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Tip of the hat for the Washington Generals call back

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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.

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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?

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They only exist to lose against the Harlem Globetrotters. It makes no sense to support them.

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Ah OK thanks

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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.

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Numbers achieved by having two or more sets of Trotters/Wizards on the road simultaneously.

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The team that traveled with the Harlem Globetrotters for the purpose of losing to them.

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"Some conditions are 99.9% biological and only 1% psychosocial". Is this deliberate to emphasize the overlap?

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No, I'm just terrible. Fixed, thank you.

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Happens to the best of us! And to me, too.

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Where is the Social Model having an effect in the real world? The essay seems pretty scant on examples.

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Jul 14, 2023·edited Jul 14, 2023Author

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".

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I understand that it's taught-that was clear from the article. Are there any examples of actual implementations outside of education?

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Just asking for examples of group z applying this to group y

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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.

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What does it mean to implement a model?

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Implement things based on a model. Like actually refusing to give people cataract surgeries because it's society's fault for not accommodating them.

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I don't think anyone goes that far, no.

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Ok, what’s the furthest you’ve seeen anyone go and how frequent is it?

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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.

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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

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I t be to agree. But that’s not what the article is about.

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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.

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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.)

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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.

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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.

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Jul 14, 2023·edited Jul 14, 2023

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.

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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.

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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

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Maybe he was subblogging that with this article?

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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.)

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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

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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."

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"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

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>"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.

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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.

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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.)

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Jul 14, 2023·edited Jul 14, 2023

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

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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.

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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

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Claiming “on average CI improves QoL” is a far cry from “CI fixes deafness”

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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"

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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."

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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/

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Sample size 1, but my wife's father absolutely loves his.

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Glasses do not give me 20/20 vision, but they do mean I can drive - with them.

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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.

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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.

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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).

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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.

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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.

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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.)

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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.

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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.

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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.

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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.)

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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.

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Yup, the deaf communities are the new Amish. They're insular and live within society, but apart from it.

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Isn’t the American disability act an example of implementing the social model?

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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.

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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.

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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.

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That all makes sense to me.

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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).

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Jul 19, 2023·edited Jul 19, 2023

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?

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Jul 14, 2023·edited Jul 14, 2023

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.)

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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.

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"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.

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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.

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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.

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Jul 14, 2023·edited Jul 14, 2023Author

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.

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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...

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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.

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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).

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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?

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Jul 14, 2023·edited Jul 14, 2023

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.

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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.”

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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.

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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.”

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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.

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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.

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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.

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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.

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Jul 14, 2023·edited Jul 14, 2023

"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.

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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.

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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.

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>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.

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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.

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Except a society capable of making these 'accomodations' cannot exist without people who are "non-impaired".

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Jul 14, 2023·edited Jul 14, 2023

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...

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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?

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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').

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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).

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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.

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"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

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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.

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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

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Jul 14, 2023·edited Jul 14, 2023Author

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?

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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)

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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.

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On this model, most philosophical views are processes for seizing power.

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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.

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> 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

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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?

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“ 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.

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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.

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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.

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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?

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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.

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> 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. )

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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?

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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.

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"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.

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"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. )

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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").

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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.

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Fwiw this is known in the field as the Charity Model, if I understand things correctly

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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.

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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

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I don't think there's any question of truth here; no one using the social model would make a different empirical predictions of what they would physically observe in a given situation, compared to someone using the medical or interactionist model.

Rather, this is just a question of framing the same empirical truths in a different ethos, in a way that suggests different actions for clinicians and therapists, city planners and architects, relatives and friends, etc.

Given that there's no empirical disagreement, truth isn't at issue, all that's at issue is which framing creates the best outcomes.

In teh SF definition especially, I see a useful reframing towards utilitarianism in the social model: focus on whichever combination of treatments and accommodations actually make people's lives better, rather than looking for 'cures'.

This matches Scott's 'just take the hair dryer in the car with you' story in terms of consequentialist treatments, for me.

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>social causation intuitively produces a sense of social responsibility

No, it doesn't. It merely asserts that a population of people are entitled to a certain standard of living and that other populations must foot the bill.

