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Abstract
Purpose. The aim of this work is to provide a general view of the conceptual elaborations on disablement in the 20th century and to discuss the role of these different contributions in developing the current concepts of disablement.
Method. A review of the literature on conceptual models of disablement in the past century has been performed.
Results. The 20th century has witnessed important theoretical considerations on health, diseases and their consequences. These considerations have generated various conceptual models, some of which share the same focus and point of arrival, the so-called ‘Disablement Process’. Among the models that were developed, two stand out, which were drafted and disseminated under the aegis of the World Health Organization, namely the International Classification of Impairments, Disabilities and Handicaps (ICIDH) and the International Classification of Functioning, Disability and Health (ICF), but these are just one part of the conceptual elaboration in the field. Further conceptualization was produced in health and social settings by specialists, self-advocacy associations and activist groups.
Conclusions. The current ICF model of the World Health Organization has been translated and recognized in 191 countries; it also incorporates the contribution of self-advocacy associations and it is now recognized by most of them. This model has enjoyed higher visibility than other conceptual models, though its level of development was not higher or more original. To our opinion the ICF is not very clear on the essential choice of the model, i.e., to see disablement as a dynamic process that happens when personal limits collide with socio-environmental needs, rather than as a personal feature. This choice is instead clearer in other models, like Nagi's 1991, the Institute of Medicine (IOM) model by Brandt and Pope, where the identification of three dimensions (the individual, the environment and the individual-environment interaction) clarifies the role played by all three dimensions within the process of disablement and introduces major hints for further considerations on how to create virtuous processes of enablement.
Notes
1. Actually there are two IOM models that refer to Nagi's work Citation[3]: One dating from 1991 Citation[4] and published in a book entitled ‘Disability in America’, by Pope and Tarlov; the other published in 1997 in the book ‘Enabling America’ by Brandt and Pope Citation[5]. The first book saw the personal participation of Nagi, who had been invited to develop the model but could not do it directly, so he commented on the model later in the book. The second work contains a reworking of his research. As we will see later on in the paper, a further analysis was carried out in 1994 by Verbrugge and Jette Citation[6].
2. The ambiguity that associates to the definition of handicap in the ICIDH is even more striking in the central part of the manual that deals with the experience of the disease, where handicap is described as follows: ‘Either the awareness itself, or the altered behaviour or performance to which this gives rise, may place the individual at a disadvantage relative to others, thus socializing the experience. This plane reflects the response of society to the individual's experience, be this expressed in attitudes, such as the engendering of stigma, or in behaviour, which may include specific instruments such as legislation. These experiences represent handicap, the disadvantages from impairment and disability’Citation[8], p. 26]. In this case explicit reference is made to stigma or to behaviours through which the response of society becomes evident. If handicap was described before as a disadvantage deriving from impairment or disability, in this section of the manual contains a more explicit reference to the environment.
3. We deem it important to underline that most scholars who studied this issue match their personal experience with university or study experiences. The expression ‘social model of disability’ is attributed to the writer Mike Oliver who, in 1983, used it to define the influence of society and of its organization on the manifold deprivations experienced by disabled people Citation[13]. In this respect the South African psychologist, now living in England, Vic Filkelstein is mentioned as well. One of the founding members of UPIAS, in 1980 he stated that disablement was to be conceived as the direct result of the development of the Western industrial society.
4. The ‘Society for Disability Studies’ was founded in 1982 as a section of the ‘Study of Chronic Illness, Impairment, and Disability (SSCIID)’ and renamed ‘Society for Disability Studies’ in 1986. Among its founders: Daryil Evans, Steve Hey, Gary Kiger, John Seidel, Irving Kenneth Zola (in http://www.uic.edu/orgs/sds/)
5. This distinction brings to mind the subsequent distinction between capacity and performance, which is dealt with in the discussion about the ICF model.