Tip of the hat for the Washington Generals call back

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


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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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

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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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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"Together, We Can Reach Entirely New Levels Of Disagreeing With Bryan Caplan About Mental Illness" — Love it.

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I think the closest thing to an example of the social model being right is probably high-functioning autism. Throw an aspie on a deserted island and throw a normie on a deserted island and there's *not* clearly a difference there; the issue is mostly (not quite entirely; there are a couple of other effects, but they're minor) that normies detect us as Other.

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This is reminiscent to me of the famous Ronald Coase paper, The Problem of Social Cost.

Coase was writing in an economic context and talking about the problem of pollution and other externalised costs. But he had the same key insight - identifying who is causing the problem and making them responsible for fixing it is not always the best way to address the problem.

The Social Model of Disability is akin to the Polluter Pays Principle - it frames the cost of certain issues as a matter of justice and fairness, and insists that the costs must be borne in a way that alleviates this perceived unfairness. But in doing so it neglects to recognise the stark reality that not all problems can be reasonably resolved in this manner. Both of these ideas are more interested in theoretical conceptions of justice rather than in dealing with the messy reality where their prescriptions sometimes become unworkable.

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Functionally speaking I think these aren't models (of reality) but disguised moral claims about when it is normatively appropriate to accommodate a disability.

I've long wondered if it wouldn't make more sense to simply offer some disabled individuals large sums of cash rather than ask people constructing buildings etc to accommodate them. Obviously wouldn't make sense for the common easy to accommodate cases and it would have to be enough to account for the harms resulting from potential lack of community/etc but at the very least it seems to me that we should ask the disabled if they'd prefer yearly/lump sum cash payments whose NPV is less than the NPV cost of accomodations.

Unfortunately, the really weird fact that we somehow don't understand laws that demand buisnesses lay out money as a tax means it's not a real option. Still, I think considering this in extreme hypothetical scenarios demonstrates the claim that it should always be society who offers an direct accomodation can't possibly be correct.

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Jul 14, 2023·edited Jul 14, 2023

I have to admit that as much as I'm trying to be charitable and open minded, the idea of the "Social Model" just seems incredibly alien to me. It feels like its advocates' model of the world is that humans are ethereal social spirits flying around and supporting or oppressing each other. Whereas my worldview is very much formed around the belief that the world is by default unforgiving, full of pain and suffering and death, and humans have to work to improve it. People can and should talk about social issues - who eats cake and who eats bread - but this should be grounded in the understanding that we need tractors, irrigation, fertilizers, logistics and plain physical labor to have bread in the first place. And clearly, all of these are harder to do for people with disabilities. And of course, this doesn't mean disabled people are to blame in any way! But surely it must be possible to disentangle blame and objective physical limitations.

I wonder if this can also be phrased in the "thrive vs survive" framework.

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Like a lot of my woke beliefs that irritate rationalists (standpoint epistemology, systemic explanations for racial disparities, etc), I think an important and easily-missed feature of this discourse is that whether we admit it or not, most adherents of the social model treat it "seriously but not literally"—specifically, as a moderately strong prior rather than a brittle, irrational foregone conclusion.

I'm a biomedical researcher, obviously I'm aware that (some) diseases and disabilities are objectively worth trying to cure. But I also try to stay on guard for the possibility that "disabled people are, sadly, less able to do things than abled people" is a thought-terminating cliché. Most people are abled along any given dimension, and even without raising the cynical possibility that abled people don't like being inconvenienced for the sake of including a minority, it's clear that it's easy for abled people to forget about or fail to imagine the experience of disabled people (top-of-mind example, saw a semi-viral tweet the other day about whether it was weird to see a couple sitting on the same side of a booth in a restaurant, and hundreds of people were discussing without anyone mentioning the possibility that one of the people could only hear out of one ear and not very well).

So any time I (a mostly abled person) think about or am told by another abled person about an accessibility issue framed as an objective biological fact, like "you don't see wet lab workers in wheelchairs because they wouldn't be able to reach the benchtops," I always try to check myself and see if I can think of a reasonably cost-effective social solution to this obstacle. Obviously it will sometimes be the case that there is no such solution, but I believe that in expectation, making the mental effort to think about it for a moment is both epistemically worthwhile and increases the likelihood that my thought will lead to some positive-EV practical conclusion.

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I spent some time with Scientologists and they do not believe that. They are generically against psychiatry, although the individuals I spoke to said modern psychology and psychiatry was better than the stuff in the 70s. But more importantly their whole practice is set up as a kind of therapy.

There is a lot of Stanislovsky Method-esque training as well as sessions designed to "clear" people of "engrams", which are described as basically maladaptive thought processes they picked up during times of trauma. You don't create your own parallel therapy system if you don't think people have the equivalent of psychological problems.

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As an aside this kind of thing is why I think it's often really important to be a bit of an ass about definitions. The reason a bunch of bad stuff gets through is that people feel bad about pushing hard on what exactly is meant and feel they have to respond to the gist.

If, when someone starts explaining the social model, you interupt them and ask them to spell out exactly what is it they mean is caused (is it the condition, fact it's a big deal, etc) and what they mean by caused by society (does that just mean we could imagine some society where it wasn't true?) then it's hard to believe anyone would find this model ever attractive.

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Jul 14, 2023·edited Jul 14, 2023

"Two Arms and a Head", the painfully frank memoir/suicide note of the paraplegic philosophy student Clayton Schwartz, opens by deriding a quote from Stephen Hawking. I'll just post his first paragraph:

>“I try to lead as normal a life as possible, and not think about my condition, or regret the things it prevents me from doing, which are not that many."

>Is anything in man so deep-rooted and prevalent as the drive to see things as they are not? What Professor Hawking says here is reasonable, up until the last five words. That’s where the sky cracks and falls. Relativity and quantum mechanics may both be mind-bending and baffle the understanding, but no less than when a world-famous mathematical and scientific genius who can do little more than twitch his cheek and move his eyes; who cannot feed, dress, wash, or care for himself in the most rudimentary way; who would, if abandoned next to a stockpile of food and water, starve and eventually die of dehydration where he was left, positioned as he was left, tells us that there are “not that many” things he cannot do.


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IMO the most insidious problem with the Social Model was only very lightly touched on in this article: the way it interferes with Step 1, as in "the first step to solving a problem is admitting that it exists."

When people deny that a disability is a real, objective problem, and especially when they start bringing political pressure to bear on those who prefer not to deny it, they perpetuate the problem by making it more difficult to perform any sort of research that might end up leading to a cure. Yes, it's definitely nice when society is able to accommodate people with disabilities, but how much nicer would it be to never have to in the first place because we can fix the disabilities?

People pushing the Social Model push to make that bright future impossible.

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Fixing society is hard. Fix biology. One of the top SSC posts.

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If this is going to be a primary topic du jour on this blog, I will become the Commenter who Harps On My Belief that it’s really hard for any kind of discourse to proceed in this area until we all Stop Worrying and Learn to Love Teleology.

(Also, somewhat à propos: I wonder if Scott would still pretty much agree with his previous negative review of After Virtue?)

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Something I notice about woke people is that they are not comfortable admitting to having any sort of negative reaction to any group, except I suppose they'd make exceptions for Nazi's and serial killers (and of course for members of their own cohort who are insufficiently woke about some issue). But denial of negative judgments seems like a really core thing. So it seems to me that that denial lies at the root of a bunch of woke nonsense like the Social Model of Disability.

When I see someone who is disabled or deformed I invariably have a craving to stare at them. I feel intensely curious about what the problem is and exactly what it looks like. Of course I do not stare, unless I can figure out a way to do it without the person being aware of what I'm doing, because I don't want to make them uncomfortable. Also, I generally have a negative, "that's ugly" feeling about their disability. I am pretty sure my inner reactions are not at all unusual, and I don't really feel guilty about them. Once I get to know someone who has a disability all that stuff fades away pretty fast and they just look like themselves to me.

But it seems to me that there are a whole bunch of people walking around these days who have somehow ended up believing that even their private thoughts and feelings must be pure as the driven snow. Where the hell did that idea s come from? Is it because the country is becoming less religious, and people have a need for rules about what you are supposed to think and feel? I live in Boston, and used to see in psychotherapy people of Irish descent who grew up with old-style Catholicism -- the kind that tells young males that they will go to hell for masturbating, and that thinking of a sin is equivalent to doing the deed. The people I saw from that cohort had been left with terrible anxiety disorders. This woke religion seems about as harsh as old-school Catholicism, though about different issues.

Anyhow, my theory of the Social Model is that it's an attempt by people who hate themselves for their spontaneous negative reactions to disability, and invented the Model as a way of atoning for their sin.

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So if a disabled person washes up all by themselves on a desert Island... are they the victim of the society, the society that makes them a victim, or both?

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Is your statement that your grandma "Didn’t want some kind of social revolution. She just wished she could see again" drawn from conversation with her, or is it just a conclusion you've drawn on your own? It seems to pit against each other two things that really aren't mutually exclusive.

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The Medical Model exactly as stated (with the "you must stigmatize people with disabilities" part included) was hugely historically popular, and calling it a straw man is only true insofar as the real people who believed it have (mostly) died off. Although it wasn't called the "medical model" at the time, that set of beliefs was the grounding for the eugenics movement and played a huge role in historical abuses of disabled people. I think Deafness is a really good example of this. The oral education of Deaf people imposed on them by hearing doctors didn't work, because there WAS no medical remedy for deafness at the time. The Cochlear implant is relatively recent, and it's not a flawless solution. In the place of the actual practice of medicine was inhumane education, which determined the worth of a Deaf person by how well they could learn how to speak, as opposed to recognizing sign language as an actual valid language with a grammar and so on. This is the ideal example of the social model versus the medical model - Deaf people were never "incapable" of speech, rather, hearing educators at the time, influenced by Alexander Graham Bell's theories of eugenics, were incapable of recognizing that the Deaf were perfectly proficient in sign language. A medical inadequacy, solved by a social solution.

I agree with you that 1) this dichotomy is outdated and doesn't correspond to modern beliefs very well and 2) that we could stand to be less skeptical of medical interventions that do work, especially with regards to mental health. Nevertheless, I think there are circumstances where the parable of the social model versus the medical model is incredibly valuable. Specifically, the circumstance when someone suggests the most humane medical intervention for a disability is to sterilize the affected population to prevent them from perpetuating their inadequacy.

Otherwise, you make a good point. I think it's worth it to change how we teach the history of this particular paradigm shift in accessibility care, and to consider the negative implications of how the social model interacts with modern psychiatry and medically treatable disabilities.

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The social model is one of those concepts where I struggle to understand how anyone sincerely believes it, and yet I know some people do. Like, your example of a blind person on a desert island -- of *course* it is inherently better for a person to be able to see, regardless of the society they live in.

I am mostly aware of this attitude as it regards the deaf community - both from friends with deaf relatives, and from media. Reading this, I was reminded of the movie Sound of Metal, about a drummer who loses his hearing and integrates into a deaf community. Its main thesis, which is spelled out didactically by the deaf community's leader, is that deafness is not a disability, and that deaf people should never be made to feel any "lesser" for their lack of hearing or to seek a cure. Basically following the mantra of the social model of disability. (now I will spoil the ending)...