>does it matter necessarily if society "caused" the disability if the larger motivation is to promote social action?

Okay, so you're literally admitting that this has nothing to do with truth and therefore the 'social model' is a form of political propaganda that is useful to your desired ends?

>whether the approach is infrastructural or medical in nature,

The social model proper REJECTS the medical options here as stigmatizing and dehumanising, because it implies there's something wrong with these people that needs to be fixed.

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>It merely asserts that a population of people are entitled to a certain standard of living and that other populations must foot the bill

i do generally agree with this. you clearly fundamentally disagree with me, which is fine, but i would like to point out that the nice thing about this is that you too get kickbacks from large scale structural accommodations for the disabled. it sure would be nice to have expanded public transit, no?

>Okay, so you're literally admitting that this has nothing to do with truth and therefore the 'social model' is a form of political propaganda that is useful to your desired ends?

no. i am making the case that the social model's usefulness is not in its capacity as an epistemic device to determine the "truth", it's better as a lens for thinking about possible solutions. there are a considerable number of people who are blind who want to participate meaningfully in society. whether they are blind because they were born that way, or drank rubbing alcohol, or suffered from a pre-existing condition that went untreated is, on the level of policy, not especially relevant — we will still need to implement blind-friendly crosswalks anyway.

>The social model proper REJECTS the medical options here as stigmatizing and dehumanising

sure, and i'm okay with letting that aspect of it go as i think it's at best tertiary for the relevance of the social model. (although i do say this as somebody who is fully able-bodied, so i have never experienced stigmatization nor dehumanization due to medical intervention and thus don't have much of a stake in that. i suspect a disabled person might disagree)

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"i am making the case that the social model's usefulness is not in its capacity as an epistemic device to determine the "truth", it's better as a lens for thinking about possible solutions."

And it's a terrible lens for thinking about possible solutions, because it antagonizes the people (or "society", which is made up of people) who would have to fund and implement those solutions. My reaction to the social model is not "wow, I didn't know until now that it was possible to make disabled people's lives easier! It sure took political propagandists spewing obvious falsehoods to make me realize that wheelchair ramps are a thing!" It's more along the lines of "fuck you, I'm not giving you a single extra cent, you son of a bitch ingrate blaming me because you can't see!"

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> whether they are blind because they were born that way, or drank rubbing alcohol, or suffered from a pre-existing condition that went untreated is, on the level of policy, not especially relevant — we will still need to implement blind-friendly crosswalks anyway.

I disagree, as it's highly relevant to what policies we should set to prevent more people from going blind.

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I think it does matter how someone got disabled, and it becomes everyone's business when society is expected to pay for accommodations (and treatment, hopefully). If 10,000 people did some kind of stupid tiktok challenge and became disabled, I think that's pretty relevant information on whether society "must" or "should" accommodate them. It's a much better argument that society should help out when someone was harmed beyond their control.

I think society can and should set standards that say something like "if you harm yourself in a very predictable way through negligence and expect us to pay to restore your place in society, we reserve the right to socially shame you and withhold those payments at our discretion."

Why? Because we really really want to discourage people from doing bad things that have real costs on society. That's why we make criminals pay fines or go to jail. That's why taxes on cigarettes are so high. Accommodations are often expensive and disruptive. People creating the need for an accommodation based on poor decisions or knowingly harmful activities are asking or demanding that society incur costs that would otherwise not be needed. That's not okay.

We might decide to help people anyway, but it makes a difference how they became disabled.

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I think the social model of disability is bad, but I'm amused by the way this community views propaganda in a wholly negative light. Propaganda is a crucial tool for any political movement. Politics is a dirty business and if you aren't getting dirty you don't care about winning. And if you don't care about winning, you're a sitting duck, a victim in waiting. (Quietism is respectable, I have no problem with staying quiet and keeping your head down. But if you enter the political arena and you aren't willing to play hard, that's SUICIDAL.)

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Why are medical organizations promulgating "dirty" political propaganda?

