What's Wrong with Disability?

There is a serious danger I shall reinforce your prejudices that a philosopher is inclined to spend his time wondering whether things we all know to be so are really so indeed. G.E. Moore has a famous, or perhaps notorious paper considering whether I know this is really a hand I see before me.

The question that provides the title for my contribution to this discussion might well seem similar. Disabilities are surely deficiencies, defects, things we wouldn’t want if we had the choice (an extreme context for revealing one's attitude here is that of pre-natal testing and selective abortion — it is hard to claim that one is offering a disabled person completely equal respect if one thinks it right to abort a foetus that would have the same disability). I am endebted to a recent book (Silvers et al., 1998, briefly reviewed in Brandon, 2001) for the realisation that things are perhaps not so straightforward. This paper is an invitation to join in a search for a defence of what might seem the natural view, or an account of what is really going on when people espouse it. One way to phrase the problem is to wonder whether some element of normativity ought to reside in our conception of normality. Can we give a good reason for this thought? An important qualification needs to be recognised: I am not talking about people who lose abilities they have cultivated, but about those who have chronically been without the ability in question. So the question is not whether you or I would mind becoming disabled, but whether we should have minded if we had been disabled all along. (Which of course makes it much harder to answer by imaginative means.)

Let me begin by filling in a little more on the context of this discussion. I have already indicated the joint book by Silvers, Wasserman and Mahowald. In that, Silvers gives a comprehensive background to the issue and in particular focuses on what she calls the "medicalizing of disability". She reviews the ways cultures categorise people, including those we now recognise as disabled, and observes that "in the modern era, the progressive approach to justifying the disadvantage visited on physically, sensorily, or cognitively impaired individuals substitutes a physiological or mental deficit for the moral flaw blamed by antiquity. This medical model fixes on reducing the numbers of people with disabilities by preventative or curative medical technology" (p. 59) She notes that "designating an anomaly, difference, or change in one’s customary functioning as sick, diseased, or a defect or deviance in health is potentially coercive" (p. 66) and reminds us of fairly recent aberrations such as that being an only child was a disease in itself.

A second context I want to invoke is the thought of a "human being as being a basic concept in the philosophy of mind, and, consequently, in ethics" (Williams, 1986, p. 197) or what others have disparaged as speciesism. In philosophy these ideas are often encountered in proximity to Aristotle — Williams for one often claims that ancient Greek ways of thinking about how we should live address our particular needs more closely than important figures such as Kant within later western traditions. Williams is suspicious of what one might call the cult of persons, but as we have seen insists that the notion of a human being is evaluatively irreplaceable and fundamental.

If we return now to the problem as phrased in terms of statistical normality, the first point to make is that, in general, being statistically normal doesn't seem on reflection to have anything going for it, though it is the stuff of stereotyping: Bennett (1965) gives the example of phenol-thio-urea that most people find very bitter but some tasteless — so what? Or we might note left-handedness, that has certainly given rise to more than enough stereotyping (cf. the etymology of sinister) and coercion but to no purpose. We can note how long it took the scientific world to discover colour blindness.

There are some non-normal conditions that are painful, constantly or occasionally. The pain here gives us excellent reason to try to do something about them. But when the condition is not painful, what ground have we got for wanting to change or compensate for it? They are certainly not now plausibly seen as moral issues.

The conditions in question are ones in which a person lacks or is seriously deficient in a normal human bodily-based capacity (blind, deaf, partially paralysed, ...) rather than hyperefficient in such a capacity (as a person with the hearing of a dog might be). I say 'bodily-based' to suggest that we are not concerned with a lack or deficiency in learned behaviour — I cannot play a piano but that is not a relevant "disability" since I have the bodily parts required to do so (though by now they might never again work with the requisite finesse).

It is worth stressing that it is only serious deficiency that counts here. No one has a second thought about correcting deficiencies in eyesight by wearing glasses — or if they do, it is only a matter of fashion and they might choose contact lenses instead. We think in terms of disability when the deficiency is so great that it cannot be corrected by the normal (in both senses!) technology. The fact that most academics couldn't see to hunt wild animals if they were to return to neolithic conditions, let alone know how to kill and prepare them, doesn't lead us to think any the less of ourselves; what would then have been a quick route to extinction is perfectly OK. The complaint from the disabled is that by contrast we do stigmatise blindness or reliance on a wheelchair.

The Aristotelian emphasis on the flourishing of specimens of a species might seem to provide a rationale for an assumption that we should not only improve somewhat deficient organs but seek to compensate for serious problems or complete lacks. Such organs and their associated capacities are functional for the animal concerned so the animal is impaired by lack or deficiency in them.

