Sick Role Model

This essay sets out to explain how and why disability has been constructed as a medical problem; additionally, the way in which the medical model has influenced policies and practices for disabled people will be evidenced. According to Brisenden (1986) the term ‘disabled’ is used collectively to describe individuals who do not function the same as people who are classified as 'normal’. However, the Equality Act 2010 defines disability as having a ‘physical or mental impairment that has a substantial and long-term negative effect on your ability to do normal daily activities’ (Gov.uk, 2015). Using a range of sources, this essay will succinctly highlight issues surrounding disability during the early twentieth century, before giving a definition

of the medical model of disability. Additionally, a brief explanation of the social model will be incorporated before discussing Oliver (1990) and his longstanding belief that disability is viewed as an individual and a medical problem. Furthermore, the works of functionalists such as Parsons (1951) personal tragedy model will be discussed in order to explain the sick role and creation of the medical model; furthermore, the way in which the functionalist view influenced policy changes in disability will be discussed.
In 2014, there were over 11 million people registered as disabled in the UK (Gov.uk, 2014).

The disability movement of the 1970s helped ensure that every single person registered disabled, has the right to feel part of society, they have the right not to be discriminated against, or excluded from participation in any social event, organisation, or employment (Gov.UK, 2015). Nevertheless, for much of the twentieth century, disabled individuals had no rights; they were viewed as a burden on society, unable to fulfil any social roles, a victim of a personal tragedy and were sanctioned to the sick role (Barnes & Mercer, 2014). The sick role theory belongs to the functionalist sociologist named Talcott Parsons. Parsons (1951) reasoned that sickness threatens the natural order of society because illness impedes a person contributing to society. Parsons (1951) argued that good health is ‘normal’ and is necessary for a functional society, his views sickness as deviant behaviour since ill health deviates from a normal function. The sick role allows a person to have two rights; firstly, to be exempt from normal social roles; secondly, that the person is not held responsible for their condition (Parsons, 1951). Thus, giving authorisation for the individual to be absent from work, school or other societal duties. However, for the absence to be authorised, Parsons (1951) points out that the individual needs to fulfil two obligations. Primarily, the person should try to get better; secondly, the person should seek medical help and cooperate with the medical professional. Therefore, any absence must be recognised by a medical expert who must certify that the person is ill, this certification or doctors note legitimises the illness and authorises the person to be excused from their duties (Giddens & Griffiths, 2006). However, the sick role is a model that only takes into consideration short term illnesses. For instance, a person suffering from sciatica may be excused

