Critically evaluate the Medical Model and the Social Model of Disability, as applied to people with learning difficulties/disabilities

BA LEARNING DIFFICULTIES/DISABILITIES

SESSION: 2009/2010

SEMESTER: One

SUBJECT: Psychological and Social Development (LG0901G)

STUDENT ID: 0905405/0901361

Critically evaluate the Medical Model and the Social Model of Disability, as applied to people with learning difficulties/disabilities. Your answer should address how these models have developed over time.

Within the essay consideration should be given to the place of intelligence and labelling within each model.

Also discuss how each model affects the possibilities for inclusion amongst people with learning difficulties/disabilities.

Submissions must include Harvard referencing.

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'Disabled ' people are thought of by society as being inferior (Bochel et al., 2005); this essay will reflect upon some of the ways in which inequality for people with learning difficulties/disabilities has been explained over time. This concept of discrimination can be explored by questioning what is meant by the term 'disability ', with reference to the ideas broached by both the medical and social models of disability. Consequently, this essay will aim to evaluate how each model has affected the possibilities for inclusion amongst people with learning difficulties/disabilities.

There are diverse views on what the term 'disability ' actually means. The medical model was predominately used to define and explain the term during the 20th Century. It supported the idea that the disabled person was the problem, not society. This model is sometimes referred to as the 'individual model ', because the problem is deemed to be with the individual. In contrast, the social model of disability implies that it is society and an inaccessible environment which disables people, not their impairment (Oliver, 1983).

Medical explanations of disability are supported by 'science ', with the eugenics movement essentially underpinning the medical approach to disability. The eugenics era, with the development of intelligence testing, was when disability was initially 'construed as an undesirable deviation from normal existence ' (Snyder and Mitchell, 2006: 03). Eugenicists seen disabled people as a threat to society, and their aim was to improve the human race by preventing the reproduction of 'defectives ', by sterilising and segregating those classified individuals from society (Barnes, 1991). The social classifications which arose from the movement have had a profound impact on how society views individuals with impairments today. The medical profession fostered such negative perceptions of disability from the eugenics movement, with the medical language of disability soon becoming the social language of insult and ridicule. This subsequently became a cultural tool constructed by society, used to devalue and marginalise specific groups of people (Christensen and Rizvi, 1996). The medical view of disability has therefore also highlighted that those with an impairment are different, with society also stressing this fact.

With society respecting the opinions of those with status, it became perfectly acceptable to exclude people with learning difficulties/disabilities from any decisions made about their lives. Thompson (2000) implies that by drawing on a 'medical model ' approach, and valuing the opinions of an 'expert ', there is a lack of inclusion of the person, with decisions often being made without reference to the individual concerned. In turn, devaluing this group of people from the rest of society, and disregarding any opinions they may have.

Social theory has also been known to mirror the medical view with regards to disabled people, with such individuals being seen as 'less than whole ' (Dartington et al. 1981:126), and unable to conform to society. Such negative connotations, has resulted in disability being perceived as a 'personal tragedy ' (Oliver, 1983). Disabled critics discarded such existing accounts in the social sciences as being irrelevant, 'theoretically backward ' (Abberley, 1987: 5) and resolutely 'disablist ' (Oliver, 1996b). Nonetheless, the 1960s and 1970s analysed disability as a form of social deviance and sickness (Barnes and Mercer, 2003). People were generally scared of those who did not conform to the norm, therefore, disabled people were generally stigmatised, with society viewing disability as 'dysfunctional ' (Topliss, 1982:112). As a result, disabled people were taken away from society, and formed the body of institutions and the like.

Industrialisation had a huge effect on the lives of people with impairments, with medical explanations stimulating the development of provision for disabled people, which saw them being segregated from their communities into institutions such as hospitals, asylums and workhouses. This had a substantial impact on how society viewed people with impairments, with Goffman (1961) implying that they were 'put away ' for their own good, and to stop them from being a burden on society. In other words; out of sight, out of mind.

In addition to this provision, the medical model approach is often used by governments, and social policies are often based on data collection that has taken this approach. Oliver and Barnes (1998) criticise the use of such data collection, and they put forward the idea that classifying and counting disabled people, with reference to the medical model, is a false and inadequate way to define 'disability '. They base their argument on the key point that 'disability ' is a social construct. Also emphasising that the use of the medical approach to aid policy-making is inappropriate, and can also be misleading. As an alternative, Oliver and Barnes propose that social policy makers would gain more by investigating the impact that 'disabling environments ' have on people with impairments. Thus looking more at the social aspects and measuring the extent to which society is disabling people with impairments.

