I just found out that the Generals won a few games against the Globetrotters. As many as 6! So assuming 6 is correct, their win/loss record is something like 6-16,000.
It's in a bunch of medical school curricula and a lot of disability rights groups use it. If you do any work with medicine or disability you've probably heard it taught as "the right way to think about things".
And to be clear, I think the social model is clearly out of balance. I just wonder how much effect it's actually having on how businesses and organizations behave.
Technicallyyyyyyy there were those people on Twitter getting mad about Mr Beast giving lots of people eye surgeries. But that's actually more of an example of people complaining about capitalism/inequality, not necessarily the Social Model. I'd bet a lot of money that some of those people were using the Social Model, though.
I went through a phase of being really interested in sign languages, I can totally understand why deaf parents might be worried about their children not being part of their community, and a shared language is a big part of that.
That said, I'm sure a child of deaf parents would end up fluent in Sign Language regardless, and so this does feel like a decision to deprive their child of something that could be really beneficial to them, without really gaining anything by it.
From what I understand (a couple of decades old) cochlear implants are not an adequate replacement for normal hearing, and have some unpleasant side effects. (The only one I remember, though, is excessive sensitivity at certain frequencies.)
Perhaps they've been improved a lot since I noticed articles about them, otherwise I wouldn't be too sure that it's not in the child's benefit to wait. (And I'm sure glad I never had to make that kind of judgement call.)
I have definitely heard it used to argue against giving children cochlear implants, deafness is probably the area where it's most contentious.
That said, most times I see the social model mentioned it's usually about how a combination of medical devices (like wheelchairs and prosthetic limbs) and social accomodations (like ramps and not being weird when people have a missing leg) provide the most benefit to people with disabilities.
The most extreme example I can think of is a social worker I know vociferously arguing that someone's tendency towards physical aggression towards roommates was just a "different way of being" that we needed to find better ways to accommodate rather than seek to modify. Given that offering plans for behavior modification was my role on the support team, this put us at opposed positions, and it became necessary for me to find professional and sophisticated ways of saying, "What the hell?" in emails.
I personally don't think this is an issue of importance and doesn't really have any major impact on quality of medical care. DOs undergo many hours of training in Osteopathic manipulation despite the fact that there is limited evidence for its benefit, yet I think the quality of care between the MDs and DOs is quite similar. I think physicians are smart enough to know when something works and when something doesn't.
How did no-one in the 200 comments I've skimmed mention a famous real world example in which youtuber Mr Beast paid for something like 1'000 blind people to get operations to cure their blindness in exchange only for being filmed for 15 seconds with a beaming My Beast....
<i>and got promptly attacked by thousands of shrieking harridans of the social model for debasing the poor victims' noble blindness</i>!!!
Scott covered this on a linx-post. Video+outrage+how can there be outrage?! - Not much into Mr Beast, would have missed out on that vid without Scott - and it turns me into a cry-baby from second 17 to end. Each f...ing time. https://www.youtube.com/watch?v=TJ2ifmkGGus
It feels really weird to think that this is an important point to argue about. I have a REALLY hard time thinking that anyone would take that "Social Model" seriously as a general argument. I have heard people argue in favor of it in specific cases, but I don't think I've ever heard anyone argue in favor of it, e.g., cases of muscular dystrophy.
OTOH, I have heard of folks from societies of deaf people argue against taking their children and teaching them to speak. (I've never heard that most people in those societies feel that way, but it's conceivable.)
I never would have believed people would literally defund the police, then they did because a world model said police are an institution of the majority and are therefore inherently harmful to minorities
You can carry on not believing it, because people didn't literally defund the police. People literally attempted to pressure their local governments to cut police budgets, with results ranging from total lack of success to very modest success. And they did so not because a world model said police are an institution of the majority and are therefore inherently harmful to minorities, but for a variety of reasons clustering around "a world model said police are an institution of the powerful and are therefore inherently harmful to the less powerful" and "a world model said (or frankly, simple observation reveals) that many police departments are outfitted with extremely dangerous and expensive military-like toys but often lack the training, ethics, or emotional maturity to wield them without killing people unnecessarily."
"Literally lessfund the police" didn't have the same ring to it
Part of the lack of success has been the dramatic increase in non-police shootings. 1000 men, women and children a year. I think that put the brakes on it
I hear deaths of unarmed black men during arrests has tripled to 30 per year. My theory is that quality cops abandoned high risk areas while a major drop in active policing means there are now more violent encounters where incidental or negligent deaths in custody can occur. I am very unhappy with these tragedies and don't feel any short to medium term hope for it to return to as it was
The theory that an institute of the powerful would be inherently injurious to the less powerful makes me the most unhappy in that reducing the influence of that institution was therefore the solution preferred instead of research and training into non-lethal weapons and first responders which seems like the likely choice otherwise
It is a convenient way to talk about things. The Medical model puts too much onus on the Doctor. Self-help groups and peer-support may be effective and perhaps cheaper in some contexts. Equally important is that the Social Model strengthens the political constituency for higher spending on Health. Sadly, because of Baumol Cost Disease (which can only be defeated by exporting a lot of health services) there is a crowding out effect whereby the 'second order' public good (which consists of demanding more provision of the first order good) consumes more and more resources while the 'first order good' (e.g. medical interventions) get rationed or simply disappear.
Probably the clearest example of the Social Model being taken literally and taken to extremes are the self-professed "deaf community" members who actively oppose cochlear implants, sometimes even denying them to their deaf children, on the grounds that fixing their disability is "an attack on their identity as deaf people." (If that sounds like an over-the-top parody of someone's idea of what a crazy activist would say... that's Poe's Law for you. As horrifying as what I just described is, it's quite real.)
Cochlear implants do not by any means “fix” deafness. They are incredibly expensive, remove any residual hearing (not all deaf people have 0% hearing) risky (as all surgeries in the head are) and the sound quality is such that some who get them simply choose never to wear the external device. There are also scenarios where wearing the device is impossible, like swimming.
Your description matches perfectly the plot of Sound of Metal (a recent Oscar-winning film). Based on a google search for "Sound of Metal cochlear implant accurate" I'm left with the impression that your claims are highly controversial, in the sense that some people really do agree with that description, but also some with cochlear implants consider it nonsense fearmongering.
I'd be interested in a survey of cochlear-implant satisfaction, not sure how else we can resolve this as it seems at least somewhat subjective.
I tried to google for some surveys and came away unsatisfied. The rest of this comment is a description of what I found, since I think it's good epistemic practice, but I am unqualified for this analysis so feel free to stop reading:
Best I could find (links below) is a study of older patients (paywalled) which found 68% of respondents were satisfied with their implant, and 25% somewhat satisfied, zero of 60 respondents expressed regret. Then another study doing a review of studies on quality-of-life which is far too long and complicated for me to read, but the conclusion says QoL seems to improve after a CI when using surveys designed for deafness specifically (hence subject to more straightforward bias, like maybe they ask if you can hear more things), whereas if you just ask "how is your life now" there's insufficient evidence that CI improves QoL.
It seems very clear that CI improves the ability to hear, in the sense that you're on average more likely to understand what people are saying and notice quiet noises. That stuff is straightforward to measure and an obvious inventive for the medical establishment
The main argument against CI has got to be about the desirability of the type of hearing it affords you. Ideally we should poll a bunch of people who could hear, went deaf, then got an implant and ask how the three compare, but if anyone has conducted a survey like that I couldn't find it (we know for a fact that we'd get a range of responses, so only percentages matter). Satisfaction/regret after implantation would be a really useful metric, because it directly addresses "should we encourage deaf people to get CI" and it indirectly addresses "does CI give a subjectively desirable hearing experience," but those surveys also elude me. Just asking "how's life?" and checking for correlation pre/post CI is a proxy for satisfaction/regret, which as mentioned is a proxy for "do you like receiving sound input this way"
Cochlear implants, while imperfect, are getting better. My legally deaf and blind friend can now hear better than at any time in her life.
The more fraught issue is that American Sign Language could be driven into extinction over the next century or so by improvements in technology:
"ASL-only speakers can be highly protective of their culture, and some fear its eradication by cochlear implants, somewhat as many lesbians fear that the current popularization of sex change therapies among butch girls threatens the long-term existence of their sexual orientation."
Found it via the Wikipedia page very easily, my usual go-to for this sort of thing. The sampel sizes even in the meta reviews seem to be small though, I think it's generally just assumed that people want to be able to hear if possible.
It would be my guess that it depends on the surgeon and the device. Certainly that matches the description of using a cochlear implant that I heard a decade or so ago, but one would hope that they have been improved in the intervening period.
OTOH, that's a pretty small market, so perhaps they haven't been. Or perhaps only some of them have been.
Someone with an artificial limb (or even someone who needs glasses) has similar issues, but I think they'd generally still consider the prosthetic to be a useful improvement - this seems to be the consensus on cochlear implants as well. Sure, maybe it doesn't "fix" disability, but I'm not sure why you'd make that your goal when you could instead aim to improve quality of life by giving people access to experiences and independance that they'd otherwise be denied.
The two people I know who are missing hands don't wear their prosthetics. People always want to make analogies to glasses, but many (possibly most?) interventions for pretty profound disabilities like missing limbs are more give and take. It really depends on the disability and the person. In the case of limb prosthetics, some are actually quite useful (foot prosthetic s) and some are really more cosmetic (full double leg replacements).
Probably the hardest part of talking about something like "disability" is we inevitably end up overgeneralising - I suppose I was thinking of lower leg prosthetics, I am aware that there isn't much that can be done if the knee is missing. I don't know anyone with a prosthetic hand, I assumed they were more useful than they apparently are but I can imagine any function being too clumsy to be worth it.
My point was that it's not a dichotomy between curing and accommodating, there are useful things that medicine can do but also profound limits.
Logan wrote a much more rationalist response than I will, but I can at least attest that quantitatively the surgeries are not particularly risky. And as described to me by surgeons, the results depicted in 'Sound of Metal' are only accurate in that they show the initial effects immediately post surgery. Neuroplasticity is everything. In children the results can be amazing. In adults who are dedicated to their neuro rehab, the results are great. In adults who expect an immediate miracle, they will be frustrated and disappointed.
