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Looking into Language: A Study of How Medical Students View Disability
May 31st, 2012 by Rachel Cohen-Rottenberg

In the paper “What does ‘disability’ mean for medical students? An exploration of the words medical students associate with the term ‘disability,’” Margaret Byron and her colleagues discuss a study they carried out to assess the concepts, descriptors, and images that medical students associate with disability. With a twofold purpose of understanding how better to teach medical students about disability and determining whether a short course would change the way that medical students think about the issue, the researchers analyzed the words that students associated with disability before and after a four-day course. They found that before the course, the students tended to use negative and depersonalizing terms associated with loss, victimization, and the medical model of disability (which holds that disability derives solely from impairment in the body), and that afterward, they tended to use more positive terms associated with personal empowerment and the social model of disability (which holds that disability is the result of inaccessible architectural and social environments). While the authors’ research is cause for cautious optimism about the potential of a disability course to change hearts and minds, Byron and her associates fall short of a more rigorous analysis that would move past the problem of language and into the social construction of disability that underlies language. In the study, this problem manifests itself in three ways: in the uncritical assumption that certain words, when applied to disabled people, are inherently positive or negative; in the idea that one should attempt to see the person, not the impairment; and in the ways in which the students interacted with disabled people.

At the time of the study, the lead researcher, Margaret Byron, was a Senior Lecturer in Disability at the University of Bristol and the Project Director for Partners in Practice, where she worked to create equality in healthcare for disabled people; not surprisingly, her aims in the larger world inform the purpose and the methods of her research. For the study, carried out between 1996 and 2000, four sets of students participated in a four-day course taught by fourteen different teachers, eleven of who were disabled. While 381 students began the course, only 189 completed it. Before and after the course, the students wrote down two words that they associated with disability. Two professionals associated with the course used statistical analysis to analyze the words according to frequency of use and a series of dichotomies that consisted of a) symbolic icons versus personal qualities, b) the language of loss and deficit versus the language of empowerment and ability, and c) the medical model versus the social model. The purpose was to discover whether the words the students associated with disability changed after they had participated in the course. In 1999, the researchers also held a focus group before and after the course, in which a small number of students participated in open-ended discussions on disability issues (Byron et al. 2005, 176-179).

The results of the study showed a shift in the students’ associations with disability from concepts embedded in the medical model to those embedded in the social model. Before the course, the majority of the words used ten times or more included words associating disability with pity, difficulty and suffering, while after the course, the majority of the words used ten times or more were associated with empowerment and independence (Byron et al. 2005, 179). Moreover, the dichotomies shifted significantly. The use of depersonalized visual icons to describe disabled people (“wheelchair,” “white stick,” “orange badge,” “bobbles on the pavement”) shifted from 29% of the words to 7%, while terms associated with personal qualities increased (Byron et al. 2005, 180-182). In fact, terms denoting what the authors call “positive” personal qualities (“strength,” “capable,” “real people,” “normal person,” “your average Joe”) increased by 44% and terms associated with what they deem “negative” personal qualities (“dependence,” “inadequate,” “suffering”) decreased by the same amount (Byron et al. 2005, 180-182). In addition, words associated with loss and deficit decreased by 33%, while words associated with empowerment increased by 42% (Byron et al. 2005, 180). The shift was summed up in a 27% decrease in the use of the medical model, and a 39% increase in the use of the social model (Byron et al. 2005, 180). While noting that these changes might have derived simply from the students parroting back new concepts after the course, the researchers conclude that the changes are inherently positive and bode well for future courses on helping medical students view disability differently (Byron et al. 2005, 182-183).

From my perspective, however, a failure to grapple with several core issues makes the researchers’ conclusions questionable. For example, the study suggests that the term “normal person” has positive implications (Byron et al. 2005, 182), while the word “dependence” has negative implications (Byron et al. 2005, 180). But only in an ableist society would the word “normal” carry a positive valence; as Lennard J. Davis points out in “Bodies of Difference: Politics, Disability and Representation,” the concept of normal exercises a great deal of social and psychological tyranny over people’s lives because it is a simply a statistical average and a social construct that cannot be attained by anyone. As Davis writes, the construction of the category of normal creates the marginalization of disabled people:

Under normalcy, no one is or can be normal, just as no one is or can be equal. All have to work hard to make it seem that they conform, and so the person with disabilities is singled out as a dramatic case of not belonging. This identification makes it easier for the rest to think they fit the paradigm. (Davis 2002, 105)

Moreover, only in an ableist society, in which the values of individualism and independence are held in high esteem, could a term like “dependence” take on a negative valence. Dependence on others for help need to not be seen as infantilization, helplessness, or tragedy, but as an indication of the interdependence of all human beings and as a reflection of a basic human need for assistance and comfort. The failure of the study to investigate the implications of these types of words lessens its usefulness is terms of understanding how to change thinking about disability.