from their duties for a short time, but once better they will once again become functional in society. Consequently, a disabled person cannot be expected to fulfil the first obligation of the sick role as their condition is unlikely to change. Consequently, the individual is said to have chosen a dependant role and deemed not to be of 'full human status' portraying the person to be a second class citizen (Sieglar and Osmond, 1974: p. 116). In light of this, the disabled suffered oppression, became segregated from the rest of society and in many cases the disabled were medicalised and institutionalised (Lang, 2001).
Since the sick role had become the dominant approach in regards to ill health, the practices that dealt with disability relied heavily on medical intervention; Oliver (1990) refers to this practice as the medical model of disability.
“The medical model is presented as viewing disability as a problem of the person, directly caused by disease, trauma, or other health condition which therefore requires sustained medical care provided in the form of individual treatment by professionals” (Langtree, 2016).
Since the medical model views disability as a problem intrinsic to the person, the medical model is often referred to as the individual model of disability (Tarzian, 2007). The fundamental mechanics of the medical model seeks to cure or fix what is wrong with an individual; medical intervention such as surgery, rehabilitation, or medication is used in an attempt to normalise the individual and enable them to function in society (Brisenden, 1986). However, some methods of medical intervention contradicts the pursuit for normalisation. Tarzian (2007), brings attention to the highly controversial case of Ashley, a nine year old girl who is profoundly disabled. Surgeons carried out a full hysterectomy on Ashley followed by breast removal surgery and then prescribed Ashley a lifetime of medication to prevent growth and sexual maturation in order to keep her small and easy to care for. Arguably, this type of medical intervention could be considered unethical and morally incorrect by disability activists. Moreover, it reverberates the eugenic methods that were forced upon disabled people for much of the twentieth century in a bid to terminate defective genes (Barnes, 1991). Even today, the use of birth control on people with learning disabilities is an accepted form of eugenics (Meacham, 2015).
In 1976, a newly formed group became the voice amongst the disabled; the Union of the Physically Impaired against Segregation (UPIAS), stood against the dominant medical model that had decided the fate of the disabled for so long. According to the view of UPIAS (1976), individuals should not be labelled as disabled; individuals who have defective or missing limb(s), or a learning disorder, should instead be deemed as impaired. Furthermore, UPIAS (1976) describes disability as the restriction imposed on the impaired by organisations and society; for instance, schemes for education, housing, recreational activities were all planned without considering the impaired. Consequently, the impaired became excluded from everyday mainstream activities which able bodied people take for granted. Moreover, as technology grew and society became more culturally sophisticated, further exclusion could be felt amongst the impaired (Barnes, 2003). From this argument grew the social model of disability (UPIAS, 1976), the difference between the two models can be explained by exemplifying a wheelchair user wanting to enter a building with steps. The individual will not receive help to enter said building under the medical model as the problem is the wheelchair; therefore, the wheelchair user has now been excluded from partaking in an activity. However, the social model resolves this issue by adding a ramp for ease of access (Scope, 2015). The works of Oliver (1990) has dominated the Social Model of Disability; furthermore, without fellow activists and academics such as Vic Finkelstein (1980, 1981) and Colin Barnes (1991), the positive view of disability may not have occurred (Shakespeare and Watson, 2002). However, despite the successful lobbying and support for the impaired; Oliver (1990) argues that the core of disability is still dominated by the medical model.
The strength of Oliver’s argument is further evidenced throughout disability policy and legislation; for example, to claim Disability Living Allowance (DLA) or Personal Independence Payments (PIP), the disability must be recognised and assessed by a medical expert. Furthermore, the scope of the disability will dictate the amount of financial help available to the individual (Gov.uk, 2015). However, in order to ascertain the scope of a disability, doctors must have a criteria to follow. Therefore, in 1980 the World Health Organization (WHO) introduced a framework for working with disability. The International Classification of Impairments, Disabilities and Handicaps (ICIDH). The ICIDH proposed that disability should be determined by using terms such as Impairment, Handicap and Disability. According to WHO (1980), an impairment is loss or abnormality of physical bodily structure or function, this covers cognitive, psychological and physiological functions. Disability is the limitation or function loss which prevents the performance of an activity which is considered normal for a human being. Finally, handicap is an impairment or disability which limits a person performing roles which are considered normal in respect of their age, sex and social and cultural factors.
Oliver (1990) argued that the framework published by WHO (1980) reinforced the conception that disability is viewed like a disease in need of treatment; furthermore, the ICIDH came under criticism from other proponents of the social model. Finkelstein (1998: p, 2), displays criticism of the ICIDH by raising concerns over ‘people with abilities’ (PWA) controlling the definition of disability and displaying it in a negative way. Additionally, Finkelstein (1998: p, 2) expresses concern over how PWA decide how disability should be assessed for benefits, environmental adaptations, assistive devices, or assistance in the home such as a personal assistant. Moreover, the language used in the original ICIDH was found to be derogatory; further painting disability in a negative light (Barnes, 2003). Subsequently, WHO altered the disability framework, taking into consideration both the medical and the social model and producing what advocates consider a universal classification (Barnes, 2003). The International Classification of Functioning (ICF) still maintains three levels; however, the choice of language is no longer negative or derogative, instead of using terminology such as Disability and Handicap, it uses the terms Activity and Participation. The new terminology takes in to account individual abilities such as communication, mobility, self-care, and interpersonal skills; demonstrating that many impaired individuals are capable of contributing to the social role (WHO, 2001). Nevertheless, the ICF is still reliant on the medical model to assess impairment; similarly, the Equality Act 2010 has a specific medical criteria that individuals must meet in order to be protected under the Equality Act 2010 legislation (Gov.uk, 2015).
One main concern of using an organisation to assess an individual’s impairment is that the information given to the assessor can be misjudged or the framework can be misinterpreted, causing undue stress and turmoil to the individual. This can be evidenced by looking at recent cases of disability assessments carried out by ATOS. Warren, Garthwaite & Bambra (2014) highlight a case of a vulnerable adult named Mark Wood. Mark, who suffered from complex mental health issues, died of starvation after having his benefits stopped. ATOS pronounced him fit for work upon attendance of a medical assessment; his medical records, which clearly documented his impairment, were not accessed during the decision making process. Arguably, it could be said, that the medical model of disability has had a negative impact on Mark and the lives of other impaired individuals.