Although their attitudes may correspond to the Social Model, I think they actually predate it. Deaf people have their own language, and their own distinct communities where they congregate. They can't easily assimilate, because few people who aren't deaf or related to deaf people learn sign language, and they have shared experiences unique to people without hearing, so they've developed what they consider to be a distinct culture which they're quite protective of. They may have contributed to the development of the Social Model, but I don't think it represented a change in their social attitudes (although the reduction of Deaf communities due to the invention of the cochlear implant definitely did.)
The rise in the well-being of the deaf from the old "deaf and dumb" days due to the standardization and spread of sign languages and the development of boarding schools for the deaf where, after a long struggle, sign language use was encouraged is an example that sometimes the Social Model can do a lot of good.
Similarly, the decline in persecution of lefthanded children for using the sinister hand has made life better for a significant number.
It's also worth considering how unique this is to Deaf people, there isn't a Blind commununty in the same way, because blind people can share a language with the sighted. There is braille, but that's mostly just an alternative writing system. I think some of the difficulties in the discussion come from trying to generalise a lot of different things that we all call "disability".
Sign languages are really interesting (notably there's a lot of them, it's not like all Deaf people can understand each other), but while they're great within a community they reveal the obvious limits of the social model since most people can't understand the language and probably aren't going to learn unless they know a Deaf person.
And of course sign languages also pose different problems for amputees who can speak voices languages just fine. There is no possible universal accommodation in language.
Well, ... "no possible" is a bit strong, though we certainly couldn't build one now. And it would need to include "locked-in" folks. This clearly implies that it would need to be a mechanical mind-reader. Likely it would need to train on each person individually, and do a transform into a more universal symbology.
Now if you'd said "no universal accommodation" I'd probably agree, as I can't think of one this side of Jack Williamson's "With Folded Hands". But when you restrict it to language I suspect that we could build one in the next decade or two. (I'm NOT sure it would be a good idea.)
I can't help but think this is going to really backfire on those parents is a really tragic way, as opposed to going ahead with the implant but also making sure their child also learns sign language (probably inevitable if your parents are deaf) and can become a bilingual member of the deaf community.
I have glasses, and I really would be blind without them! (e.g. if I take them off to go swimming I can easily get lost because anything more than a few metres away is a blur). If I found out that my parents had decided to not give me them as a child because they wanted me to have a "visually impaired" identity, I think I'd be rather angry with them when I later realised what was possible.
No, because it's not opposed to medical interventions.
What Scott describes here as the social model is what the literal words describing the social model say. But what he describes as the interaction model is what most people actually come to understand the social model to be.
The ADA implements either the social model or the interaction model, because the difference between the two is in medical interventions in disabled people, which is a thing that the ADA doesn't address.
It's used extensively in disability rights. This is an area I have a lot of experience with, and in that (admittedly anecdotal) experience, I'd say most people don't *really* believe it, but find it useful as a way to get people to think more intelligently about the interaction between accommodation and people's innate conditions when we describe someone's disabilities. That said, there is a more radical core group who absolutely believe the claims in the strongest sense and they tend to be those most apt to throw out charges of bigotry, so it becomes necessary to dance around the subject.
The Social Model is very popular among disability activists, and as a result tends to be influential in the thinking of people with disabilities who have any contact with that sphere. That ideology seems a priori likely to have a really toxic effect on people, and my experience (admittedly limited to just a couple of people) seems to bear that out. Having a significant disability that can't be cured is awful; having one which isn't well accommodated by society is even worse. But the Social Model tells people with disabilities to blame *all* of the bad experiences they have as a result of their disability on society's evil oppression of themselves. This can make the people in question unpleasant to be around, obviously, but I'm sure it's also just psychologically unhealthy in itself. It can feel appealing at some level to have someone to blame all your suffering or deprivation on, but living in a constant state of resentment is just about as miserable a psychological state as I can imagine.
I mean you will hear that exact line of argument trotted out if you are disabled (I am disabled in a very minor way and absolutely got speeches about the social model from medical providers when it happened in the mid 90s at age 14) or when discussing accommodations. I am not sure many people other than activists really believe it, but they certainly use it as a cudgel to get their way a lot and get some truly insane/inefficient accommodations approved.
I can think of more than a few rec areas in my state where trails/facilities have been abandoned because there wasn't a way to make them "accessible".
In my current neighborhood we had an amazing volunteer fundraised and built playground 3x better than any other playground at a grade school, but well before it was at the end of its life they tore it up and replaced it (despite the school district being super broke) so that now a C+ playground was 40% useable by disabled kids instead of a A+ playground being 20% useable by disabled kids.
A similar thing happened back in my home town too with two different newish giant playgrounds ripped up to make them more accessible (and in the process made much more samey, boring and smaller).
First, I used to work at a large corporate job (as in, the job was at a large corporation, not a large job) which involved a lot of contact with people with various disabilities, especially hearing disabilities. Late last year, as part of our training (about a half-day out of a 10 day program, so ~5% of the time) was spent uncritically going through this model, presenting it as the only correct/compassionate model. Most of my other trainees there were not especially well educated, so for them this was the only education they've received on the topic. Anecdotally, most seemed to swallow it uncritically. (The culture at that workplace was such that pushing back even a little bit would have gotten me fired, or at minimum in deep trouble.)
Second, a few days ago I was at a methodology workshop at a university (back to my studies), and the first speaker ostensibly talked about different ways to engage with participants/gather data that don't involve traditional language-dependent measures, like interviews or surveys. This speaker took up the morning slot, so ~2 hours of an 8-hour day of a three-day workshop (although I skipped the next two), so ~10% of the total time. They uncritically repeated this model, which based on comments and discussion was treated as not only valid, but again, obviously true and the only way of looking at things. These people were either PhD students or working academics in a range of fields from psychology to design to law to business.
That isn't direct, concrete consequences, but if both average people are being taught this stuff, and academics are actively swallowing/repeating it, that seems plausible to lead to said consequences?
The biopsychosocial model has a bad reputation in disability activism circles because it is regularly used to tell disabled people that their problems are all their own fault and should be fixed with the power of positive thinking rather than, say, painkillers, or that all disabled people could work if they tried hard and believed in themselves. Especially in the UK where the phrase has been used extensively by the DWP to deny a lot of people disability benefits on the grounds that their impairments are theoretically within their gift to overcome.
The social model as actually practiced by the disability rights movement sees availability of medical interventions as an important variety of social accommodation for impairments - but the emphasis is on the person with the impairment wanting the intervention, rather than society wanting the intervention to make the person more convenient. (A standard example of treatment to make someone more convenient rather than actually being what the person wants to happen is ABA for autism, but there are equivalents for physical impairments like the historical 'pillow angel' horror.)
The typical example is pain treatment switching to 'cost-effective' psychological treatment rather than painkillers. (This is especially bad for the people who already know the first line psych treatment of worksheet based CBT doesn't work for them / makes them actively worse, which is fairly common in autistic women, who are also especially prone to chronic pain conditions)
"the prioritisation of return to work, increased activity and cost savings are all signs of this problem."
I can't speak to cost savings, but this statement implies getting back to a normal or fulfilling life (which for most people includes returning to work and increasing activity) is bad? Is that what you mean? I am not sure that view is held by most people with chronic pain.
Are you in the UK? Given the difference in the UK health care regime and that of the US, you may have a very different view of how the biopsychosocial model is used in practice. Because the US doesn't have a monolithic health service, decision are made in a much more piecemeal way. The application of models isn't done consistently. And given the profit driven approach in the US, "cost savings" aren't at the top of the list for doctors or health providers (or even patients if the have insurance). I can assure you that in the US we have much more of a problem of using TOO MANY painkillers, not taking them away from people who need them (though some government policies are resulting in this and its shameful, but its not due to the biopsychosocial model).
> fairly common in autistic women, who are also especially prone to chronic pain conditions
Autism is a very complex condition with physical, social, and psychological factors. Given the correlation of autism and chronic pain, its not a jump to say that the chronic pain experienced by people with autism also has physical, social, and psychological factors.
What data or guideline should make anyone consider psychotherapy more cost-effective than analgetic drugs for chronic pain conditions? For what timespans and outcomes? State of the art would be a combination of both with other interventions, IIRC, still with often dissatifiying results.
Really, what part of the biopsychosocial model sounds like "own fault"?
I kind of disagree with the way the disability rights movement uses the term "more convenient" as a way of saying "bad and ill-intentioned". If for example someone is constantly screaming really loudly, then trying to prevent that is "making them more convenient", but I am sometimes in favor of doing this (especially on a crowded ward full of lots of other people). Obviously it's better to solve the underlying problem somehow or give them some private ward where nobody else has to hear them; equally obviously this isn't always an option.
EDIT: Oh wait, it's the "psych" part, isn't it? I guess I always thought of that as something you add in to make people happy so they don't accuse you of medicalizing things too much, but I can see how that could go wrong if you take therapy too seriously. I'd be happy to move to "biosocial" but the therapists would never go for it.
The place this is mostly evidently a problem is chronic pain treatment, especially in light of the opioid crisis - a lot of people have had their painkillers taken away and replaced with platitudes and cognitive behaviour therapy, and the biopsychosocial model is regularly cited in defence of this.
The biopsychosocial model regularly gets sold as a cost-effective way of treating pain, and people in constant pain generally hate to be told they're getting a treatment they consider less effective because it's cost-effective, regardless of whether it's actually a good treatment or not...
I agree this model seems like a very bad fit for chronic pain treatment.
Do chronic pain patients like the Social Model? I think of the Social Model as saying that people should medicalize things less, whereas in chronic pain usually the problem is we're not medicalizing them enough.
Depends on whose framing of the social model we're talking about. I generally see two in the wild:
Mostly neurodiversity advocates goimg full social model and demanding that nobody attempts to treat their condition as an impairment at all; this is generally not welcomed by people with intrinsically pain-causing impairments. (The Deaf community has also been going in for this for much longer than we had the present vocabulary for it.)
Mostly 'classically' physically disabled people like wheelchair users attempting to get people to distinguish impairment and disability, but acknowledging that both exist and it's good to treat a impairment if possible, but generally considering currently society is if anything too pushy on that (eg pushing surgeries with high chances of failure / unacceptable side effects and then considering the impairment the person's own fault for declining them) and needs more of a push towards accommodating impairments and not turning them into disabilities. Chronic pain patients are generally quite on board with this because fatigue accommodation is often quite similar to other physical impairment accommodation and is vitally important to them (and often this is a fight they have over which painkillers to use, as most people find fatigue more aversive than pain but have trouble explaining this to healthcare providers).
