What is the medical model versus the social model of disability?
Julie Bascom, in her keynote speech at Drexel University in 2021, discussed the medical and the social model of disability, and how both models address disability as a problem that needs to be solved, but they focus on very different things. In the medical model of disability, the person's disability is a pathology to be solved through medical services such as treatment, surgery, medicine, therapy, and other medical curative measures. A medical model can also involve institutionalism. In the medical model of disability, the focus is on cure and prevention. For example, when talking about autism, the bulk of current autism research funding goes towards investigating basic biology, including hereditary information and DNA studies, and exploring the causes of autism with the explicit goal of preventing future autistic people from existing.
In contrast, a social model of disability focuses on identifying the artificial barriers imposed by a society that generally doesn't value accessibility. It's about breaking down barriers to self-advocacy, personal agencies, self-determination, inclusion, equitable access, increasing supports, including communication supports, home and communication community-based services, access to education, transportation, housing, employment, and fair wages.
The social and medical models of disability aren't an either/or situation. If an illness, injury, or disease can be helped with medical treatment, then absolutely a medical model is what's needed. But for a neurodevelopmental condition, which can impact every area of life for neurodivergent people, it's not their neurodivergence that needs to be cured, but rather the barriers around them that need to be removed.
Much of the world defines autism by the medical model of disability:
- Qualitative deficits in social interaction
- Qualitative deficits in communication
- Restricted repetitive and stereotyped patterns of behavior, interests, and activities
Autism within a neurodivergent-affirming, social model of disability framework:
- Autistic differences in social interaction
- Qualitative differences in communication
- Autistic patterns of behavior, interests, and activities
What's important to highlight about a social model of disability is that it does not minimize the very real challenges that autistic people experience secondary to their autism, often on a daily basis. In the social model of disability, SLPs would address these real challenges by first presuming competence, and providing access to robust communication systems and supports without gate-keeping or judging cognitive abilities to be too impacted. SLPs would provide supports, accommodations, and modifications to address physical and environmental barriers, including sensory barriers. We wouldn't pathologize or stigmatize naturally occurring autistic traits like stimming, lack of eye contact, or social communication presentation. We wouldn't provide treatment to make the autistic person look less autistic.
We know there's no cure for autism. If your treatment worked to reduce the signs or symptoms of autism, it's because the autistic person is masking and your treatment may have inadvertently harmed them in the process. In the social model of disability, the priorities are acceptance and accommodation, and all neurodivergent-affirming practices start with the social model of disability.
This Ask the Expert is an excerpt from the course, The Neurodiversity Movement: An Overview for Autism Service Providers.