The protagonist learns about the existence of cochlear implants, which he is told have the power to restore his hearing. Eventually he saves up his money and gets the operation, after which two things happen:

a) the leader of the deaf community tells him he is no longer welcome there, since he sought to "cure" his deafness, and that would send the wrong message to the other deaf people.

b) although he can technically hear, it's not what he expected; everything is distorted and staticky. People sound like robots, there is constant feedback. If the point of curing his deafness was, in part, to be able to enjoy music again, then it is a failure. (In the final shot of the film, the protagonist turns off the implants, since the silence is preferable to the constant feedback)

We, the audience, are meant to accept the leader's message here (the social model of disability), but to me, it rang hollow. If cochlear implants actually worked as the main character had hoped, and fully restored his hearing as it was originally, then of course it would be the right choice, and every deaf person would get them, because being able to hear is simply preferable than the alternative. The movie just reinforced to me that the whole social model attitude of "disabilities aren't real, society is the problem" is a coping mechanism for when an adequate physical cure does not exist yet.

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I also do think your examples in "Why I Disagree With The Social Model" are pretty questionable. I mean, confronting the spaceflight one--it's not like you steer a rocket by looking out the windshield. I'm neither blind nor a rocket scientist, but rockets are small enclosed spaces where everything has a designated spot and looking out the window adds nothing at all. Of course NASA could make a spaceship that a blind person could operate. Unlike a ramp to Everest, the cost and effort would be trivial compared to the total cost of the endeavor. It doesn't mean NASA's evil for not having done so, but it's still a choice and I don't think that's an inherently sighted activity. I don't think pointing out the failings of the literal version of the social model has to mean limiting our creative thinking about what is "inherent" in the way that some of these examples do.

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Blind person here. As a member of the disability community myself, I basically agree with this post. I've been concerned about the social model for a while, but Scott has an uncanny ability to put my thoughts into words much better than I ever could.

One thing I will add, it is often much easier and cheaper to "solve" disability by changing society than by curing it in the first place, and therefore advocacy for that course of action is certainly not unwarranted.

Some people even argue that curing or preventing disabilities often slows down progress on the social front, as fewer disabled people means less pressure on society to make the necessary accommodations. According to this argument, this effect causes progress on the medical front to have less of an effect than we would assume, as it negatively affects the disabled people that cannot be cured. I'm personally pretty unconvinced, but I will admit that this effects works in the opposite direction; countries which had a sudden influx of the disabled, usually war veterans, often made a lot of progress on the social front. None of this detracts from the main point, and in my opinion these effects are small enough that they shouldn't be of much concern.

As an anecdote, I have seen a person in the blind Twitter community (which, for obvious reasons, recently became the blind Mastodon community and basically became Tumblr reborn) unironically argue that, with the advent of mobile apps which let trained helpers assist people over video calls, there's nothing stopping a blind person from becoming a surgeon or a pilot, and it's all just stupid, discriminatory laws that need to be changed. Granted, this was a singular, radical opinion, but it's indicative of a more general sentiment. You don't have to look hard if you want to find a blind person who would require all software developers to make all software, external or internal, perfectly accessible from day one.

PS. A bit unrelated, but It would be great if we could finally get proper alt descriptions on this blog; we usually get something along the lines of "07857d17-f333-45e4-9a54-deaac6969d28", which might be helpful to a computer, but definitely not to us.

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I suppose it seems to me that so long as the idea of "impairments" being bad on their own is taken seriously, and "disability" just refers to the social aspects, this is a "merely" verbal debate. It's just defining "disability" as the social bit but allowing that biological "impairments" exist separately and are bad. Emphasizing that distinction seems to be how the social model theorist will push back, and it looks like once they do that, it's going to collapse into a verbal debate, where everyone agrees there are biological problems and social problems alike, but one side wants to say the biological problems, while bad, aren't in the category "disability". Maybe this is an important "merely" verbal debate, but it does seem like a verbal debate.

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A couple formatting/wording suggestions and a more substantive critique.

First, there are two places my clinician friends will get hung up in the intro. One is on the reference to the Washington Generals. People with ADHD (who might be very interested in reading this post) struggle with even conventional metaphores, and an unconventional, undefined metaphore like this may be a barrier. I would suggest briefly defining it.

The other is the reference to bravery debates. You define it in the middle of the linked post ("arguments where people boast about how brave they are to take an unorthodox and persecuted position, and their opponents counter that they’re not persecuted heretics, they’re a vast leviathan persecuting everyone else"), and I think it would help your readers to include that definition in the post body. It would particularly help if you found a way to define them in such a way that, as you argue they are, the idea of a bravery debate sounded like a normal thing people experience in actual debates. For example, you might say "Maybe this is a bravery debate - pushing a one-sided idea that's incomplete, but that society needs to think about more."

A more substantive critique is that you haven't explicitly dealt with the possibility that Social Model advocates have redefined disabilities, handicaps, and barriers - not as an intrinsic physically-rooted functional barrier to participating in meaningful occupations, but as the set of impositions by society's in response to an impairment. "Impediment" would refer those activities that an impairment physically prevents you from doing (i.e. how blindness prevents you from driving safely or surviving on a deserted island). But the "disability," "handicap," or "barrier" would be defined as just those things society prevents you from doing due to your impairment (i.e. how society prohibits blind people from obtaining a driver's license, or perhaps from going on a rafting trip).

Is this a sneaky rhetorical Motte-and-Bailey strategy, or an appropriate recategorization that increases the flexibility and conceptual coverage of the English language? Why not both? Let's say that the Social Model project as I've hypothesized it is desirable. Then there are perhaps three ways to implement it. One is to make an argument that we ought to redefine terms like "disability" to refer to artificial barriers against people with impairments and try to achieve broad social consensus. Good luck with that. Another is to construct new terms and endow them with the meaning we want, as you did when you coined "bravery debate." But that requires you to teach and normalize new language, and it undercuts the the ability to enforce your new ideas on the wider population.

The most impactful approach, and the one progressives have won with time and again, is to just assert that these terms have a new meaning, start using them that way, and to police the language of people who use the old meaning. The success of the Social Model is another piece of evidence that this strategy works pretty well.

Under the hypothesis I'm laying out here to explain the Social Model, it's not a bravery debate - not a neglected half-truth that needs more consideration by society. It's a redefinition of terms that makes its claims, properly understood, consistent with common sense, yet more strident in their call to action because it casts society's failures to maximally reduce the very real disabilities it imposes on people with impairments as an injustice that is in urgent need of correction.

And the right thing to do in the face of that call to action is to think about and focus on the common-sense, most impactful steps society could take to oppress the disabled less - not to focus on corner cases like the wheelchairs-in-submarines example that only seem to apply if you've misunderstood what Social Model activities (I am guessing) mean when they refer to "disability." I believe they are hoping you will adopt their language and way of thinking, then apply your common sense to figuring out impactful anti-oppressive steps society should take, then advocate for them in the language of the Social Model. Instead, what you are doing is giving a regressive old-school definition of terms like "disability," eliding the useful distinctions Social Model activists are trying to draw, and then arguing weird edge cases and operating under the assumption that Social Model activists are probably just misleading people, rather than assuming they're trying to spread valuable new categories and definitions. That's not a bravery debate either - it's just kind of annoying.

This little essay is not meant to be interpreted as a straightforward endorsement of the Social Model, because I do think that there are plenty of people who'll get confused by the redefinition and be mislead. If there isn't plenty of space being made for "onboarding" and an active effort to preserve plenty of space for conversation about the ways that medicine can help people overcome impediments, the limitations on society's ability to help minimize those impediments, and good reasons for society to disable some people through the imposition of artificial barriers to participate in certain meaningful occupations, then I think that Social Model activism would be replacing one misleading way of thinking (what they call the "Medical Model") with another (the one-sided interpretation of the Social Model you outline here).

But I do think that if we had one set of terms to refer to impairments and impediments (physically rooted) and another to refer to diagnoses disabilities (socially rooted and oppressive), that would be a clearly useful and common-sense set of conceptual distinctions to have. I would personally advocate for conversations that seek to reinforce these linguistic distinctions, having the nerdy in-depth conversation about definitions and concepts that doesn't make for very powerful activism but does, I think, lead to long-term consensus on the truth.

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Jul 14, 2023·edited Jul 14, 2023

This is perfectly timed. There are so many zoomers who are used to leveraging the social theory of disability to their universities (title 9 says I need nap time or you sleep with the fishes), and that's because at university they are a paying customer. They are used to this obsequious notion of customer service.

In the working world, you are an employee. You no longer dictate the terms. Either you become your own boss as a freelance duct cleaner or you get an alarm clock, you dig?

And as an appeal to experience, I say this as someone whose disability cost myself a hard won career. I acknowledge that I cannot ideology my way into working a job my body won't allow me to work. So I'm trying to learn enough to start in another field where having tons of physical limitations is not so fatal.

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I’ll partially defend the social model of disability.

However, I do want to say that the version of the model I am defending comes from Elizabeth Barnes’ book, “The Minority Body.” I think her book, which is fairly short and good, does a better job of exploring the nuance of the social model of disability, and presents a more difficult model to rebut than the definitions you have used. She posits, for example, that disability (at least physical disability, she suggests that mental disabilities are the same, but declares them beyond the scope of her book) are “mere difference.”

I tend to agree, physical disabilities are “mere difference.” There is nothing inherently better about being sighted versus being blind. There is nothing inherently better about walking versus using a wheelchair. It is only once we impose certain values that these differences become salient.

One could imagine, for example, a world where deaf people are the norm. 99% of people are deaf, whereas 1% of people are sighted. The world is designed for deaf people, who speak exclusively using sign language, and little thought has been put into how loud or high-pitched noises may affect hearing individuals. Now it is those who can hear, not those who are deaf, who are disabled. Consider the same sort of world-changing thought experiment but for blind people.

It is slightly tendentious, but I would argue that every physical disability can be defended as “mere difference” in this manner. A world designed for people with wheelchairs is not ideal for those who walk. A world designed for those with gigantism or dwarfism would be poorly designed for those of more normal height. Even a world designed for people experiencing some sort of very common pain-disorder (please do better than to note that I called this a “dis”-order, it’s hard enough talking about this subject in an analytic way without people breaking words into their component parts and forcing you to pick new and confusing ones just to avoid literal implications) would have those without the disorder disabled insofar as their unusual medical priorities are delegitimized in importance.

This is still, technically, the social model of disability. However, what annoys me about the definitions you used is that they suggest, incorrectly when compared to philosophers of disability, that accomodations are easy to provide or that society is malicious is not providing accomodations.

Where I differ with Barnes is that I do not particularly care that society has values which occasionally require it to discriminate against certain members, so long as that discrimination is the logical result of society pursuing a legitimately agreed-upon social good, and not the result of cruelty or some other bigotry.

It is fine that we prioritize efficiency in fulfilling social goods. It would be a terrible, Harrison Bergeron-esque world if we attempted to ensure that no social good could be pursued until everybody was equally happy with their individual treatments and help. I actually like Barnes’ book because she spends much of her time arguing that disabled people are not unhappy. They are in fact, generally quite OK (Barnes herself has some sort of painful disorder which I cannot recall from memory), and tend to take much of their identity from their disability. They are, in other words, not miserable wretches whom society must drop everything in order to help, but merely one of many interests groups in a democratic, pluralistic society--albeit one with a more salient cause than many others.

I’d like to end with an example of left-handed people.

Left-handed people were long stigmatized, in part due to ancient beliefs that the left-hand side was associated with demons (see the kabbalistic text “Emanations of the Left-Hand Side” by Rabbi Isaac Ha-Kohen for a medieval Jewish example). This stigma persisted well into the early 20th century, and left-handed schoolchildren were bullied terribly by teachers and students alike.