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To forward their political agenda. "Medical organizations shouldn't have a political agenda!" Too. bad, they do. That's the real world. If it's any consolation, American non-profit medical groups may have a liberal agenda, but they are also institutionally low-key hostile towards socialist goals like universal public health care. They want more tax dollars to fund their little fiefdoms, but they DON'T want to be cut out as unnecessary middlemen. This explains the surprisingly vicious fight between Bernie supporters and Liz Warren supporters in the 2020 Democratic primary. Rank-and-file nurses were more open to Bernie, while LPNs, doctors and admin sided with Warren.

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"The social model proper REJECTS the medical options here as stigmatizing and dehumanising, because it implies there's something wrong with these people that needs to be fixed."

There isn't even a sharp boundary between medical options and infrastructure. Eyeglasses can be looked at as a medical option, as a prosthetic, or as (admittedly rather local and personal) infrastructure.

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yup. there’s a lot to unpack here, but a case this everyday and this difficult suggests maybe we should just throw out the whole suitcase (category structure) and start over. easier said than done, of course.

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Many Thanks!

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One strange illustration of how Americans think about things is that the passage of the Americans with Disabilities Act a third of a century ago turned out to be a boon to undisabled mothers pushing baby carriages because of all the ramps that were constructed for the smaller number of people in wheelchairs.

That got me thinking: Why didn't we build ramps for mothers pushing baby carriages before? Why did they benefit only as an accidental byproduct of society's concern for The Disabled? To my mind, mothers pushing baby carriages should rank up near the top of society's priorities, but instead they don't seem to come up much. Mothers pushing baby carriages simply aren't seen in modern America as one of the recognized groups whose rights must be protected from discrimination, so nobody much noticed that they'd benefit from ramps to get around staircases.

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Also just in general, there's a nice property where anyone with any mobility can go up a ramp, but only able-bodied people without wheeled cargo can go up stairs.

And a similar thing applies to many accomodations - they make things easier for everyone, not just the people with the relevant disability.

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If that was the case, the market would have already made those improvements. Your fantasy world where tradeoffs don't exist and every policy you support is universally good in every way does not exist. Everything has tradeoffs.

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The tradeoff with ramps is that they take up more space than stairs and more time to create than a simple drop curb, I agree that without people arguing for more accomadations these would not have been implemented, it's just interesting how often the benefits can be widely distributed.

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The spread of wheelchair ramps may have contributed to the growth in wheeled suitcases.

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A large amount of urban planners, like enterprise software product managers, are known for not caring much about users but more about satisfying some set of architectural vision and pseudo-engineering requirements at a minimum cost.

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I guess one of the reasons I feel the Social Model isn't literally true (but is still useful) is that the "State of Nature" is not particularly accomodating to any of us, regardless of our level of physical ability, and civilisation is an ongoing process to make it more convenient. E.g. paved roads are a relatively new innovation, before they existed a wheelchair would not have been a very useful way of getting around, but as the lack of ramps shows we didn't create them with people with disabilities in mind. I think that it's a sign of progress that drop curbs are now assumed as part of urban design rather than something people in wheelchairs have to specifically advocate for.

That said, I don't think there's any way to structure society such that being in a wheelchair never poses a barrier to accessibility, because uneven surfaces are the default in the natural world. That's not to say we shouldn't keep trying, but it does illustrate the limits of the social model, as opposed to the Medical Solution of giving everyone cyborg legs (sadly still a WIP).

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There's also the possibility of accomodations making things worse for those who do not need them. For example, a bathroom that is not wheelchair accessible might allow for more stalls than one that is wheelchair accessible .

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There may also be an interaction with the size of baby carriages - once there were ramps, carriages started increasing in size. Now some of them are almost the weight of a wheelchair.

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Baby strollers for some are conspicuous consumption, for others a disability accommodation. The less industrialized world is still full of mothers physically fit enough to wear a toddler while also carrying goods to market. The poor in the first world don't need strollers because they don't stroll.

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>Why didn't we build ramps for mothers pushing baby carriages before?<

We didn't want to encourage them to leave the kitchen.

Kitchen doors used to be three feet thick and lock from the other side.

