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From International Socialism
2 : 129, Winter 2011.
Copyright © International Socialism.
Copied with thanks from the International Socialism Website.
Marked up by Einde O’Callaghan for ETOL.
Many young women full of devotion and good-will have been engaged in superficial charities. They have tried to feed the hungry without knowing the causes of poverty. They have tried to minister to the sick without understanding the cause of disease. They have tried to raise up fallen sisters without understanding the brutal arm of necessity that struck them down ... We attempt social reforms where we need social transformations. [1]
Evidence shows the recession in the UK has already hit disabled people hard. [2] The new government’s huge public spending cuts include further attacks on meagre but vital disability benefits. [3] Their aim is to roll-back hard-won ‘social reforms’ affecting all sections of the working class. Understanding the nature of disability discrimination can therefore play a part in defending these reforms and uniting resistance to the attacks which lie ahead.
This article aims to articulate a Marxist approach to the issues of disability and impairment and to begin a debate which is perhaps overdue. Is the discrimination faced by disabled people a form of oppression like that suffered by other minorities under capitalism? What happened to the disability movement and the social model of disability which inspired it? Is it possible – and desirable – to achieve a society free of disability?
Disability is a widely misused and misunderstood concept, as illustrated by the World Health Organisation (WHO) definition:
Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives. [4]
These definitions reflect the progress made since disabled people were referred to officially as spastics, imbeciles and cripples. However, they also obscure the vital distinction established by the disability movement between individual impairment and disability as social discrimination. [5] Leaving aside terminology for the moment, WHO figures do indicate the extent of impairment globally:
Hearing loss, vision problems and mental disorders are the most common causes of disability ... Worldwide, an estimated 650 million people (10 percent of the total population) live with disabilities, the vast majority in low-income and middle-income countries ... A significant proportion of disabilities are caused by traffic crashes, falls, burns, and acts of violence such as child abuse, youth violence, intimate partner violence, and war ... up to one quarter of disabilities may result from injuries and violence. [These] include: physical and/or cognitive limitations due to neurotrauma; paralysis due to spinal cord trauma; partial or complete amputation of limbs; physical limb deformation resulting in mobility impairments; psychological trauma; sensory disability such as blindness and deafness. [6]
The WHO’s 2008 report also highlights mental disorders as among the 20 leading causes of disability worldwide, with depression alone affecting around 120 million people. Fewer than 25 percent of those affected have access to adequate treatment and healthcare. In 2004 the Labour government estimated Britain’s disabled population to be 10 million. The statistics show beyond doubt that a very large number of people are disabled. Second, many of their impairments are socially caused, and third, a large majority of disabled people are poor.
Weaker, older or impaired members of pre-class societies were more likely to survive with the development of settled agricultural production and surplus crops. Feudal societies saw impairment in religious terms, as a mark of either good or evil, which meant those affected often faced persecution. However, the rural production process, and the extended nature of the feudal family, allowed many to make a genuine contribution to daily economic life. Families living and working as large groups were able to provide networks of care for children and the elderly. This way of life, typical for much of the world’s population for thousands of years, was to virtually disappear in the last three centuries.
The rise of capitalism forced people off the land. In Britain production for the market began on a scale sufficiently small as to be carried out in the home, and therefore impaired people could still play a role. However:
the rural population was being increasingly pressed by the new capitalist market forces, and when families could no longer cope the crippled members would have been most vulnerable and liable to turn to begging and church protection in special poor houses. Market forces soon favoured machinery which was more efficient and able to produce cheaper more plentiful woven material. Those working larger looms would more likely survive and cripples would have had greater difficulty working such equipment. [7]
The Industrial Revolution accelerated the pace of change enormously. Larger-scale machinery concentrated in factory towns increasingly destroyed the old cottage industries as well as traditional family structures, with members forced to find work away from the home or patch of land. The new factory worker “could not have any impairment which would prevent him or her from operating the machine. It was, therefore, the economic necessity of producing efficient machines for large-scale production that established ablebodiedness as the norm for productive (i.e. socially integrated) living ... production for profit undermined the position of physically impaired people within the family and the community”. [8]
Working lives previously shaped by the hours of daylight and the seasons were now determined by the rhythm of the factory – even more so with the invention of gaslight and round the clock working. People’s bodies were now valued according to their ability to function like machines:
Factory discipline, time keeping and production norms broke with the slower, more self-determined and flexible work pattern into which many disabled people had been integrated. As work became more rationalised, requiring precise mechanical movements of the body, repeated in quicker succession, impaired persons – the deaf or blind, and those with mobility difficulties, were seen as – and without job accommodations to meet their impairments, were – less “fit” to do the tasks required of factory workers, and were increasingly excluded from paid employment. [The Industrial Revolution] removed crippled people from social intercourse and transformed them into disabled people. [9]