Then, people realized that this treatment of left-handed people was superstitious, cruel, and stupid. For the most part, they stopped doing it. A disability was “cured” not by making left-handed people right-handed, but by societal accomodations.

So far this seems like a pure victory for the social model, but not so fast.

The British Military uses the SA80 rifle for infantryman. The SA80 is a purely right-handed weapon. It ejects the spent cartridge out of the left side, and so cannot be safely used in a left-handed manner. Left-handed soldiers must use the SA80 in a right-handed manner. This is still an interaction with society, because it is society, and specifically the military, the military-industrial complex, and British Parliament, which has decided to build exclusively right-handed SA80 rifles.

However, the reasons for doing so are not cruelty to left-handed people. It is a matter of cost and consistency between soldiers. These are equally legitimate values to pursue in addition to equality. No person, involved in the decisionmaking process here needed to have a hatred of left-handed people. They simply decided that it was more important to accomodate the right-handed majority than the left-handed minority. If left-handed people were the majority and right-handed people the minority, it stands to reason that the opposite decision would have been made.

Left-handed people, in other words, are discriminated against merely because they have “minority bodies.” Unlike Barnes (who does not use this precise example), I think this is often acceptable, but this is still the social model of disability.

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¨Nowadays this perspective has been abandoned by everyone except a few holdouts, Bryan Caplan, and the Scientologists¨ Don´t forget Alex Jones!!!

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You seem to go back and forth between the terms "standard model" and "interactionist model" (without ever explicitly saying that they're the same).

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This type of post is useful to see just how many commenters read the posts carefully and how many skim and comment based on the topic (and some sort of mood affiliation). I'm curious whether you think the median individual hold's view closer to the Medical Model or the Social Model? Reading through your links, and some of the comments, there's this suggestion that people seem to have pretty bad/outdated views of impaired/disabled people. I'm sure I'm guilty of some of the things they mention, but I typically think most people just don't know how to interact with impaired people because they meet very few of them. Maybe this would be an interesting set of questions for the next ACT survey?

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I have OCD, so the "social model" has struck me as utter nonsense. No amount of societal accommodation would eliminate the suffering that occurs when I stop taking my meds and my brain decides to light itself on fire and torture me endlessly with "what if"s about made-up nonsense where if I don't do everything perfectly me and my family die.

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An interesting and well-written essay, somewhat undercut by my utter inability to imagine anyone taking the other side of these arguments. You say they exist and I believe you, but I'm in bizarre dark matter world on this one.

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I think a version of the orthodox Social Model can be charitably rescued if you replace Society with the Environment in general. For example, a blind person marooned on an island has to deal with an overly adverse environment (a modern society, as a part of the "environment" would make it less adverse).

The point is that disability, unlike an impairment, is relative (in Eliezer's terms, a two-place function https://www.lesswrong.com/posts/eDpPnT7wdBwWPGvo5/2-place-and-1-place-words). Society is a part of that second place:

ability = f(impairment, environment).

The degree of "ability" is a reasonably smooth function of both arguments. Sometimes it is a total disability, sometimes it is a minor inconvenience, and sometimes it's a huge bonus, even for the same value of the "impairment".

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Having just spent a semester in a bioethics course where the Social Model was very much the local consensus, this was a satisfying read. Your points about the distinction between society causing vs. failing to resolve a disability and the biopsychosocial model being a sane way to acknowledge social conditions' influence without throwing out biology altogether were well-put. Not sure whether this was a genuinely great piece or it just happened to be ribbing my recently acquired outgroup, probably about 70% the latter if I'm honest with myself, but a pleasure either way.

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You're mixing politics and models together and then arguing against a weird mix of both, instead of any individual concrete point.

The social model just means that a disability is defined by what society thinks a person should be able to do, not some objective list of "things humans should be able to do". A blind person can't drive a car, true. They also can't fly around like an eagle, but are not considered disabled for lacking this capacity. The inability to appreciate a sunset or an opera is a tragedy, as is not being immortal, but only some of those are disabilities. If possible, it'd be better to have sight restored than to be granted blindness accommodations, and it'd be super cool to be granted the ability of flight, understanding the distinction between the two is the point of the social model. This should be seen free from political activism, value neutrally. It's not wrong of society to have some abilities assumed and others not, that's just how society is going to function.

The biopsychosocial model is good for developing treatments for disabled people, do what you can to give capacity medically and work out accommodations for what you can't, but there is still a need for an understanding of what disability is, which is what the social model does. You haven't replaced that, or even attempted to, because you mixed up political action and model of understanding to argue against. The biopsychosocial completely fails as an explanation of what disability is.

You may want to call this a "motte", but the social model is still correct then, it's just a bunch of political activism that's been tacked on you disagree with. Which is fine, but still means you're wrong on the majority of this article.

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The "social model" (taken literally) is so obviously nonsense that it's surprising anyone would even pretend to commit to it.

Thought experiment for its proponents: image you live in a utopia that has implemented all conceivable accomodations and is perfectly welcoming to everyone. Would you be willing to have your hands surgically removed? Your feet? Your eyes? Your ears? If not, why not - shouldn't make a difference, right?

As for placing the responsibility for fixing their issues on the disabled, rather than on society: this is obviously an issue where a reasonable compromise has to be struck, but there is at least some responsibility that lies with the disabled person. Example (inspired by Scott's doctor with glasses): if I wear my glasses, I can do my job perfectly fine. If I don't, I pretty much can't. Do I have an obligation to society to wear my damn glasses, do my job and pay my taxes, rather than refuse, and apply for disability benefits instead? Damn straight I do. And if I lived in a world where there are no glasses, but the alternative would be an affordable and fairly safe surgery such as lasik, I would have an obligation to do that as well.

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I mean, I might be wrong about my understanding of how activists these days are using the Social Model, but here's how I understand it:

Social model is not anti-cure, it's that you should NOT be forced to get a cure in order to do regular day to day things.

I like short-sightedness as an example. Myopia is managed by either visual aids (glasses) or it can be treated with lasik. Socially, glasses are commonly accepted. They're also generally acknowledged as Really Important To People - so you don't just grab someone's glasses or move them if it inconveniences you. You make sure the owner of the glasses is always in control of them, and if you have to remove them for whatever reason (usually dentist or swimming), they need to take good care of them and watch over them carefully. Insurance covers glasses. You can drive with glasses.

You can get LASIK if you like, but you don't need to. If you're managing your condition with glasses, you could consider LASIK if it makes your life easier, but you aren't forced to if it's not an issue - people understand LASIK is really expensive, takes a number of consults, and quite invasive.

Wheelchair users are saying that really, once you get used to it, being wheelchair bound is fine as long as the footpaths are traversable, there are elevators, and people treat the wheelchair with the same care and respect that they do glasses when they need to part with it. You should not force them to do many invasive surgeries to walk again, if they're finding the wheelchair ok.

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As someone with not one but two disabilities (Narcolepsy and Tourette's syndrome, the latter with "all the fixins"), I fully endorse this message. Another major problem with the general approach of "society has all the responsibility to accommodate disability" is when the person's disability symptoms come into conflict with *other* people's natural rights, and Tourette's syndrome is a pretty good example of this, especially if you have some of the more extreme symptoms (as I do, on occasion).

Like, there is literally no way for society to accommodate absolutely everything. It is good for society to try to accommodate me a reasonable amount, and I'm very, very, grateful that I'm privileged enough to say that for most of my life, it by and large has. But there are things society can't and even *shouldn't* try to accommodate too, and this is very important.

I did a long interview about this once if you're curious about all the bizarre details I'm alluding to:


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'This couldn’t because their disability prevented successful naval service, or Nelson’s victories would have been impossible. It must have been because of state discrimination.'

Missing a 'be' before 'because'.

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Agree - essentially the social model of disability discounts the fact that human beings are inherently physical creatures with physical constraints. And a disabled person may have MORE physical constraints laid on top of this.

A non-physical, social-only model of disability discounts this.

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I mean, if you were teleported to a world where almost everybody is able to see infrared light and people rely on each other being able to see infrared light, you'd be disabled even if nothing intrinsic to you changed...

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The current state of affairs looks very much as if people originally followed the Medical model which led to lots of terrible things, so the Social model was developped as a challanger and then they synthesized into the Interactionist model which people actually follow now.

Social model is just as wrong as Medical one, yet as it came after it and thus led to correction the prevously flawed practises we celebrate the Social model and shame the Medical one. In the world where the Social model came first and we had bad history with people refusing to treat cataract due to it, it would've been the opposite.

Also, I have to notice that "society makes people disabled" is the matter of category border, not a fact. We can define our terms so that "impairment" is the medical condition while "disability" is societal one. It makes sense to have different words for it and be able to talk about them separately. We just shouldn't forget the difference between "being able to talk about them separately" and "assuming they are always separate and there is no relation between them whatsoever".

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I do appreciate that you take people seriously at what they *say* they mean.

But this is the first I have heard about it as a regularish person. So I'm curious if this is a pre-emptive post by you to head off a crazy idea, or is it in response to a bunch of people trying to implement hair-brained schemes with the social model in place.

Even if it is just pre-emptive I don't think its a bad idea to make the post. The last decade has shown me that there should have been more pre-emptive challenges to crazy ideas. I just don't feel like there were many concrete examples of what these people were doing, rather than what they were saying.

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I think the social model works especially bad for autistic people. I have an autistic kid and he's very sensitive to noise and can't stand other children making noise - and autistic kids are also, in general, far noisier than neurotypical kids (stimming, talking during inappropriate times, and of course meltdowns.) And in fact, both of these traits often exist in the same autistic person - my kid included.

Basically, these are "competing access needs" which can occur across disabilities, except in this case the needs are competing even *within* the same disability.

Obviously many ways of "fixing" this is problematic. Accommodating autistic people should never involve removing autistic people from a space. It's a really difficult situation.

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Part of what is going on is that we are in a post-truth world where activists say what they think will have the best effect, or just say what they want to be true, without worrying about what is true. It make sense for them to do this because a lot of people will say they believe the thing that sounds most inclusive or whatever and aren’t concerned with what is true.

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I wonder if proponents of the purest Social Model would ascribe to some model of passive causation. It may slide between concepts of causation and responsibility, but take the classic trolly problem for example: if you refuse to pull the lever, your failure to act when you plausibly could have is part of the chain of events leading to the people on the tracks dying. It’s not one billiard ball colliding into another type “causation” but I see how it can make sense to say a failure of action can have causal power in some situations. To analogize the splitting of the terms “impairment” and “disability” you might say the runaway trolly is the physical impairment which is of initial causal power, but society’s failure to “flip the switch” of accommodations is what “causes” the disability according to how I would understand the Social Model. I’m not sure what I think about that framework, and honestly fits your “standard model” too in some ways, but it sets the focus is on society acting or not acting (with impact on disability) contrasted with what are assumed to be a pre-given set of facts about impairment.

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I think you are slightly misunderstanding the LITERAL interpretation of social model.

It says not to treat disabilities medically, but it also separates disability and impairment, and doesn’t say anything against impairment being medically treat, just disabilities.

