Towards a Contextual Psychology of Disablism

Brian Watermeyer

• Publisher: Routledge
• Year: 2012
• eBook ISBN: 9781136283819
• Topic: Medicina
• Subtopic: Prestazione di assistenza sanitaria

In recent years, disability studies has been driven by a model of disability which focuses on the social and economic oppression of disabled people. Although an important counterbalance to a pathologising medical model, the social model risks presenting an impoverished and disembodied view of disability, one that ignores the psychological nature of oppression and its effects.

This innovative work argues that a psychological framework of disability is an essential part of developing a more cohesive disability movement. Brian Watermeyer introduces a new, integrative approach, using psychoanalysis to tackle the problem of conceptualising psychological aspects of life with disablism. Psychoanalytic ideas are applied to social responses to impairment, making sense of discrimination in its many forms, as well as problems in disability politics and research. The perspective explores individual psychological experience, whilst retaining a rigorous critique of social forces of oppression. The argument shows how it is possible to theorise the psychological processes and impressions of discriminatory society without pathologising disadvantaged individuals.

Drawing on sociology, social anthropology, psychology and psychoanalysis - as well as clinical material - Towards a Contextual Psychology of Disablism shapes a view of disabled subjectivity which is embodied, internal, and political. Presenting a range of conceptual ideas which describe psychological dynamics and predicaments confronting disabled people in an exclusionary and prejudiced world, this volume is an important new contribution to the literature. It will interest students and researchers of disability studies, including those working within psychology, education, health and social work.

1 Cultural Othering and Material Deprivation

If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow and the squirrel’s heart beat, and we should die of that roar which lies on the other side of silence.

(Middlemarch – George Eliot, 1871, p. 207)

Introduction

The history of disability as a societal phenomenon is probably as old as humankind itself, incorporating a myriad of cultural responses to the ‘marked body’. A central argument of this book is that the tendency of bodily difference to evoke visceral, partly hidden emotional responses is an important mediator of the social forces which have driven disabled people to the margins of society. The modern era has witnessed an immense institutional and cultural othering of the disabled minority, leading to a host of systematic exclusions from social participation. Biomedical diagnosis, bureaucratic categorisation and prejudice maintain exclusion of disabled people from the economy, as well as the mainstream production of culture. Around the globe, the hallmarks of the social predicaments of disabled people are poverty, mass unemployment, shunning and discrimination. Inequality is woven deeply into the structure and function of societies designed and developed with the needs of only the nondisabled majority in mind.

Over the course of the twentieth century, the rise of biomedical health care in Western nations saw academic and institutional responses to disability becoming dominated by medicine. But critics of modern health care pointed to its lack of attention to social factors which mediate the way illness or disability is experienced. Biomedicine’s tendency was to view disability as a problem of dysfunctional or diseased bodies, neglecting the reality of discrimination. This meant that the social and economic marginality of disabled people tended to be ascribed to individual, impairment-related factors, rather than contextual ones. What became perjoratively termed the medical model effectively placed responsibility for the poverty and exclusion of disabled people at their own door, as an unfortunate, but inevitable outcome of functional defects. In response, disabled academics and activists began to galvanise political resistance, shaping the disabled community into a civil rights movement lobbying for change.

The crux of their position was that it was discrimination and systemic disadvantage, not bodily frailty, which was at the heart of the marginal, deprived status of disabled people. Under the banner of this new social model approach, marginality became understood as a product of oppression. In addition, it was argued that discriminatory societies selectively ascribed the ‘disabled’ identity to some citizens, as a means of absolving the state from responsibility for fulfilling citizenship rights. The architects of this new model were academics from disciplines such as sociology and social policy, who mainly subscribed to an historical materialist model of society. This paradigm views access to participation in the economy as primary in shaping social inequality, tending to regard cultural or psychological factors as less important. Along the way, the discipline of disability studies was born, with strong foundations (especially in the United Kingdom) in a partisan, emancipatory approach to disability research. Social modelists vehemently rejected the diagnostic and rehabilitative methods of medicine, seeing these as instruments of social control rather than upliftment. But the social model-dominated disability movement was to bring its own silences. These were based on materialism’s strategic eliding of unique, personal aspects of disability experience, as well as the domain of the psychological.

To the political vanguard of the social model, psychology had been at the forefront of pathologisation, characterising disabled people as inherently damaged rather than victims of social injustice. Exploring psychological aspects of disability, in this view, would divert attention from the real, material issue of barriers to participation. Consequently, the cycle of victim-blaming would be perpetuated. But as disability studies has developed, mainly feminist scholars have objected to the materialist orthodoxy of the social model. These writers argue that a focus on the public domain of structural barriers sidelines the equally politically important worlds of the personal, the bodily and the psychological. The social model was unable to make provision for disabled subjects who were diverse and embodied, with personal and psychological histories upon which social suffering had left impressions. George Eliot’s roar of human experience which lay beyond the silence required by the materialist view would present significant political dilemmas. The social model’s need for this sterile disabled figure was clear, but it left much of the real-life experience of the disabled population un-theorised and uninterrogated.