Specialisms were developed to help maintain and reproduce the new working class. Poor Law officials and an expanding medical profession developed pseudo-scientific categories to identify those of the poor who were unfit for work – ”the sick, the insane, defectives, and the aged and infirm”. Dependence on others was now identified as a social problem and impairment equated with sickness and illness. Throughout the 18th and 19th centuries those identified as disabled were segregated into workhouses, asylums, prisons and special schools. This had “several advantages over domestic relief: it was efficient, it acted as a major deterrent to the able-boded malingerer, and it could instil good work habits into the inmates”. [10]
Isolating disabled people in institutions – barbaric and oppressive as they were – led to the intensive study and treatment of impairments, creating the basis for clearer scientific understanding and classification. Mental impairment, for example, was seen as a single category until Langdon Down’s reports for the London Hospital in 1866. These identified, among other conditions, what later became known as Down’s Syndrome. [11]
With labour power now a commodity whose components were separately identified and valued, people with mental health problems were also increasingly categorised and placed in segregated institutions. In 1826, the first year for which statistics are available, fewer than 5,000 people were confined in asylums throughout England. By 1900, this had increased to 74,000. [12]
Capitalism represented a huge advance from previous societies in many ways. For the first time in history the productive capacity existed to feed, clothe and house the entire global population, while scientific and medical advances offered the prospect of understanding and curing diseases. But the new working class creating this wealth were excluded from any say over what was produced and how, suffering for their pains physical and mental impairment on an unprecedented scale. Those marginalised or excluded from production, either by injury or already existing impairments, also became marginalised or excluded from wider society. In this way capitalism created disability as a particular form of social oppression.
Life expectancy in the industrial towns was incredibly short. Manchester’s Medical Officer of Health reported in 1875 that “the average age at death of the Manchester upper middle class was 38 years, while [for] the labouring class [it] was 17; while at Liverpool these figures were represented as 35 against 15”. [13] Cholera epidemics, poor hygiene and sanitation were not only a threat to the poor, and social reformers increasingly saw an unregulated free market as counter to the interests of British capitalism. Charities such as Barnardo’s and the Spastics Society took a growing role in caring for disabled people. Their often wealthy patrons lobbied for state intervention, better standards of treatment, and education for their disabled children.
The years of explosive strikes and growth in trade unions known as “New Unionism” also saw the formation of the British Deaf Association and the National League of the Blind and Disabled (NLBD). Founded as a trade union in 1899, the NLBD affiliated to the Trades Union Congress three years later. [14] Its members (including blind war veterans), mainly working in sheltered workshops, campaigned for better working conditions and state pensions. The league organised a national march of blind people on Trafalgar Square in 1920, carrying banners with a new slogan – “Rights Not Charity”. Despite the small numbers, its aims were widely supported. The first legislation specifically for blind people was passed in the same year, followed by more in 1938. [15]
The upsurge of reforms also led to a reaction from the right. Eugenicists believed that, just as weaker or “inferior” members of a species weren’t meant to survive in nature, they were not meant to survive in a competitive human society. From the late 19th century,
advocates of eugenics ... propagated the myth that there was an inevitable genetic link between physical and mental impairments and crime and unemployment. This was also linked to influential theories of racial superiority, according to which the birth of disabled children should be regarded as a threat to racial purity. In the notorious Buck v. Bell decision of 1927, the US Supreme Court upheld the legality of the forced sterilisation of disabled people ... By 1938, 33 American states had sterilisation laws and between 1921 and 1964 over 63,000 disabled people were involuntarily sterilised ... Whether or not codified into law, the sterilisation of disabled people was common in a number of countries in the first half of the 20th century, including Britain, Denmark, Switzerland, Sweden, and Canada. [16]
Eugenics theory advocated the enforcement of a new concept, “normalcy”, through the elimination of “defectives”. It attracted widespread establishment support in Europe and the US, but was taken to its logical and genocidal conclusion by Hitler’s fascist regime. The extermination of disabled people was the first stage in its plans to “purify” the Aryan race of those considered weak or unproductive:
Nazi ideology considered disability to be a sign of degeneracy and viewed nearly any disabled person as a “life not worthy of life” [or] as [a] “useless eater” ... Compulsory sterilisation for people with disabilities became German law in 1933. More than 400,000 people with disabilities were forcibly sterilised ... A formal killing operation known as Aktion T-4 quickly followed, designed specifically for people with disabilities. The Nazi mechanisms for mass extermination of Jewish victims, such as carbon monoxide poisoning in “shower rooms”, were first developed and perfected through the disability programme. As a result, more than 275,000 people with disabilities were murdered in the Aktion T-4 programme, not counting all those who lost their lives in the concentration camps and after the formal phase of T-4 ended. [17]
The Holocaust was unique in its scale and barbarity, but it was also the product of a system that sees human beings as commodities to be bought and sold – or discarded as insufficiently profitable. As for eugenics, the theory fell from favour only after the nature and scale of Nazi atrocities became known in the years following the Second World War.