So wanting to cure the impairment of blindness is more like wanting surgery to implant magnets in your hands so you have a sense of electromagnetic fields around (which I’m definitely in favour of, the more senses the better)

But curing the disability of blindness should be done socially, like designing cars & their infrastructure so that they can be safely driven by the blind

You say NASA building spaceships for the sighted only didn’t deprive the blind, but I disagree, if most everyone in society was blind, we’d still want to go to space and spaceships would’ve been built with the blind in mind, and the blind were deprived of the opportunity of living in a more blind compatible society

Also you bring up the example of a blind person being disadvantaged on a desert island, but it’s not like there aren’t natural environments where blindness is advantaged, hence why blindness has evolved more times than sightedness has (though blindness is easier to evolve than sightedness)

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Mostly agree, but:

1. The point about spaceships and cars is weird and feels exactly like the point the social model is trying to make. Spaceships and cars require sight because they were designed that way, by sighted people. If all humans were blind, they would've designed them differently.

2. Mt. Everest is a bit of a strawman, but it's certainly true that the natural world is not always very accommodating to disabilities.

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I summarise this as:

* People used to believe (mostly) medical model of disability

* People made a big argument that we should have less than 100% medical model of disability and more than 0% social model of disability (or more than we usually had at the time)

* As with every new idea in the history of all fields, some people wanted "More of this than we have now" and some people wanted "All this, all the time, for everything. And any exceptions are trivial edge cases we can ignore". And lots of people didn't worry about which of those we'd aim for until we'd started moving at all.

* Social model of disability caught on. Some people are still fighting to have it applied to them. Some people are dutifully passing down the arguments of the original fight. Some people are preaching straw men for various honest or disingenuous reasons. While some people are fighting not to recognise that there are many cases where it doesn't apply and we shouldn't have 100% social model of disability.

I think "social model of disability doesn't apply 100% of the time" is true (with caveats depending on who I'm talking to).

But if some people use "social model of disability" to mean "applies 100% of the time" and other people use it to mean "applies more than 0% of the time", then regardless of whether they have reasonable reasons for interpreting that way, and regardless of any official definition, a claim "against the social model" will sometimes be true and sometimes be false depending on the definition which is used by the person reading it

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It's funny you use blind astronauts as an example, as Radiolab podcast did an episode last year on disabled people in space and how they are being overlooked: https://radiolab.org/podcast/right-stuff

A specific example I remember is that blind astronauts would be extremely effective during an emergency involving the station filling with smoke, as they would know their way around in ways a sighted person wouldn't.

Definitely worth a listen/read (there's a transcript).

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You switch between the interactionist model, the standard model, and the biopsychosocial model. It is a bit confusing, also since you give no references to others using these concepts (except with regard to the good old biopsychosocial model).

In the context of disability, you can replace the two first with a concept that is dominant up here in Scandinavia: The Gap model, also referred to in the literature as the relational model. The model refers to the gap between a person's capabilities and the demands of his/her environment.

The policy implication is that the gap should be made as narrow as possible (ideally closed), by interventions aimed at both sides: both to empower the individual, and to reduce barriers in his/her physical and social environment. The Gap-model is well-established; it is used both in research reports and in government papers.

I must add that the quotes you provide from US University websites sound as if the webpages have been written by naive, well-meaning people, not by people who have tried to seriously confront the policy dilemmas in this field. The quotes you provide are also not aligned with how disability is defined in the UN convention on the rights of people with disabilities, Article 1. Quote:

"Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others."

...the important point to notice in this definition is "in interaction with". Which leads directly to the Gap-model (what you call the interactionist model/standard model).

...plus, the critique you refer as to the medical model, seems unaware of how the medical model is formulated by influential spokespersons for this model. For example, here is Saad S. Nagi's (1991) medical definition of disability: An "expression of a physical or mental limitation in a social context, a gap between the individual's capabilities and the demands created by the physical and the social environment." (See "Disability concepts revisited" in Pope, A & Tarlov, A (eds.): Disability in America. Institute of Medicine, Committee on a National Agenda for the Prevention of Disabilities).

...Nagi's definition illustrates that the assumed reductionist-individualistic bias of the medical approach is less pronounced than argued by the critics. As illustrated in the above quote, Nagis' upgraded medical model brings the social context of the individual into the definition of disability, including both the physical and social environment.

You further refer the critique by some militant "social model of disability" activists against what may be labelled compensatory policy measures, including cash transfers and services targeted on people with disabilities. This criticism holds that by singling out people with disabilities for special treatment their "difference" is emphasised, potentially resulting in stigmatisation and social marginalisation. What these activists often fail to see, however, is that singling out people with disability for special treatment is also necessary if you use regulation policies (anti-discrimination legislation and the like, which is extremely popular in the US) to improve their conditions.

Let me give an example: Arie Rimmerman (in his 2013 book "Social inclusion of people with disabilities. National and international perspectives"), shows that such potentially stigmatizing singling-out takes place with regard to anti-discrimination legislation. I recommend the book for his discussion of cases brought to court based on the US anti-discrimination act (p. 110-11) and the UK and Israeli equivalents (pp. 117 and 123). His examples illustrate that in order to apply anti-discrimination legislation, judges must decide if the offended person is really "disabled". And to have one's disabilities scrutinised by judges or a jury, is obviously at least as potentially stigmatizing than having to demonstrate "disability" in order to be awarded a cash benefit or subsidised service.

For example, Rimmerman quotes a US case where the court found that the Anti-Discrimination Act did not apply since the plaintiff "despite her undisputed impairment [carpal tunnel syndrome] and the demonstrable limitation that it created, ... failed to qualify as disabled because 'she could still brush her teeth, wash her face, bathe, tend her flower garden, fix breakfast, do laundry, and pick up around the house'" (p. 111).

The example is instructive of how human rights-based legislation (here: anti-discrimination) creates exactly the same targeting problems as traditional compensatory measures (disability pensions and disability services, such as being granted the right to have a paid personal assistant helping with activities of daily living). To simply shift from compensatory policy measures (benefits and services) to legal policy measures (human rights legislation) as some activists advocate, does not avoid the necessity to investigate whether people are disabled or not disabled, i.e. it is still necessary to target ("brand") the benefactors as disabled.

A brief aside to the theories of science: The social model of disability exists in a strong and weak version, roughly corresponding to the difference between strong and weak social constructivism. Strong social constructivists argue against anything that contains a trace of essentialism: There are no objective facts, only interest-driven "constructions". If one accepts this view, that all disability is WHOLLY socially constructed, it makes theoretical sense to abolish all policies that one way or another target people with disabilities. Since targeting, however well-intended, serves to maintain a social construct that can (in theory) disappear if we stop interpreting it as real. This strong social model of disability can be associated with some militants within the disability movement who portray any policy except mainstreaming (i.e. only very general stuff, such as making buildings wheelchair-accessible) as oppressive.

In contrast, weak social constructivists (e.g. the sociologist Peter Berger, co-author of the enormously influential Berger/Luckmann book The Social Construction of Reality) maintain that all reality is subjected to socially derived interpretations, but does not therefore infer that all interpretations are equally valid - that none corresponds better to an outside "reality" than others. (For an elaboration of this view, see Peter Berger's later book "In Praise of Doubt" , co-authored with Anton Zijderveld.)

Applied to disability, the weak version of the social model confers that disabilities are (also) connected to biological phenomena that exist independently of how we talk about the world. Here, disabilities are regarded as a complex interface between the individual and his/her surroundings. In practice, the weak version is very close to the updated medical model, as interpreted by Nagi (see above). Policy implications are also similar: Disability policies should be geared toward making the surroundings more accommodating to people with disabilities, but as a supplement - not as a replacement - to cash benefits, subsidised services, and legal protection targeted particularly at this group.

(Short version: radical social constructivists believe that there is no reality outside language. Weak social constructivists believe that the body is older than language.)

Ending this long comment with a personal opinion:

I find the policy implications of a pure social model-approach to disability politically dangerous. This is so, since it is utopian to believe that mainstreaming alone will remove the need for targeted efforts directed at this group. A pure social model - approach can even serve as an ideological veil under which benefits can be scaled down and services dismantled. (Some people within Departments of Finance and Treasuries might like the social model for this reason.)

Activists hell-bent on the strong version of the social model of disability are in some sense modern-day equivalents to Lenin's useful idiots, in that their academic chatter can be used to put a progressive gloss on the scaling-down of medical and social welfare benefits and services targeted at this group.

Here is the basic question: Are people with disabilities to receive rather more benefits, services and/or legal protection than an "ordinary" citizen facing the many tribulations in life? If so, there must be some way to identify who has disabilities and who has not. We simply cannot avoid this.

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I feel that the problem underlying all of this is that the term "cause" is getting philosophically misused throughout the article. I could equally say, "I am personally the cause of all disability in the world because I have not invented a solution to heal it", or "God is the the cause of all disability, for He allows it to exist, or at least does not provide help to deal with impairments". I think we should take a step back and become very clear on what do we mean by the word "cause". I am afraid that in the social model, for example, it is used to hide the implication of responsibility and blame.

I am not sure what the rational definition of "cause" is, but my first attempt to fix it would be to say "inaction can not be a cause of action. Action can either be caused by some other action, or be spontaneous and self-generating". Otherwise we can use loads of insane counterfactuals to explain causation (the cause of the murder was that the aliens did NOT abduct the murderer).

We could say that the idea which causes the problem here is "counterfactual model of causation": if assuming that A had happened implies that B would not have happened, then not A causes B. So maybe we should be careful to not sneak counterfactuals into our explanations of cause and effect. So "a hammer hit the ball, so the ball flew" is a good cause-and-effect chain, while "if a hammer had not hit the ball, the ball would not have flown" is a bad cause-and-effect chain.

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This feels incomplete to the point of being borderline straw-man-ish. Yes, it's a good takedown of the Social Model. Then what? (Sorry Scott, we're used to more :D)

The really fascinating topic hinted here is not how the Social Model came to be - this is very well covered as being the natural reaction of some people at a certain point in history. The fascinating topic is why modern institutions in the west have such a strong tendency to take these kind of positions as official. Because it happens too often and in too similar ways not to be a standard failure mode. If by any chance that's the next article in the series, yey.

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Now I am wondering how much a wheelchair ramp for Mount Everest would actually cost. 1 trillion $ sounds way too much.

But great article!

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Jul 14, 2023·edited Jul 14, 2023

> Before people invented spaceships, blind people couldn't be astronauts, because nobody could be astronauts; going to space was just fundamentally difficult. Then people invented spaceships that could be piloted by sighted astronauts, but couldn't be piloted by blind people.

As a matter of history this is wrong. The first spaceships didn't need any piloting; they could be (and were) flown equally well by a monkey as a human. Presumably the same would be true of a blind person.

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Jul 14, 2023·edited Jul 14, 2023

You wrote: "To support his point, he gave various examples. Lord Nelson, who was blind in one eye, was a great Admiral. But in his own day, disabled people were banned from the Navy. This couldn’t because their disability made successful naval service impossible, or Nelson’s victories would have been impossible. It must have been because of state discrimination."

In my hobby exploring the British navy in the age of Nelson, I have come across many amputees and other types of disabled people serving on ships. Many of them were injured early in their careers and nevertheless rose in the ranks.

Here is a quote from a discussion of "Lame Captains and Left-Handed Admirals: Amputee Officers in Nelson's Navy," by Teresa Michals:


"Michals identified more than 40 amputees who attained the rank of commander or above. All but four of those officers held subordinate positions when they received their injury. One of them, Sir Watkin Owen Pell, lost his left leg as a rank-and-file seaman during an 1800 battle with a French warship. He was 12 years old at the time. After becoming an amputee, Pell spent another 60 years on active duty, the last 20 or so as an admiral. He was knighted by Queen Victoria in 1837."

