Disability: beyond individualization, psychologisation and medicalization

Knowledge about disabled people has and continues to be dominated by the medical and allied professions and inevitably this provides only one story of disabled life: a story of a problem seeking solutions (Grue, 2015). The rehabilitative professions write most of what is read and written about disability. As a family therapist I wondered how family therapy might be constructing disability? If, as Michalko (2012) has noted, medicine finds a home in all kinds of places to what extent has it made family therapy, and in particular its conception of disability, its home? Haydon-Laurelut, Nunkoosing & Wilcox (2015) found that contemporary family therapy journals frame disability predominantly through an individual medical model. This is perhaps unsurprising as it is reflective of the cultural dominance of this narrative of disability (Oliver, 1990). Haydon-Laurelut et al (2015) suggested that disability might have become so penetrated by medical discourse that it becomes difficult to ‘see’ it outside of this frame. More evidence is required on this issue however these findings raise questions as to how systemic therapists engage with disability. This paper draws upon the finding of the study that the articles analysed almost without exception failed to demonstrate knowledge of disability studies. The paper will therefore introduce concepts from disability studies and explore how they might support a therapeutic practice with disabled people, which goes beyond medicalization. The foundational model of disability studies is the social model of disability (Oliver, 1990). The social model emerged form the disabled peoples movement and advocated the notion that disability was something that people with impairments had imposed upon them. These were termed “barriers”. For example, a building with a door that is too narrow to allow them to enter disables a person who uses a wheelchair. A person who has a cognitive impairment is disabled by a therapy that consists of questions too complex for them to benefit from it. It is this stance that leads to the use of the term ‘disabled person’ rather than person with a disability. The person does not come ‘with’ a disability; societal barriers to full inclusion disable the person. The social model makes the important distinction between a person’s impairment and disability which it views as the restrictions of activity placed upon the persons (hence the disabled person) of a society that takes account of only some of its citizens. So disability, for the social model, concerns the difficulties people with impairments face when they attempt to take their place as citizens. However the social model (as is the case with all the ideas of disability studies presented in this paper) is a product of both academia and the social and political movement known as the disabled peoples movement (UPIAS, 1976). These are powerful and important ideas in particular contexts. However, as Cecchin implies in his quotation (above), in the context of systemic therapy, one story will not do. Ideas from social theory may not be intrinsically more useful than medical ideas and the context of the individual therapy conversation must be acknowledged. The paper will return to this issue in the section on considering and coordinating disability-stories.