues against a straw man version of the Social Model, and not even a very good one at that. He is mistaken that the medical model has lost relevance and also mistaken that the social model is well understood by all and widely accepted. His version of the social model betrays the lack of understanding you would expect from someone who has spent a lot of time thinking about mental health but very little time thinking about disability.