How Disability Has Been Understood

An introduction to Who Bears Responsibility for Disability

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Disability As Framing

Historically, disability has been understood through a mix of individual responsibility, charity, and biological deficit and sometimes all at once.[1] For a long time, impairment was framed as something that sat squarely within the person: a physical, mental, or sensory condition to be managed, overcome, or adapted to by the individual themselves.

When people were unable to meet the expectations of wider society, the responsibility was rarely assumed to rest with the world around them. Instead, it was more often understood as a personal failing or limitation, and the question wasn’t whether society could or should change but whether the individual was willing to adapt to society.

Disability as Individual Deficit

This prevailing way of thinking, often referred to as the medical model (more on other models of disability later), helps to explain how disability has been understood over time and why certain responses to disability have come to feel so natural. As disability scholar Michael Oliver said:

“Within a medical model, disability is defined as a functional limitation caused by physical, mental or sensory impairment.” [2]

Simply put, the medical model of disability talks about people with disabilities rather than disabled people. It approaches disability in a way that places both the problem and responsibility onto the individual body or mind. The response that follows is predictable: diagnosis, treatment, rehabilitation, or cure. If something doesn’t work then the prevailing assumption is that the person needs to be fixed, supported, or corrected in some way. Important structures such as social arrangements and the built environment are therefore often ignored as root causes of disability.[3]

When Disability is Treated but Exclusion Sticks Around

How disability is framed matters because it shapes not only how disability is understood, but what sort of response is seen as appropriate. Paul Abberley in The Concept of Oppression and the Development of a Social Theory of Disability argues, “The medicalisation of disability provided ideological justification…as natural, necessary, and benevolent response to impairment.” [4] Rather than empowering disabled people to live independently and with agency, the medical model has often been used to justify segregation, institutionalisation, and societal exclusion masquerading as care and protection.

When disability is identified as being a problem relating to the individual, the consequences extend beyond diagnosis or treatment. As Michael Oliver observed:

“Once disability is defined in individual terms, the logical response is to separate, treat, or manage disabled people rather than to change society.” [5]

Thinking in these terms makes it difficult to imagine alternative responses. When individuals are positioned as the problem, rather than the solution, attention is drawn inwards toward perceived deficits, while the structural and systemic conditions that shape exclusion remain largely overlooked. Over time the limitations of this approach to how society thinks about disability became increasingly apparent. Disabled people continued to experience exclusion from education, employment, housing, and public life.[6] The persistent nature of these barriers raised an uncomfortable question — if people’s bodies and minds were being treated and managed why did exclusion remain so rampantly widespread?

A Shift in Thinking

It was in direct response to these contradictions that the social model of disability began to emerge. An antithesis to the medical model, the social model was developed by disabled people drawing on their lived experience to challenge the assumption that impairment itself was the primary disabling factor. Instead, it redirected attention towards society and asked whether the problem lay not with individuals who lack agency within systems that deny them any meaningful ability to exercise it, but with inaccessible built environments, institutional practices, and discriminatory attitudes.

To think in terms of the social model of disability is to understand that it isn’t a wheelchair, hearing aids, or speaking British Sign Language (BSL) that disable someone. What disables people is the absence of accessible places and spaces that have been designed with disabled people in mind. What disables people is not having a hearing loop installed at reception or an infrared system in conference rooms. What disables people is a lack of staff training in BSL.

Language Matters

At the very basic level people don’t disable themselves — environments, systems, and structures do. And they do it very well. This is why many disabled people and organisations use the term disabled people as opposed to people with disabilities. The intention behind person-first language is often well placed, aiming to highlight the person rather than the impairment. This framing though can have unintended consequences.

By describing someone as a “person with a disability”, their impairment is positioned as something inherently wrong with them, something internal, personal, and inseparable from who they are. This reflects medical model language and thought, where disability is treated as something that is an individual problem rooted in body and mind.

Using the term disabled people however recognises that individuals are disabled through no fault of their own, by barriers and disabling factors created by society. The difference in language shifts the emphasis away from something that is wrong with the person and towards the social, environmental, and systemic factors that create disability in practice.

When Models Overlap

The models discussed above rarely sit neatly apart from one another. They often overlap and reappear in ways that can be hard to spot unless you are actively looking for them. It’s entirely possible to find medical, charitable, and social model framings of disability sat side by side, sometimes within the same organisation and within the same policy.

This becomes apparent when organisations adopt the language of the social model, but struggle to apply it consistently. Inclusion may be referenced in strategy documents or public statements, while day-to-day processes continue to focus heavily on assessment, eligibility, and evidence of impairment. Disabled people are asked, often repeatedly, to demonstrate limitation in order to access support that is ostensibly about removing barriers. It’s at these points where we often see responsibility shift back onto the individual.

Even when disability support is discussed publicly, charitable framing is often prevalent. Support for disabled people is talked about as something that is provided, allowed, or enabled through kindness and generosity, rather than something that should already exist. Whilst the charitable framing is well intentioned, it can reinforce the idea that disabled people lack any meaningful agency and that inclusion is optional rather than expected.

Thinking about disability in terms of framing helps us to make sense of these contradictions. It allows us to see how responsibility moves depending on which model is being applied, and how easily responsibility can drift away from systems and structures even in settings that describe or champion themselves as inclusive. Whilst it’s not always deliberate, it’s not usually without consequence.

Looking Forward

This essay is the first in a series titled Who Bears Responsibility for Disability. I’m starting with disability framing deliberately because how disability has been understood sets the scene for almost everything that follows. It influences what questions get asked, what solutions are considered reasonable, and where responsibility is assumed to sit.

I hope that by looking at different models of disability, including how systems and structures can be disabling in practice, and how responsibility is often shifted back onto individuals through design, policy, and process, this series can examine where responsibility has historically been placed, and where it might more fairly sit.

[1] Colin Barnes, Disabled People in Britain and Discrimination (London: Hurst & Company, 1991), 2.

[2] Michael Oliver, Understanding Disability: From Theory to Practice (Basingstoke: Macmillan, 1996), 32

[3] Tom Shakespeare, “The Social Model of Disability,” in The Disability Studies Reader, ed. Lennard J. Davis, 4th ed. (New York: Routledge, 2013), 214.

[4] Paul Abberley, “The Concept of Oppression and the Development of a Social Theory of Disability,” Disability, Handicap & Society 2, no. 1 (1987): 8–9

[5] Michael Oliver, The Politics of Disablement (London: Macmillan, 1990), 47.

[6] Tom Shakespeare, Disability Rights and Wrongs (London: Routledge, 2006), 30–31.