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You are echoing the idea of "sane-washing" here, first elaborated on by the twitter account @ne0liberal:

https://twitter.com/ne0liberal/status/1334218313472356353

It's similar to a motte and bailey - a crazy idea is introduced and the originators and many others absolutely believe in the crazy version. For whatever reason it catches on politically and so it goes through a period of 'sane washing' where it's explained they didn't REALLY mean the crazy stuff, just this more reasonable version. 'Abolish the Police' went through this. The original version was absolutely about literally abolishing the police, and then it eventually was sanewashed by Vox and others to be about changing police budgets or something.

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Good point, although I think it would be almost maximally offensive to use that term in the current article!

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Not quite my recollection. As I recall the term "defund the police" was invented specifically as a strategic compromise between people who wanted to reduce police budgets and people who wanted to reduce police budgets to zero. It was deliberately ambiguous, but could be used in an honest statement of both positions- allowing people to do their own thing, under a broad banner of agreement that police budgets were too high. In that regard, it's not too dissimilar to "end cruelty to animals in food production" which some people will interpret as seeking the abolition of most or all uses of animals in farming, and others will see as about cage hens etc.

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Do you have any sources for this to point to? I've never seen anything to indicate that it was a deliberate compromise, but I've long seen it as an accidental one. I've participated in a number of discussions where large numbers of participants supported "defunding the police," and thought they were all backing the same position, until I asked them specifically what they meant, and discovered in the process that they mostly supported completely different things and believed each other's actual positions were ridiculous mischaracterizations meant to discredit the movement.

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I do not have any sources, this is just my vague impression, apologies if my memory of this is wrong.

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This seems correct to me as well. I think there was probably one group of people who sincerely wanted to reduce but not eliminate police budgets, another group of people who really were using it as a smokescreen for eliminating the police and assumed everyone else was as well, and a whole bunch of other groups of people who were doing their own weird things with it.

The same thing is probably going on with the Social Model of Disability. One group of people is using it as a rhetorical technique, another group of people believes it literally and totally and means exactly what they say, both groups of people believe they're on the same page. It's all a pretty substantial blackpill on the organised left's capacity to do anything.

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There was also "abolish the police" at the very start of the summer 2020 uproar, but outside of Minneapolis (where it took about a year to die down), it died down relatively quickly. You did have people trying to sanewash "abolish the police" into all sorts of totally unrelated things.

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Thanks, I don't think I realized this.

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It's not right. 'Defund the police' has its origins in police abolitonism.

https://grahamfactor.substack.com/p/its-not-about-police-reform

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Your link, if anything supports my claim:

"What’s remarkable about this image is that it lays out the whole plan. They intend to start with “reasonable reform” like consent decrees and changes in use-of-force policies, move on to defunding police, and finally abolish police altogether. This didn’t happen because defunding the police is still massively unpopular, and so this graphic and message have been memory-holed and you won’t find them on the 8 Can’t Wait website today. But now we know what they’d like to do if they could."

That's exactly what you'd expect if "defund the police" was meant to be a multiply interpretable demand which some people interpreted in terms of a final goal of abolition, and others didn't. Some people who supported it wanted to use it to escalate to abolition via a sequence of steps.

No one's claiming "defund" wasn't supported by a bunch of abolitionists, the point is that it was supported by both abolitionists and non-abolitionists, for different purposes, in a sort of hedge-the-differences grand bargain. As far as I can remember, that's why it took off, much more so than previous demands to abolish the police which lacked the relevant ambiguity.

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Nope, it was absolutely started by police abolitionists, and its framing as an extremely moderate view on policing created ONLY after 'defund the police' proved to be electorally toxic and that less policing was clearly leading to more crime.

https://grahamfactor.substack.com/p/its-not-about-police-reform

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Which part of that overlong post supports your position. I skimmed it and don’t see the support. It reads like a lot of “this person said this and that person said that@.

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The supporters of "defund the police" on my social media timeline insist, strenuously and explicitly, that they mean the complete abolition of the police. They deny any ambiguity or willingness to compromise.

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Jul 15, 2023·edited Jul 15, 2023

I don't know, if something was first said by a crazy person but 99.9% of people who say it now mean a different sane thing, and any support for the people saying it will end with the sane version being implemented, it seems pretty fair to just say the sane version is the 'real' meaning of the phrase?