In addition to not addressing the ableist implications of words deemed “positive” or “negative,” the authors of the study fail to consider one of the most troubling aspects of the ways in which people have attempted to address the issue of terminology: an insistence upon person-first language. The logic of person-first language is to put the person before the disability; proponents of person-first language use the term “person with disabilities” rather than the identity-first language of “disabled person.” The underlying idea of person-first language is that one should “see the person, not the disability.” The study by Byron and her associates echoes this kind of thinking; in commenting upon the students’ increased use of terms describing “positive” personal attributes, the authors note that this outcome “fit well with the aims of the course, which were that the student should see the person, not the impairment, and should understand the social model of disability” (Byron et al. 2005, 182). However, inherent in person-first language is the implication that disabilities render one less of a person. After all, why say, “See the person, not the disability” rather than “See the person and the disability,” unless disabilities seem somehow dehumanizing? Moreover, person-first language asks the speaker to not see what is already apparent: a difference that has a significant impact upon a disabled person’s everyday experience. This type of denial is not a feature of the social model of disability, whose adherents tend to prefer identity-first language and to be seen as fully human with their disabilities, not despite them (Shakespeare 2010, 268-269). Thus, in their uncritical acceptance of the imperative to separate the person from the disability, the researchers fail to address the negative view of disability that underlies this approach and do not realize the extent to which it conflicts with the social model.

Finally, while the authors seek to break down barriers between medical students and disabled people, they do so in a way that continues to make disabled people seem alien and apart. For example, they provide opportunities for the students to interact with disabled people, but their methods make these visits akin to a special field trip or exhibit. The point of the interactions seems to be for able-bodied students to learn about the patients’ disabilities, not to befriend them, to spend time with them on their own terms, or to learn about their lives as disabled people in an exclusionary society. Instead, the emphasis is medical — which is understandable, given the context, but not particularly useful in terms of changing perceptions of disabled people as simply having defective bodies in need of care. The response by one student in a focus group shows the continued impact of the medical model even after a four-day course based on the social model. The student depersonalizes the disabled people she had come into contact with during the course by referring to them by their disabilities only: “It’s good that you can kind of pick what you enjoy doing. Like today you could have picked either learning, or vision or hearing and you can pick what you enjoy and what you want to learn more about, which is good.” (Byron et al. 2005, 182) In other words, the student learned about the patients’ medical conditions — their learning challenges, their sight, their hearing — rather than about the patients as whole people in a social context.

No amount of changing the language about disability will change the position of disabled people in society without serious attention paid to underlying attitudes. While I applaud the work being done to help people talk about disability differently, that work is only the beginning of a long process of understanding how people think about disability and why. As S.E. Smith writes in “Language Matters, But It’s Not the Most Important Thing,” the issue “isn’t the word, it’s what lies behind it. It’s what the word reinforces and reveals.” (Smith 2011)

Sources

Byron, Margaret, Zoë Cockshott, Hilary Brownett, and Tina Ramkalawan. “What does ‘disability’ mean for medical students? An exploration of the words medical students associate with the term ‘disability’.” Medical Education 39 (2005): 176–183. doi:10.1111/j.1365-2929.2004.02062.x.

Davis, Lennard J. “Bodies of Difference: Politics, Disability and Representation.” In Disability Studies: Enabling the Humanities, edited by Sharon L. Snyder, Brenda Jo Brueggemann, and Rosemarie Garland-Thomson, 100-106. New York, NY: Modern Language Association of America, 2002.

Shakespeare, Tom. “The Social Model of Disability.” In The Disability Studies Reader, edited by Lennard J. Davis, 266-273. New York, NY: Routledge, 2010.

Smith, S.E. “Language Matters, But It’s Not the Most Important Thing.” This Ain’t Livin.’ February 24, 2011. Accessed May 20, 2012. http://meloukhia.net/2011/02/language_matters_language_matters_but_its_not_the_most_important_thing.html.

© 2012 by Rachel Cohen-Rottenberg

Investigating Silences: A Review of “The Rhetoric of Ableism” by James L. Cherney
May 29th, 2012 by Rachel Cohen-Rottenberg

The following is a critical annotation I recently wrote for my graduate coursework.

In his thought-provoking 2011 article, “The Rhetoric of Ableism,” James L. Cherney discusses the ways in which rhetoric creates and perpetuates the ideology of ableism, a set of beliefs and practices that make the able body the sine qua non of human worth and happiness. He argues that discrimination against disabled people is supported by the ways in which ableism is embedded in textual and visual representation, and that the project of deconstructing the rhetoric of ableism must take its place alongside activism that targets specific instances of discrimination. By analyzing ableist rhetoric, Cherney believes, scholars and activists can understand not only how ableism is perpetuated, but also how other forms of oppression are reinforced by similar tropes. He concludes that a thoroughgoing analysis of current rhetoric can result in neologisms that interrupt and transform ableist representations.