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Any day that involves Scott Alexander dunking on Bryan Caplan is a good one.

And speaking of disabilities, I think Caplan has a uniquely strong one when it comes to seeing contradictory evidence. Oh, I know, bubbles, internet, "have-you-been-on-twitter?". But this is different. People on twitter who ignore evidence counter to their views still see it - they will dismiss it as "fake news", or as "biased" or start speculating about your sexual attraction to barnyard animals, or whatever. But there is still some sort of reaction.

Caplan isn't like this. It's like his whole visual and pre-frontal cortex edits out contradictory evidence. I swear, you could have all the world's experts screaming at him all the reasons why he's wrong, and all he would see would be an endless, empty plain, with the wind blowing mournfully and the tumbleweeds drifting....

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Despite the bogeyman comment and all the scare quotes, the "Medical Model" is what the man in the street believes to be the best explanation of disability. If I have only one leg, it is the loss of the leg that causes disability. Medical professionals and society at large can ameliorate that difference between me and my bipedal friends, but they cannot remove it entirely, or magic it away. That is why the Social Model is pie in the sky. The Medical Model does not imply stigmatization, nor that we should not accommodate, and certainly does not remove the human rights we choose to accord each other. That's all piffle.

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Just to " to come at the bravery debate from the other side" that gets a lot of sidekicks in this post: Please note: Thomas S. Szasz was no "anti-psychiatrist." We both believe in psychiatry between consenting adults. We are opposed to institutional psychiatry and coercion. We are not opposed to contractual or consensual psychoanalysis, psychotherapy, or counseling, what have you, as long as the designated client is able to fire his or her therapist at any time. ... If people want to take drugs to control the way they think, feel, behave and perceive, by all means they should be free to do so. See Szasz's work: "Antipsychiatry: Quackery Squared", published by Syracuse University Press, 2009. See the review by Dr. Ron Roberts 2010: https://fee.org/articles/antipsychiatry-quackery-squared

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"You and your comrades had just won a great victory in getting the medical establishment to de-list homosexuality as a mental disorder, and - sure enough - the problem had been society’s persecution of gays, not the “disorder” itself. "

From a utilitarian perspective, what consequences of decriminalising and destigmatising homosexuality would you consider compelling evidence that actually the problem is homosexuality and not society's persecution? Because what we actually got was AIDS. Clearly, you think the actual number of gays who died in incredibly horrible ways is not compelling evidence that homosexuality itself is the problem, but what number would you consider compelling?

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Lots of good, common sense, here (as usual).

On a general note, it seems to me that some people (particularly those who lean a bit social-ist), often see “social” as damning criticism and a mic drop. As if something is necessarily suspect if it can be shown to be “just” a social thing. It looks a lot like the mirror image of the naturalistic fallacy (that “natural” = “good”).

While I think it can be really helpful to understand something like disability (or mental illness or the economy or race or gender or...) as a social phenomenon, that should not be the end of the reasoning: “X is just a social construct, therefore it’s okay to simply reject it and condemn society for it.”

In a larger context, I don’t think anyone would disagree that “social” is mostly a good thing. It implies sharing, collaboration, agreement, negotiation and compromises, getting along, civility, tolerance, and certain concessions to practical realities. In short: give and take. Usually in tension with others and the environment.

So, I would like to reframe how some of these things are often presented:

If X is socially constructed, then flat-out rejection of X is anti-social behavior.

There may be a time for some (disciplined) anti-social behavior, but most of the time, it’s as unwelcome and unhelpful as it sounds. The socially acceptable way to run with the “it’s social” argument is to use it to start, not end, the conversation: “X is in part a social construct, therefore it can be changed and improved upon. How can we do that together, and how can we do it faster?”

It’s great if anyone wants to change the culture and society for the ever more perfect – even when it pushes people out of their comfort zone. But unlike what some seem to think, the changes can’t be dictated by anyone, even when those who want to dictate are experts, or particularly deserving individuals, or powerful special-interest groups, or armies of white knights and Don Quixotes.

Instead, I think the loudest and most adamant voices demonizing the rest of us for social oppression and exclusion would do good to remember that social phenomena aren’t just unavoidable, but usually good, and that the best way to change the culture and society is to be more social (as opposed to anti-social): Listening as well as speaking, making suggestions not demands, giving examples not orders, negotiating and navigating societal realities, giving and taking, and so helping new and more helpful social constructs evolve.

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Navy soldier here. I’d like to elaborate on the “person who uses a wheelchair aboard submarine” thing.

First, I served on an auxiliary, on which lack of space is less of a problem than on e.g. frigates or submarines. We had wide corridors and elevators. It still wouldn’t work. For a million reasons: the elevators aren’t always in use (e.g. during heavy seas, or in the event of a fire), the ship’s compartments are separated by hatches where a wheelchair couldn’t get through, etc etc. How would they even get up the gangway? (Granted, I can come up with technological solutions to that last one – but would they work ship-to-ship? Not every harbour is big enough for every ship to be moored directly on the quay. Also, would the wheelchair-accessible gangway take longer to set up than the standard one? If yes, then when the ship is returning home after several months at sea and the families are waiting on the pier, everyone else will hate you.)

Second, every person aboard a warship has additional jobs in addition to their main role. For the troops, that’s mostly stuff like cleaning and, in pandemic times, disinfecting, but more importantly, your role in the event of fire/water breach/NBC alarm/general alarm (crew to action stations). I cannot come up with roles that most people with disabilities could sensibly fill in one of these events. Which is the reason there are physical requirements, more so than any inconvenience caused by accommodations that could be made to make everyday life aboard warships more accessible. “Can get from port A to port B” isn’t the standard warships have to reach, even though it’s what most warships do, most of the time. It has to be useful in wartime.

I agree with Scott’s point and I get what it’s like to really want to do something like serve in the Navy. For transparency’s sake, I also had to jump through various hoops and provide additional doctor’s assessments for nine months before the German Navy accepted me (though in my case it was the psych eval they were worried about). I wouldn’t have wanted to be there unless I had the confidence that I could pull my weight. That’s not just due to a sense of honour, or maybe fairness. Life aboard warships is already hard enough; you don’t want to be that person who’s not pulling their weight.

An interesting text to read alongside this one: https://slatestarcodex.com/2014/08/16/burdens/

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Scott I don’t think debating with retards like these is the best use of your considerable talents.

The “social model” is fake and not worthy of this level of engagement

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"The model says that people are disabled by barriers in society, not by their impairment or difference."

Is this the reification of a teen's response to a sarcastic dad who said "oh, yes, it's the world that's the problem, not your behavior"? I appreciate looking at the world through different lenses but this one is bonkers.

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Are you planning to flesh out the Interactionist model more? I think that’s where I align although I also think of ability/disability as relative scales and contextual in an ultimate sense. I would be less abled than a person who could see Dark Matter in general, but more abled in a scenario where their ability to see Dark Matter would distract them from a task where only seeing regular matter was the most important.

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Also just to be that guy, The Social Model is a justification for every progressive fever dream piece of legislation mandating more and more expensive demands on property owners to satisfy some abstract vision of an imaginary just society. Using the Social Model I can explain why we NEED the Green New Deal and to retrofit homes not only for clean energy but accessibility. It turns out the real pandemic was lack of accessibility, et cetera, ad nauseam

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I don't think Caplan regards it as "fine" to use drugs and that society should stop stigmatizing it. Rather, he thinks that addiction is an excuse used by people who want to use drugs (or drink) and society shouldn't take such excuses seriously.

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The number of people who apparently quite sincerely want to live in Harrison Bergeron world continues to appall me.

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People are fundamentally the same but specifically different. We are practically defined by our social and therefore our moral nature.

Modern society has excelled at creating divisions by providing overwhelming incentives to view each other as economic units in return for social order, miraculous scientific advancement and unprecedented wealth at all levels of society. This, but at the cost of much of our humanity.

What I've described has happened, in general, in every civilization as a cycle documented since the 14th century(1) and this due to evolved human nature taking 10s of thousands of years to change however technology, that is, our control over our environment and each other(Abolition of Man, CSL) advances far more quickly.

To mitigate the harm "society" does to individuals and vice-versa we must individually choose to gradually include others in our definition and sense of 'self'. If we can agree on this can we also agree the first step is the encouragement chiseled over the entryway to the Oracle of Delphi?

Good luck to Us.

(1) https://drive.google.com/file/d/1btPKl8ynTBr32c17VfKt2mcgD_I97nUg/view

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Made me think of how dominant a discourse can be that means well, but treats a situation we’re you’re not tall enough, or short enough, to reach the fruit while you’re stranded as mystically socially caused. The scurvy you’d get is because some blameable people, not the shipwreck. I thought similar things when I read an anthropologist try to make the case natural disasters were socially constructed because society doesn’t respond well enough. Not because we have yet to master tsunamis, earthquakes, and volcanoes.

I get the case made as an appeal against context, but the unflinching prescriptive adherence of supposed adherents is irksome and the pretension this belief is inherently productive is distracting. Mind the contextual loam of your theories people. Once again, American shit cannot walk and chew gum at the same time, there’s a denied gum chewing gym taken from someone. America SUCKS at wisdom. (America is my stand in for who’s/whats /wheres cultures this kinda hierarchical theory/praxis fetish bc I sure as shit see it here).

I wish for decent folk....

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The social model of disability seems like an example of a general phenomenon where professionals feel the need to push incredibly hard on a counterintuitive (wrong) position because the general public's common sense is wrong in the opposite way. No one with any expertise admits to supporting the medical model, but that's everyone's default assumption before they acquire expertise. So the training ends up trying as hard as possible to beat that assumption out of people to the extent that if you took it literally you'd make the opposite mistake.

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I was taught the social model in a disabilities studies class that I took last fall semester in college. I'm not sure how it is taught in other courses/activist groups but I remember that it was largely used to critique capitalism and the emphasis on productivity and labor. The idea was that if it wasn't for society's unhealthy emphasis for production and labor, there would be no such thing as disability, as disabled only meant so in the context of being less productive. I think the social model serves as one of the intuitive and easy ways to support current negative attitudes on capitalism in college campuses.

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Why is it that whenever you find something that when taken at it's word would be both completely asinine and very destructive in "unexpected" and "unintended" ways it turns out a Marxist from the 70s came up with it?

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I think we should abolish the ADA and let the free market decide what types and degrees of accommodations are worth building and what sorts of disabled people are worthwhile to hire for which sorts of jobs.

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The Social Model is so wrong that if you didn't quote a bunch of proponents at the beginning of this article, I would have assumed it was an invented strawman. I'm hard of hearing and wear hearing aids. With my aids, I can hear most things fairly well. If people take the time and effort to look at me and speak clearly, I can understand almost everything. But I will never, no matter what technology I use or what accomodations people make, be able to hear as well as someone with perfect hearing. And the reason is 100% physical, not social - I have a physical disability that prevents me from hearing as well as the typical person.

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> we wouldn’t typically say “the police caused the assault”. We would say “I caused the assault, and the police failed to prevent it.”

The problem is that many people's idea of moral causality actually is this messed up (or at least, it is when it comes to certain topics). You don't have to look hard to find people blaming politicians for making a bad but vague tweet and then one of their ten thousand followers committing violence because of it. Or calling them mass murderers for saying that COVID wasn't that big of a deal, or saying the NRA has blood on its hands because something something guns. I think for the most part, this is just people using the facade of moral reasoning to support their pre-existing policy preferences. It contributes to the modes of thinking (common among extremists) of black and white/us vs them, while also allowing them to shift blame to those who can implement those policy preferences. Kind of like suing a company or government rather than an individual person, because the former has more money, not because they're actually culpable (in fact I assume this often uses the same justification--they didn't do enough to stop it, or perhaps very slightly encouraged it).