If I believe that disability is an interaction between both biological and social factors, that the strongest version of the Social Model is false, and that people with chronic pain should get good access to pain killers, is there any existing group/term here that I can identify with or support?
That is what most people in disability activism call the social model, but I appreciate that's imprecise because others also use that for the pure social model; I don't think there's a precise term, I think biosocial model could actually catch on and at least won't set off a knee jerk reaction, and I think the most important signalling mechanism in the direction of the moderate version of the social model is using the words impairment and disability separately rather than referring to a condition as a disability.
The use of opioids to treat chronic pain is incredibly more complex than “good access to pain killers.” In fact, it’s good example of the biopsychosocial dimensions of the suffering from chronic pain. The topic is way beyond the scope of this comment, so I’ll just offer one anecdote:
I have a patient who has right lower extremity complex regional pain syndrome, so severe that her leg has atrophied and she has to use a knee walker. She has tried all interventions and still lives with 9/10 daily pain. One day she came to a followup visit and told me she had stopped her (substantial but not excessive) opioid regimen altogether. Shocked, I asked her why on earth? She said, “I got tired of being the person in the corner at the family gatherings who is treated kindly but also ignored because I’m a little bit numbed out by the pain medicine. I’m going to live with the pain and be the real me.”
I thought that part of the problem was that there AREN'T any good long term pain killers. E.g., that opioids have habituation problems such that after awhile they're no better than aspirin.
As someone who has been treating chronic pain for years, I aver that the biopsychosocial model is exactly the most sound way to approach the problem. The suffering from chronic pain has biological, psychological, and social dimensions and there are often ways to help people along each of those dimensions, depending on the problem. There is no chronic pain management clinician who uses the framing biopsychosocial “to tell disabled people that their problems are all their own fault.”
In the US the specialty of chronic pain management came out of anesthesia and has been historically overly focused on the biological cure--- “when my pain goes away, I’ll be OK.” Chronic pain is pain that is chronic in spite of physical treatments. You have to help people learn “I can be OK living with pain.”
Im not a doctor, but have done a lot of (amateur) research on biopsychosocial model when it comes to pain and I have never heard it used in the way the original poster describes. It's always much more what you describe. To me the biopsychosocial model is a way to introduce nuance to treatment and introduce a model which takes into account all factors influencing a condition.
Right. The biopsychosocial paradigm applies to many complex human conditions. For another example, I think it would add some nuance to the current volatile discussions around the idea that gender is purely a social construct.
Cases like this have been motivating opposition to the social model for some time - see e.g. the work of Susan Wendell (1997, 2001), who taps into a broader trend of saying that the social model has historically neglected the perspective of some disabled people, especially women, whose impairments are harmful and not only because of social stuff. Tom Shakespeare is another very influential critic of the social model on related issues.
Though, as others in the thread have said, part of the issue is that the social model was always something of a broad tent, and so the line between posing a problem for it, and precisifying it in a preferred direction, is very blurry. Perhaps some of what I wrote in section 6 here is vaguely helpful: https://jesp.org/index.php/jesp/article/view/572.
A lot of abuse of people with disabilities, particularly mental illness, and even more particularly intellectual disabilities, results from the fact that people are trying to make their interactions more convenient for them. They want to do something easier, quicker, or cheaper to help someone, and it results in a lower quality of life for that person, where "lower quality of life" might mean "horrific abuse." Institutions, as you know, are infamous for this exact problem. Coming to understand this is a keystone to promoting more humane treatment of the disabled. But because of that, every single person with any kind of interaction with disability rights likely has heard the concept, and not everyone is the best at picking up on ideas and using them with appropriate nuance. So you see this idea get used in sloppy and promiscuous ways where not extending infinite resources towards a person is treated as an act of malice. That was never the intent when you're trying to teach people patience or advocate for resources above the level of persistent neglect, but it is how the concept sometimes get invokes in the real world.
"the fact that people are trying to make their interactions more convenient for them. They want to do something easier, quicker, or cheaper to help someone, and it results in a lower quality of life for that person...not everyone is the best at picking up on ideas and using them with appropriate nuance."
A general truism that scales and transfers to most every other human activity over time. 'Character is destiny,' evergreen.
Your edit here is a fascinating point that could be an entire post. Even without therapists being involved. After all, choosing to literally have completely different mental processes instead of going to therapy implies that if someone else doesn't choose this, he's at fault.
Millions of people objected to the COVID vaccines, and not solely on the ground that they questioned the safety/efficacy (though of course there was that, too). Many objected solely to the government requiring them to make a certain medical decision. Then when they were told they weren't allowed to go to work or interact with society in meaningful ways, they balked that they would be required to make a medical decision the way the government wanted them to, or sacrifice freedoms they'd previously enjoyed without doing that thing.
This could be similar to one reason deaf people might be so virulently opposed to cochlear implants. "Look, you can hear now. Good for you! Just make sure you go get the surgery."
Say you're doing mostly fine, but then some people come along and tell you to go make a medical modification to your body in a way that will amplify its capabilities in line with social expectations. In a way, society is asking you to make a medical decision in the way they approve. "I'm good, no thanks." Except it's not really a choice if society effectively shuns you for deciding in an unapproved way.
This doesn't have to be the same as the mandates for vaccines, to have the same effects on keeping your job, etc. Maybe you reject the modification, but many other people choose to get the implant and in so doing reduce the number of people who need the kind of deaf accommodations you need. At the limit, if everyone went to get the implant, you'd be the last person to provide accommodations for, so few if any people would provide them. You'd essentially be forced, by social convention, to make a medical choice you objected to.
Your optimal play in this situation is to attempt to stigmatize when other people choose to get the implant, advertise the implant, or inform people about the availability of the implant. The fewer people who feel comfortable getting the procedure, the more easily you'll be able to go through life without having to get it yourself. Thus, ironically, the only way to preserve your own freedom to make this medical choice the way you want is by pressuring others to make the choice in the same way.
Caveats: I have low confidence in this analysis, and would be interested to hear from anyone who has direct experience in the community. I'm not making any specific claim about deaf people in general, just reasoning out the incentives that I would naturally expect from this kind of situation.
Social model as a pure philosophy tends to be the domain of eg neurodiversity advocates (and, interestingly, the Deaf community who've been doing it a lot longer than current vocabulary).
Social model as a way of distinguishing impairment (the actual condition) and disability (how the person is actually harmed, usually via social factors), and suggesting that society goes too hard on trying to fix the impairment and not hard enough on trying to fix the disability, is much more widespread - so people should have painkillers (of the kind they want which balance pain and fatigue to their choice) and also fatigue accommodation and adequate rest.
Depending on the severity of the disability caused by the impairment, that seems clearly not actually the case? People with different impairments can compensate for each other even in a state of nature; some things which disable people in modern life are not even noticed at other developmental stages?
Most historical people had some kind of impairment by modern standards, generally caused by inadequate nutrition, but they still built a society capable of improving to our current state.
And I hope that as technological advancement continues, future people will consider most of us to be impaired in comparison to themselves...
Why should anyone help anyone? Either altruism or enlightened self interest (impairment isn't a binary state, eg lots of people who do useful jobs have impaired vision but nowadays we correct it with glasses and everyone is better off for this).
If you pick a specific impairment and posit everyone has that one, sure, you can pick one that makes people die out in the ancestral environment. Most modern humans would also die in the ancestral environment. This says nothing about their ability to contribute today, if that's how you judge the worth of a person (which seems overly harsh to me given we have surplus around to support quite a lot of people who don't 'pull their weight').
I dunno that's true in the general case, e.g. it's not obvious to me that a society with no hearing people at all would be impossible (though it'd be pretty different from ours).
It is certainly possible at a low-tech level. (Well, almost certainly.) I've read about communities of the deaf in Egypt in (very late) Roman Republic times. From the reports (which may be biased) it wasn't that different from other remote villages. To me this implies that they paid taxes rather than depended on largess.
"society’s failure to provide adequate bus routes is better considered a failure to resolve the disability, not the cause of it."
overall point taken, but i do think the more salient/useful feature of the social model is that its theory of social causation intuitively produces a sense of social responsibility. does it matter necessarily if society "caused" the disability if the larger motivation is to promote social action? whether the approach is infrastructural or medical in nature, either way the responsibility to accommodate falls on society's shoulders at large. i think the social model's recognition of this necessity still advantages it over the biopsychosocial model
Can you rephrase this? It sounds like you're saying this is an unnatural framing that's being used because it has the right political implications, which is exactly my complaint.
essentially i'm pointing to a functional disconnect between the two models. if the question is "what causes disability?" then i would agree that turning to the biopsychosocial model makes sense there. but if the question is "what should we do about it?" then i think the social model proves the more useful there. this is assuming we agree generally that social action of some sort is what's called for in order to solve the problem of, say, providing blind people with options for transportation
I guess I'm asking if you're just saying (sorry for hostile reframing) "anything is justified if it makes good propaganda".
For example (sorry for offensive example), suppose incels were to say "it's society that's making us single", and when you asked what they meant, they meant that, although it was their own characteristics that made nobody want to date them, society refused to give them free state sponsored gfs. And instead of framing this as "society has not solved our undateability", they were reframing this as "society causes our undateability".
Is your position that the incels' argument is no better or worse than the Social Model's, but that you politically support the Social Model but politically oppose incels for other reasons, so you would let the Social Model have convincing-sounding-propaganda-strongly-worded-framings but deny the incels' right to use the same? Or do you think there's some fundamental difference?
i'm more making a "pay mind to the baby in the bathwater" kind of argument. the social model orients towards the insight that disability is, pragmatically, a social problem — not in the sense that it caused it (this is the bathwater), but in the sense that it takes organization on a societal level — whether that means universal health care or expanded public transit — to alleviate it.
with the incel analogy, i think we'd have to accept the incel premise that undateability is a disability for which they're owed accommodation, a fundamental right they've been unjustly denied access to. i think, firstly, that the social model makes its argument in the context of the question of disability, and so naturally we run into errors of translation when applying it to a situation outside of that environment.
doing this translation and applying it anyway though, i think the essence of the social model recognizes that incels are a phenomenon of social concern in the first, and thus call for a social approach in order to solve it. (of course this would mean something like a materialist study of incel echochambers rather than state sponsored gfs, because again involuntary celibacy isn't a disability)
This example demonstrates nicely that the "social model of disability" is actually a two-step process for seizing power: First, advocates of the model push to define "disability" (absurdly) as a failure of society to accommodate an impairment, thus establishing themselves as absolute authorities with the prerogative to define terms arbitrarily in the area of disability. Second, those advocates leverage their established authority to define "disability" to include groups they wish society to accommodate, and to exclude those they don't wish society to accommodate. As a result, they accrue arbitrary power to redirect society's resources towards those they deem "disabled" (or whose "disability" they wish to highlight at the moment for political purposes), and away from those whose claims of "disability" they choose to dismiss (again, presumably for political purposes).