Like, we do this with words constantly, their meaning changes to however people actually use them rather than what they originally meant.

I feel like we've all more or less agreed that the descriptivists are right and the prescriptivists are wrong when it comes language. This seems like trying to be a prescriptivist for entire phrases and ideas, which feels doubly perverse to me.

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Jul 16, 2023·edited Jul 16, 2023

I think there is a lot of empirical disagreement over the "and any support for the people saying it will end with the sane version being implemented" part of your argument.

A crazy politician will start the "Tigers Eating Peoples Faces" party, people will vote for them because "Tigers are photogenic and endangered and worth supporting, and there's no way he's being literal", and then be shocked and outraged when their faces get eaten by tigers as a result.

N.B. I deliberately avoided real examples because I can only think of current culture war ones, I would appreciate a historical one that wouldn't trigger people's arguments as soldiers instincts.

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Literal Hitler clearly said that European Jews will be annihilated if they cause a new World War and everybody ignored that part, including Jewish publications.

https://en.wikipedia.org/wiki/Hitler%27s_prophecy

> At the time of the speech, Jews and non-Jews inside and outside Germany were paying close attention to Hitler's statements because of Kristallnacht and the possibility of war.[30] In the following days, the speech attracted significant commentary in Germany.[34] The German-Jewish diarists Luise Solmitz and Victor Klemperer mentioned the speech in their diaries but paid little attention to Hitler's threat.[44] Outside Germany, coverage of the speech focused on the geopolitical implications of Hitler's discussion of foreign policy,[45][46] while the threat to Jews went unremarked.[45] The New York Yiddish newspaper Forverts printed a headline referencing Hitler's threat against the Jews, but the article below it only discussed the threat of war and Hitler's alliances with Italy and Japan. The Warsaw Yiddish newspaper Haynt discussed the speech in several issues beginning on 31 January, but did not emphasize the prophecy. On 31 January, it printed the main points of the speech without mentioning the prophecy; in an analysis of the speech published the next day, columnist Moshe Yustman discussed appeasement and other foreign policy issues.[47]

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Seems to me that a significant issue here is a lack of clarity that is used to make motte-bailey type arguments.

First, we have to understand what exactly is it that is claimed to be caused by society. Is it:

1) The actual state of the person's body/mind. Is it society that causes a paraplegic to be unable to move their legs via nueral messages? (only ppl w/ crazy views about social construction of reality believe this).

2) Is it the fact that the person's condition creates a limitation for them that is caused by society? That it creates a significant limitation?

3) Is it the fact that limitation is regarded as a disability that is caused by society?

Of course, in some sense 3 is trivially true in that society in some sense is responsible for all the concepts we deploy and their boundaries but the problem is that people tend to use the theory with meaning 2 in mind but then defend it via meaning 3.

And more broadly we have to ask what one means by being caused by society or only via society. The natural understanding of what 2 means is that it would somehow not be a serious limitation in a state of nature without society. However, if you interpret cause to mean just that: if society was different than this fact wouldn't constitute a significant limitation than of course it's true because you could imagine a society where anyone who was caught walking or using their legs is immediately shot.

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Jul 14, 2023·edited Jul 14, 2023

A very central example is a congenitally wheelchair-bound person's ability to traverse a building.

Society doesn't cause the person to be unable to use their legs, but it does build buildings with stairs instead of ramps/ elevators/chairlifts, and with hallways too narrow for a wheelchair.

And notably, ramps, elevators, and wider hallways are usable by the able-bodied as well, and also useful to people pushing strollers or transporting large or heavy objects.

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That's certainly true, but that would be accurately described by saying: the choices people make -- and especially the standards we adopt -- make a huge difference in the ability of the disabled to function in society. And the fact that this much clearer statement is both the simpler and more obvious one calls into question the motive for advancing this more complicated theory.