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As an academic in medical sciences this touches a few nerves. I will never forget an argument at a seminar made by a Deaf studies researcher suggesting that funding research exploring prenatal genetic intervention for congenital hearing loss was tantamount to funding the genocide of the Deaf community. Following this stuff to its logical conclusion lands you in weird places.

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"It requires that we refuse to treat blind people whose sight could be restored with simple ten-minute cataract surgery" Thank you! As I was reading the quotes describing the Social Model, cataracts were the counterexample I had in mind. Thank you for covering it!

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I think actually some form of the medical model is pretty much universally held in cases where we can actually solve the problem. As someone else pointed out in this thread, glasses are pure medicalism, they're literally a prescription. The correction of deformed teeth using braces, the surgical correction of cleft palates, the use of prosthetic replacement limbs, physical therapy, ear tubes, orthotic shoes. We do things to medically correct/prevent disabilities all the time, and most of them are completely uncontroversial.

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I was about to write a comment that said something like, "If you have to argue this hard in favor of basic common sense, then it probably means that the people you're arguing against are so thoroughly inoculated against it that you're wasting your time".

But then I realized that this comment was bad, and I should feel bad.

Because deep down I can see that the Social Model of Disability isn't really relevant to the world of natural human relationships, where common sense applies. Rather, it's the sort of thing that results from the world of modern bureaucracy, where individuals are subject to the agents of vast interconnected institutions, whose actions are the result of policies set by obscure processes involving negotiations between countless levels and arms of authority, and in which any individual actor is incentivized more than anything to cover their own ass.

Someone once said that bureaucracy is basically unaligned AI; well, things like the the Social Model of Disability are basically prompt hacking.

Last summer I had a serious back problem. Fortunately, the problem could be treated effectively by a combination of drugs and physical therapy. I got the treatment, AND, while I was recovering, I got people to help me, and otherwise arranged things in my life, so I could avoid lifting heavy objects. I and everyone around me could see that the medical treatment and the accommodations were both patently good ideas; nobody had to appeal to any Models or Theories to justify either. But also, in my case, the treatment and the accommodations were both relatively minor and easy to obtain. My life, my livelyhood, and my basic rights were never under threat, and I never had to fight to bend the will of any institutions to get what I needed.

So again, I don't think things like the Social Model of Disability are really for human beings discussing or figuring out their lives. They're for nudging the system in a different direction. And in certain situations, for certain individuals, nudging the system is way more important.

Not the exactly the same topic, but highly relevant: https://www.thedriftmag.com/the-bad-patient/

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I think this post is well argued but treats the theory within the rather narrow scope of an academic theory taught to clinicians or informing policies, when the way I've come to view the Social Model of Disability is as embodied by a broader, more roughly-defined mindset whose effects are largely, well, social. It goes hand-in-hand with the youth social movement towards SJ/"woke" ideology although isn't directly implied by the form of that ideology that blossomed ten years ago: it adds a particular bent to it where the point is people are disadvantaged by oppression and lack of privilege *only ever* in the narrow sense of privilege-as-conferred-by-society rather than as some inherent advantage. It's predicated on the assumption that no condition/trait can ever be viewed innately in a negative light (in fact, on Tumblr I've run across the mentality that a belief that Trait X is both genetic and innately bad is essentially eugenicist!). It's spread far beyond the traits that are widely classified as "disabilities", to neurotypes, mental illnesses, obesity, and other things (although there seem to still be some mental illnesses, such as depression, that are okay to consider "bad"). There is practically no such thing as an Unfortunate Condition; there is only Societal Oppression which is to blame for the hardships people suffer from certain conditions.

As others have pointed out, this mindset was around in a big way within certain particular communities (the deaf community) decades ago, but it's caught hold in a hundred more places since then and seeped into our youth culture. I first came to understand this when Stephen Hawking died and a bunch of my (very academic) friends were posting articles about how it's disgustingly ableist to portray his ALS condition and associated symptoms as bad things he would have liked to overcome, as though it's perfectly *lovely* to not be able to move like all but three of your muscles, using such arguments as "being paralyzed eventually inspired him to come up with his scientific ideas in a more geometric way, which was enriching to his research" and "when Hawking was offered a more human-sounding artificial voice, he refused, therefore not having a human-sounding voice is fine if not better than the alternative". I don't have time to try to hunt down those articles from 2018, but I hope I'm not uncharitably relating my memory of their arguments here.

I've come to see this creeping through the way younger generations view the way social interactions and society should work now more pervasively even than the original now-much-attacked oppression-olympics ideology that has come to be called "woke", and with much less explicit recognition and pushback from outsiders to the ideology. This post is a start for attacking it from the academic end, but I'd like the broader social implications of this to become part of the cultural discussion a bit more. Maybe over the next few years it will be.

As Freddie deBoer said in a very emotional video about this ideology where applied to mental illness (https://youtu.be/yKB6F_VYuZY?t=586), "What I just, I hate, I hate, I hate about modern liberal culture is, everything is not good. Some things in life are just bad. Some things are just, like, just bad, and they're not chosen, and you can't change them, and they suck, so we deal with them, but they're just bad, and they don't need to be fucking bright-sided all the time."

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Scott, I'm glad that you too recognize the importance of democratizing access to mountains. We should aim to pave routes to the summits of all peaks to enable the hitherto-gatekept vistas to be enjoyed by all. "This dream is one of unity, one where any individual can reach into the heavens, even if just for an ephemeral day trip from Denver in a rental 4Runner. One where you can purchase a hot dog and browse the wares of a souvenir shop in sparse alpine air. One where the literal heights of our society are not confined only to those with the means to reach them on their own."


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I think this article articulates some valid criticisms of the social model. However, I disagree with the contention that the social model is meant as literal truth, and that the people who articulated the social model in the '70s and '80s (a more accurate time frame) didn't see it as primarily a political tool. I wrote up a response here going into some of the history and looking at some early papers from back then. It's a first post, so would appreciate thoughts.


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The Social Model explains why you reject it. The fact is Society has actively abused and traumatized you to such an extent that you can' no longer understand that you DESERVE hundreds of millions of dollars in compensation from the State because CAPITALIST Society has wilfully maimed your capability (vide Amartya Sen, Martha Nussbaum, Patti Obaweyo-Golem et al) to endorse the Social Model.

By contrast, any Structural Causal Model of disability which improves organic capabilities and functionings irrespective of which Society its interventions are implemented in, can't account for why different people choose different Grievances, or allegations of fanaticism and stupidtiy, to brandish at each other. This is perfectly understandable. Politics may be supervenient on biology but is not reducible to it.

In the old days, of course, we had a Causal Model which featured God, rather than Society, because God had a lot of power whereas Society spent a lot of time starving in between getting ravaged by invaders or viruses or whatever.

Disabled people were obviously greatly loved by God because their patient suffering on Earth bought them an eternal reward. Sadly, some lepers etc. cursed God instead of praising Her Holy name and thus ended up in Hell. You too, are dearly beloved of Society which is why it has spent so much time maiming and crippling and scotomizing your understanding. That is why you won't get hundreds of millions of dollars in compensation from the Government whereas I, who share your disability, will definitely be getting a check for loads of dosh any day now.

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> There’s no such thing as drug addiction; people just voluntarily choose to use drugs. Society stigmatizes that choice by casting it as a disease where the person can’t control their drug use.

This is the opposite of the way modern efforts at stigmatization and destigmatization are usually phrased. The choice is more blameworthy than the nonchoice. Is Szasz working in a different paradigm where voluntarily choosing to use drugs is admirable and involuntarily doing the same thing is culpable?

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I'd guess that "medical model" is what people call it when they want to disagree with it, but normally it's just not named. Like if you search for "cataracts" you don't get anybody saying "the medical model says that cataracts cause blindness" or anything else about the medical model. You just get stuff that IS the medical model: about cataract surgery rather than audiobooks and braille.

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“Drunk with victory, you might see the arc of history pointing to the complete liberation of all categories of supposedly “mentally ill”. So why not the supposedly “physically ill” too? Why not liberate everybody?“

A lot of this stuff originates with overreaction to overreach and/or arrogance of authorities. I think that “drunk with victory” sentence might apply just as aptly to someone like Ron desantis, reacting to some antiscientific Covid stuff, then overplaying his hand.

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So, I agree with you for the most part, but I think you missed a crucial part of the history of the Social Model that really should be mentioned (to cover off, I prefer pluralist/intersectional models mysel and would prefer that be the default hands down).

So to cover my biases. I have Autistic Catatonia and spontaneously lose cognitive and motor functions in response to stress. I also cannot feel stress. These things combined means that there is very little society can do to accomodate my disability when I am disabled. When I am not disabled, I am fully functional, have 4 degrees, and occasionally engage in game design and disability advocacy. About the only thing I can do to accomodate for my disability is not travel alone so that someone is always around to deal with things if I am crossing the road and lose the ability to walk or identify what a car is. If that can't be managed, basically I am not allowed to leave my house ever.

According to the Social Model of disability, I am not disabled. Also, blaming society achieves absolutely nothing for me.

BUT, I want to draw focus on that. Blaming society. That fundamentally is what the Social Model is all about and I feel it's important to stress that this is the entire point of the Social Model. It's a no-compromise political standpoint intended to force people to change or rethink policies. The social model plays the blame game because that's one of the most effective political strategies known to mankind. At most fundamental levels the social model is about changing how we look at disability, and it almost doesn't matter if it's right, what matters is if it forces us to address the point. Furthermore large parts of the pluralist and interactional and bio/eco/social/medical movements have evolved OUT of the Social Model, and many of your own criticisms of the Social model came out of people who were trying to improve the model.

It's worth noting that the medical model isn't a total fiction either. Aside from the fact that the medical model is more about mentality and approach to disability rather than anything else, fundamentally the medical model is an extreme that tends to be based on the way surgeons are taught - focus on the body/operation/disorder and leave the rest to the nurses, GPs and psychs. The medical model and the social model are both extremes like being political left or politically right. No one really 100% meets the definition of "left" or "right", but people do tend to look for dichotomies and lean more in one direction than the other (even if reality is infinitely more complex). Now again, I think the intersectional model is better, and the mediating tools model, and the pluralist model, and a bunch of others, but not only are these models often seen as more complex, they're often politically weak standpoints because they don't create a strong us vs them mentality, they don't cast blame, they don't provide a banner to unite around, etc., etc., but these things are kinda the entire point of a no-compromise position. By not compromising you (theoretically) force the other party to change, readjust, come up with a new position and eventually you get somewhere agreeable - or at least you create an opening for a third party to step in and take over. That is what the Social Model is about. It's not (read as shouldn't) be the dominant standpoint, but it should be about forcing people to bring these questions to the table by starting from and maintaining a position of strength. Now that doesn't mean there aren't people who don't blindly follow the Social Model to the point of stupidity, but I've met people who adhere to the medical model as a standpoint too.

Also you seem to have totally missed the charity model of disability which the Social Model is generally intended to confront also. Although I do say generally because usually it's listed as medical model first, charity model second, and frankly I'd be dead if it wasn't for the charity model even if the way it's carried out is very insulting a lot of the time (add onto this the conditional charity model and... there's a lot of depth to these arguments).

