Impairment

Impairment is one of the most contested and complicated terms in disability studies, second only to disability itself in terms of multiple definitions and theoretical arguments made around its meaning and significance in the experience and scholarship of the body. It can be traced both chronologically and ideologically, and it continues to be the subject of considerable debate.

The origins of impairment as a term in disability studies may be positioned in the development of documents by such organizations as the Union of the Physically Impaired Against Segregation (UPIAS) in Great Britain and the World Health Organization (WHO). In 1976, UPIAS offered its own definitions, omitting handicap as a term of art and drawing a distinction between impairment and disability: Impairment refers to “lacking part or all of a limb, or having a defective limb, organ or mechanism of the body”; disability refers to the social oppression (whether due to stigma or to restrictions) imposed on people with impairments. The important distinction for UPIAS lies in location: Impairment is located in the body; disability is located in society or culture.

In 1980, the WHO's International Classification of Impairments, Disabilities, and Handicaps (ICIDH, revised in 1993 and again in 2001, when it became the International Classification of Functioning, Disability, and Health, or ICF) distinguished among impairment, disability, and handicap as terms to describe what might be categorized as “nonnormate” bodies. The ICIDH defined impairment as “any loss or abnormality of psychological, physiological or anatomical structure or function.” It defined disability as the lack of ability to perform particular acts or functions in a way that is “normal,” and handicap as the disadvantage(s) resulting from impairment and disability. Like most such classification systems, all versions of the WHO's definitions were criticized from various corners of the scholarly and professional world, often because such critics thought the distinctions either too rigid and unrealistic in representing the overlaps among the categories or because they saw the definitions as lacking in social consciousness or analysis.

From these competing sets of definitions arose a body of scholarship—originating primarily in Great Britain with such writers as Michael Oliver and Tom Shakespeare—that distinguished between a “social model of disability” and a “medical model of disability.” Impairment as a term was assigned to the medical model, which was also seen as positing the location of the body's “problems” within the individual and which looked to such tropes as cure, charity, personal tragedy, and pain and suffering as dominant modes of thought. In some circles, much, if not all, of rehabilitative science and practice came to be understood to be located within the medical model. Thus, impairment, which in its earlier usage might have been viewed as a neutral term (if such a thing can be said to exist), became a negative, oppressive term in this binary of social/medical pairing, if only by association.

Some theorists argued that discussions of impairment (by which they meant the physical, psychological, and cognitive experiences of individuals) should either be eliminated from disability studies discourse or, at the very least, shared only within the disability community “behind closed doors.” Reasons for this argument varied, but they included concerns that any frank discussion of what might be construed as “limitations” might be used to oppress disabled persons even more (i.e., such discussions might be considered evidence that disabled persons really are, in important ways, “inferior” because of their bodies) and might, for example, be used in arguments supporting such things as discriminatory employment practices and physician-assisted suicide. Others feared that too much emphasis on narratives of impairment might depict disabled people as participants in victimology—that such narratives might represent disabled [Page 921]persons as passive, or whiny, or irrational. Later, as the 1990s drew to a close, many of the original theorists of the social/medical dichotomy began to rethink its efficacy, and the term impairment began to be reintroduced in a more wide-ranging set of discursive formations. One of the criticisms of the dichotomy between social model and medical model was that it created an unreal or inaccurate division between impairment and disability; another was that it in some respects was guilty of setting up two “models” where only one group had actually articulated a model—in other words, it is unlikely that physicians and therapists would ever have agreed that they subscribed to all of the things attributed to the “medical model” per se.

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