Unaccounted for: impairments, disabilities, and the social model

I’m sure many people have written about this before, and I think I’ve even touched on it in another post, but I want to share my thoughts about how I relate to the social model of disability. For those unfamiliar with this model (versus the traditional medical model), here is a journal article or a more cognitively accessible description.

So, first off: yes! Yes yes yes, a thousand times yes. We absolutely are disabled by society’s lack of accessibility. This is such a helpful framework for talking about disability justice and changing the world. And at the same time, secondly: the social model doesn’t fully account for all experiences of disability.

This seeming paradox is true even for me as an individual. There are aspects of my disabilities that are essentially societally created – ways that my brain is not accounted for by the systems, institutions, and individuals around me – but there are also aspects that are just sheer intrinsic impairments, things that would still disable me even in a perfectly built anti-ableist world. This is mostly true of my mental illnesses, but also (maybe controversially? at least in some circles?) of my experience of autism.

Sensory processing differences are a significant impairment, for myself and many other autistic people, that can’t entirely be accommodated. The sun may be too bright even with sunglasses, even the quietest train may be too loud despite ear protectors (although I’ll note that I’m currently on a train with layered earplugs and ear protectors and it’s positively glorious), we may have restricted food intake due to taste and texture sensitivities, and our auditory processing might not be very good even in environments with little background noise. Executive dysfunction can also be significantly disabling, even for those of us with access to assistive technology and/or support people. And personally, I just periodically run out of capacity for social interaction. Using AAC helps moderate that, and spaces that use color communication markers help greatly, but I think even if those accommodations were constantly available and affirmed I would still sometimes just not have the spoons (description of spoon theory here) to interact.

My mental illnesses are even more clearly unaccounted for by the social model. I doubt there is any combination of medicines or other psychiatric supports that would permanently prevent the pain and consequences of future bipolar episodes, and I have long since concluded that I am likely to have some degree of disordered eating (and/or associated distress) no matter what treatments I try. It helps prevent mood episodes that I don’t have to work to survive right now, and it would probably help immensely if I had in home supports to help me prepare food in a more normative way, but there aren’t accommodations or societal changes I can think of that would erase these disabilities entirely. Same goes for PTSD – some of my triggers are uncommon enough that they wouldn’t generally show up in a list of content warnings even if the entire world was doing their best to content-warn everything. And even if everyone around me were conscious of loud noises and sudden movements, nature itself (not to mention civilization) is liable to startle me from behind.

Here’s the thing, though – although the social model doesn’t account for these realities, I don’t want to bounce back to the default medical model in order to explain them. Why? The medical model, in my experience, is drenched in value judgements. There is a vile disdain that seeps through when disabilities are discussed simply as diseases and disorders. The negativity goes beyond the innate distress of our impairments and enters a realm of morality, where those of us who experience these impairments are unworthy. Not only does the medical model fail to illustrate the need for societal accessibility, it shapes the vicious ableism that makes disabled people unhireable, undateable, unsupported, and unwanted.

So even where the social model fails to explain my life I refuse to revert back to the medical model to fill in the gaps. want to retain the power to name and describe the ways I suffer, not leave the delineation up to the cisnormative, heteropatriarchal, racist, sizeist, ableist field of medicine. When I say I am disabled, that is a personal identity – shaped by both impairments and societal barriers – that transcends flat diagnostic criteria, insurance codes, and prescriptive cries of “cure!”. I see myself both surrounded by clouds of inaccessibility AND enduring other clouds that exist solely within my own mind. I am not comfortable in the world nor am I comfortable with only myself. There is an ongoing dynamic interchange between these discomforts; neither is absolute or isolated. I will not give my unaccommodatable impairments back to the medical model just because they don’t fit the social. They are MINE. I will carry them forward with me as I carve out a place in the world. The place I am carving might never be easy or enjoyable, no matter what access barriers are torn down. But I aim to make it a place in which my disabilities are acknowledged, accounted for, not as curses or demons or failures or signs that I am not a worthwhile person, but simply as parts of who I am.

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