Anyway. This is something I've studied a decent amount because of the impact the Social Model, Charity Model and Medical Model has had on the Australian model, and in particular studying the history of the IDF (the former ICIDH), and a few other things. But I'm not an expert. And I'm also speaking from the perspective of a disabled Australian and not Ireland (our history with the social model mostly goes back to the late 80s at best).

To recap, the point of the Social Model is to be a political advocacy stance first and foremost. Do I agree with it? No. But it has had positive effects that may not have been achieved otherwise including the invention of pluralist/interactionist models? Yes. It has also had many negative effects, including the fact that you can't base an economic system around the social model but some people think you can for some reason (holy crap, that's a rant). But I think it's worth addressing that the point of the social model is to be a no-compromise political stance first, and like all no-compromise political stances it has flaws. But those flaws are generally considered less important by the people who are advocating it for whatever reason, if only because it invites people to fix those flaws.

Otherwise I largely agree with you, I just really feel you missed the point about the Social Model's political history and how important it has been to creating and generally improving the models we have now.

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If there was no Society and individual homo sapiens would have to survive on their own, those with disabilities would be at a disadvantage and would prefer to not have their disability.

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I feel like including this definition sort of gives the game away:

> Disabilities are restrictions imposed by society. Impairments are the effects of any given condition. The solution, according to this model, lies not in fixing the person, but in changing our society.

> Medical care, for example, should not focus on cures or treatments in order to rid our bodies of functional impairments. Instead, this care should focus on enhancing our daily function in society.

This definition already feels like a utilitarian reframing of the interactionist model.

Society and medical conditions both cause problems, we just use the words 'disability' and 'impairment' to differentiate them for clarity.

Medical care is a central part of the process, but it should have a utilitarian goal of improving function and quality of life, rather than an essentialist goal of 'fixing' 'defects'.

This puts me in your mind of 'just take the hair dryer in the car with you' story in terms of improving quality of life over solely looking for 'cures'.

If you say most people teaching the social model don't teach it in this reasonable way, I believe you.

But you frame your argument as demonstrating that the *definitions* given for the social model are bad and insane, and that the proponents do actually follow those insane definitions instead of some more moderate sensible thing people might reinterpret them as.

This definition seems sensible and good, given a charitable reading, so it undermines that framing of the argument.

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>I would respond in two ways: first, even granting this, the blind person’s inability to drive remains due to their blindness, not society. The Social Model explicitly says that all impairments only become disabilities in response to society’s choices. I only need to find one counterexample to prove its universal statement wrong.

Isn't the response just, their inability to drive is an impairment, their inability to get to the store is a disability?

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The line between a "cure" and an external social support is very blurry, with glasses, prosthetics, implants etc.

Suppose you give blind people a handheld clicker, and a drug that boosts their hearing, and you train them to navigate by sonar. That's part drug, part training and part external device, working together to do something with both upsides and downsides compared to sight.

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In the article linked below, student activists explain how they learned to use the “social model” to force university administrators to give in to their demands on campus. When asking nicely didn’t work, accusing the administrators of prejudice akin to racial prejudice helped them force administrators to give in. The students also call it the “minority model” in which they “reframe…disabled people as an oppressed minority.” https://library.osu.edu/ojs/index.php/dsq/article/view/4253/3593

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If taking LSD and being gay and being depressed in bed all day are entirely valid life choices under the hippie social model, why isn't taking antidepressants or getting cataract surgery.

The movement seems so keen to label everything as a "valid lifestyle choice", except choosing to get medical treatment.

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Dear people of earth, I would like to ask for your help in optimizing the insight of ACX. Let me explain how you can help.

It is fine to have weird beliefs (which generally make for great ACX articles), just please coordinate to avoid situations where the majority believes (or teaches) what would sound like a bad straw-person. Otherwise, Scott will feel obliged refuting these in articles with titles like "Contra the flat earth cosmological model" or "Contra the miasma model of COVID epidemiology", where the likely reader response is "Duh, that 'theory' is obviously wrong", which is my reaction to this article.

As a side effect, it will also stop me from updating towards "the universe I inhabit is a bad straw-person argument".

I can sort of get where the social model is coming from, people see society fail to accommodate people with disabilities and thus aggravate their hardship. So they decide to over-adjust into the plain silly belief that actually disabilities would be fine if not for society.

This is general bad.

If you want to raise the minimum wage, don't say a just minimum wage would be 1000$/h.

If you want to fight sexism, don't claim that the median woman would be physically stronger than the median man in a gender-equal society.

If you want to emphasize the importance of the kindergarden, don't claim that kids who don't go there will all grow up to be sociopaths or werewolves.

Contrary to common belief, each of these statements is not just a cheer for your pet cause, but has hidden within it an actionable claim about the world. If the only problem with disabilities were that society was not accommodating enough, forcibly blinding, deafening and crippling a large percentage of the population would solve the issue. If everyone is disabled, society will certainly be maximally accommodating, so the formerly able-bodied 'victims' would not be off any worse. In actual reality, disabilities suck even in societies which place a high value on being accessible, so such a policy would be utterly monstrous (just like the equivalent policy of dissuading patients with disabilities from getting medical or technological help to overcome them to whatever degree is feasible, (e.g. using wheelchairs, glasses, eye surgery, hearing aids etc)).

To avoid such unfortunate implications, try to keep your cheers general. Let us say your pet cause is dental hygiene. You could say:

a.) "Brushing your teeth three times a day is the most important thing in the world" -> Bad. This is immediately actionable and suggests prioritizing toothpaste over nutrition for malnourished people in developing countries.

b.) "Most health issues are ultimately caused by bad dental hygiene" -> Bad. It would prescribe better dental hygiene as a way to avoid most illnesses, (which to my knowledge would not actually work).

c.) "Brushing your teeth is important" -> Good. There are almost no factual claims in that statement alone which could be considered false. Lots of things can be important, so even the people who believe that daily nail trimming is more important than brushing ones teeth would have no reason to object.

The problem is that the last one is not a good signal of group membership, as it is cost-less to send. If there is a radical group of fans of dental hygiene, they probably signal membership by claiming that brushing and flossing is important than climate change, systemic racism and prevention of nuclear war. "Look, I am so invested in The Cause that I will propagate even the most laughable claims which support it."

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I think the Biopsychosocial Model might be missing the factor of ... minority-ness.

Imagine a world where approximately everyone is deaf. There's no point in spending considerable expense and effort engineering machines to be quiet, no point in adding things like mufflers on cars; they can't be annoyed, hurt, or distracted by noise. (The din is probably somewhat bad for the local wildlife, but no more so than other stuff we inflict on wildlife.)

Now, imagine being a hearing person born in this world. If you go out into the countryside, or construct a special sound-proof room, you have a mild advantage - you can sometimes sense things happening behind you. Speaking, non-sign-based language doesn't exist. But being around appliances, industrial machinery, and vehicles is somewhere between annoyingly distracting and intensely painful for you, often leaving you with debilitating headaches; it's somewhat comparable to an allergy or an autistic sensory disorder.

Prosthetic ear-plugs or ear-muffs can help somewhat, simple surgery can resolve the condition entirely, and it tends to fade somewhat with time.

Is this society's "fault"? Society didn't make you unable to bear loud noises. Society could have put in the effort to soundproof or redesign every single machine, but understandably that would cost billions or trillions. This isn't like the persecution of gay people, it's not a result of stigma.

And yet... there is obviously a sense in which hearing is only "a disability" in this hypothetical as a result of "the way society is", of being a minority.

(Some disabilities would outright make a society where they're possessed by the supermajority impossible - quadropalegia, extreme schizophrenia, perhaps. Others might not offer much disadvantage to those without them if they were the minority, e.g. I think people who can walk would do fine in a society of wheelchair users, and "in the land of the blind, the one-eyed man is king" is probably correct.)

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The radical version of the Social Model of Disability comes from the radical left ideology: equality of outcomes. Just like the radical version of the infamous growth mindset.

It is pointless to discuss the object level with the proponents if the meta level is so different.

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Jul 16, 2023·edited Jul 16, 2023

I don't think people literally believe the social model of disability. At least, not any more than believe in the Caplan model. Rather, people think society has approximately the intellect of a toddler (I'm not sure they're wrong) such that the only messages about disabled people it can comprehend are "more accommodation" and "less accommodation". The social model of disability is what happens when you try to talk a toddler into supporting more accommodation. The literal meaning of the words is completely retarded, but that's because they imagine themselves to be talking to retards, proponents will say it's directionally correct.

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I completely agree - I'm also very critical of the social model because it's a very poor fit for my own condition, where the one thing I wish society would do most is come up with a good medical solution!

That said, let me for the sake of argument defend the pure social model. As you said long ago in a post on why PETA pulls such extreme stunts, it's because there's already an organisation in the niche of like-PETA-but-without-the-dumb-bits, and very few have heard of it. I imagine that before the social model theorists entered the debate, there were already a lot of "hey maybe we chould build a ramp to the local library" petitions and people went that's a great idea, maybe we should discuss it in a few years' time or so. Then the social-model Marxists appear and demand RAMPS EVERYWHERE! NOW! and ... by some process of Hegelian dialectic, we end up with a synthesis of a society with some kerb cuts, ramps, wheelchair lifts, the ADA, legal protections for taking service dogs everywhere unless there's a very very good reason not to, subtitles and occasionally sign language interpreters on TV, etc. etc.

What was the social model useful for? For dragging the world kicking and screaming into a state where a wheelchair user can (sometimes) shop in their local store, vote, and take the bus into town. That doesn't make the model right, but it sure made the world a better place. Personally I think that ditching the social model in favour of the interactionist one is not only true, but more useful to continue improving accomodations for disabled people nowadays (including ones who want a medical solution). I also think that the social model privileges 'nice' disabilities over 'horrible' ones, and physical over mental ones. You can require a wheelchair but still, in an accomodating society, have a good quality of life. But with afflictions like - I don't know, complex PTSD? Psychosis? Severe Anxiety? - you by definition dot no have a good quality of life, and society can do only so much about it, but medicine sometimes works really well. I pretty much endorse everything Freddie deBoer has said about his own condition and why the social model is a bad fit for that. But I'll still give the social modellers credit for putting the idea of "maybe society should sometimes build ramps rather than separate-but-"equal" off the disabled people" in the spotlight in the first place; maybe such an extreme version of the model was necessary to achieve this in the first place.

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What counts as a controversy these days : D

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As someone with severe disabilities, I wholeheartedly agree. The Interactionist Model is obviously correct, and what most people seem to believe. I am sick and tired of activists endorsing the Social Model, effectively declaring that my painful, debilitating condition shouldn't be medically treated.

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Jul 16, 2023·edited Jul 16, 2023

I found it disappointing that you switched mid-paragraph from explaining how Szasz took his views too far, to explaining instead Caplan's caricature of said views (especially after the recent post where you claimed not having an ongoing debate with Caplan, which post convinced me that his views on this issue are noise as opposed to signal). If Szasz is the stronger anti-psychiatry thinker, I'd be more interested in a fair critique of that. (Do you have any long-form writings on Szasz already, by any chance?)

Edit: never mind! I parsed the subclause incorrectly.

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After an admittedly brief internet skim of the topic, a somewhat notable absence from this post may be Mike Oliver, who seems to have to coined the term 'social model' and whose work, Wikipedia tells me at least, so make of this what you will, was 'widely cited as a major moment in the adoption of this model', and a 1990 paper of his on the topic paints a fairly different picture to the one you offer us from Mr Finkelstein (he does credit UPIAS's ideas for forming the basis of the model, but seems to have engaged in a bit of sanewashing).