Disabled people themselves have fought for their rights since the late 1960s, with the disability rights movement emerging as a result of their dissatisfaction with mainstream political parties and policy-makers. This brought about a demand for equal rights and full citizenship, and also for 'disablement ' to be defined as a social process, rather than a medical one (Frankenstein, 1981). In the opinion of Oliver (1990) the movement may claim to be the 'new social movement ' (NSM), or more negatively, a 'liberation struggle ' (Shakespeare, 1993).

The Union of Physically Impaired Against Segregation (UPIAS) implied in 1976 that people who have a physical impairment are often excluded from mainstream social activities because of society, thus disabling them. Consequently, it is not their impairment that disables them, but an environment which is inaccessible and discriminatory. In 1983, Mike Oliver referred to this concept as the social model of disability.

The social model was massively important in the British disability movement. It identified a new approach which enabled people with impairments to tackle society and its 'disabling ' environment, with the predominant focus being barrier removal. Whereby, if people with impairments are disabled by society, then the precedence is to dismantle these disabling barriers, in order to promote inclusion. Shakespeare and Watson (2001: 10-11) endorse that 'rather than pursuing a strategy of medical cure, or rehabilitation, it is better to pursue a strategy of social change ', as implied by the social model of disability.

The social model has also impacted on disabled people themselves, for example, Liz Crow (1996) states that 'social model of disability has enabled me to confront, survive and even surmount countless situations of exclusion and discrimination '. Disabled people began to think of themselves in a totally new way, and became empowered to mobilise, organise, and work for equal citizenship. Rather than the demeaning process of relying on charity or goodwill, disabled activists could now demand their rights.

This raised awareness of exclusion and discrimination stimulated legislation, such as the Disability Discrimination Act (DDA) in 1995. Despite its good intensions, a medical approach has been used to help define this. Although the act was developed to help disabled people feel more accepted by society, it has been widely viewed by disability groups as being 'confusing, contorted and unsatisfactory ' (Gooding, 1996).

In 1980, the World Health Organisation (WHO) put across the concept of an International Classification of Impairments, Disabilities, and Handicaps (ICIDH). Based on the medical model, this approach to disability was favoured by medical sociologists. From being involved in the creation of this concept, medical sociologist Mike Bury has defended its use in the field known as 'the sociology of chronic illness and disability ' (Bury, 1997). Bury has been one of the few sociologists to openly engage with the ideas brought about by the social model of disability, even so, he finds little value in them, and states that its main problem is that it is 'oversocialised ' (Bury, 2000: 1074). He brings to light the fact that chronic illnesses such as stroke, arthritis and multiple sclerosis do indubitably restrict and disable people, and that it is not society which imposes these restrictions. Thus, he feels the social model has not produced a coherent approach which can address the real practical needs of disabled people (ibid., 2000). In turn, by not considering the debilitating reality of chronic illnesses, the social model has consequently excluded this group of people from the category of 'disability '.

Both the social model and the disabled people 's movement have frequently been criticised for failing to address diversity. Disabled people 's organisations must consider the wide range of individuals and groups included in the disability category. This includes, for example, those with a learning difficulty, mental health condition, or even people with a chronic or life threatening illness. Shakespeare (1992) sees the identity politics of the disability movement as one of its fundamental failings. With the predominate focus of the movement being geared more towards promoting inclusion and equal rights for those with physical or sensory impairments, it has failed to consider the opinions of others included in the disability category.

In addition, Shakespeare (1992) suggests that the accomplishment of the disability rights movement has been to separate the connection between the physical body and the particular social circumstances of people with impairments, and to focus on what really disables people. This being discrimination and prejudice. 'To mention biology, to admit pain, to confront our impairments, has been to risk the oppressors seizing on evidence that disability is "really" about physical limitation after all ' (ibid., 1992: 40). He seems to indicate that there is an inkling of doubt over disability being contrived solely by society, which is not dissimilar to Bury 's 'oversocialised ' view of the social model ' (Bury 2000: 1074).

