The deficit view of disability

 

In a recent article published in Disability Studies Quarterly (free online) Janette Dinishak writes about the deficit view of disability. The article is is called ‘The Deficit View and Its Critics’. You can read it by following the link here:

Here is a summary of the article:

The central issue is our understanding and characterisation of difference.

  • The deficit view tends to characterise target individuals or groups  “primarily (or even solely) in terms of their perceived deficiencies, dysfunctions, problems, needs, and limitations”.
  • Critics claim that the deficit view is harmful and “diminishes people’s life chances and even their humanity.”
  • Jannette Dinishak claims an additional harm: the deficit view impedes our pscyhological and philosophical progress in understanding differences like autism.
  • In relation to autism, research has concentrated on “what is wrong” this is posited as consistent with conditions classified as ‘disorders’.
  • In relation to autism, diagnosis and intervention is concentrated on “what is wrong”: “negatively valued deviations from norms” ignoring strengths, gifts and talents.
  • The neurodiversity movement rejects the search for a ‘cure’ as autism is an integral part of the person, and some aspects of autism are positive. Although acknowledging impairments can be negative how they are experienced is often the product of social, political and environmental factors.
  • A deficit view can be characterised as a broad approach where the concentration on deficits influences every aspect of research and reasoning. Critiques interrogate and challenge dominant depictions of autism and propose alternative enabling constructions. A deficit approach is a framework, a way of looking at things that will not change just because of a piece of fresh evidence.
  • A narrower use of the term ‘deficit view’ for autism relates to the cluster of hypothesised ‘lacks’ that explain autism. This is more akin to an empirical claim that can be challenged.
  • Viewing something as a deficit has a normative function, it suggests what someone ought to have. A lack or absence is only problematic if it ought to be there.

“Disability rights movements argue that people with differences such as blindness, deafness, or paraplegia, for example, are not necessarily deficient or impaired. Rather, the question of whether lack of sight, hearing, or a limb constitutes a deficit is person- and context-specific (Silvers 2003). A person with a lack of sight, hearing, or a limb may experience harm or suffering in connection with the lack in some social and material environments but not others. For example, a person in a wheelchair is not disabled with respect to building entry if the building is wheelchair accessible. Thus, not being able to walk is only a deficit in contexts in which walking is the only way to self-locomote.”

  • A deficit is a deviation from the normal. Deviation, whether as lack or excess, is then contrasted with ‘normal’ as both a descriptive standard and an evaluative, or ideal standard and ‘normal’ is an aspirational goal to return to, maintain or aspire to.
  • Medically, pathologies are manifestations of disease. Psychologically, to pathologize devations in mood and behaviour is to treat it as unhealthy. All deficits are necessarily pathologies (as are excesses). A deficit view of autism therefore involves a particular type of pathologization.
  • Three problems with the deficit approach to autism:
    • it may result in overlooking other explanations. For example avoiding eye conduct may result from heightened emotional responses, rather than lack of social connection.
    • There is a moral complacency in accepting the standard of normal, including an acceptance of the values involved in making judgments of what is normal. For example, suffering is part of the diagnosis but there is no clear correlation between autistic deficits and suffering.
    • It leads to deficit terminology – even when no clear deficit is apparent. For example, brain scans are discussed in terms of deficits where the cortex is thicker rather than thinner. High performance in tests are interpreted as by-products of deficits in other functions. Neurotypical comparators are never described as having deficits when they perform lower than autists. This demonstrates that test results are interpreted differently depending on whether a diagnosis of autism is known.
    • These problems can be overcome by researches becoming aware of them and taking steps to address them.
  • Stronger objections to the deficit view:
    • Seeing people in terms of deficits dehumanises them, or at least makes them deficient in a vital quality of being human.
    • Dehumanisation is used to justify oppression, marginalisation and exploitation of alterity. Dehumanisation limits ability to understand and interpret out-group members’ behaviour.
    • Deficit views impede our understanding of the phenomena concerned.
    • Deficit views are quantitative. They compare the absence (and sometimes the excess) of a feature rather than analysing the quality of specific traits and functions. “In an important sense, the phenomenon has no identity of its own, independent from mere quantitative comparison with what is labeled normal.” A deficit approach is therefore conceptually constraining. There become only two options: order and disorder, rather than an alternative order.
    • Some autistic people have called for recognition of their alternative order and positive recognition of qualitatively different states of being.
  • Conclusions
    • Deficit views of ‘others’ have proved historically dangerous. In particular humans are sensitive to classifications made of them and others, they both react to and remake them.
    • Deficit views have been applied to women and people of colour of low social economic status, measured according to a specific standard and explanations for difference explained in terms of a single factors internal to the subject, ignoring multiple and complex external factors. Deficit explanations occasion negative personal and social impacts.
    • Of major importance is the limiting nature of the deficit view. It impedes progress in understanding difference and can lack critical analysis of the relationship between description and evaluation and of the production of ‘expert’ knowledge.

My views:

The deficit view of disability is new to me. It seems to reflect the medical model of disability critiqued by disability rights activists on similar grounds to the criticisms of the deficit view: ‘experts’ (medics, social work professionals, and so forth) are criticised as viewing the person as the cause of the disability and for the framing of disability as negative and atypical.

The idea that viewing ‘otherness’ through a single lens or paradigm precludes progress in understanding is also redolent of debates on equality. For example, both the distributive paradigm of liberal egalitarians and the methodology of ‘luck egalitarians’ have been criticised as producing theory which misses the point.  The blaming of individuals for the difficulties they face in society, without reference to the structural inequalities that constrain some and enable others, and the reinforcing and reproduction of structural relations are points made by feminists like Iris Marion Young and Nancy Fraser.

Where I find this work particularly instructive is in its particular application to autism and the study of autism. Although the author recognises that researchers are capable of self-reflection there nevertheless has been a scramble to understand autism and an uncritical application of theories to individuals on the autistic spectrum. Exposing the harms of deficit views clearly provides a cautionary tale to parents and carers of autists, teachers, medics, employers and others about uncritically accepting expert knowledge and validates those who refuse to conform to limiting stereotypes about who they are.

Looking more broadly at the world of work, again our understanding of the harms of a deficit approach should act as a prompt to see and respond to individual employees as who they really are. Furthermore, the key lessons is that heterogenity is normal and thinking about the qualitative differences between us is more instructive and useful than comparisons of what can or cannot do, have or haven’t got. This may present us with a case for both modifying and universalising our approach to disability.

Employers should not be expecting standard individuals and seeing people who are disabled as some how less and requiring more. Employers should be expecting diversity and that each individual employee will come with different qualities, needs and talents, which will fluctuate and change over time.

 

 

 

 

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Author: Caroline Lambert

I am a postgraduate student at the London School of Economics. My background is in discrimination law. I have a particular interests in disability discrimination and human rights. I fit the Equality Act definition of a disabled person.

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