Now, I don't personally believe "incels" should be defined as disabled--but then, I don't believe anybody else should be, either, if we accept the social model definition, which attributes all disability solely to social failures of accommodation. When "disability" is redefined as an unlimited claim on societal resources for accommodation, the power to define/emphasize--or downplay/refuse to define--a condition as a disability becomes far greater than anyone should rightly possess in a democracy.
More like, the less nuanced propaganda, the more effective it is. You understandably are disgusted by this, because it's basically the definition of a symmetric weapon, but they do often happen to beat asymmetric ones in the short term. Still, kudos for fighting the good fight anyway.
This is where I feel like I'm in the Twilight Zone. Isn't it really, really obvious that the point of the Social Model is its propaganda value? Isn't that essentially what its proponents say about it themselves? None of the scientific, governmental or advocacy organizations you quoted did an empirical study that found concrete evidence that fit the Social Model but not the Medical Model. How could they? It's not that kind of model. It can't be true in the way the theory of gravity is true, only in the way "thou shalt not kill" is true. It's an assertion of a terminological paradigm, not of a fact. Calling it "propaganda" is like calling a fish wet, as though that was an insult.
Its creators and proponents are not asking themselves "which model fits reality best?" -- they're asking, "which model advances societal progress the most?" Anybody who cares primarily about whether a model fits reality would be embarrassed of the Social Model.
It seems to me that the point of models of this kind is to dress up policy priorities as scientific facts. So trying to find a more accurate model is futile. It's like trying to pick out the saltiest equilateral triangle. The more fruitful path is to ask what role these models play in society. How does an empathetic, benevolent person who is also committed to honesty and clear thinking interact with a model of this kind in an ethical way?
“ It seems to me that the point of models of this kind is to dress up policy priorities as scientific facts.”
The disconnect here is that the usual meaning of “model” is usually “a thing that accurately represents another thing” or more precisely in this domain, “a tool we can use to make accurate predictions about reality”.
So if you call it “the Social Model”, and phrase all your training as if it is, in fact, a model (an accurate representation of reality), but it’s really just the “Social Rhetorical Strategy”, that is going to bother Scott.
A better term for what it is might be 'analytical lens' or 'framework', with the idea that you should look at a situation from several 'analytical lenses' in order to figure out possible solutions.
So you can look at disabled people under the 'medical lens' and propose solutions from that for how medical interventions may address their problems. And then you can also look at it under the 'social lens' and propose solutions for how social accommodations or restructuring society may address their problems.
And there may be a somewhat outdated assumption that everyone uses the medical lens by default, so you have to be really pushy about getting people to use the social lens at all.
They admit that they are advocating for society accommodating disabled people, but I don't think they admit in all contexts that that's why they choose the Social Model in the first place.
Once someone admits that he chooses his arguments based on their propaganda value, not truth, he basically gives up on convincing you if you aren't already convinced, because there is no reason for you to trust him.
Perhaps they admit in some discussions that they choose the framing for its propaganda value, but for it to have propaganda value, they rely on it not being publicized everywhere the framing is pushed.
So if you care about the truth, and about society making good decisions based preferably on asymmetric weapons, it's a good thing to publicize the fact that the framing has been chosen for propaganda value, not truth. Except perhaps if you fully agree with the goals of the propaganda; but even then you should reevaluate whether you might have been convinced by bullshit arguments.
Maybe I misinterpreted the Contra Caplan, but it seemed like that one said that mental disorder is currently political, but there's no other way. Whereas this one is saying that physical disability is currently political, but it should be redefined in a way that doesn't blame society as much?
But the social model does not allow for there to be any limits on degree of accommodation. If someone's disability is entirely the result of society's treatment, then it is reasonable to demand that society stop wrecking "disabled" people's lives. Wrecking lives is a crime. There should be no limits at all on how much we expect society to limit the wrecking of lives. But if the limitations that disabled people experience are the manifestations of illness or injury, it does make sense for society to put some limits on accommodations: Most of the money and efforts should go into setting up accommodations that give the most bang for the buck -- that help many disabled people in ways that make a real difference. But heroic, very expensive accommodations that would benefit only a tiny minority of the disabled -- such as building a handicap ramp up Everest -- can legitimately be skipped.
> There should be no limits at all on how much we expect society to limit the wrecking of lives
Most of the inhabitants of modern society appear to be entirely on board with wrecking some lives in the process of attempting to improve others. ( See, for instance, the subject of Aaronson's famous "Comment 171". Can easily find via Google; I suspect that Scott would prefer not to have it linked here. )
this is a good point, i can see the disadvantage there. i suppose i'm made a little uncomfortable here, because as with all lines in the sand i don't think there's a fair way to differentiate between what ratio of bio:psycho:social reasonably constitutes what degree of response — i.e what exactly counts as "most bang for the buck"? who'd make that call in the first place?
Many things, maybe everything, in the regulating of society involves that kind of judgment call. Any rule about who can do what is going to benefit some greatly, benefit some a moderate amount, and harmsome. We have to look for ways to set things up so there's the most total benefit, while minimizing the number of people who are greatly harmed. Speed limits: If everyone drove 5 mph on the turnpike there would be no fatal accidents, but many people would be harmed in various ways by the obligation to drive so slowly. The higher you make the speed limit the more fatal accidents there are, but of course there is a lot of benefit to being able to travel quickly. I don' t know whether we are setting speed limits at the optimal point, but it makes sense of think of cost-benefit while setting the point.
"We have to look for ways to set things up so there's the most total benefit, while minimizing the number of people who are greatly harmed." Interesting take. I personally would like to set things up to spread out pain equitably, first and foremost, and leave "total benefit" as a tertiary, even quaternary.
"Any rule about who can do what is going to benefit some greatly, benefit some a moderate amount, and harm some. We have to look for ways to set things up so there's the most total benefit, while minimizing the number of people who are greatly harmed."
Very much agreed! ( Albeit there are also second order effects: If a regulation sets a precedent for a future regulation which e.g. might make some effort they are considering making irrational (e.g. some types of "windfall" taxes), then they may decide making the effort is a bad choice. )
The social model might inspire some useful conclusions ("we should be more accommodating of disability when designing society"), but the biopsychosocial/interactionist model does the exact same thing! And the latter is much less likely to lead to less useful, and potentially harmful, conclusions ("we should invest fewer resources into finding medical cures for disability," "it is society's responsibility to accommodate all possible disabilities even at enormous cost").
While I'm all in favor of better bus systems, I don't think this is properly framed as ac accommodation to blindness. The accommodation would be allowing seeing-eye dogs on the bus. Or letting the blind person and their companion ride for one fare. And I'm also in favor of that. For that matter, I'd even be in favor of letting them ride for free, whereas I think most people should by a token amount.
HOWEVER, society is not obliged to provide accommodations. It chooses to do so, as a means of strengthening social cohesion. This is true of all accommodations, including those for having a low income. I often think that society should provide more accommodations, but this is because they strengthen social cohesion. If too many people feel that they are being treated unfairly, society tends to fall apart. (This is one of the problems with much of social media. They foster feeling of outrage.)
Note that society is not a person. I can care about other people (well, some other people), but society does not have that capability, except in an extremely extended metaphorical sense.
Even if you think being truthful can come second to rhetoric, I think you do still have to show that this kind of framing is more effective overall. To me, this sort of thinking really just seems to be leading to more polarization.
see my response to OP. obviously it does no one good to privilege politics over truthfulness, but i do think the two models perform two different functions
Tip of the hat for the Washington Generals call back
I didn't get this part, what are Washington Generals in this context?
> a sort of Washington Generals of disability models which nobody will admit to believing.
https://en.wikipedia.org/wiki/Washington_Generals
Thanks but this doesn't explain why Scott has mentioned them in this quote. Are they a baseball team nobody admits to supporting or something?
They only exist to lose against the Harlem Globetrotters. It makes no sense to support them.
Ah OK thanks
I just found out that the Generals won a few games against the Globetrotters. As many as 6! So assuming 6 is correct, their win/loss record is something like 6-16,000.
Numbers achieved by having two or more sets of Trotters/Wizards on the road simultaneously.
https://frinkiac.com/caption/S06E15/856071
The team that traveled with the Harlem Globetrotters for the purpose of losing to them.
"Some conditions are 99.9% biological and only 1% psychosocial". Is this deliberate to emphasize the overlap?
No, I'm just terrible. Fixed, thank you.
Happens to the best of us! And to me, too.
Where is the Social Model having an effect in the real world? The essay seems pretty scant on examples.
It's in a bunch of medical school curricula and a lot of disability rights groups use it. If you do any work with medicine or disability you've probably heard it taught as "the right way to think about things".
I understand that it's taught-that was clear from the article. Are there any examples of actual implementations outside of education?
Just asking for examples of group z applying this to group y
And to be clear, I think the social model is clearly out of balance. I just wonder how much effect it's actually having on how businesses and organizations behave.
What does it mean to implement a model?
Implement things based on a model. Like actually refusing to give people cataract surgeries because it's society's fault for not accommodating them.
I don't think anyone goes that far, no.
Ok, what’s the furthest you’ve seeen anyone go and how frequent is it?
Technicallyyyyyyy there were those people on Twitter getting mad about Mr Beast giving lots of people eye surgeries. But that's actually more of an example of people complaining about capitalism/inequality, not necessarily the Social Model. I'd bet a lot of money that some of those people were using the Social Model, though.
There are deaf people with deaf children who refuse to let their children get cochlear implants. Personally I think this is a form of child abuse
I t be to agree. But that’s not what the article is about.