Even although, the social model has been criticised for focusing primarily on those with physical or sensory impairments, it has been said that the same principles, with regards to discrimination, can be applied to people with learning difficulties (Shakespeare, 1998). However, as indicated previously, Shakespeare (ibid.) does also express concerns about where those with learning difficulties stand in terms of the social model, along with uncertainty over why learning difficulty appears inconsequential in relation to the disability movement. More often than not, the term 'disability ', when used in disability literature and the like, refers to those with physical or sensory impairments and ignores the experiences of people with learning difficulties. Often supporters of the disability rights movement and the social model believe that impairment can be removed by manipulating society 's views and the environment. When emphasizing this statement, it has been noted that by focusing on a physical impairment which is visible, creates more of an impact (Swain et al., 2004). This may be why intellectual and developmental impairments have often been overlooked in this context. By giving them more consideration, may also consequently highlight the fact that impairment and disability may indeed be linked, thus threatening the philosophy behind the social model and the main thrust of the disability movement.

Despite this, there are those who have strong views on the negative treatment of people with impairments, and lean heavily towards promoting the social model, where it is society and an inaccessible environment that causes disablement, not impairment (Oliver, 1983). Vic Finkelstein is a disabled clinical psychologist and an activist for disability rights, and also a founder member of Union of the Physically Impaired Against Segregation (UPAIS). Finkelstein (1980) contends that disabled people are discriminated against; thus making it difficult for them to gain access to good education and employment opportunities. They encounter stigma, prejudice and social oppression. He and others with similar beliefs have fought to redefine disability in terms of social oppression. Finkelstein states that society should change as the social system fails to take into consideration the accounts of individuals with impairments. He argues that disabled people and disabled organisations should be involved in the decision making process in the planning of services such as welfare, housing, state benefits, education, transport, employment and access to public services. He, like others who support the views of the social model, would like to see the removal of all disabling barriers (ibid., 1980).

As previously discussed, this proposal by Finkelstein is not as straightforward as some activists may claim it to be, as the term 'disability ' relates to such a wide group of people. Similarly, the ideas of 'celebrating diversity ' are not as simple as they seem, as 'disability is a much more complicated issue than recent social models can allow for ' (Norwich, 2000: 111). In terms of psychology, Norwich (ibid.) also indicates that all psychologists, to an extent, conform to a social model way of thinking, stating 'Who doesn 't believe in a social model? ' (ibid., 2000: 111). He sees the divisions between the medical and social models as nonsensical. Indicating that medical models, as intended, should be viewed as hard biomedical models, but despite this, things are made more complicated by there being the more socio-medical models. All undoubtedly very confusing, therefore stressing, how easily the intentions of each model can be misunderstood.

Additionally, Norwich (2000) discusses inclusion in terms of education. He states that 'a good education will address issues of inclusion, equality and participation ' (ibid., 2000: 110), but he also stresses that there are practical and ethical limits in terms of education from the point of view of society and the individual concerned. For example, the expression of personal choices and preferences can often impede upon the education of the individual or group concerned. Nonetheless, with recent consideration being given the ideas broached by the social model, opposed to the medical model, the term 'inclusion ' is commonly being used when referring to education. A truly inclusive system aims to offer equality, entitlement, and effective provision to all children (Wall, 2006). Farrell (2001: 7) states that 'for inclusion to be effective pupils must actively belong to, be welcomed by and participate in a school and community - that is they should be fully included. ' The question being, in terms of the bigger picture; can inclusion be effective for all?

Nonetheless, Rieser (2006) proposes that the 'social model ' has important implications for our education system, and is particularly relevant in extinguishing such prejudicial attitudes towards disabled people, which have been learned through others. This is especially pertinent in primary and secondary schools, as this is the stage where such attitudes of discrimination are initially formed, through contact with the preconceptions and intolerances of other people.

Despite such efforts to move away from the dictatorial approach which has been derived from the medical model, Rieser (ibid.) also makes it clear, from the perspective of someone with a learning difficulty/disability, how such perceptions are still relevant today.

Other people 's (usually non-disabled professionals ') assessments of us are used to determine where we go to school; what support we get; what type of education; where we live; whether or not we can work and what type of work we can do; and indeed whether we are even born at all, or are allowed to procreate.

Rieser (2006: 135)

This is a powerful statement, which emphasises how people are devalued and deprived of voicing their opinion because they are seen as being different and unable to conform to society.