Historically, it is true that most psychological theory on disability has taken an individual, pathology-oriented position, ignoring social realities almost completely. But this does not mean that a critical, contextual psychology of disability is impossible to create. To begin, a new model would aim to use psychological concepts to illuminate the intra-psychic and interpersonal mechanisms of prejudice, as well as tracing the psychological predicaments of the self in a disablist social milieu. Lifelong processes of socialisation, in which disablist culture impresses itself on impaired individuals, would be a central focus of study.

This book is an initial, exploratory response to the theoretical challenge sketched above. At centre stage is the question of whether we can create a psychological model of life in disablist society which mirrors individual intra-psychic reality, while making sure to retain an analysis of structural forces of inequality. Beyond this, dynamic psychological factors must be at work in both the origin and perpetuation of prejudice. These elements must be conceptualised if we are to understand their workings and begin to imagine change. I believe that the discipline of psychoanalysis has much to offer disability studies in addressing these difficult challenges. Like other branches of psychology, psychoanalysis’ traditional theorising of disability has lacked any real contextual analysis – to most disability studies scholars its appearance here probably seems incongruous. Seldom recognised, though, is the power of psychoanalysis as a framework for social critique, aiming to unpack the unconscious narratives of inequality. Psychoanalysis is curious about the formation of the self and, in its more critical incarnations, how selfhood and ideology are connected by socialisation. The issue of the social mirroring disabled people are subject to applies directly here, posing questions about how disablist culture shapes the self. Further, psychoanalysis has much to say about the psychological nature of unequal intergroup relations, the scapegoating of minorities and the unconscious forces at work in political movements. From a critical psychoanalytic perspective, disabled people are used as containers for the projection of the disavowed existential conflicts of a control-oriented, self-centred modern world. There can be little question that disablist inequality has an influential unconscious narrative. We need psychoanalytic ideas to conceptualise this. As corollary, ‘oppression’ is not a visible, unidirectional force emanating from the dominant group. Instead, it is a dynamic social process, often involving the internalisation of disablist culture by those who are subordinated. In this model, change will require an understanding by all of their participation.

This work begins to develop psychoanalytically informed concepts which connect psychological experience to semiotic and material aspects of disablist culture. What is required is a psychological account of the trauma of socially situated disability, which carefully connects subjective struggle to the distorted social formations which surround the disabled body. In contributing to this project, this book uses the psychoanalytic lens to create a new, interpretive synthesis of a broad range of theoretical ideas on disability.

After thoroughly examining the epistemological crossroads at which disability studies finds itself, I use psychoanalytic ideas to explore socialisation in a disablist world. Besides the re-interpretation and evaluation of existing ideas, I draw on my own experience of psychoanalytically oriented group psychotherapy with severely physically impaired adults. The aim is to describe the often subtle psychological predicaments of life in a disablist culture, bringing dynamics of inequality into relief. The difficult, conceptually awkward reality is that disabled people have inner lives, histories and unique impairments. Somehow we must make a place for the subjective world of disablism; emancipation must surely depend on our ability to describe the lived effects of ideology. The poorly theorised state of problems such as internalised oppression constitutes both a critique and a limitation of disability studies and the disability movement. In addition, the interest in unconscious aspects of the disability phenomenon applies as much to the nature of disability theory and politics as to the underpinnings of oppressive social structures. Psychoanalysis can throw much light on the reasons why the terrain of disability is as contested as it is, incorporating heated disciplinary disputes as well as political conflict.

In the balance of this chapter we consider the cultural phenomenon of bodily symbolism; that is, the resilient logic that the nature of the soul, or the self, is ‘written on the body’. On examining these meanings, there can be little question that disability has a trajectory of psychological experience which is rooted in culture and socialisation. After this I present a brief orientation to the worldwide development challenges facing the disabled community, orienting the reader to the global arena of disability inequality and politics. These short sections begin to sketch a world of distorted cultural and material responses to the impaired body. The balance of the book explores theoretical and political reactions to these problems, the lack of a psychological strand and possible new conceptual directions.