I went through a phase of being really interested in sign languages, I can totally understand why deaf parents might be worried about their children not being part of their community, and a shared language is a big part of that.
That said, I'm sure a child of deaf parents would end up fluent in Sign Language regardless, and so this does feel like a decision to deprive their child of something that could be really beneficial to them, without really gaining anything by it.
From what I understand (a couple of decades old) cochlear implants are not an adequate replacement for normal hearing, and have some unpleasant side effects. (The only one I remember, though, is excessive sensitivity at certain frequencies.)
Perhaps they've been improved a lot since I noticed articles about them, otherwise I wouldn't be too sure that it's not in the child's benefit to wait. (And I'm sure glad I never had to make that kind of judgement call.)
I have definitely heard it used to argue against giving children cochlear implants, deafness is probably the area where it's most contentious.
That said, most times I see the social model mentioned it's usually about how a combination of medical devices (like wheelchairs and prosthetic limbs) and social accomodations (like ramps and not being weird when people have a missing leg) provide the most benefit to people with disabilities.
The most extreme example I can think of is a social worker I know vociferously arguing that someone's tendency towards physical aggression towards roommates was just a "different way of being" that we needed to find better ways to accommodate rather than seek to modify. Given that offering plans for behavior modification was my role on the support team, this put us at opposed positions, and it became necessary for me to find professional and sophisticated ways of saying, "What the hell?" in emails.
I personally don't think this is an issue of importance and doesn't really have any major impact on quality of medical care. DOs undergo many hours of training in Osteopathic manipulation despite the fact that there is limited evidence for its benefit, yet I think the quality of care between the MDs and DOs is quite similar. I think physicians are smart enough to know when something works and when something doesn't.
Mr Beast!!
Mr Beast!!
How did no-one in the 200 comments I've skimmed mention a famous real world example in which youtuber Mr Beast paid for something like 1'000 blind people to get operations to cure their blindness in exchange only for being filmed for 15 seconds with a beaming My Beast....
<i>and got promptly attacked by thousands of shrieking harridans of the social model for debasing the poor victims' noble blindness</i>!!!
Amazingly not even the only such example:
https://www.deseret.com/2023/4/14/23682606/mrbeast-most-influential-people-time-magazine-criticism#:~:text=Some%20critics%20called%20MrBeast%20%E2%80%9Cdemonic,shoes%20to%20children%20in%20Africa.
Scott covered this on a linx-post. Video+outrage+how can there be outrage?! - Not much into Mr Beast, would have missed out on that vid without Scott - and it turns me into a cry-baby from second 17 to end. Each f...ing time. https://www.youtube.com/watch?v=TJ2ifmkGGus
Maybe he was subblogging that with this article?
It feels really weird to think that this is an important point to argue about. I have a REALLY hard time thinking that anyone would take that "Social Model" seriously as a general argument. I have heard people argue in favor of it in specific cases, but I don't think I've ever heard anyone argue in favor of it, e.g., cases of muscular dystrophy.
OTOH, I have heard of folks from societies of deaf people argue against taking their children and teaching them to speak. (I've never heard that most people in those societies feel that way, but it's conceivable.)
I never would have believed people would literally defund the police, then they did because a world model said police are an institution of the majority and are therefore inherently harmful to minorities
You can carry on not believing it, because people didn't literally defund the police. People literally attempted to pressure their local governments to cut police budgets, with results ranging from total lack of success to very modest success. And they did so not because a world model said police are an institution of the majority and are therefore inherently harmful to minorities, but for a variety of reasons clustering around "a world model said police are an institution of the powerful and are therefore inherently harmful to the less powerful" and "a world model said (or frankly, simple observation reveals) that many police departments are outfitted with extremely dangerous and expensive military-like toys but often lack the training, ethics, or emotional maturity to wield them without killing people unnecessarily."
"Literally lessfund the police" didn't have the same ring to it
Part of the lack of success has been the dramatic increase in non-police shootings. 1000 men, women and children a year. I think that put the brakes on it
I hear deaths of unarmed black men during arrests has tripled to 30 per year. My theory is that quality cops abandoned high risk areas while a major drop in active policing means there are now more violent encounters where incidental or negligent deaths in custody can occur. I am very unhappy with these tragedies and don't feel any short to medium term hope for it to return to as it was
The theory that an institute of the powerful would be inherently injurious to the less powerful makes me the most unhappy in that reducing the influence of that institution was therefore the solution preferred instead of research and training into non-lethal weapons and first responders which seems like the likely choice otherwise
>"Literally lessfund the police" didn't have the same ring to it
Perhaps not, but it's less blatantly wrong, and therefore looks a bit less silly with the word "literally" included.
It is a convenient way to talk about things. The Medical model puts too much onus on the Doctor. Self-help groups and peer-support may be effective and perhaps cheaper in some contexts. Equally important is that the Social Model strengthens the political constituency for higher spending on Health. Sadly, because of Baumol Cost Disease (which can only be defeated by exporting a lot of health services) there is a crowding out effect whereby the 'second order' public good (which consists of demanding more provision of the first order good) consumes more and more resources while the 'first order good' (e.g. medical interventions) get rationed or simply disappear.
Probably the clearest example of the Social Model being taken literally and taken to extremes are the self-professed "deaf community" members who actively oppose cochlear implants, sometimes even denying them to their deaf children, on the grounds that fixing their disability is "an attack on their identity as deaf people." (If that sounds like an over-the-top parody of someone's idea of what a crazy activist would say... that's Poe's Law for you. As horrifying as what I just described is, it's quite real.)
I remember reading a story about a deaf same-sex couple who wanted to have IVF baby and purposely tried to select for deafness.
https://www.theguardian.com/world/2002/apr/08/davidteather
Cochlear implants do not by any means “fix” deafness. They are incredibly expensive, remove any residual hearing (not all deaf people have 0% hearing) risky (as all surgeries in the head are) and the sound quality is such that some who get them simply choose never to wear the external device. There are also scenarios where wearing the device is impossible, like swimming.
Source?
Your description matches perfectly the plot of Sound of Metal (a recent Oscar-winning film). Based on a google search for "Sound of Metal cochlear implant accurate" I'm left with the impression that your claims are highly controversial, in the sense that some people really do agree with that description, but also some with cochlear implants consider it nonsense fearmongering.
I'd be interested in a survey of cochlear-implant satisfaction, not sure how else we can resolve this as it seems at least somewhat subjective.
I tried to google for some surveys and came away unsatisfied. The rest of this comment is a description of what I found, since I think it's good epistemic practice, but I am unqualified for this analysis so feel free to stop reading:
Best I could find (links below) is a study of older patients (paywalled) which found 68% of respondents were satisfied with their implant, and 25% somewhat satisfied, zero of 60 respondents expressed regret. Then another study doing a review of studies on quality-of-life which is far too long and complicated for me to read, but the conclusion says QoL seems to improve after a CI when using surveys designed for deafness specifically (hence subject to more straightforward bias, like maybe they ask if you can hear more things), whereas if you just ask "how is your life now" there's insufficient evidence that CI improves QoL.
https://www-clinicalkey-com.proxy.lib.duke.edu/#!/content/playContent/1-s2.0-S0385814620301140?returnurl=null&referrer=null
https://karger.com/aud/article/26/2/61/44273/Systematic-Review-of-Quality-of-Life-Assessments
Claiming “on average CI improves QoL” is a far cry from “CI fixes deafness”
It seems very clear that CI improves the ability to hear, in the sense that you're on average more likely to understand what people are saying and notice quiet noises. That stuff is straightforward to measure and an obvious inventive for the medical establishment
The main argument against CI has got to be about the desirability of the type of hearing it affords you. Ideally we should poll a bunch of people who could hear, went deaf, then got an implant and ask how the three compare, but if anyone has conducted a survey like that I couldn't find it (we know for a fact that we'd get a range of responses, so only percentages matter). Satisfaction/regret after implantation would be a really useful metric, because it directly addresses "should we encourage deaf people to get CI" and it indirectly addresses "does CI give a subjectively desirable hearing experience," but those surveys also elude me. Just asking "how's life?" and checking for correlation pre/post CI is a proxy for satisfaction/regret, which as mentioned is a proxy for "do you like receiving sound input this way"
Cochlear implants, while imperfect, are getting better. My legally deaf and blind friend can now hear better than at any time in her life.
The more fraught issue is that American Sign Language could be driven into extinction over the next century or so by improvements in technology:
"ASL-only speakers can be highly protective of their culture, and some fear its eradication by cochlear implants, somewhat as many lesbians fear that the current popularization of sex change therapies among butch girls threatens the long-term existence of their sexual orientation."
Found it via the Wikipedia page very easily, my usual go-to for this sort of thing. The sampel sizes even in the meta reviews seem to be small though, I think it's generally just assumed that people want to be able to hear if possible.
https://en.wikipedia.org/wiki/Cochlear_implant#Outcomes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776066/
Sample size 1, but my wife's father absolutely loves his.
Glasses do not give me 20/20 vision, but they do mean I can drive - with them.
It would be my guess that it depends on the surgeon and the device. Certainly that matches the description of using a cochlear implant that I heard a decade or so ago, but one would hope that they have been improved in the intervening period.
OTOH, that's a pretty small market, so perhaps they haven't been. Or perhaps only some of them have been.
Someone with an artificial limb (or even someone who needs glasses) has similar issues, but I think they'd generally still consider the prosthetic to be a useful improvement - this seems to be the consensus on cochlear implants as well. Sure, maybe it doesn't "fix" disability, but I'm not sure why you'd make that your goal when you could instead aim to improve quality of life by giving people access to experiences and independance that they'd otherwise be denied.
The two people I know who are missing hands don't wear their prosthetics. People always want to make analogies to glasses, but many (possibly most?) interventions for pretty profound disabilities like missing limbs are more give and take. It really depends on the disability and the person. In the case of limb prosthetics, some are actually quite useful (foot prosthetic s) and some are really more cosmetic (full double leg replacements).
Probably the hardest part of talking about something like "disability" is we inevitably end up overgeneralising - I suppose I was thinking of lower leg prosthetics, I am aware that there isn't much that can be done if the knee is missing. I don't know anyone with a prosthetic hand, I assumed they were more useful than they apparently are but I can imagine any function being too clumsy to be worth it.
My point was that it's not a dichotomy between curing and accommodating, there are useful things that medicine can do but also profound limits.