Williams (1991) proposes that by looking to disregard the negative stereotypes portrayed by the medical model, disablement has been viewed by some as if it had nothing to do with the physical body. We could say that the argument over how 'impairment ' differs or doesn 't from 'disability ' could be related to whether or not we see the physical body as having anything to do with disabling individuals. Most legislation conforms to fact that it does, whereas, supporters of the disability rights movement believe that it doesn 't, with the view that it is society which has disabled people with impairments.

There is also the view that although social attitudes and environmental barriers create limits and restrictions upon people with impairments, for example, conversely, there are also certain circumstances where impairment in itself may limit someone 's ability to fit in. Shakespeare (2006) remarks that socio-political accounts of disability have considered that people with impairments do in fact face inherent problems because of their individual deficits. These being over and above the limitations which society and an inaccessible environment present. This is particularly relevant with regards to those with degenerative conditions, where it is difficult to disregard the negative aspects associated with their impairments (Williams, 1999). Carol Thomas (2004) has also considered this concept in relation to explanation of the social model, proposing that in addition to social oppression, disabling aspects can to be attributed to impairment:

Once the term 'disability ' is ring-fenced to mean forms of oppressive social reactions visited upon people with impairments, there is no need to deny that impairment and illness causes some restrictions of activity, or that in many situations both disability and impairment effects interact to place limits on activity.

Thomas (2004: 29)

This again highlights how the way in which people with impairments are acknowledged by society, depends heavily upon how the term 'disability ' is perceived, and whether or not it is related to impairment.

Furthermore, how sociologists explain inequality for people with disabilities fundamentally comes down to how they define and explain the term 'disability '. Medical sociologists, like Bury, have generally taken the view of the medical model, and activists, like Finkelstein and Oliver, have conversely sided more heavily on the social model. There is relevance from both view points to how society and contrived attitudes have aided to discrimination against people with impairments.

Likewise, psychologists view the concept of inclusion for people learning difficulties/disabilities in diverse ways, depending on their general theoretical beliefs. Although Norwich (2000) believes they all tend to lean towards the social model way of thinking, opposed to the medical model, they do all perceive the social model very differently. There is much confusion over the exact focus and possibilities for inclusion in terms of the social model because there are such diverse views on the model itself.

To conclude, it can be observed that both the medical and social models of disability have affected the possibilities for inclusion for people with learning difficulties/disabilities. Initially, fostering a medical approach devalued and excluded people who were different from society. People were negatively labelled and stereotyped because of this way of thinking, and are often still categorised by their impairment for social policies and the like. It can be noted that opinions are slowly changing, with more consideration now being given to the social attitudes and environmental factors which may affect on how someone with a learning difficulty/disability is included in society. Nonetheless, the focus of the social model is still unclear, more notably in terms of people with learning difficulties. Inclusion is obviously important, and is becoming an increasingly relevant at present. For example, within educational settings, a truly inclusive culture enables all students to learn alongside each other. However, this is difficult to imagine without determining some level of additional support. This requires some consideration to be given to the degree in which an individual 's impairment impedes upon their learning, thus, to an extent adopting a medical approach. In addition to people with learning difficulties, the fact that people with mental health problems and chronic conditions are also included in the disability category needs to be given more consideration by both the social model and disability rights movement. Shakespeare (1992) agrees with this, and stresses that the identity politics of the disability movement is one of its fundamental failings. All in all, each model has had an affect on the possibilities for inclusion amongst people with learning difficulties/disabilities.

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REFERENCES

Abberley, P. (1987) The concept of oppression and the development of a social theory of disability. _Disability, Handicap and Society_, Vol. 2 (1), 5-19.

Barnes, C. (1991) _Disabled people in Britain and Discrimination_. London: C. Hurst & Co. (Publishers) Ltd.

Barnes, C. and Mercer, G. (2003) _Disability (Key Concepts)_. Cambridge: Polity Press.

Bochel, H., Bochel, C., Page, R. and Sykes, R. (2005) _Social Policy: Issues and Developments_. Essex: Pearson Education Limited.

Bury, M. (1997) _Health and Illness in a Changing Society_. London: Routledge.

Bury, M. (2000) _On chronic illness and disability_. In: Bird, C.E. Conrad, P. and Fremont, A. M. (eds.) _Handbook of Medical Sociology, 2nd ed_. Upper Saddle River, New Jersey: Prentice Hall.