Written on the Body¹

Across world culture there exists a long history of explaining behaviour, and indeed self, through the nature of bodies. Somatic characteristics are by their nature compelling and material, instinctually drawing attention away from more subtle aspects of personhood, especially in the crucial first moments of contact. The body mesmerises us. It has the potential to indelibly mark out to the observer constraints upon what or whom the soul it carries may be. To the gaze, it is the body which provides a material, ‘corporeal anchor’ that reflects and that constitutes the psychological realm (Garland-Thomson, 1995, p. 603). Next to gender, the most widely influential bodily signifier is skin colour, which in every context holds a myriad of personal meanings, often expressed as binary oppositions between members of racial groups. Frantz Fanon placed fantasies about blackness at the very core of European civilisation (Fanon, 1952; Frosh, 1989). Further, as Morris (1993) notes, the correlating of physical attributes with undesirable aspects of the psychological self is, to say the least, familiar to the feminist movement. The response of feminism has been to locate such assumptions within a critique of socio-political context. Rosemarie Garland-Thomson (1995) tells of her dismay at a bedtime fairytale she reads to her young daughter, in which the ‘good’ girl’s sexual and personal worth emanate from ‘an outer beauty that parallels her inner virtue’ (p. 599). Conversely, the ‘bad’ girl’s poverty of morals and character is mirrored and confirmed by her indelicate, unfeminine features. For the ‘bad’ girl, the already devalued state of being a woman is made more condemning by failure to redeem herself with beauty. Attractiveness, thus, is firmly linked to virtue (Asch and Fine, 1988).

In a world of fervent somatic symbolising, disability is at centre stage. Bodily differences or ‘flaws’ lend themselves to analogies with deeper moral or civil shortcomings (Mitchell and Snyder, 1997). In Shakespeare’s Richard III, there is no question that the protagonist’s sinister, beastly ways are constituted mutually with his bodily deformity. In fact, he brazenly conspires with the audience, reasoning that since he is not worthy of this world’s purer pleasures, villainy and avarice can be his only ambitions. In the horrific unfolding of the play, every twist can be ‘traced back to Richard’s consciousness of himself as a “deformed, unfinished” man’ (Kriegel, 1987, p. 31). Richard is described as having teeth from before his misshapen birth, allowing him to ‘gnaw a crust when two hours old’ (Richard III, II.iv). Clearly identifiable here are ideas of base oral obsession, deprivation and greed, located within Richard from his very birth. His evil, therefore, is not so much a result of his deformity as a co-constituent with it of his overall self.

Modernity’s promise of technologies to master the natural world brings hopeful possibilities – which quickly transmutate into obligations – to perfect the body. Bodies successfully made to appear youthful and powerful have ‘increasingly become a sign of social worth’, and pivotal to the ‘notion of the self as a project’ (Giddens, 1991 in Turner, 2001, p. 253). The fantasy of a body completely amenable to the perfecting, subduing action of technology singles out those who fail in this task as inferior, negligent or immoral. Davis (1997a) traces the late modern development of scientific measurement and assignation of the bodily identity. This ranges from scores on intelligence tests to fingerprinting. These characteristics supposedly express a coded genetic essence. The allocation of an indelible corporeal character, interspersed with measurements of prowess such as intelligence, laces each individual into an ‘identical relationship’ with his or her body (p. 15). Ultimately, the body embodies the identity. In this way, one’s resultant identity becomes ‘as indelible as one’s place on the normal curve’ (ibid.). Achieving normalcy on that same curve – by virtue of a body that is ‘natural and healthy’ – becomes a prerequisite for ‘a good life … one worth living’ (Michalko, 2002, p. 37). As we shall see, for people with ‘errant’ bodies there is the converse attribution. Namely, that these lives are not worth living.

So prized and praiseworthy are characteristics of vitality, health, vigour and energy in common-sense accounts that questioning their association with virtue may, at first glance, seem incongruous. Habitually, observations of how closely a body approximates the fantasy media ideal are accepted as compliments. Such compliments cleanse and illuminate not only the body, but also its ‘inhabitant’. We revel in praise for our stamina, our ability to work long hours, our resilience and energy, our resistance to disease. But a discourse which constructs health not as a chance occurrence, but as an admirable achievement, is heard very differently from within a disabled body. Here, the individual is positioned as not only physically flawed, but also as personally deficient (Wendell, 1997).

In the cases of race and gender, interrogation of societal forces and the action of civil rights campaigns have worked to erode away bodily attributions. The evidence of oppression has grown and (to some extent) overtaken the urge to ascribe poverty, backwardness, immorality or any other form of inadequacy to bodily difference. Disability, though, presents opportunities for symbolisation which are legion, provocative and fantastic, rendering fantasies about the disabled self correspondingly florid. If the shape of the disabled body is infinitely diverse, infinitely contorted, so must be the shape of the disabled soul. Fantasies of limitless bodily dysmorphology feed, and feed upon, ideas regarding the frighteningly diverse states and shapes of the human character.

