Ivkov, Bojidar (2006) Models and Conceptions of the Disability. Publishing House „Slavena”, Varna. ISBN 978-954-579-598-5
In the present work, for the first time in Bulgarian sociological literature, an attempt is made to systemize and – of the positions of sociology and disability – analyze the existing models of disability, as well as the basic theoretical conceptions, on which these models are built and through which the existing processes and phenomena in the sphere of disability are explained. The similarities and the differences between the models are revealed and analyzed.
The main approach, adopted in the work, is based on the concept that the modern discourses about how disability is perceived, respectively how it is defined, are actually discourses about its meaning. Two basic meanings are formed – medical and social. Each of these meanings contains many models of disability and conceptions about it, which are influenced by two main “philosophies”.
1. The first one, the medical philosophy, is the one, in which disabled people are perceived as problematic individuals, for whom society should take care. This approach is most likely a consequence of the ideology of paternalism, segregation and discrimination. This way, in the different models of disability in its first meaning – medical, work-medical, rehabilitative, administrative, etc. it is stressed on the diversion from the norm, abnormality, pathology, illness, reduced abilities and, consequently, on the dependence and the inability of disabled people to take care of themselves and to make decisions about their own lives. Therefore, they need care that is offered in places, created for this particular purpose and by the respective specialists. In the medical meaning and the here-contained models of disability, desubjectivisation and nosologisation on a personal level, as well as the medicalisation of the disabled people’s social life, activate (formally and informally) the germination and confirmation of negative social concepts about disabled people, ascertain the prejudice and negative stereotypes concerning them among the society – in other words, they legitimize the “normal condition” of non-disabled people over disabled people , the marginalization and their social exclusion. This situation is a consequence of the ideology, based on the interpretation of the social norm as a homogenous category that reflects the characteristics of the “healthy” part of the population. Within the framework of this meaning, the relations between disabled people and specialists are perceived as relations of authority, in which the specialists have a dominating position, and disabled people are in a subordinate position.
Specific attention is given to the so-called work-medical model of disability, which has dominated the social politics towards disabled people in Bulgaria for a long time. Its most typical elements are a high level of instutionalisation of disabled people, social isolation and separation, special education, provision of employment in a closed area (stratified method), nosologisation, medicalisation, etc.
The examination of the models and the conceptions in the first meaning shows that for the medical (or individual) model of disability and its derivatives, the stress is on the clinic terminology – “desease”, “injury”, “norm”, “pathology”, etc. Here “a social element” is defined as “dependent”, “unable”, and in the administrative model – “needing help”.
2. The second, social “philosophy”, defines disabled people as rightful citizens and members of the society, as users of all services that it offers. This philosophy is a consequence of the ideas for social integration and citizen rights of disabled people.
In its social meaning disability is viewed as a normal aspect of a disabled person’s life, and discrimination, based on disability, is indicated as one of the most considerable problems, connected with disability. The accent is on these aspects of society’s life, which could be changed and respectively make disabled people a part of the social life of society. When analyzing the social models of disability, a method is adopted that is also used by other authors: a symbolic division to British and North American social models of disability. The so-called British models include the materialistic model of disability and the model of independent life, and the North American models – the psycho-social model, social-political, cultural, the model of human diversity and others. Such a method is often used by authors who analyze the influence of the models of disability on the social work.
In the framework of the social meaning some sociological conceptions are examined, through which a successful attempt is made to analyze the problematic of disability and disabled people. In consideration are taken the sociological conceptions of Marx, the symbolic interactionism, Goffman’s dramaturgical sociology, the conception for the social construction and others.
In the social meaning the stress is on the limitations, which society puts before disabled people – “the not normal condition”, institutional discrimination, inaccessible public space, not properly adapted transportation system, segregation in the education, the decisions, excluding disabled people from the employment market, etc. In fact, the problem here is shifted from disabled people to society. These questions are discussed in one way or another in all social models of disability. The materialistic model of disability originates from Marx’s teaching and uses as a methodological base the Marxist sociology and Marxist politeconomy According to this version of the social model of disability, the suppression (perceived in the context of Marxist politeconomy and sociology), which disabled people encounter, originates from the economic and social structure of capitalism. The society’s organization itself is such that it produces institutional separation and social exclusion (and/or isolation) of disabled people, and consequently their total discrimination. A crucial part is given to economics when producing a category “disability” through the employment market and the social organization of work. The main purpose of capitalistic production is the benefit, therefore it is little or not at all interested in the slower, requiring more care and attention from the employers, productive tempos of work of disabled people.
Examined in details is the social model of independent life of disabled people, which originates from the conceptions for normalization and valorization. Along with the other important aspects of this model, a particular attention is given to the questions about decarceration and deinstutionalisation of the social places for disabled people, about the normalization of the living conditions there, as well as the increase as a whole of disabled people’s life. Substantiated is the belief that society and disabled people are both not ready for a general and quick deinstutionalisation. The former should be implemented gradually, with proper life conditions for disabled people in society being created.
A considerable place is devoted to the so-called North American models of disability, starting with the psycho-social model, in the base of which the ideas of the symbolic interactionism and the dramaturgical sociology of E. Goffman can be found (as well as his conception of the stigma), and reaching the social model of the citizen rights and the question whether here a new meaning is being conceived. Special attention is given to the stigmatization of the people with mental disorders.
In the social model, based on the conception for social construction, a main attention is given to the construction of the social status of disabled people, to their social reality and how this reality itself creates disabled people. Farther on, on the base of the ideas of A. Giddens for the detraditionalisation of the old societies, a social model is analyzed in which the main place is devoted to the question for the possibilities of disabled people, for denying the stigma and one new self-definition and construction of the self identity. This leads to an inevitable loss of dependence of disabled people from the not-disabled people.
In the social-political model of disability, disabled people are viewed as a suppressed minority. Here the resolutions of the problems are not as medical as they are political. In the so-called cultural model of disability, it is viewed as an unusual cultural phenomenon, and in the model of the human diversity it is perceived as a normal condition of the person and a question of human rights in the model of the human rights, based on the ideas for social integration of disabled people.
Finally, on the base of an abundant and diverse empirical and statistical material, the Bulgarian model of disability is a subject to a critical analyses, and the thesis is being substantiated, that since 1990 there is a transition from the work-medical to the administrative model of disability, i.e. a movement within the framework of the medical meaning. The access to all services is directly bounded to the expertise of working capacity, completed entirely on the base of medical criteria, and disabled people still remain an object of the social politics, most often having a restricted access to services and recourses. They are a social category that is most exposed to the processes of marginalization and social exclusion.
In the text many proposals are implicitly made for a change in the social politics towards disabled people and the total reorientation of the model of disability towards the social meaning.