Logan wrote a much more rationalist response than I will, but I can at least attest that quantitatively the surgeries are not particularly risky. And as described to me by surgeons, the results depicted in 'Sound of Metal' are only accurate in that they show the initial effects immediately post surgery. Neuroplasticity is everything. In children the results can be amazing. In adults who are dedicated to their neuro rehab, the results are great. In adults who expect an immediate miracle, they will be frustrated and disappointed.
Although their attitudes may correspond to the Social Model, I think they actually predate it. Deaf people have their own language, and their own distinct communities where they congregate. They can't easily assimilate, because few people who aren't deaf or related to deaf people learn sign language, and they have shared experiences unique to people without hearing, so they've developed what they consider to be a distinct culture which they're quite protective of. They may have contributed to the development of the Social Model, but I don't think it represented a change in their social attitudes (although the reduction of Deaf communities due to the invention of the cochlear implant definitely did.)
The rise in the well-being of the deaf from the old "deaf and dumb" days due to the standardization and spread of sign languages and the development of boarding schools for the deaf where, after a long struggle, sign language use was encouraged is an example that sometimes the Social Model can do a lot of good.
Similarly, the decline in persecution of lefthanded children for using the sinister hand has made life better for a significant number.
It's also worth considering how unique this is to Deaf people, there isn't a Blind commununty in the same way, because blind people can share a language with the sighted. There is braille, but that's mostly just an alternative writing system. I think some of the difficulties in the discussion come from trying to generalise a lot of different things that we all call "disability".
Sign languages are really interesting (notably there's a lot of them, it's not like all Deaf people can understand each other), but while they're great within a community they reveal the obvious limits of the social model since most people can't understand the language and probably aren't going to learn unless they know a Deaf person.
And of course sign languages also pose different problems for amputees who can speak voices languages just fine. There is no possible universal accommodation in language.
Well, ... "no possible" is a bit strong, though we certainly couldn't build one now. And it would need to include "locked-in" folks. This clearly implies that it would need to be a mechanical mind-reader. Likely it would need to train on each person individually, and do a transform into a more universal symbology.
Now if you'd said "no universal accommodation" I'd probably agree, as I can't think of one this side of Jack Williamson's "With Folded Hands". But when you restrict it to language I suspect that we could build one in the next decade or two. (I'm NOT sure it would be a good idea.)
I can't help but think this is going to really backfire on those parents is a really tragic way, as opposed to going ahead with the implant but also making sure their child also learns sign language (probably inevitable if your parents are deaf) and can become a bilingual member of the deaf community.
I have glasses, and I really would be blind without them! (e.g. if I take them off to go swimming I can easily get lost because anything more than a few metres away is a blur). If I found out that my parents had decided to not give me them as a child because they wanted me to have a "visually impaired" identity, I think I'd be rather angry with them when I later realised what was possible.
Yup, the deaf communities are the new Amish. They're insular and live within society, but apart from it.
Isn’t the American disability act an example of implementing the social model?
No, because it's not opposed to medical interventions.
What Scott describes here as the social model is what the literal words describing the social model say. But what he describes as the interaction model is what most people actually come to understand the social model to be.
The ADA implements either the social model or the interaction model, because the difference between the two is in medical interventions in disabled people, which is a thing that the ADA doesn't address.
It's used extensively in disability rights. This is an area I have a lot of experience with, and in that (admittedly anecdotal) experience, I'd say most people don't *really* believe it, but find it useful as a way to get people to think more intelligently about the interaction between accommodation and people's innate conditions when we describe someone's disabilities. That said, there is a more radical core group who absolutely believe the claims in the strongest sense and they tend to be those most apt to throw out charges of bigotry, so it becomes necessary to dance around the subject.
The Social Model is very popular among disability activists, and as a result tends to be influential in the thinking of people with disabilities who have any contact with that sphere. That ideology seems a priori likely to have a really toxic effect on people, and my experience (admittedly limited to just a couple of people) seems to bear that out. Having a significant disability that can't be cured is awful; having one which isn't well accommodated by society is even worse. But the Social Model tells people with disabilities to blame *all* of the bad experiences they have as a result of their disability on society's evil oppression of themselves. This can make the people in question unpleasant to be around, obviously, but I'm sure it's also just psychologically unhealthy in itself. It can feel appealing at some level to have someone to blame all your suffering or deprivation on, but living in a constant state of resentment is just about as miserable a psychological state as I can imagine.
That all makes sense to me.
I mean you will hear that exact line of argument trotted out if you are disabled (I am disabled in a very minor way and absolutely got speeches about the social model from medical providers when it happened in the mid 90s at age 14) or when discussing accommodations. I am not sure many people other than activists really believe it, but they certainly use it as a cudgel to get their way a lot and get some truly insane/inefficient accommodations approved.
I can think of more than a few rec areas in my state where trails/facilities have been abandoned because there wasn't a way to make them "accessible".
In my current neighborhood we had an amazing volunteer fundraised and built playground 3x better than any other playground at a grade school, but well before it was at the end of its life they tore it up and replaced it (despite the school district being super broke) so that now a C+ playground was 40% useable by disabled kids instead of a A+ playground being 20% useable by disabled kids.
A similar thing happened back in my home town too with two different newish giant playgrounds ripped up to make them more accessible (and in the process made much more samey, boring and smaller).
Without going into details, I have two examples.
First, I used to work at a large corporate job (as in, the job was at a large corporation, not a large job) which involved a lot of contact with people with various disabilities, especially hearing disabilities. Late last year, as part of our training (about a half-day out of a 10 day program, so ~5% of the time) was spent uncritically going through this model, presenting it as the only correct/compassionate model. Most of my other trainees there were not especially well educated, so for them this was the only education they've received on the topic. Anecdotally, most seemed to swallow it uncritically. (The culture at that workplace was such that pushing back even a little bit would have gotten me fired, or at minimum in deep trouble.)
Second, a few days ago I was at a methodology workshop at a university (back to my studies), and the first speaker ostensibly talked about different ways to engage with participants/gather data that don't involve traditional language-dependent measures, like interviews or surveys. This speaker took up the morning slot, so ~2 hours of an 8-hour day of a three-day workshop (although I skipped the next two), so ~10% of the total time. They uncritically repeated this model, which based on comments and discussion was treated as not only valid, but again, obviously true and the only way of looking at things. These people were either PhD students or working academics in a range of fields from psychology to design to law to business.
That isn't direct, concrete consequences, but if both average people are being taught this stuff, and academics are actively swallowing/repeating it, that seems plausible to lead to said consequences?
The biopsychosocial model has a bad reputation in disability activism circles because it is regularly used to tell disabled people that their problems are all their own fault and should be fixed with the power of positive thinking rather than, say, painkillers, or that all disabled people could work if they tried hard and believed in themselves. Especially in the UK where the phrase has been used extensively by the DWP to deny a lot of people disability benefits on the grounds that their impairments are theoretically within their gift to overcome.
The social model as actually practiced by the disability rights movement sees availability of medical interventions as an important variety of social accommodation for impairments - but the emphasis is on the person with the impairment wanting the intervention, rather than society wanting the intervention to make the person more convenient. (A standard example of treatment to make someone more convenient rather than actually being what the person wants to happen is ABA for autism, but there are equivalents for physical impairments like the historical 'pillow angel' horror.)
The typical example is pain treatment switching to 'cost-effective' psychological treatment rather than painkillers. (This is especially bad for the people who already know the first line psych treatment of worksheet based CBT doesn't work for them / makes them actively worse, which is fairly common in autistic women, who are also especially prone to chronic pain conditions)
Citation: https://www.healthcentral.com/pain-management/chronic-pain-biopsychosocial-model - this article which I just found by searching 'biopsychosocial model' on the surface looks fine, but the prioritisation of return to work, increased activity and cost savings are all signs of this problem.
https://www.disabilitynewsservice.com/biopsychosocial-basis-for-benefit-cuts-is-cavalier-unevidenced-and-misleading/ is an example of a common kind of article about how the model is misused in the UK.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255230/#b5 is a more scientific review with citations.
"the prioritisation of return to work, increased activity and cost savings are all signs of this problem."
I can't speak to cost savings, but this statement implies getting back to a normal or fulfilling life (which for most people includes returning to work and increasing activity) is bad? Is that what you mean? I am not sure that view is held by most people with chronic pain.
Are you in the UK? Given the difference in the UK health care regime and that of the US, you may have a very different view of how the biopsychosocial model is used in practice. Because the US doesn't have a monolithic health service, decision are made in a much more piecemeal way. The application of models isn't done consistently. And given the profit driven approach in the US, "cost savings" aren't at the top of the list for doctors or health providers (or even patients if the have insurance). I can assure you that in the US we have much more of a problem of using TOO MANY painkillers, not taking them away from people who need them (though some government policies are resulting in this and its shameful, but its not due to the biopsychosocial model).
> fairly common in autistic women, who are also especially prone to chronic pain conditions
Autism is a very complex condition with physical, social, and psychological factors. Given the correlation of autism and chronic pain, its not a jump to say that the chronic pain experienced by people with autism also has physical, social, and psychological factors.
Yes, I am in the UK - so my posts here are very much based on the UK situation, not the US one, which I know less about.
What data or guideline should make anyone consider psychotherapy more cost-effective than analgetic drugs for chronic pain conditions? For what timespans and outcomes? State of the art would be a combination of both with other interventions, IIRC, still with often dissatifiying results.
Really, what part of the biopsychosocial model sounds like "own fault"?
I kind of disagree with the way the disability rights movement uses the term "more convenient" as a way of saying "bad and ill-intentioned". If for example someone is constantly screaming really loudly, then trying to prevent that is "making them more convenient", but I am sometimes in favor of doing this (especially on a crowded ward full of lots of other people). Obviously it's better to solve the underlying problem somehow or give them some private ward where nobody else has to hear them; equally obviously this isn't always an option.
EDIT: Oh wait, it's the "psych" part, isn't it? I guess I always thought of that as something you add in to make people happy so they don't accuse you of medicalizing things too much, but I can see how that could go wrong if you take therapy too seriously. I'd be happy to move to "biosocial" but the therapists would never go for it.
The place this is mostly evidently a problem is chronic pain treatment, especially in light of the opioid crisis - a lot of people have had their painkillers taken away and replaced with platitudes and cognitive behaviour therapy, and the biopsychosocial model is regularly cited in defence of this.
