According to Simi Linton, disability studies serves as “a location and a means to think critically about disability, a juncture that can serve both academic discourse and social change” (1). She also emphasizes the necessity of a sociopolitical analysis of disability, claiming the disability rights movement has “resulted in new paradigms used to understand disability as a social, political, and cultural phenomenon” (2).
While the medical/individual model of disability locates the problem within the individual and focuses on “treating the problem” or finding a cure, the social models locates the problem within society and focuses on eliminating structural or attitudinal barriers (Barnes and Mercer, 11). The social model differentiates between impairment – the individual’s mental, physical, cognitive difference – and disability – the social, attitudinal and physical barriers that prevent an individual from successfully integrating into society (Barnes and Mercer, 12).
This distinction complicates the disorders and conditions presented in the Rose, Talbot and Elliot articles. The social model of disability not only claims disability/disorder/dysfunction to be a social construction, but also criticizes the medicalization of disability and the very act of locating the issue within the individual. What could this mean for the various instances of over-medicalization presented in the articles?
The manifesto of Nikolas Rose’s “Neurochemical Selves” reads: “While our desires, moods, and discontents might previously have been mapped onto a psychological space, they are now mapped upon the body itself, or one particular organ of the body—the brain. And this brain is itself understood in a particular register. In significant ways, I suggest, we have become “neurochemical selves” (188). Thus, human “problems” or “disorders” will increasingly be physically located in the brain, reinforcing the medical model and further discounting the social aspects of difference. Additionally, this movement from abstract DSM categories to physical brain phenomena will facilitate drug marketing and sales. Prescribing rates rose eight-fold in the decade from 1990 to 2000 alone (210). Rose argues “such drugs do not so much seek to normalize a deviant but to correct anomalies, to adjust the individual and restore his or her capacity to enter the circuits of everyday life” (210). I, however, argue that this very ideology only serves to reinforce medicalization and does not succeed to locating the problem outside of the individual. “Correcting anomalies” indicates there is something to correct – to fix – which is the epitome of medical model thinking.
The “Brain Gain” phenomenon (as presented in Margaret Talbot’s piece) is in a sense the consequence of the over-medicalization of “disorders” and the over-distribution of drugs to treat them. I argue this over-medicalization is pushing the standard distribution of the bell curve to the right, raising standards of performance for everyone, and ultimately forcing people to perform even better than typical in order to be “normal.” Enter neuro-enhancing drugs and a competitive society, and it logically follows that everyone feels they need to be popping pills in order to compete. Talbot’s article also addresses the cyclical nature of the identification of disorders, writing “New Psychiatric drugs have a way of creating markets for themselves. Disorders often become widely diagnosed after drugs come along that can alter a set of suboptimal behaviors” (5). Thus, the very creation of ADHD as a disorder legitimizes the alleged “symptoms” and promotes the prescription of drugs to treat it. The ease of acquiring these drugs then fuels the “Brain Gain” issue, which then raises the standard of human performance, and the cycle begins again.
Similarly, the medicalization of shyness as a “social phobia” (as articulated in Carl Elliots’s work) also functions to reinforce the medicalization of conditions and to legitimate stereotypes and stigma. Thanks to its 1987 debut in the DSM III, “social phobia” is now a bona fide disorder that can be diagnosed and treated. Diagnosis implicitly blames the individual, locating the problem within his deficits. Without acknowledging cultural problems and societal attitudes we will not truly treat “problems” such as social phobia as much as legitimize them and fuel the pharmaceutical industry.
In the article “Amputees by Choice,” Carl Elliot discusses what John Money terms “apotemnophilia,” or the attraction to the idea of becoming an amputee (209). From a disability studies perspective, common attitudes towards “apotemnophiliacs” also relate to the medical v. social model debate. If someone without legs would not experience discrimination and difficulty integrating into society, would it be so absurd that someone would autonomously join them? Since society tends to employ the medical model to evaluate the experience disability, we tend to focus on people’s deficits or inabilities as opposed to viewing them as a person like anyone else. If disability were not viewed as a problem to be fixed, society would be les judgmental and critical of those with differences, impairments, and disabilities.
When will a drug be invented to cure societal problems such as physical and attitudinal barriers or stigmatization of difference? Until this occurs, we, as a society, must continue to think critically about human variation and strive to be inclusive as opposed to exclusive and to search for sustainable cures to societal issues. Medicalizing and treating disorders/problems/disabilities with drugs only serves to reinforce the medical/individual model of difference, discounting the real, problematic effects of social attitudes and barriers that probably create these “problems” in the first place.
Barnes, Colin and Geof, Mercer. 2003. “Disability: A Choice of Models” and “Disabling Societies: Domination and Oppression.” In Disability. Cambridge: Polity Press. Pp. 1-41.
Elliot, Carl. 2003. “The Face Behind the Mask” and “Amputees by Choice.” In Better Than Well: American Medicine Meets the American Dream. New York: W.W. Norton and Company. Pp. 54-76, 208-236.
Linton, Simi. 1998. “Reclamation.” In Claiming Disability: Knowledge and Identity. New York: New York University Press. Pp. 1-7.
Rose, Nikolas. 2007. “Neurochemical Selves.” In The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. Princeton: Princeton University Press. Pp. 187-223.
Talbot, Margaret, “Brain Gain: The Underground World of ‘Neuroenhancing’ Drugs.” The New Yorker, April 27, 2009.