He certainly doesn't reject treating 'the person' as a crucial element of alleviating disability, but he conceives of the role of doctors as primarily being to tackle illness, which will in turn resolve the 'disabling effects' brought on by that illness. Moreover, he does seem to basically subscribe to the 'all models are wrong...' dictum;

'The only escape for all concerned is to jointly work on the problems of disability within the parameters of the social model which while it does not guarantee a cure, nevertheless offers the possibility of developing a more fruitful relationship between doctors and disabled people'

While he does clearly view the social model as superior to (at the time) existing models, it also seems that he doesn't view it as containing some undeniable truth about society and disability, but rather a way of thinking about disability that would facilitate a better response from doctors, policymakers et al.

This is why I don't think the desert island analogy really contributes anything; the social model, at least to Oliver, seems to be a tool for describing disability as it exists now in society and for making resultant policy decisions - hence why his earliest (I think?) work to reference the model, 'Social Work With Disabled People' (1983), was orientated towards welfare/social work policymaking and social work practice. From the book;

'Disability is neither an individual misfortune nor a social problem... [it] is thus a relationship between individual impairment and social restrictions imposed by social organisation'.

This definition of disability, and his social model that accompanies it, thus simply seeks to distinguish between the fact of the 'impairment' and how that impairment manifests itself under our current system of social organisation. Either way, given Oliver's apparent influence, he seems an important counter-example to;

'The Social Model goes on to say that it’s only okay to treat disability with accommodation, not with medical cures (if you’re going to object that it doesn’t say this, please read the quoted statements from proponents above).'

Insofar as he agrees with this characterisation of his social model, it's only because he conceives of medical treatment as working through the intervening stage of treating 'impairment', which in turn can alleviate disability.

Separately, some of your quotes from proponents of the social model seem a bit weak? Especially from the first of the second set of quotes, from 'The Social Model Explained';

'But for many, the main disadvantage of living with a disability is less about their own body and more about society’s response to them'

'Many'? 'Less' and 'more'? Seems much less than an absolute declaration that all disability is societal in origin, no?

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As a person with a disability (vision, coincidentally), I've been saying "it's both" to people for years when they either won't make simple accommodations or insist on removing legitimate expectations because I can't possibly be expected to do anything to help (the poor widdle dear, I can almost hear people saying). I would be furious if I learned that my doctor could improve my vision but wouldn't because society should accommodate me, just as I am furious when simple accommodations like larger print (or zoomable digital) documents aren't available "because that's your problem not our problem". Disability is more complicated than that, and different disabilities and different instances of the same disability will fall at different points in the space outlined by the biological, psychological, and societal vertices.

Some limitations are inherently medical, not societal. Your astronaut example resonated for me because as a child of the space-race era that's exactly what I wanted to grow up to be -- until I learned that the path to "astronaut" passed through "pilot" and "pilot" requires 20/20 vision which I would never ever have. But it made sense and I moved on to other things.

Society sometimes tries to overcompensate in ways that are patronizing, making the people they claim to want to help feel even worse. As an example, when I was preparing to sit for the SATs (this was in the days of paper exams and #2 pencils), having seen a practice test, I asked for a larger-print copy when taking the real one. They gave me a large-print test, a private seating, and unlimited time. I asked why the unlimited time and they said because of my vision. I said it's my eyes that don't work right, not my brain, and that's why I was getting the large-print copy. The proctor couldn't understand why I wouldn't want to take every advantage they were offering me or why I felt I didn't need it. I kept time myself since the proctor wouldn't; anything else felt unfair. I have no regrets.

At the time I'd never heard of the social model of disability, and now I wonder if I was on the receiving end of it: *I* couldn't possibly have a problem, so society must do everything possible to mitigate, even when that didn't make sense. It left me feeling demeaned, not uplifted like the creators of that policy probably intended. Fortunately, school administrators never tried to interfere with the medical treatment for my vision problems.

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I feel like the social model is a useful extreme to check your thinking against at times. I find it helpful to consider abilities that every person lacks but that aren't outside of the realm of possibility in nature. Like, people can't see UV light even though some animals/ insects can. This makes the fair skinned among us liable to get sunburns and eventually skin cancer, so we invented the UV index and I check that before going outside with my shirt off or whatever. We don't understand the UV index as an accommodation, though. I imagine the point of the social model is, at least partially, to make the point that we are all constantly accommodating and being accommodated in these kinds of ways, and the point of that is to diffuse the arguments of some who want to refuse to accommodate disabled people for one reason or another. Obviously there are times when it makes sense to not build accommodations, like the ramp up Everest. Then again, there are times when accommodations are essentially costless but people still don't like them. I've heard of many professors refusing to let students record their lectures, for example, even if they have something like an auditory processing disability and it would be helpful for the student to play the lecture back at .75x speed.

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Maybe. Sounds like psychological speculation. 7

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Not to be devil's advocate, but it would seem to me that there are a few conditions for which the social model of disability makes sense. I'm thinking mainly of short stature (as in, being between 135cm and 155cm, say) - and would say the same of being very tall, only one doesn't need to say anything about it, as somehow it is not *seen* as a problem (although it involves much of the same lifelong inconveniences as being of short stature: things not being designed for you, stares, etc.).

Of course, again, any sort of dogmatism doesn't help. Robert Reich makes sense (to me) when he says:

"From time to time, worried parents of abnormally short children phone or email me, seeking reassurance. I tell them what I’ve told you, just now.

I also tell them that if they or their children are desperate, they can resort to limb-lengthening surgeries, growth hormone treatments with unknown and potentially dangerous side effects, humatrope, and a wide variety of homeopathic or crank remedies.

But I gently urge them not to do any of these things. I tell them to love their short kids. Inundate them with affection, and they’ll be okay."

- but Messi's parents obviously did the right move when putting Messi on growth hormones! I'd also imagine that the right dosage of growth hormones is better known by now; they've been used for more than a generation.

(There are very real health problems - other than short height - that come with Reich's condition, and it would be wonderful to prevent those. There are also inevitable health problems that essentially *have* to come with being extremely short or extremely tall - that's basically engineering. In principle, though, you can be of Reich's height and completely healthy, as plenty of pygmies will tell you.)

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A bit off topic, but someone out there might find this interesting...

My dad worked in brain injury rehabilitation. One of the main thrusts of his career was moving the field away from a "medical" model, where patients were given mental exercises to get their neural systems back in shape. (Roughly analogous to physical therapy, where patients are often prescribed stretches, lifts, etc.)

What he advocated for was a kind of social approach, but very different from what Scott describes here. Rather than saying society at large is obligated to accommodate a patient's impairment, he worked with patients and the people around them (family, therapists, etc) to find strategies to help the patient lead as normal of a life as possible in their particular case.

If this has anything to do with Scott's post, maybe it's highlighting one of the tricky dimensions at play. That is, some impairments are quite common (blindness, loss of limbs). Some are either less common, or express themselves in more idiosyncratic ways. The more common an impairment is, the more reasonable the social model (the weaker/common sense version) is.

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This is another post à clef about transsexuals, isn't it.

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I found Unspeakable Conversations, by Harriet McBryde Johnson, useful for getting insight on the Social Model from the perspective of one of its advocates. https://www.nytimes.com/2003/02/16/magazine/unspeakable-conversations.html

Her take on her own disability, a congenital neuromuscular disorder that left her unable to walk, bathe, or dress without assistance, was that she could not say it had made her life "worse", given that she had never lived without it. Her condition didn't distress her; it was just the way life was.

It would be absurd to claim that disabilities don't inherently limit capacities; what Social Model advocates claim is that it is a consequence of social context which limitations are generally considered *problems*. Humans can't fly (without machines), but we don't consider our flightlessness a *problem*, just a fact of life.

If all humans were deaf, we would likely consider the inability to hear a simple "part of the human condition", not a problem. (Maybe we'd invent artificial ears; maybe some transhumanists would dream of a future where we would be genetically enhanced to have sound-perceiving senses; but society probably wouldn't prioritize this very urgently.) Some all-deaf communities are already living in this context, where people can go through life without encountering situations where the fact that they can't hear presents itself as particularly frustrating or unfortunate.

Your example of a blind person on a desert island seems to misunderstand the social model. The blind person is just as blind on the island as she would be in society; but she might not *mind* that she's blind. Yes, counterfactually, if she could see, she could do more things; but if she has never heard that humans are "supposed" to have sight (or has been alone so long that she no longer compares herself to other humans), she might consider it a silly counterfactual, no more worth thinking about than the counterfactual world where she could fly like a bird.

An impairment is only *distressing* in itself if it violates expectations -- if a person wanted to be able to do something, but cannot -- or, perhaps, if it is itself a disorder of the distress machinery, as with depression or chronic pain.

An impairment is also only a cause of *socially recognized* dysfunction if society considers it sub-normal. If all people used wheelchairs, there would be no valued professions (like admirals) from which wheelchair users were excluded. We'd either have wheelchair-using admirals or no admirals, tautologically.

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I, like a lot of disabled people, agree with Scott’s arguments and conclusions here. But Scott’s characterization of the Social Model’s supposed omnipresence within contemporary discourse jibes with my own experiences.

From my own observations of the subject in academia, I believe the Social Model is currently something of a bête noire among disability researchers, and has been for quite some time. I have not seen a recent disability studies paper for cite it without immediately disclaiming, qualifying, or justifying it. Entire branches of contemporary Disability Studies, like Critical Disability Theory or Disability Justice, define themselves in opposition to it. Its chapter in the introductory text The Disability Studies Reader (Ed. Davis) is mostly a long criticism of it, ending on this damning claim that “the Social Model has now become a barrier to further progress.” These are not signs of a popular, dominant paradigm, to say the least.

The problematic separation between “impairments” and “disabilities” have been roundly criticized in disabled circles since the early ‘90s, as a more diverse cohort of activists (the members of the UPIAS were mostly mobility/physically disabled) pointed out that some impairments, like chronic illness, are going to inhibit full participation from society even without any externally imposed barriers. Even the strongest recent argument I’ve seen for a full-fledged Social Model (Mike Oliver’s “The Social Model in Action: if I had a hammer,” available online here https://disability-studies.leeds.ac.uk/library/author/oliver.mike/) has to concede that the Social Model isn’t a model, isn’t even a coherent theory of disability, but a useful “practical tool” for eliciting political concessions (as another example of his pragmatistic view of the model, Oliver notes that medical and rehabilitative interventions in the lives of disabled people are still useful).

Scott is right, however, to point out that popular discussion of disability has really stuck on to the Social Model past its shelf life; the American Psychological Association and UCSF badly need to update those pages. While medical organizations should not uncritically cite the social model without emendation, the activist orgs Scott cites I assume are drawing from Oliver’s perspective, and foregrounding the Social Model as a beginner-friendly training wheel into larger debates about Disability. Such a method isn’t without precedence, one can think of how LGBTQ groups still talk about how “sex/gender is to nature/culture” eons after feminist academics have jettisoned that maxim. I think any arguments against this practice among activist groups needs to take place on rhetorical grounds rather than rational ones.

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"Caplan says that we shouldn’t medicalize certain conditions, because it's possible in theory for individuals to overcome them, so they must just be choosing not to so, so it's all their fault."

"not to so, so" seems like a typo. I assume you intended "not to do so, so" or "not to, so"

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What about cochlear implants on perfectly normal deaf babies? Society makes us disabled because they value auditory communication.

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