Through an examination of the history of the American freak show, Garland-Thomson (1997b, p. 59) shows how a distorted body may be so saturated with symbolism as to become ‘pure text’, obliterating humanity. Such ‘enfreakment’ (ibid.) is at one extreme of a continuum on which varying admixtures of body and self are able to be heard. But what her image demonstrates is the pervasive squeezing away of the self by bodies that are all-too-readily appropriated as text. The hegemonic position of the body as a text of identity is evident in universal drives to repair, correct and enhance its nature. When we improve our bodies, we improve ourselves. Paradoxically, this position both frees and entraps. We are seduced by the modernist possibility of change, while endorsing a meaning system which affixes our selfhood to an ultimately fragile and failing body. We have the illusion of control, at the cost of subjection.

The textual message emblazoned on the disabled body is, first and foremost, one of suffering and abjection. Throughout history, writes Henri-Jacques Stiker, disability and suffering have remained inseparable (Stiker, 1982). As liberal societies organise life and identity around axioms such as free agency, mastery, progress and individual will, the image of the disabled person destabilises the very foundations of convention, appearing as the absolute counterpoint to the ‘good life’ (Garland-Thomson, 1997b). In popular media in the United States, Hevey characterises the image of the impaired body as the ‘site and symbol of all alienation … the contorted body is the final process and statement of a painful mind’ (Hevey, 1992, p. 73). So dominant are cultural associations to bodily frailty, according to Susan Sontag, that it is not possible to ‘take up one’s residence in the kingdom of the ill unprejudiced by the lurid metaphors with which it has been landscaped’ (Sontag, 1991, p. 3).

Linguistic traces of the association of impairment with misery appear in a range of popular discourses. For example, allocation of individuals to the categories of ‘fortunate’ and ‘unfortunate’ occurs around a fulcrum of the body. In the midst of life crises or losses, the mantra that one is, in fact, ‘fortunate’ to have ‘my health’ is almost proverbial. Bodily impairment, consequently, is seen as prohibiting temporality or change in how one’s sense of self is viewed. One simply is ‘an unfortunate’. The unspoken nature of disabled experience occupies the pinnacle of a shadowy, yet consensual, hierarchy of suffering. If the self is written on the body; the wretched self is written on the impaired body.

One aim of this book is to present a new synthesis of ideas on why and how disablist inequality is so prevalent. But before tracing a course through the varying explanations offered by theoretical ideas, it makes sense to begin with an outline of the socio-political circumstances under which disabled people live. My discussion now moves to a short review of what is known about the structural disadvantages faced by the world’s disabled population.

Disability: The International Development Context

Although substantial gaps in data exist, it is incontrovertible that a vast majority of the world’s disabled population live in conditions of extreme disadvantage. Charlton calls this reality ‘a human rights tragedy of epic proportions’, which embodies ‘a fundamental critique of the existing world system’ (Charlton, 1998, p. ix). Poverty, indignity, exclusion and the routine contravention of basic human rights are the touchstones of the social predicaments of the world’s disabled population.

Disablist oppression is part of the structure of societies designed in ignorance of the needs and lifestyles of people with impairments. Exclusion manifests in visible and invisible, deliberate and inadvertent, active and passive aspects of everyday cultural, economic and political life. Rather than being the work of a bigoted minority, disablist exclusion recruits all as participants. Providing only for the needs of the nondisabled is a shared legacy.

Defining disability is a notoriously complex, contested task. Consequently, widely divergent definitions have provided global prevalence data sets which are ‘inherently problematic’ (Coleridge, 1993, p. 104). Combining this bewildering store of data has inevitably involved compromises, leading initially to an international prevalence estimated at 10 per cent of the population. This quickly became prominent in the discourse of disabled lobby groups worldwide. The 10 per cent figure was convenient as a hold-all descriptor for slogans, but was soon shown up as a coarse over-simplification. The estimate fostered the incorrect assumption that approximately one tenth of any population will ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Dedication
• Contents
• Introduction
• 1. Cultural othering and material deprivation
• 2. Theorising disability
• 3. Psychoanalysis and disability studies: an unlikely alliance
• 4. Bioethics, disability and the quality of life debate
• 5. Exploring the cultural shaping of socialisation: the psychological positioning of disabled lives
• 6. Oppression, psychology and change: initial conceptual reflections
• 7. Conceptualising the psychological predicaments of disablism: disability, silence and trauma
• 8. Disability and the distortion of personal and psychic boundaries
• 9. Disability and loss
• 10. Concluding reflections
• References
• Index