I get that this is advanced by well-intentioned people who are upset we don't do more to accommodate the disabled but that's not a good reason to launder the fact that societal choices can make a big difference into something more -- a near absolute which obscures the fact that there are real tradeoffs here. That while sometimes affordable changes can enable someone with a disability essentially the same ability to navigate the world as someone without the disability at other times either accomodations can't bridge the difference or aren't practical.

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The disabled aren't entitled to anything. Absolutely no one is entitled to anything at all from anyone else. It's because of your personality anyway.

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Jul 14, 2023·edited Jul 14, 2023

At my work place, there were steps (it's a government building, so it does have the fascist large offset architecture). They needed to put in a ramp after it was built, so they did.

No one, but no one, uses the ramp - because it's a switchback. A straight ramp would put the bottom end in traffic. "Accommodating" in a way that people not in wheelchairs would use would mean tearing down the existing building and constructing a new smaller one so the ramp could be fit on the existing lot.

Oh and there's an elevator, which is accessible without using the stairs (there's parking under the building and the first level is exposed on the sides and accessible) - but they >also< had to put in the ramp.

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I think the example of the spaceship is actually helpful. It’s very natural for nasa to build a spaceship that needs sight to be usable. But if they also build it so that only people between 5’10” and 6’0” can use it, and only people with normal smell faculties (because, say, some sensors report with smells that would be unnoticeable to some people or problematic ally overpowering to others) then we can see some of the possible variance in 2.

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Interestingly that's exactly what NASA does. There are minimum and maximum height requirements to be an astronaut because it's very expensive to make multiple models of spacesuits and or to test and launch more complex adjustable mechanisms to make the various treadmills, seats etc adjustable.

I think that points to exactly why the way the theory is stated is very misleading. Yes, it's true that choices in how we design our environment can make a big difference for how people with different physical attributes/abilities are able to manage. But these aren't free choices, they are trade offs imposed by reality with costs and benefits we have to balance.

Yes, in most cases it makes sense to require new buisnesses to have a wheelchair ramp but not to require nasa to accommodate even relatively common variation in height. And there are going to be all sorts of cases in between from historical or artistic concerns to thr fact that in rural northern Canada lever doors give bears access (ok I included that bc it's a neat fact).

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I'd add that this kind of theory is why I have my anti-charity attitude (to theories not people). Sure, if one pushes and pulls at all the definitions you can give it a meaning that's at least plausibly true.

However, what you can't do is render it an efficient means to communicate an understanding of how disability and society relate. The theory only complicates and obscures the truths that the examples people use to explain the theory convey.

Those examples illustrate important points but moving beyond them to this theory seems to only make mistakes and confusion more likely.

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Jul 14, 2023·edited Jul 14, 2023

I consider the ADA a disaster myself but the reference to Everest (which I'm sure has been conquered by people with various limitations) recalled to me that in the early 70s, I think it was, 3 young disabled men climbed the highest peak in Texas, Guadalupe Peak. Sure, it's not the Rockies - but it's still an amazing feat. There's a trail but it's plenty rocky in places. I have forgotten the nature of their disabilities. But suffice to say they were wheenchair users, and on the parts of the trail where wheelchairs were of no avail, they essentially pulled them and clambered on somehow.

Very probably someday soon, activists will find fault with the marker that tells of this trek but for now you can read about it at the national park.

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This model is so dumb that mockery rather than a thousand earnest words is the most appropriate response.

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Moderate warning, 50% of a ban. Fewer comments like this, please.

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Jul 14, 2023·edited Jul 14, 2023

Sorry, I'm not sure where I erred in a partially ban worthy way. Obviously your serious reply shows you disagree that the social model of disability is so unserious as to be undeserving of a serious reply, but surely disagreement isn't grounds for banning.

Maybe I can try to make my point in a different way. Is there any comperably prominent expert view or theory that is so unserious that you think mockery or another non serious response is most appropriate? I'm not interested in the specific view or theory, just whether or not such a case exists. By appropriate I mean meriting and/or effective in exposing as unserious.

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I think that if a viewpoint is sufficiently entrenched that it's systematically argued for by experts, then mockery probably won't help change that, even if it's arguably deserved. It might be cathartic, but anyone sympathetic to open mockery probably wouldn't have taken the experts arguing the position seriously in the first place.

