What is disability? There are many ways to answer this question. But how sport and exercise psychologists define disability has profound implications. Either intentionally or unintentionally, their perspective of disability will shape how research is carried out, what is deemed valuable in applied practice, who is considered the expert, and what is to be done to enhance the lives of people with disabilities. Thus, sport and exercise psychologists cannot ignore this question. Within sport and exercise psychology there are several ways to understand what constitutes disability; this entry discusses four of them.
The Medical Model and the Social Model
Two popular models for understanding disability are the medical model and social model. The medical model, or what is sometimes referred to as the individual model of disability, is based on decades of Western thinking that defines disability as largely an individual deficit. Documented in 1980 by the World Health Organization, disability was defined as impairment, the loss or abnormality of psychological, anatomical, or physiological function. In this sense, disability was defined as any restriction or lack of ability (resulting from an impairment) to perform an activity in the way or within the range considered normal for a person. Therefore, disability is caused by parts of the body that do not work properly. The medical model shaped much early social and welfare policy and furthermore has, deliberately and by default, informed a great deal of sport and exercise psychology work on disability. Consider the example of spinal cord injury (SCI) and athletic identity. In such a study, participants with SCI would be labeled as having a physical disability and the dominant focus of identity and sport participation questions would be on the individual; such a project would be particularly amenable to survey research. Disability, as defined by the SCI, is the same for all participants. It is a medical problem or matter.
In recent years, the medical model has been widely criticized. Critics argue that it relies exclusively on individualistic medical definitions and biophysical assumptions of normality. However, normality is a highly contentious concept; normality is influenced by various cultural and historical forces that, in turn, mean what is normal in one сultural or context might be defined as not normal in another. Moreover, the medical model paints an overly negative and tragic image of people with disabilities. Individuals are depicted as defective and therefore disability is seen as a personal tragedy that should be overcome. As a result, individuals with disabilities may be pitied, stigmatized, and subject to a number of negative consequences. In relation to the previous two criticisms, the medical model has been further criticized for locating solutions to the problem of disability within the individual. By consequence, the individual’s impairment needs to be cured or dealt with by health and medical professionals. Disabled bodies, rather than society, are seen as the site where interventions should take place. The focus on the normalization of the body and compliance with medical standards creates a hierarchy of power in which individuals with disabilities lose autonomy over their bodies to medical experts; failure to follow medical advice identifies an individual as deviant, potentially leading to stigma and other negative outcomes. As a result, power and control is placed in the “expert hands” of the medical profession as opposed to people with disabilities themselves.
In the 1960s, the disability movement began to challenge the assumptions of disability put forth by the medical model; this challenge was fuelled by a new understanding of disability. The social model posits that disability is the result of sociostructural barriers that serve to exclude and restrict people with impairments. For example, in this model, inaccessible sporting facilities or negative attitudes from coaches produce disability as opposed to individual impairments. The social model contains several key elements. It claims that social structures and attitudes exclude people with disabilities from participation in certain activities, such as sport. Furthermore, the social model asserts that people with disabilities are an oppressed social group. It also distinguishes between the impairments that people have and the oppression that they experience within society. Therefore, the social model severs any causal link between impairment and disability. Disability is reconceptualized as having nothing to do with impairment and the body; rather, it is a social construction and a restriction of activity. Consider again the example of SCI and athletic identity. When framed from the social perspective, researchers might examine how individuals with SCI are either denied access to sporting opportunities based on physical impairments and thus cannot develop an athletic identity based on these oppressive, sociostructural barriers to sport.
The social model has had an important impact on the lives of people with disabilities, including elite athletes and people interested in engaging in leisure time physical activity. First, it enabled the identification of a political strategy to remove barriers and oppression. If people with impairments are disabled by society, as the social model proposed, then the priority is not to pursue a strategy of medical cure or psychological rehabilitation. Rather, it requires the removal of disabling barriers in order to promote the inclusion of people with impairments. This model has been instrumental in shaping antidiscrimination law. Indeed, the social model was a catalyst for the numerous legislative measures and policy initiatives to address the oppressive environments encountered by many persons with disabilities. For example, by law, it has meant that people with disabilities should be able to access gyms, sport clubs, sporting stadiums, and so on.
The second impact of the social model was on people with disabilities themselves. Offering an alternative to the medical model of disability, the social model was and remains very liberating for many individuals with disabilities—it offers them a very different narrative of disability that enabled them to understand that they themselves were not at fault—society was. They did not need to change; society needed to change. They did not have to identify their impairments as tragic; rather, they could accept their body and lives as they chose. In such ways, the social model is a source of empowerment and a way to restore the autonomy of body and choice for people with impairments. The social model as a counternarrative has enabled people with hearing impairments to positively think of themselves as communicating in a different language compared to individuals without hearing impairments. As a result, they view themselves in affirmative ways and do not consider themselves as having a disability.