Christensen, C. and Rizvi, F. (Eds.) (1996) _Disability and Dilemmas of Education and Justice_. Buckingham: Open University Press.

Crow, L. (1996) _Including all of our lives: Renewing the social model of disability_.

In: Morris, J. (ed.) _Encounters with_ strangers. London: The Women 's Press.

Dartington, T., Miller, E. J. and Gwynne, G. (1981) _A Life_ Together. London: Travistock.

Farrell, P. (2001) _Special education in the last twenty years: have things really got better?_ British Journal of Special Education, 28 (1), 3-9.

Finkelstein, V. (1980) _Attitudes and Disabled People_. Monograph number five. New York: World Rehabilitation.

Finkelstein, V. (1981) _Disability and the helper/helped relationship: An historical view._

In: Brechin, A., Liddiard, P. and Swain, J. (1981) _Handicap in a social world_. Hodder and Stoughton: London.

Goffman, E. (1961) _Asylums: Essays on the Social Situation of Mental Patients and Other Inmates_. Harmondsworth: Pelican.

Gooding, C. (1996) _Blackstone 's guide to the Disability Discrimination Act_ 1995. London: Blackstone.

Norwich, B. (2000) Profile. In: Clough, P. and Corbett, J. (eds.) _Theories of Inclusive Education: A Students ' Guide_, 107-111. London: UK Sage Publications.

Oliver, M. (1983) _Social Work with Disabled People_. Basingstoke: Macmillans.

Oliver, M. (1990) _The Politics of Disablement_. Basingstoke: Macmillans.

Oliver, M. (1996b) _A sociology of disability or a disablist sociology?_ In: Barton, L. (ed.) _Disability and Society: Emerging Issues and Insights_, 18-42. London: Longman.

Oliver, M. and Barnes, C. (1998) _Disabled People and Social Policy - from Exclusion to Inclusion_. London: Longman.

Rieser, R. (2006) _Disability equality: confronting the oppression of the past_. In: Cole, M. (ed.) _Education, equality and human rights: issues of gender, 'race ', sexuality, Disability and Social Class_, 134-156. Oxfordshire: Routledge.

Shakespeare, T. (1993) 'Disabled people 's self-organisation: a new social movement? ' _Disability, Handicap and Society_, Vol. 8 (3), 249-263.

Shakespeare, T. (1992) _Renewing the social model of disability_. Coalition.

Shakespeare, T. (ed.) (1998) _The Disability Reader_: _social science perspectives_. London: Cassell.

Shakespeare, T. (2006) _The Social Model of Disability_. In: Davis, L. J. (ed.) _The Disability Studies_ Reader. 2nd edition, 197-204. New York: Routledge.

Shakespeare, T. and Watson, N. (2001) _The Social Model of Disability: An Outdated Ideology_. In: Barnartt, S. N. and Altman, B. M. (eds.) _Exploring Theories and Expanding Methodologies: Where We Are and Where We Need to Go_, Vol. 2, 9-28. Amsterdam and New York: JAI Press.

Snyder, S. L. and Mitchell, D. T. (2006) _Cultural Locations of Disability_. Chicago: The University of Chicago Press, Ltd.

Swain, J., French, S., Barnes, C. and Thomas, C. (2004) _Disabling Barriers Enabling Environments_. London: UK Sage Publications.

Thomas, C. (2004) _Developing the Social Relational in the Social Model of Disability: A Theoretical Agenda_. In: Barnes, C. and Mercer, G. (eds.) _Implementing the Social Model of Disability: Theory and Research_. Leeds: The Disability Press.

Thompson, N. (2000) _Theory and Practice in Human Services_. 2nd edition. Buckingham: Open University Press.

Topliss, E. (1982) _Social Responses to Handicap_. London: Longman.

Wall, K. (2006) _Special Needs and Early Years: A Practitioner 's_ Guide. 2nd edition. London: UK Sage Publications.

Williams, G. (1991) _Disablement and the Ideological Crisis in Health Care,_ Social Science and Medicine, Vol. 33 (4) 517-524.

Williams, S. J. (1999) _Is Anyone There? Critical Realism, Chronic Illness, and the Disability Debate_, Sociology of Health and Illness, Vol. 21 (6) 797-819.