The author is an assistant professor in the Department of Communication at Wayne State University, where his areas of specialization include rhetoric and critical theory, particularly with reference to disability and the disability rights movement. In his article, he makes clear his desire to bring his expertise in the field of rhetoric to bear on the discrimination that disabled people face. Given that his interests are political, rhetorical, and ethical, he bases his analysis on the work of two thinkers whose interests mirror his own: Stuart Hall, a rhetorician concerned with the relationship between rhetoric and ideology (Makus 1990, 495), and Stephen Toulmin, a moral philosopher whose work focused, in part, on how human beings construct arguments (Stygall 1987, 96-98). Drawing from Hall’s definition of ideology as “the concepts and the languages of practical thought which stabilize a particular form of power and domination” (Hall 1996, 26, cited in Cherney 2011, 2), Cherney concerns himself with addressing the problem of how to critique ideological claims about disability that are considered self-evident and thereby outside the realm of rhetorical analysis. To address this issue, he begins with Toulmin’s definition of a “warrant” as a “self-authorizing statement” (Toulmin 1984, 46, cited in Cherney 2011, 5), and creates the concept of “rhetorical norms” — knowledge claims that are considered obvious and beyond analysis (Cherney 2011, 5). He then discusses three examples of widely accepted ableist rhetorical norms: “deviance is evil,” “body is able” (a reference to the notion that all ability resides in the body, rather than in the relationship between the body and the social/architectural environment), and “normal is natural” (Cherney 2011, 5-7).

As a writer interested in how language creates culture, a disability-rights activist whose primary mode of activism is the written word, and a person sensitive to the power of language, I am especially interested in the ways that Cherney articulates the problem of ableist thinking as rhetoric that poses as arhetorical, placing itself outside the realm of critique. In Cherney’s view, ableism is an exceptionally difficult ideology to name and to reject because it is “that most insidious form of rhetoric that has become reified and so widely accepted as common sense that it denies its own rhetoricity — it ‘goes without saying.’” (Cherney 2011, 2) For instance, in the minds of most people, it is simply a given that disabled people should become as able-bodied as possible. When attempting to critique such an idea, whose truth appears obvious, one comes up against charges of absurdity, as Cherney found when one of his professors attempted to dismiss his analysis of pervasive ableism with the retort “Next you’ll be telling me that those stairs discriminate!” (Cherney 2011, 4) Of course, the stairs do discriminate — against anyone who cannot walk. Moreover, Cherney addresses the ways in which purveyors of ableist rhetoric pose as value-neutral while leveling the accusation of partisanship at those who critique their rhetoric (Cherney 2011, 4) — a common experience for those of us who critique mainstream scientific or cultural work. I have often found myself stymied as to how to address rhetoric pretending to be above rhetoric; Cherney’s analysis is a reminder that, because all language supports ideological agendas and power relationships, the key is to a) critique how language works to uphold structures of power and b) create expressions that counter ableist representations.

With regard to creative expression, Cherney suggests that, in order to deconstruct ableism, it is not enough to engage in analysis; we must construct a new language. In a particularly apt turn of phrase, he writes, “Identifying ableism requires rhetorical invention, for to critique a rhetoric that goes without saying requires new words.” (Cherney 2011, 8 ) While Cherney lists a number of strategies that counter ableist tropes — disability narrative, critiques of mainstream cultural productions, new disability histories (Cherney 2011, 2) — he does not provide examples of what a new language might look like. However, he opens up the potential for new rhetoric by suggesting that, in our quest for a new language, we will uncover ableist rhetorical norms used against other minority groups (Cherney 2011, 10). While he does not follow up on the implications of analyzing the ways in which disability is deployed against other marginalized people, it seems to me that such a process can, indeed, lead us in the direction of creating the neologisms he hopes for.