Critique of the Social Model
Despite the important impact the social model has had, recently this way of understanding disability has also been critiqued. First, it has been criticized as ignoring the cultural and experiential dimensions of disability. For example, with the emphasis on the removal of social barriers, matters like athletic identity, emotional regulation, stories of mental coping strategies, or psychological well-being are passed over.
Second, it is argued that the idea of a barrier-free world is constrained by the natural environment, is at times economically impractical and is not possible for all people with disability. Moreover, by accommodating some impairments, barriers may then be put in place for other bodies. For example, wheelchair users can find curb cuts useful to enable their movement through the built environment. However, blind people might find that the same curb cuts make it difficult for them to differentiate pavement from road, and leave them walking into the path of a vehicle. Wheeling their way to play in a local tennis tournament, wheelchair users might have difficulties with tactile paving, which gives locational cues to people with visual impairments.
Third, in separating impairment from disability, critics have been keen to stress that the social model overlooks the importance of the body and impairments in people’s lives. Indeed, impairment is not simply biological but profoundly psychological and social too. Consider again the example of SCI. By providing ramps, accessible washrooms, adapted sport and so forth, social barriers are removed and thus, in theory, so should the experience of disability. Yet after injury, bodily changes can lead to a host of new issues previously unknown to the individual, including the experience of pain, chronic health conditions, a new body and a new method of mobility. Thus to reduce disability to solely sociostructural barriers is overly simplistic. In light of these critiques, other models of disability have very recently emerged but have not yet garnered much attention within the sport and exercise psychology literature.
The Social Relational Model
One such model is an extension of the social model: the social relational model. It defines disability as a form of social oppression that involves the social imposition of restrictions of activity on people with impairments as well as the socially engendered undermining of their psychoemotional well-being. Like the original social model, the social relational model takes account of the sociostructural barriers and restrictions that exclude and oppress persons with disabilities. However, the social relational model also accounts for the social processes and practices that place limits on the psychoemotional well-being of people with impairments. In addition, the social relational model underscores the importance of impairment. It sees impairment and disability as linked and interactive. For example, an able-bodied person may tell a spinal-injured wheelchair athlete that they cannot be a coach at their tennis club because they are impaired: The athlete cannot run around the court or stand to serve, so they should not be a tennis coach. In this case, damage may occur to the psychoemotional well-being, and concomitantly the identity as an athlete or coach, of the person with disabilities. The damage is not solely the result of structural barriers. Rather, any damage caused, and the oppression and restrictions of activity that go with this, is an effect of impairment that operates in and through social interaction. Accordingly, the social relational model brings the body and impairment into focus, recognizing the impaired body as a biological, experienced, and psychosocial entity while maintaining that people with impairments can still be oppressed. It is an approach to understanding disability that keeps social oppression at the heart of matters and yet considers disability in a far more layered, complex, embodied way than was detailed in the social model. Consider once again the example of SCI and athletic identity. Research from the social relational model of disability could explore how participation in adapted sport at the elite level reduces felt stigma and embodied concerns in certain contexts and therefore increases the individual’s perceived quality of life. Or, in relation to impression management, it might examine able-bodied people’s attitudes toward both people with disabilities who are physically active and people with disabilities who are not.
The Interactional Model
In the interactional model, disability and how it is experienced is understood as a consequence of the complex relationship between factors intrinsic to individuals, and extrinsic factors arising from the wider context in which these individuals find themselves. Intrinsic factors include the nature and severity of individuals’ impairments, their own attitudes to these impairments, their personal qualities and abilities, and personality. By contrast, extrinsic or contextual factors include the attitudes and reactions of other people; social support systems; the extent to which the environment is enabling or disabling; and wider social, cultural, and economic issues pertinent to disability in society. The interactional model is similar to the social relational model such that impaired bodies are brought back into the understanding of disability. Both models also consider the relational aspect of disability. Therefore, as with the social relational model, a researcher interested in SCI and athletic identity would explore how interactions and impairment intersect to create an identity. In particular, a project framed from this perspective could examine how interactions in specific contexts (like dialogue or conversations in the locker room) either produce or detract from certain identities, such as that of the athlete and that of the person with disabilities.