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Even if it's _not_ sufficiently entrenched, mockery is still not appropriate. If it's _actually_ fringe, then straight up ignoring it is perhaps appropriate (No one has time to seriously and deeply address every weird thing that 3 people online believe). If it's gotten enough traction that ignoring it isn't an option, then it also has enough traction that mockery won't be effective.

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>Is there any comperably prominent expert view or theory that is so unserious that you think mockery or another non serious response is most appropriate?<

If no one attempts to seriously discredit it, you don't actually know how dumb it is. Maybe there are counters to your counters, which you won't find out about unless someone gives a serious argument that provides the opportunity to present them.

"Why" something is dumb is always valuable to explain. We don't need to do it ourselves on every topic, but we certainly don't need to discourage other people's attempts.

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This felt less earnest than most of Scott’s post, and the examples given seem more mocking & uncharitable than they should be & the literal interpretation seems less literal & support by quotes than it claims it

I don’t have a staked position on the topic, as I don’t know anyone disabled and my politics doesn’t take a side on the topic

However, while Scott’s rhetoric often convinces me, this has done the opposite for once

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Interpreting a model's description literally is not being uncharitable. If the model permits absurd conclusions, then that's a problem with the model.

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I’m saying it was insufficiently literal

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I assume by "it", you mean Scott's examples. What's an example that you think is not literal enough?

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He’s not taking the distinction between disabilities & impairments literally, and lumping them together

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And I disagree, so maybe you could point to what you think is the worst offender.

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They're the same position descriptively, the difference lay in the normative stance

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Jul 14, 2023·edited Jul 14, 2023

Maybe this is stupid, but do birds think of us as disabled because we cannot fly? (Like, insofar as they think.)

Or to put it another way, I can't exactly climb Mount Everest either. Does that make me disabled?

It seems to me that we all have a scope of things we can not do, and those are very much on a spectrum. What's the point at which it becomes a disability? When we can't provide for ourselves at all? Or when we can't do the things that society demands of us?

These all seem like naive questions that people have good answers for--I'm just trying to think it through. But it kinda-sorta-seems like you could steelman something useful out of the Social Model? Even if it's mostly pretty stupid.

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I like the answer that a disability is a limitation that is unnatural. Not artificial - a birth defect is still unnatural even though it was not caused by any accident or injury. Natural in this context meaning essentially "functioning normally". A functioning eye can see, so blindness is a disability. A functioning arm cannot fly, so flightlessness is not a disability.

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Am I disabled for being short-sighted, then?

I have some gripes with the social model, but it does have some very valid points about accommodations.

Needing glasses or contact lenses is an example of a disability that is accommodated in most places. More specifically, the technology that "makes" these people not disabled is accommodated.

Most places do not make you remove your glasses before you enter, even if it may be potentially an issue (for example you can wear glasses to saunas even if it makes your glasses fog up). If it is a serious issue, it gets accommodated (fit over safety glasses that go over most glasses).

Mobility devices and/or service animals don't always get these accommodations. Especially service animals - a real service animal is NOT an issue, even in a food service venue, because the animal is trained to make it not an issue (emotional support animals are a different story and I don't like those people misusing accommodations for service animals).

It's not saying that lasik is bad or shouldn't be available. It's acknowledging that lasik is super expensive and sometimes inherently not an option and sometimes limited accessibility and people are getting on fine with glasses. If they're fine with glasses, you shouldn't force them to get an expensive, invasive procedure just so it makes your life easier (e.g by not providing fit over safety glasses).

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Yes, I would say that short-sightedness is a disability.

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This is exactly where the social model derived language around impairment and disability is really useful.

Short sightedness is an impairment, but you have a good solution available which is socially accepted and generally accommodated (glasses) so you are not disabled by the impairment.

Acceptance of glasses and accommodation for them in eg safety equipment has considerably improved within my lifetime (eg when I was a kid I was embarrassed to wear my glasses as 'speccy' and 'four-eyes' were common insults).

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>This is exactly where the social model derived language around impairment and disability is really useful.

How? Glasses and other similar accomodations precede the social model in the first place!

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