Consider the parallels between cultural representations of genderqueer people and disabled people. In popular culture, genderqueer people are not only marginalized as a gender minority, but also by means of ableist rhetoric. For example, as discussed in the Questioning Transphobia piece “Radio Show Hosts Incite Abuse Against Trans Children,” a 2009 Sacramento, CA radio show featured two hosts referring to children with gender dysphoria as “idiots” and “freaks.” In coming up against this rhetoric, one might reflect on why it is used in this context. What is it about genderqueer and disabled people that brings out charges of freakishness? One area of commonality is that both groups are outside the easy dualisms that most people take for granted. Genderqueer people do not fit the gender binary, and this fact calls forth a great deal of hostility, as reflected by the responses to an article about “X” being added as a gender option on Australian passports. As noted in the article “Freaks and Perverts” on the A.E. Brain site, one reader said in response to the new category, “Male or female, that’s it! Don’t confuse yourself with another!” and a second said, “Sorry. Their [sic] are only two genders, male and female. Period. No debate. Deal with it.” This rejection of people who do not fit into an accepted dualistic paradigm brings to mind Robert Murphy’s analysis of the ways in which disabled people occupy a similarly liminal space in society at large, outside of the binaries that able-bodied people take for granted:

The long-term physically impaired are neither sick nor well, neither dead nor fully alive, neither out of society nor wholly in it… They are not ill, for illness is transitional to either death or recovery… The sick person lives in a state of social suspension until he or she gets better. The disabled spend a lifetime in a similar suspended state. They are neither fish nor fowl; they exist in partial isolation from society as undefined, ambiguous people (Murphy 1990, 131).

The fact that so many people feel such visceral discomfort and hostility toward anyone who goes outside of accepted dualisms raises the following questions: Would the problem be ameliorated by creating new language that is non-dualistic? Is it possible to create such language? Can we create new language that communicates ease with ambiguity and acceptance of paradox? And how might we critique the dualities in our own thinking?

Along these lines, it is worth pondering the ways in which Cherney helps to collapse the dualism between theory and practice. He is quite adamant in his view that theory — analyses of rhetoric and the ways in which ableism pervades our thinking — must be integrated into the disability rights struggle, for the simple reason that the ways in which we think about the world and the questions we ask determine the solutions we find. He makes an excellent case for combining the fight against specific instances of discrimination with the struggle against the views that inform them:

Because attacking the target requires forging coalitions with those who may oppose the target for other reasons, this strategically important move can actually help protect the underlying oppressive orientation from discovery, and eliminating the target can be confused with eliminating the oppressive view… Yet naming and calling into question the view itself raises the possibility of altering the very strands out of which the oppressive institutions are spun (Cherney 2011, 9).

Thus, in Cherney’s formulation, disability theory becomes an important component of the disability rights struggle — not simply a precursor or an academic exercise, but an integral part of the process. And certainly, the struggle itself generates its own theories and frameworks; after all, the social model of disability, a term coined in 1983, grew out of the activism of the Union of Physically Impaired Against Segregation (UPIAS) (Shakespeare 2010, 266). A dialectical view of the relationship between theory and practice reveals that practice generates theory, and that theory is part and parcel of practice.

Paradoxically, in its call for new kinds of rhetoric, Cheney’s analysis invites us to investigate the silences that surround the rhetoric we have. If ableist rhetoric is silent about the socially constructed nature of its assumptions, bringing those assumptions out into the open creates the possibility for speaking to the power relationships that underlie them. And given that ableist rhetoric attempts to silence its critics by diminishing their perspectives as partisan and absurd, we must consider all the ways to resist that silencing. Do we push up against it with words alone? With visual representation? Or do we simply assert the undeniable reality of our own bodies?

References

A.E. Brain. “Freaks and Perverts.” http://aebrain.blogspot.com/2011/09/freaks-and-perverts.html. September 15, 2011. Accessed April 23, 2012.

Cherney, James L. “The Rhetoric of Ableism.” Disability Studies Quarterly 31, no. 3 (2011). http://dsq-sds.org/article/view/1665/1606.

Hall, Stuart. “The Problem of Ideology: Marxism Without Guarantees.” In Critical Studies in Cultural Studies, edited by David Morley and Kuan-Hsing Chen, 24-45. London, England: Routledge, 1996.

Makus, Anne. “Stuart hall’s theory of ideology: A frame for rhetorical criticism.” Western Journal of Speech Communication 54, no. 4 (1990): 495-514. doi: 10.1080/10570319009374357.

Murphy, Robert Francis. The Body Silent. New York, NY: W.W. Norton & Company, Inc., 1990.

Questioning Transphobia. “Radio Show Hosts Incite Abuse Against Trans Children.” http://www.questioningtransphobia.com/?p=1443. June 3, 2009. Accessed April 23, 2012.

Shakespeare, Tom. “The Social Model of Disability.” In The Disability Studies Reader, edited by Lennard J. Davis, 266-273. New York, NY: Routledge, 2010.

Stygall, Gail. “Toulmin and the Ethics of Argument Fields: Teaching Writing and Argument.” Journal of Teaching Writing 6, no. 1 (1987): 93-107. http://journals.iupui.edu/index.php/teachingwriting/article/viewFile/835/807.

Toulmin, Stephen, Richard Rieke, and Allan Janik. An Introduction to Reasoning. New York, NY: Macmillan, 1984.

© 2012 by Rachel Cohen-Rottenberg

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