Disability

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.

Conclusion

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.

References:

  1. Gainforth, H. L., & Latimer-Cheung, A. E. (2012). Getting the wheels in motion: Physical activity promotion for people with spinal cord injury. In A. A. Martin & J. E. Jones (Eds.), Spinal cord injuries: Causes, risk factors and management. Hauppauge, NY: Nova Science.
  2. Hanrahan, S. J. (2007) Athletes with disabilities. In G. Tenenbaum & R. C. Eklund (Eds.), Handbook of sport psychology (3rd ed., pp. 845–858). Hoboken, NJ: Wiley.
  3. Martin, J. J., & Whalen, L. (2012). Self-concept and physical activity in athletes with physical disabilities. Disability and Health Journal, 5, 197–200.
  4. Perrier, M. J., Sweet, S. N., Strachan, S. M., & LatimerCheung, A. E. (2012). I act, therefore I am: Athletic identity and the health action process approach predict sport participation among individuals with acquired physical disabilities. Psychology of Sport and Exercise, 13, 713–720.
  5. Smith, B. (2013). Disability, sport, and men’s narratives of health: A qualitative study. Health Psychology, 32, 110–119.
  6. Smith, B., & Sparkes, A. C. (2005). Men, sport, spinal cord injury and narratives of hope. Social Science & Medicine, 61, 1095–1105.
  7. Smith, B., & Sparkes, A. C. (2008). Changing bodies, changing narratives and the consequences of tellability: A case study of becoming disabled through sport. Sociology of Health & Illness, 30, 217–236.
  8. Smith, B., & Sparkes, A. C. (2009). Narrative analysis and sport and exercise psychology: Understanding lives in diverse ways. Psychology of Sport and Exercise, 10, 279–288.
  9. Smith, B., & Sparkes, A. C. (2012). Disability, sport and physical activity. A critical review. In N. Watson, A. Roulstone, & C. Thomas (Eds.), Routledge handbook of disability studies (pp. 336–347). London: Routledge.
  10. Trachtenberg, L. J., Perrier, M. J., Gainforth, H. L., Minnes, P., & Latimer-Cheung, A. E. (2012). Challenging stereotypes of individuals with a physical disability: The impact of Paralympic athletes in television. In A. A. Martin & J. E. Jones (Eds.), Spinal cord injuries: Causes, risk factors and management. Hauppauge, NY: Nova Science.

See also: