Friday, 6 November 2009

More on the Social Model

There have been several comments on my posts so far and I want to use two of them as the basis of this post. The first suggests that my previous post needs clarification and the second gives a wonderful name for the model I hope we can develop together.

Clarification of the Social Model of Disability

Anne Marie Cunningham said...

I can see this is going to be an interesting discussion! So would a social model of medicine say that we shouldn't bother to try and treat disease? Instead we should accommodate people who have illness and make their lives as comfortable as possible.

Under some circumstances yes! Let me use mother-in-law's death as an example. She was diagnosed with kidney cancer and had the affected kidney removed. Her quality of life improved for a while but soon she became ill again. The cancer had spread to her other kidney and secondaries had appeared. She was 77 and had been widowed for seven years. She herself took the decision that she had had a good life and could face her end. Being a Christian probably helped. She refused the treatment offered (more surgery and chemo) but accepted palliative care and died soon after. Three of her four children were with her when she died.

I can imagine that in another context her decision would have been resisted by the professionals and/or family.

I guess I get a little confused about the social model of disability. If I had broke my wrist 100 years ago I wouldn't have had the surgery that helped minimise deformity as it healed and so is encouraging a return to normal function. If I had been left with impaired function in my wrist then I would have a disability and could have been handicapped by this. Yes, efforts could be made to reduce this by adapting my car or getting me software so that I could voice dictate rather than type. I might have moved in to an area of medicine that didn't involve physical contact with patient.

All of that would have reduced the impact of my disability on my life. But the medical model has meant that I haven't had to endure that.

You seem to be confusing the Medical (or Traditional) Model of Disability with medicine in general. I have edited my previous post to make it clearer when I am talking about the former, and when the latter.
To me it seems obvious that the two models are not opposed to each other but can live easily together. Medically we do what is sensible and what the patient agrees to, whilst still helping them to live socially as best they can with whatever impairment or disability is retained.

The Social Model of Disability doesn't say medical interventions are necessarily bad. Disabled children should receive the same childhood vaccinations as any other child, for example. What it discourages is medical interventions aimed at "fixing" the impairment. Many deaf people could have some hearing restored by cochlear implants but will resist the idea. They have a perfectly good form of communication in American or British Sign Language, they have no need to hear. It's your problem that you can't understand them, so get an interpretor. This is a hardline interpretation but it exists.

However, the model does support the idea of working with health and other professionals to remove the barriers. Bobath Therapy is a good example. This uses speach, physio- and occupational therapists to help children with Cerebral Palsy and their parents overcome some of the effects of their impairments. Bobath Children's Therapy Centre Wales illustrates this with a number of fictionalised stories—I find Bethan's Story particularly affecting.

A proposed name for the model

In a comment to my previous post healthskills said…
I'm both a health provider AND a patient (tell me which health provider isn't going to, at some point, become a patient?!!).

I totally endorse 'health literacy' or becoming informed and in charge of their own health management.

I'd prefer to call it 'social model of health management' rather than medicine - because medicine continues to focus on deficits, impairments and biology without considering the psychological and social, and without considering the strengths, resilience and assets we all come to health care settings with.

For me, that says it all. We have a name for the model—Social Model of Health Management. It also suggests a Twitter tag—#smhm.


  1. Hello
    I wouldn't say that I was confusing the traditional model of disability, with medicine as a whole, just that I was trying to understand where the analogy leads.

    I don't want to seem pedantic although there is a big risk that I am, but what are other examples where a traditional model of disability and a social model would take different actions? I'm trying to understand where the two models are in conflict with each other.

    I would also say that with regards to the cochlear implants, it is not universally accepted that having them is a bad thing.

    With regards to Bobath therapy I can't see that anyone would have any objections to this. If a traditional model of disability was followed are there other medical interventions that could be applied to fix the disability? There aren't as far as I am aware. So again there is no real conflict between the two.

    I'm labouring this because I think if one is going to make analogies then it is worthwhile clarifying why they are useful.

    Most people in health related areas would say that we have moved beyond the very paternalistic model that you ascribe to current medicine.... as a model at least. In reality there may still be problems.

    You give the example of your mother-in-law's death and state that you are sure 'in another context' her condition would have been resisted by the professionals or family. What kind of other context? If the existing model allows this to happen- and I don't think that there is any chance this is a one-off, then what is added by the new model?

    OK, those are my questions! Maybe next week I will do my own post setting out what I see as the barriers to being an empowered patient and not just keep asking you questions!

    Thanks again
    Anne Marie

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  3. This is a very worthy cause and an interesting blog, Keith!

    I was a programmer,too, and found myself on crutches and in chronic pain for YEARS.

    I found the distinction between 'health' and 'wellness' rather blurred. Hence the problem => solution approach to diagnosis -> treatment is too 'linear', too, methinks.

    In any case, I guess 'empowerment' is the name of the game - across all levels of being.

    And getting the right information at the right time is extremely empowering!

    THANKS for this initative!