The biopsychosocial model regularly gets sold as a cost-effective way of treating pain, and people in constant pain generally hate to be told they're getting a treatment they consider less effective because it's cost-effective, regardless of whether it's actually a good treatment or not...
I agree this model seems like a very bad fit for chronic pain treatment.
Do chronic pain patients like the Social Model? I think of the Social Model as saying that people should medicalize things less, whereas in chronic pain usually the problem is we're not medicalizing them enough.
Depends on whose framing of the social model we're talking about. I generally see two in the wild:
Mostly neurodiversity advocates goimg full social model and demanding that nobody attempts to treat their condition as an impairment at all; this is generally not welcomed by people with intrinsically pain-causing impairments. (The Deaf community has also been going in for this for much longer than we had the present vocabulary for it.)
Mostly 'classically' physically disabled people like wheelchair users attempting to get people to distinguish impairment and disability, but acknowledging that both exist and it's good to treat a impairment if possible, but generally considering currently society is if anything too pushy on that (eg pushing surgeries with high chances of failure / unacceptable side effects and then considering the impairment the person's own fault for declining them) and needs more of a push towards accommodating impairments and not turning them into disabilities. Chronic pain patients are generally quite on board with this because fatigue accommodation is often quite similar to other physical impairment accommodation and is vitally important to them (and often this is a fight they have over which painkillers to use, as most people find fatigue more aversive than pain but have trouble explaining this to healthcare providers).
Thanks!
If I believe that disability is an interaction between both biological and social factors, that the strongest version of the Social Model is false, and that people with chronic pain should get good access to pain killers, is there any existing group/term here that I can identify with or support?
That is what most people in disability activism call the social model, but I appreciate that's imprecise because others also use that for the pure social model; I don't think there's a precise term, I think biosocial model could actually catch on and at least won't set off a knee jerk reaction, and I think the most important signalling mechanism in the direction of the moderate version of the social model is using the words impairment and disability separately rather than referring to a condition as a disability.
The use of opioids to treat chronic pain is incredibly more complex than “good access to pain killers.” In fact, it’s good example of the biopsychosocial dimensions of the suffering from chronic pain. The topic is way beyond the scope of this comment, so I’ll just offer one anecdote:
I have a patient who has right lower extremity complex regional pain syndrome, so severe that her leg has atrophied and she has to use a knee walker. She has tried all interventions and still lives with 9/10 daily pain. One day she came to a followup visit and told me she had stopped her (substantial but not excessive) opioid regimen altogether. Shocked, I asked her why on earth? She said, “I got tired of being the person in the corner at the family gatherings who is treated kindly but also ignored because I’m a little bit numbed out by the pain medicine. I’m going to live with the pain and be the real me.”
I thought that part of the problem was that there AREN'T any good long term pain killers. E.g., that opioids have habituation problems such that after awhile they're no better than aspirin.
As someone who has been treating chronic pain for years, I aver that the biopsychosocial model is exactly the most sound way to approach the problem. The suffering from chronic pain has biological, psychological, and social dimensions and there are often ways to help people along each of those dimensions, depending on the problem. There is no chronic pain management clinician who uses the framing biopsychosocial “to tell disabled people that their problems are all their own fault.”
In the US the specialty of chronic pain management came out of anesthesia and has been historically overly focused on the biological cure--- “when my pain goes away, I’ll be OK.” Chronic pain is pain that is chronic in spite of physical treatments. You have to help people learn “I can be OK living with pain.”
Im not a doctor, but have done a lot of (amateur) research on biopsychosocial model when it comes to pain and I have never heard it used in the way the original poster describes. It's always much more what you describe. To me the biopsychosocial model is a way to introduce nuance to treatment and introduce a model which takes into account all factors influencing a condition.
Right. The biopsychosocial paradigm applies to many complex human conditions. For another example, I think it would add some nuance to the current volatile discussions around the idea that gender is purely a social construct.
Cases like this have been motivating opposition to the social model for some time - see e.g. the work of Susan Wendell (1997, 2001), who taps into a broader trend of saying that the social model has historically neglected the perspective of some disabled people, especially women, whose impairments are harmful and not only because of social stuff. Tom Shakespeare is another very influential critic of the social model on related issues.
Though, as others in the thread have said, part of the issue is that the social model was always something of a broad tent, and so the line between posing a problem for it, and precisifying it in a preferred direction, is very blurry. Perhaps some of what I wrote in section 6 here is vaguely helpful: https://jesp.org/index.php/jesp/article/view/572.
A lot of abuse of people with disabilities, particularly mental illness, and even more particularly intellectual disabilities, results from the fact that people are trying to make their interactions more convenient for them. They want to do something easier, quicker, or cheaper to help someone, and it results in a lower quality of life for that person, where "lower quality of life" might mean "horrific abuse." Institutions, as you know, are infamous for this exact problem. Coming to understand this is a keystone to promoting more humane treatment of the disabled. But because of that, every single person with any kind of interaction with disability rights likely has heard the concept, and not everyone is the best at picking up on ideas and using them with appropriate nuance. So you see this idea get used in sloppy and promiscuous ways where not extending infinite resources towards a person is treated as an act of malice. That was never the intent when you're trying to teach people patience or advocate for resources above the level of persistent neglect, but it is how the concept sometimes get invokes in the real world.
"the fact that people are trying to make their interactions more convenient for them. They want to do something easier, quicker, or cheaper to help someone, and it results in a lower quality of life for that person...not everyone is the best at picking up on ideas and using them with appropriate nuance."
A general truism that scales and transfers to most every other human activity over time. 'Character is destiny,' evergreen.
Your edit here is a fascinating point that could be an entire post. Even without therapists being involved. After all, choosing to literally have completely different mental processes instead of going to therapy implies that if someone else doesn't choose this, he's at fault.
Millions of people objected to the COVID vaccines, and not solely on the ground that they questioned the safety/efficacy (though of course there was that, too). Many objected solely to the government requiring them to make a certain medical decision. Then when they were told they weren't allowed to go to work or interact with society in meaningful ways, they balked that they would be required to make a medical decision the way the government wanted them to, or sacrifice freedoms they'd previously enjoyed without doing that thing.
This could be similar to one reason deaf people might be so virulently opposed to cochlear implants. "Look, you can hear now. Good for you! Just make sure you go get the surgery."
Say you're doing mostly fine, but then some people come along and tell you to go make a medical modification to your body in a way that will amplify its capabilities in line with social expectations. In a way, society is asking you to make a medical decision in the way they approve. "I'm good, no thanks." Except it's not really a choice if society effectively shuns you for deciding in an unapproved way.
This doesn't have to be the same as the mandates for vaccines, to have the same effects on keeping your job, etc. Maybe you reject the modification, but many other people choose to get the implant and in so doing reduce the number of people who need the kind of deaf accommodations you need. At the limit, if everyone went to get the implant, you'd be the last person to provide accommodations for, so few if any people would provide them. You'd essentially be forced, by social convention, to make a medical choice you objected to.
Your optimal play in this situation is to attempt to stigmatize when other people choose to get the implant, advertise the implant, or inform people about the availability of the implant. The fewer people who feel comfortable getting the procedure, the more easily you'll be able to go through life without having to get it yourself. Thus, ironically, the only way to preserve your own freedom to make this medical choice the way you want is by pressuring others to make the choice in the same way.
Caveats: I have low confidence in this analysis, and would be interested to hear from anyone who has direct experience in the community. I'm not making any specific claim about deaf people in general, just reasoning out the incentives that I would naturally expect from this kind of situation.
>power of positive thinking rather than, say, painkillers
???
Painkillers imply something is bad about pain, and we even named the 'treatment' as something literally 'killing' the pain.
Social model as a pure philosophy tends to be the domain of eg neurodiversity advocates (and, interestingly, the Deaf community who've been doing it a lot longer than current vocabulary).
Social model as a way of distinguishing impairment (the actual condition) and disability (how the person is actually harmed, usually via social factors), and suggesting that society goes too hard on trying to fix the impairment and not hard enough on trying to fix the disability, is much more widespread - so people should have painkillers (of the kind they want which balance pain and fatigue to their choice) and also fatigue accommodation and adequate rest.
Except a society capable of making these 'accomodations' cannot exist without people who are "non-impaired".
Depending on the severity of the disability caused by the impairment, that seems clearly not actually the case? People with different impairments can compensate for each other even in a state of nature; some things which disable people in modern life are not even noticed at other developmental stages?
Most historical people had some kind of impairment by modern standards, generally caused by inadequate nutrition, but they still built a society capable of improving to our current state.
And I hope that as technological advancement continues, future people will consider most of us to be impaired in comparison to themselves...
Blindness being a pretty obvious example of this clearly being the case.
And if what you're saying is true, why is up to the abled to help these people? Why not just help each other?
Why should anyone help anyone? Either altruism or enlightened self interest (impairment isn't a binary state, eg lots of people who do useful jobs have impaired vision but nowadays we correct it with glasses and everyone is better off for this).
If you pick a specific impairment and posit everyone has that one, sure, you can pick one that makes people die out in the ancestral environment. Most modern humans would also die in the ancestral environment. This says nothing about their ability to contribute today, if that's how you judge the worth of a person (which seems overly harsh to me given we have surplus around to support quite a lot of people who don't 'pull their weight').
I dunno that's true in the general case, e.g. it's not obvious to me that a society with no hearing people at all would be impossible (though it'd be pretty different from ours).
It is certainly possible at a low-tech level. (Well, almost certainly.) I've read about communities of the deaf in Egypt in (very late) Roman Republic times. From the reports (which may be biased) it wasn't that different from other remote villages. To me this implies that they paid taxes rather than depended on largess.
"society’s failure to provide adequate bus routes is better considered a failure to resolve the disability, not the cause of it."
overall point taken, but i do think the more salient/useful feature of the social model is that its theory of social causation intuitively produces a sense of social responsibility. does it matter necessarily if society "caused" the disability if the larger motivation is to promote social action? whether the approach is infrastructural or medical in nature, either way the responsibility to accommodate falls on society's shoulders at large. i think the social model's recognition of this necessity still advantages it over the biopsychosocial model
Can you rephrase this? It sounds like you're saying this is an unnatural framing that's being used because it has the right political implications, which is exactly my complaint.
essentially i'm pointing to a functional disconnect between the two models. if the question is "what causes disability?" then i would agree that turning to the biopsychosocial model makes sense there. but if the question is "what should we do about it?" then i think the social model proves the more useful there. this is assuming we agree generally that social action of some sort is what's called for in order to solve the problem of, say, providing blind people with options for transportation
I guess I'm asking if you're just saying (sorry for hostile reframing) "anything is justified if it makes good propaganda".