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References: Abberley, P. (1987) The concept of oppression and the development of a social theory of disability. _Disability, Handicap and Society_, Vol. 2 (1), 5-19. Barnes, C. (1991) _Disabled people in Britain and Discrimination_. London: C. Hurst & Co. (Publishers) Ltd. Barnes, C. and Mercer, G. (2003) _Disability (Key Concepts)_. Cambridge: Polity Press. Bochel, H., Bochel, C., Page, R. and Sykes, R. (2005) _Social Policy: Issues and Developments_. Essex: Pearson Education Limited. Bury, M. (1997) _Health and Illness in a Changing Society_. London: Routledge. Bury, M. (2000) _On chronic illness and disability_. In: Bird, C.E. Conrad, P. and Fremont, A. M. (eds.) _Handbook of Medical Sociology, 2nd ed_. Upper Saddle River, New Jersey: Prentice Hall. Christensen, C. and Rizvi, F. (Eds.) (1996) _Disability and Dilemmas of Education and Justice_. Buckingham: Open University Press. Crow, L. (1996) _Including all of our lives: Renewing the social model of disability_. Dartington, T., Miller, E. J. and Gwynne, G. (1981) _A Life_ Together. London: Travistock. Farrell, P. (2001) _Special education in the last twenty years: have things really got better?_ British Journal of Special Education, 28 (1), 3-9. Finkelstein, V. (1980) _Attitudes and Disabled People_. Monograph number five. New York: World Rehabilitation. Finkelstein, V. (1981) _Disability and the helper/helped relationship: An historical view._ In: Brechin, A., Liddiard, P Goffman, E. (1961) _Asylums: Essays on the Social Situation of Mental Patients and Other Inmates_. Harmondsworth: Pelican. Gooding, C. (1996) _Blackstone 's guide to the Disability Discrimination Act_ 1995. London: Blackstone. Norwich, B. (2000) Profile. In: Clough, P. and Corbett, J. (eds.) _Theories of Inclusive Education: A Students ' Guide_, 107-111. London: UK Sage Publications. Oliver, M. (1983) _Social Work with Disabled People_. Basingstoke: Macmillans. Oliver, M. (1990) _The Politics of Disablement_. Basingstoke: Macmillans. Oliver, M. (1996b) _A sociology of disability or a disablist sociology?_ In: Barton, L. (ed.) _Disability and Society: Emerging Issues and Insights_, 18-42. London: Longman. Oliver, M. and Barnes, C. (1998) _Disabled People and Social Policy - from Exclusion to Inclusion_. London: Longman. Rieser, R. (2006) _Disability equality: confronting the oppression of the past_. In: Cole, M. (ed.) _Education, equality and human rights: issues of gender, 'race ', sexuality, Disability and Social Class_, 134-156. Oxfordshire: Routledge. Shakespeare, T. (1993) 'Disabled people 's self-organisation: a new social movement? ' _Disability, Handicap and Society_, Vol. 8 (3), 249-263. Shakespeare, T. (1992) _Renewing the social model of disability_. Coalition. Shakespeare, T. (ed.) (1998) _The Disability Reader_: _social science perspectives_. London: Cassell. Shakespeare, T. (2006) _The Social Model of Disability_. In: Davis, L. J. (ed.) _The Disability Studies_ Reader. 2nd edition, 197-204. New York: Routledge. Snyder, S. L. and Mitchell, D. T. (2006) _Cultural Locations of Disability_. Chicago: The University of Chicago Press, Ltd. Swain, J., French, S., Barnes, C. and Thomas, C. (2004) _Disabling Barriers Enabling Environments_. London: UK Sage Publications. Thomas, C. (2004) _Developing the Social Relational in the Social Model of Disability: A Theoretical Agenda_. In: Barnes, C. and Mercer, G. (eds.) _Implementing the Social Model of Disability: Theory and Research_. Leeds: The Disability Press. Thompson, N. (2000) _Theory and Practice in Human Services_. 2nd edition. Buckingham: Open University Press. Topliss, E. (1982) _Social Responses to Handicap_. London: Longman. Wall, K. (2006) _Special Needs and Early Years: A Practitioner 's_ Guide. 2nd edition. London: UK Sage Publications. Williams, G. (1991) _Disablement and the Ideological Crisis in Health Care,_ Social Science and Medicine, Vol. 33 (4) 517-524. Williams, S. J. (1999) _Is Anyone There? Critical Realism, Chronic Illness, and the Disability Debate_, Sociology of Health and Illness, Vol. 21 (6) 797-819.