It is perhaps instructive that philosophers have appealed here to Aristotle rather than Darwin. There is debate whether Aristotle maintained the fixity and invariability of species, but whatever his position he certainly assumed a strongly normative normality — his reaction to variations is mainly that nature might produce defective specimens. As Hoffman and Rosenkrantz note, Aristotle’s standard for the naturalness of an individual animal is the nature of the species to which it belongs whereas their own, owing much more to modern results, appeals to the "original hereditary nature of that individual" (1997, p. 119). A thinker who sees women as deficient men — "The female is, as it were, a mutilated male" (Generation of Animals 2,3: 737a27) — is not likely to have a positive role to give to variation within a species. But such variation is essential for natural selection to get a grip. A Darwinian must then distinguish between good, bad, and indifferent variations, and for creatures as resourceful as ourselves, it is not obvious that the lack of some normal organs need be anything other than a matter of indifference.

Resourcefulness is one way into another problem for any biologically based approach. When an animal's options are tightly constrained, it is reasonable to think that its main organs are all essential for its flourishing. But human life is indefinitely varied; we cannot say that in our case all our normal organs are needed for survival.

Of course, if you don't have organ O you can't F (where F is some especially prized exercise of a capacity: watching sunsets or looking at Rembrandts). But you can G and H, and many people with O don't F either. So why think the lack of O is a misfortune?

But perhaps the mistake here is to invoke sunsets and Rembrandt. What everyone wants is just the ordinary exercise of these capacities — to see their family and friends and the front-door. An Aristotelian idea is useful here: we don't want to be children all our lives. We aspire to living an adult life, of the kind our species lives. Such a thought relates to the problem that chronic mental retardation poses, but we have to be careful with it in the context of physical disabilities. To illustrate the danger, consider the analogous thought about the role of literacy in adult life: Gutmann wonders why we do not insist on sending illiterate adults back to school, if literacy is essential to participation in civic life, but she has to admit that it isn't. There may be a core set (or sets) of capacities without which no one can manage a basic adult life, but we have to be careful about supposing falsely that some capacity we prize must be included (see Brandon, 1995, for further discussion of this case).

A related point, much emphasized by Silvers, is that the capacities needed for managing are often multiply-realisable. There are alternative ways of doing things. We have chosen ways that suit normal people, but alternatives exist (ramps as well as stairs, etc., etc.), and it is only right that they be mandated when they would permit other types of people to participate on an equal footing.

These initial moves have not, then, produced a rationale for the thought that there is anything that must be done to change people with disabilities rather than provide them with opportunities to join in with the rest of us. We could continue to search – this paper is in a way an invitation to do so. But another response is to propose that our initial hunch was a rationalisation of a somewhat disreputable perspective on what chronic disability entails. What typically distinguishes such disability is (a) the cost of dealing with it (both in "medicalising" ways and in terms of social action of the sort urged by Silvers) and (b) greater dependence on other assignable people. In both respects, but perhaps especially with the second, the point is not that normality avoids these things (though ideologies of self-sufficiency are rife) but that chronic disability makes extra demands beyond the taken-for-granted of a normal life. I think there is weight also in the fact that our social arrangements tend to make dependence here dependence on what I have called (borrowing from Barry’s borrowing from Bentham, Barry, 1965, p. 191) assignable individuals. It is a commonplace of "no man is an island"-type exhortation that we could not be gathered together in this room for this meeting without the all but invisible contributions of a host of other people. But these people are important, not qua individuals but qua functionaries; they are as it were anonymous. We could perhaps likewise socialise or "anonymize" the hour-to-hour care and assistance needed by many of the chronically disabled, but we tend not to. So particular persons are thrust into chronic care-giving, over and above whatever normal life, their own and that of those around them, would require of them.

I am not sure whether these considerations begin to provide an answer to my original question or an explanation of why it does not have an answer. Whichever way we take them, they reveal the unwelcomeness of disability to lie not in the state itself but in its social concomitants. This may not have been obvious at the start of the investigation and so we can possibly record some progress.

References

Barry, B. (1965). Political Argument. London: Routledge and Kegan Paul.

Bennett, J. (1965). "Substance, Reality and Primary Qualities," American Philosophical Quarterly, 2, pp. 1-17.

Brandon, E.P. (1995). "Inus conditions and justification: a case study of the logic of Gutmann's argument for compulsory schooling," in Frans H. van Eemeren, Rob Grootendorst, J. Anthony Blair, and Charles A. Willard (eds.), Special Fields and Cases, Proceedings of the Third ISSA Conference on Argumentation, Volume IV, pp. 539-545. Amsterdam: International Centre for the Study of Argumentation.

Brandon, E.P. (2001). Review of Silvers et al., on the Metapsychology website: http://mentalhelp.net/mhn/bookstore/db.cgi?&uid=default&view_records=1&ISBN=084769223X.

Gutmann, A. (1987). Democratic Education. Princeton: Princeton University Press.

Hoffman, J. and Rosenkrantz, G.S. (1997). Substance: its nature and existence. London: Routledge.

Silvers, A., Wasserman, D., and Mahowald, M.B. (1998). Disability, Difference, Discrimination: Perspectives on Justice in Bioethics and Public Policy. Lanham: Rowman & Littlefield.

Williams, B. (1986). Hylomorphism, Oxford Studies in Ancient Philosophy, vol. IV, pp. 189-199.

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