Relational and Interactional Models Compared
Although similar, there are differences between these two models. First, relational in the context of the interactional model refers to the relationship between intrinsic factors and extrinsic factors that produces disability. By contrast, relational in the context of the social relational model refers to the relationship of those socially constructed as problematically different, or disabled, as the result of bodily or cognitive variations from the normal and cultural criteria for normal. Furthermore in the interactional model, rather than reserving the word disability for impairment effects, oppression, or barriers, the term is used more broadly to describe the whole interplay of different factors that make up the experience of people with impairments. By contrast, impairment is a necessary though not sufficient element in a disability relationship within the interactional model. It is always the combination of a certain set of mental or physical attributes, in a particular environment, within a specified relationship, played out in broader cultural, historical, and political context that, when combined with impairment, create the experience for any individual. Whereas the social relational model places emphasis on oppression and doing things to challenge or eradicate it, the interactional model would suggest there are many things that could be addressed to improve quality of life. This might include physical activity to improve self-esteem, exercise to enhance body–self compassion, or sport to create meaningful friendships and opportunities for travel.
Narrative Inquiry and Narrative Analysis
Understandings of disability are shaped by the model a sport and exercise psychologist adopts. But in addition, the type of theoretical approach adopted also underpins and informs work within sport and exercise psychology on disability. One approach that is garnering interest within sport and exercise psychology disability research is narrative inquiry. The core premise of this approach is that a person is essentially a storytelling animal; stories structure our experiences. We make meaning or sense of things through storytelling, and stories act on and in us, often working to shape and inform human behavior. Such a narrative approach is, therefore, of some relevance to sport and exercise psychologists who as professionals are in the business of dealing with experience, meaning, and human behavior. In both applied practice and for research purposes, we often ask athletes with disabilities to share with us their personal accounts of key moments or phases in their career.
In so doing, we are inviting stories. These stories are not passive or uninformative. They are needed in order for people to represent experiences that remain inchoate until they can be given a narrative form. Stories not only offer and impose form to experience, they express experiences. They are one of the most powerful means we have for communicating to others events that have happened, along with our emotions, attitudes, beliefs, and identities. When people tell stories, these stories have the capacity to affect what we do or do not do, shaping who we are and might be. As such, there is much to be gained from inviting stories and then analyzing them.
Narrative analysis is an umbrella term for an eclectic mix of methods for making sense of, interpreting, and representing data that take the form of a story. It takes stories or storytelling as its primary source of data and examines the content, structure, performance, or context of the story or storytelling as a whole. The analytical interest is not simply on what is said in a story in terms of content. The language and telling itself is also examined along with the environments that give shape to narrative content, structure, and performance. That is, in a narrative analysis the interest moves between what is being said, how, and why a person or group tells and performs the story as they do, in certain places and under specific conditions. For example, the narrative analyst is interested in how a story is put together to convey meaning, namely, to make particular points to an audience. For whom was this story constructed and for what purpose? What particular capacities of a story does the storyteller seek to utilize? Why is the sequence of events structured that way and not another? What narrative resources from the cultural menu does the storyteller draw on, take for granted, or ignore? Where do these resources derive from and under what circumstances and conditions? Are there gaps and inconsistencies in storytelling that might suggest preferred, alternative, or counter narratives? What does the story say and do on, for, and with people? How do listeners or readers respond to a story, with what affects, and on whom?
A narrative analysis of disability and sport might therefore highlight performance stories in which winning at all costs is the dominant theme. It could illuminate stories of anxiety and choking or stories of moments when everything comes together and the athlete experiences the sensation of flow. An analysis of the stories of athletes with disabilities who have just retired could reveal that the type of story several of them get caught up in is one that structures and shapes their retirement experiences as meaningless and devoid of purpose. The story is one that enacts a past full of glory and excitement, but now a present that is empty and a future that is perceived as desolate. Such a story, therefore, can be seen as acting on these athletes in dangerous and negative ways. Alternatively, a narrative analysis might reveal a type of story that following retirement calls on metaphors associated with a journey of self-discovery, notions of being changed for the better following retiring, and time tenses that link the person to living fully and happily in the immediate present. In this story, resilience is a dominant theme. It is used as a resource that works for the athletes to positively adapt to retirement and the adversity that can ensue. In such ways, therefore, sports and exercise psychologists can generate a compelling account of how stories affect human lives and put in place practical resources for people with disabilities to live differently.
As we have seen, disability is a multidimensional construct that can be modeled in several different ways. Moreover, these models lead to different ways of operationalizing disability and thus will have important methodological and practical implications for sport and exercise psychologists. When considering the literature and prior to beginning a research project, it is essential for researchers to reflect on which model of disability frames their understanding, given the impact this understanding will have on the ensuing research approach and method. To develop humanistic, complex, and rich understandings of the lives of people with disabilities, researchers might also consider using narrative inquiry. Stories, after all, affect human lives.
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