For example (sorry for offensive example), suppose incels were to say "it's society that's making us single", and when you asked what they meant, they meant that, although it was their own characteristics that made nobody want to date them, society refused to give them free state sponsored gfs. And instead of framing this as "society has not solved our undateability", they were reframing this as "society causes our undateability".
Is your position that the incels' argument is no better or worse than the Social Model's, but that you politically support the Social Model but politically oppose incels for other reasons, so you would let the Social Model have convincing-sounding-propaganda-strongly-worded-framings but deny the incels' right to use the same? Or do you think there's some fundamental difference?
i'm more making a "pay mind to the baby in the bathwater" kind of argument. the social model orients towards the insight that disability is, pragmatically, a social problem — not in the sense that it caused it (this is the bathwater), but in the sense that it takes organization on a societal level — whether that means universal health care or expanded public transit — to alleviate it.
with the incel analogy, i think we'd have to accept the incel premise that undateability is a disability for which they're owed accommodation, a fundamental right they've been unjustly denied access to. i think, firstly, that the social model makes its argument in the context of the question of disability, and so naturally we run into errors of translation when applying it to a situation outside of that environment.
doing this translation and applying it anyway though, i think the essence of the social model recognizes that incels are a phenomenon of social concern in the first, and thus call for a social approach in order to solve it. (of course this would mean something like a materialist study of incel echochambers rather than state sponsored gfs, because again involuntary celibacy isn't a disability)
This example demonstrates nicely that the "social model of disability" is actually a two-step process for seizing power: First, advocates of the model push to define "disability" (absurdly) as a failure of society to accommodate an impairment, thus establishing themselves as absolute authorities with the prerogative to define terms arbitrarily in the area of disability. Second, those advocates leverage their established authority to define "disability" to include groups they wish society to accommodate, and to exclude those they don't wish society to accommodate. As a result, they accrue arbitrary power to redirect society's resources towards those they deem "disabled" (or whose "disability" they wish to highlight at the moment for political purposes), and away from those whose claims of "disability" they choose to dismiss (again, presumably for political purposes).
Now, I don't personally believe "incels" should be defined as disabled--but then, I don't believe anybody else should be, either, if we accept the social model definition, which attributes all disability solely to social failures of accommodation. When "disability" is redefined as an unlimited claim on societal resources for accommodation, the power to define/emphasize--or downplay/refuse to define--a condition as a disability becomes far greater than anyone should rightly possess in a democracy.
On this model, most philosophical views are processes for seizing power.
More like, the less nuanced propaganda, the more effective it is. You understandably are disgusted by this, because it's basically the definition of a symmetric weapon, but they do often happen to beat asymmetric ones in the short term. Still, kudos for fighting the good fight anyway.
> the less nuanced propaganda, the more effective it is
You reminded me of something Dan Luu wrote (he was generalizing from his experience at early Microsoft to make a point about how hard it is for orgs to communicate nuanced priorities): https://www.lesswrong.com/posts/JrLExmCZWTxkvK8ih/dan-luu-on-you-can-only-communicate-one-top-priority
This is where I feel like I'm in the Twilight Zone. Isn't it really, really obvious that the point of the Social Model is its propaganda value? Isn't that essentially what its proponents say about it themselves? None of the scientific, governmental or advocacy organizations you quoted did an empirical study that found concrete evidence that fit the Social Model but not the Medical Model. How could they? It's not that kind of model. It can't be true in the way the theory of gravity is true, only in the way "thou shalt not kill" is true. It's an assertion of a terminological paradigm, not of a fact. Calling it "propaganda" is like calling a fish wet, as though that was an insult.
Its creators and proponents are not asking themselves "which model fits reality best?" -- they're asking, "which model advances societal progress the most?" Anybody who cares primarily about whether a model fits reality would be embarrassed of the Social Model.
It seems to me that the point of models of this kind is to dress up policy priorities as scientific facts. So trying to find a more accurate model is futile. It's like trying to pick out the saltiest equilateral triangle. The more fruitful path is to ask what role these models play in society. How does an empathetic, benevolent person who is also committed to honesty and clear thinking interact with a model of this kind in an ethical way?
“ It seems to me that the point of models of this kind is to dress up policy priorities as scientific facts.”
The disconnect here is that the usual meaning of “model” is usually “a thing that accurately represents another thing” or more precisely in this domain, “a tool we can use to make accurate predictions about reality”.
So if you call it “the Social Model”, and phrase all your training as if it is, in fact, a model (an accurate representation of reality), but it’s really just the “Social Rhetorical Strategy”, that is going to bother Scott.
A better term for what it is might be 'analytical lens' or 'framework', with the idea that you should look at a situation from several 'analytical lenses' in order to figure out possible solutions.
So you can look at disabled people under the 'medical lens' and propose solutions from that for how medical interventions may address their problems. And then you can also look at it under the 'social lens' and propose solutions for how social accommodations or restructuring society may address their problems.
And there may be a somewhat outdated assumption that everyone uses the medical lens by default, so you have to be really pushy about getting people to use the social lens at all.
They admit that they are advocating for society accommodating disabled people, but I don't think they admit in all contexts that that's why they choose the Social Model in the first place.
Once someone admits that he chooses his arguments based on their propaganda value, not truth, he basically gives up on convincing you if you aren't already convinced, because there is no reason for you to trust him.
Perhaps they admit in some discussions that they choose the framing for its propaganda value, but for it to have propaganda value, they rely on it not being publicized everywhere the framing is pushed.
So if you care about the truth, and about society making good decisions based preferably on asymmetric weapons, it's a good thing to publicize the fact that the framing has been chosen for propaganda value, not truth. Except perhaps if you fully agree with the goals of the propaganda; but even then you should reevaluate whether you might have been convinced by bullshit arguments.
Maybe I misinterpreted the Contra Caplan, but it seemed like that one said that mental disorder is currently political, but there's no other way. Whereas this one is saying that physical disability is currently political, but it should be redefined in a way that doesn't blame society as much?
But the social model does not allow for there to be any limits on degree of accommodation. If someone's disability is entirely the result of society's treatment, then it is reasonable to demand that society stop wrecking "disabled" people's lives. Wrecking lives is a crime. There should be no limits at all on how much we expect society to limit the wrecking of lives. But if the limitations that disabled people experience are the manifestations of illness or injury, it does make sense for society to put some limits on accommodations: Most of the money and efforts should go into setting up accommodations that give the most bang for the buck -- that help many disabled people in ways that make a real difference. But heroic, very expensive accommodations that would benefit only a tiny minority of the disabled -- such as building a handicap ramp up Everest -- can legitimately be skipped.
> There should be no limits at all on how much we expect society to limit the wrecking of lives
Most of the inhabitants of modern society appear to be entirely on board with wrecking some lives in the process of attempting to improve others. ( See, for instance, the subject of Aaronson's famous "Comment 171". Can easily find via Google; I suspect that Scott would prefer not to have it linked here. )
this is a good point, i can see the disadvantage there. i suppose i'm made a little uncomfortable here, because as with all lines in the sand i don't think there's a fair way to differentiate between what ratio of bio:psycho:social reasonably constitutes what degree of response — i.e what exactly counts as "most bang for the buck"? who'd make that call in the first place?
Many things, maybe everything, in the regulating of society involves that kind of judgment call. Any rule about who can do what is going to benefit some greatly, benefit some a moderate amount, and harmsome. We have to look for ways to set things up so there's the most total benefit, while minimizing the number of people who are greatly harmed. Speed limits: If everyone drove 5 mph on the turnpike there would be no fatal accidents, but many people would be harmed in various ways by the obligation to drive so slowly. The higher you make the speed limit the more fatal accidents there are, but of course there is a lot of benefit to being able to travel quickly. I don' t know whether we are setting speed limits at the optimal point, but it makes sense of think of cost-benefit while setting the point.
"We have to look for ways to set things up so there's the most total benefit, while minimizing the number of people who are greatly harmed." Interesting take. I personally would like to set things up to spread out pain equitably, first and foremost, and leave "total benefit" as a tertiary, even quaternary.
"Any rule about who can do what is going to benefit some greatly, benefit some a moderate amount, and harm some. We have to look for ways to set things up so there's the most total benefit, while minimizing the number of people who are greatly harmed."
Very much agreed! ( Albeit there are also second order effects: If a regulation sets a precedent for a future regulation which e.g. might make some effort they are considering making irrational (e.g. some types of "windfall" taxes), then they may decide making the effort is a bad choice. )
The social model might inspire some useful conclusions ("we should be more accommodating of disability when designing society"), but the biopsychosocial/interactionist model does the exact same thing! And the latter is much less likely to lead to less useful, and potentially harmful, conclusions ("we should invest fewer resources into finding medical cures for disability," "it is society's responsibility to accommodate all possible disabilities even at enormous cost").
While I'm all in favor of better bus systems, I don't think this is properly framed as ac accommodation to blindness. The accommodation would be allowing seeing-eye dogs on the bus. Or letting the blind person and their companion ride for one fare. And I'm also in favor of that. For that matter, I'd even be in favor of letting them ride for free, whereas I think most people should by a token amount.
HOWEVER, society is not obliged to provide accommodations. It chooses to do so, as a means of strengthening social cohesion. This is true of all accommodations, including those for having a low income. I often think that society should provide more accommodations, but this is because they strengthen social cohesion. If too many people feel that they are being treated unfairly, society tends to fall apart. (This is one of the problems with much of social media. They foster feeling of outrage.)
Note that society is not a person. I can care about other people (well, some other people), but society does not have that capability, except in an extremely extended metaphorical sense.
Fwiw this is known in the field as the Charity Model, if I understand things correctly
Even if you think being truthful can come second to rhetoric, I think you do still have to show that this kind of framing is more effective overall. To me, this sort of thinking really just seems to be leading to more polarization.
see my response to OP. obviously it does no one good to privilege politics over truthfulness, but i do think the two models perform two different functions