Introduction
Disability studies form a critical area of inquiry within social work, offering insights into how society perceives, constructs, and responds to disability. Central to this discourse are the various models of disability, which provide frameworks for understanding causal attribution—explaining the origins or reasons for disability—and responsibility attribution—determining who or what is accountable for addressing or mitigating its impacts. This essay explores how different models, notably the medical, social, and biopsychosocial models, approach these attributions. It aims to discuss their implications for social work practice, particularly in terms of policy, intervention, and the lived experiences of disabled individuals in the UK context. By evaluating the strengths and limitations of each model, the essay will highlight their relevance to fostering inclusive and empowering support systems. The discussion will draw on academic literature and established theoretical perspectives to build a sound argument, considering a range of views to reflect the complexity of disability as a social and personal phenomenon.
The Medical Model: Individual-Centric Causal and Responsibility Attribution
The medical model of disability has historically dominated understandings of disability in Western contexts, particularly within healthcare systems. This model attributes the cause of disability primarily to biological or physiological impairments within the individual. For instance, a person with a visual impairment is seen as disabled due to a specific medical condition, such as glaucoma or cataracts (Goodley, 2017). Consequently, responsibility for addressing disability is often placed on medical professionals who are tasked with diagnosing, treating, or ‘curing’ the impairment through clinical interventions. In this framework, the individual is frequently seen as needing to adapt to societal norms, with little consideration for external barriers.
While the medical model provides a structured approach to identifying and treating specific conditions—often benefiting from advancements in medical technology—it has significant limitations. Critics argue that it pathologises disability, framing it as a personal tragedy or deficit, which can lead to stigmatisation and exclusion (Oliver, 1990). From a social work perspective, relying solely on this model risks overlooking systemic factors, such as inaccessible environments or discriminatory attitudes, that exacerbate the challenges faced by disabled individuals. Furthermore, the attribution of responsibility to medical professionals can disempower individuals, reducing their agency in decision-making processes about their own lives. Despite these critiques, the model remains influential in clinical settings and informs much of the UK’s health policy, such as NHS frameworks for disability care (Department of Health, 2010).
The Social Model: Societal Causal and Responsibility Attribution
In contrast to the medical model, the social model of disability shifts the focus from individual impairments to societal structures as the primary cause of disability. Pioneered by activists and scholars like Mike Oliver, this model posits that disability arises not from a person’s physical or mental condition but from the failure of society to accommodate diverse needs (Oliver, 1990). For example, a wheelchair user may be disabled not by their mobility impairment but by the absence of ramps or accessible public transport. Causal attribution, therefore, lies with social, economic, and environmental barriers, while responsibility is attributed to policymakers, institutions, and communities to dismantle these barriers through legislative and practical changes.
The social model has been instrumental in shaping disability rights movements and policies in the UK, notably influencing the Equality Act 2010, which mandates reasonable adjustments for disabled individuals in workplaces and public spaces (Equality and Human Rights Commission, 2010). From a social work perspective, this model aligns closely with values of advocacy and social justice, encouraging practitioners to challenge systemic inequalities rather than focusing solely on individual adaptation. However, the model is not without critique. Some argue that it overlooks the personal experiences of impairment, such as pain or fatigue, which may require medical or individualised support (Shakespeare, 2013). Nevertheless, its emphasis on societal responsibility offers a transformative lens for social workers aiming to promote inclusion and address structural discrimination.
The Biopsychosocial Model: Integrating Multiple Attributions
Recognising the limitations of both the medical and social models, the biopsychosocial model offers a more integrated framework for understanding disability. Developed in health psychology and later applied to disability studies, this model considers biological, psychological, and social factors as interwoven contributors to a person’s experience of disability (Engel, 1977). Causal attribution is thus multifaceted: a person’s condition may stem from a biological impairment, be influenced by psychological factors such as mental health, and be exacerbated by social barriers like stigma or lack of support. Responsibility attribution is similarly distributed across medical professionals, social systems, and individuals themselves, who are encouraged to participate actively in their care and advocacy.
This model is particularly relevant to social work, as it reflects the holistic approach often adopted in the field. For instance, when supporting a disabled client, social workers might coordinate with healthcare providers for medical needs, provide counselling for emotional well-being, and advocate for accessible housing or benefits, as seen in integrated care frameworks promoted by the NHS (NHS England, 2019). However, the biopsychosocial model can be challenging to implement due to its complexity and the need for multi-agency collaboration, which may be hindered by resource constraints or differing priorities. Additionally, there is a risk of uneven focus, where biological aspects might still dominate due to entrenched medical paradigms in health and social care systems (Shakespeare, 2013). Despite these challenges, its comprehensive nature makes it a promising tool for addressing the nuanced realities of disability.
Implications for Social Work Practice
The varying approaches to causal and responsibility attribution in these models have profound implications for social work practice in the UK. The medical model, while useful for accessing clinical support, may limit social workers’ ability to address systemic issues, often positioning them as mediators between clients and healthcare systems. Conversely, the social model empowers social workers to advocate for structural change, aligning with professional values of equality and empowerment, though it may downplay individual needs that require medical intervention. The biopsychosocial model, arguably, offers the most balanced approach, enabling social workers to tailor interventions to both personal and societal dimensions of disability. For example, in supporting a client with a learning disability, a social worker might combine personal skill-building strategies with efforts to secure inclusive education or employment opportunities.
Moreover, understanding these models equips social workers to critically evaluate policies and practices. The UK’s Care Act 2014, for instance, reflects elements of the social and biopsychosocial models by emphasising person-centred care and local authority responsibility for meeting needs (Department of Health, 2014). However, funding cuts and service gaps often undermine these ideals, highlighting the need for continued advocacy. Generally, social workers must navigate these models with an awareness of their strengths and limitations, ensuring that neither individual nor societal factors are neglected in their practice.
Conclusion
In conclusion, models of disability provide distinct yet interconnected explanations of causal and responsibility attribution, each with unique implications for social work. The medical model focuses on individual impairments and medical responsibility, offering precision in treatment but often neglecting broader societal factors. The social model, by contrast, attributes disability to societal barriers and places responsibility on systemic change, though it may overlook personal experiences of impairment. The biopsychosocial model integrates these perspectives, promoting a holistic understanding but posing challenges in application. For social work practice, these models collectively underscore the importance of balancing individual support with structural advocacy to foster inclusion and empowerment. As the field continues to evolve, social workers must critically apply these frameworks to address the complex, multifaceted nature of disability, ensuring that both personal and societal dimensions are adequately considered in policy and practice. This nuanced approach is essential for advancing the rights and well-being of disabled individuals within the UK context and beyond.
References
- Department of Health. (2010) A Vision for Adult Social Care: Capable Communities and Active Citizens. UK Government.
- Department of Health. (2014) Care Act 2014. UK Government.
- Engel, G. L. (1977) The need for a new medical model: A challenge for biomedicine. Science, 196(4286), pp. 129-136.
- Equality and Human Rights Commission. (2010) Equality Act 2010. UK Government.
- Goodley, D. (2017) Disability Studies: An Interdisciplinary Introduction. 2nd ed. London: SAGE Publications.
- NHS England. (2019) Integrated Care Systems. NHS England.
- Oliver, M. (1990) The Politics of Disablement. London: Macmillan.
- Shakespeare, T. (2013) Disability Rights and Wrongs Revisited. 2nd ed. Abingdon: Routledge.