The war economy had seen disabled people as well as women – previously considered respectively as incapable of or unsuitable for factory work – play a substantial role in wartime production. The need to rehabilitate huge numbers of wounded servicemen prompted legislation that in practice led to the expansion of existing sheltered workshops, usually paying below minimum wages. The post-war decades, however, brought virtually full employment and high levels of social spending. The foundation of the National Health Service and the expansion of the welfare state boosted further specialism within the professions. Medical advances led to more people living longer, and enabled others to carry out activities of which they were previously incapable:
Of particular importance was the availability of domestic appliances which could be operated with the minimum of physical energy and skill. Teaching a physically impaired person how to go to a well, fetch a pail of water, collect firewood and light a fire to make a pot of tea may have been impossible last century, but teaching a similarly impaired person to fill an electric kettle with water, switch on a button, etc. to make a pot of tea today is well within the accepted aims of modern rehabilitation practice. [18]
The long economic boom created space to challenge institutionalisation and the patronage of charities, with significant numbers of disabled people joining the workforce. By the 1960s some had begun to reject their labelling by the professions as deviants or patients, and to speak out against discrimination. Inspired in particular by the black civil rights struggle, the disability movement began in the US.
The “Rolling Quads”, a group of student wheelchair users at the University of California, established the first Independent Living Centre in 1971. Within a few years hundreds more were created across the US and other countries including Britain, Canada and Brazil. Its opposition to institutionalisation and stress on the self-reliance of disabled people was to give the independent living movement an enduring influence.
Jimmy Carter’s 1976 election campaign pledged his presidency to signing Section 504 of the 1973 Rehabilitation Act. These regulations, incorporating anti-discrimination law into the public sector, were partly the result of years of campaigning by disabled people, which had attracted Vietnam War veterans such as Ron Kovic. [19] In April 1977, as part of a series of nationwide protests against the refusal to ratify Section 504, a group of disabled people occupied the San Francisco Health Education and Welfare Department. The sit-in, whose numbers grew to around 120, attracted widespread support (including from the local branch of the Black Panther Party). After 25 days Carter caved in. It was a stunning victory. The protesters left en masse, singing We Have Overcome. [20] The US disability movement, however, had focused so much on campaigning for Section 504 that it virtually fell apart once it was finally implemented. It was a pattern that was to be repeated.
The UN declared 1981 the International Year of Disabled People. For reasons little to do with the UN, that year turned out to be a turning point. Disabled Peoples’ International (DPI) was formed by 250 disabled people at a conference in Canada, advocating “equal opportunity and full participation of handicapped people in all aspects of society as a matter of justice rather than charity”. [21] DPI urged disabled people to unite in multi-impairment coalitions, and by 1989 had 69 members, each representing national organisations of disabled people. [22]
The coalition that emerged in the UK, the British Council of Organisations of Disabled People (BCODP), had by its mid-1990s peak grown to 106 affiliated organisations representing 400,000 disabled people. [23] Its protests, sometimes involving several thousand people, included a “Rights Not Charity” demonstration at the Department of Health and Social Security in 1988, and two mobilisations against ITV’s Telethon in 1991 and 1992 – the latter putting an end to the notoriously patronising charity fundraiser. BCODP activists were from the outset hostile to organisations “for” (as opposed to “of”) disabled people – primarily the professions and the hugely better-funded disability charities. This was even truer of smaller, more radical organisations such as the Direct Action Network (DAN). However, these principles rapidly gave way to joint campaigns with the big disability charities, on the grounds that the overriding priority was now to secure anti-discrimination legislation similar to that passed in the US in 1990.
John Major’s weakened Tory administration formed a task force to draft new laws. The BCODP refused to participate as a body, but some activists argued they could exert more influence by being involved. [24] The result, 1995’s Disability Discrimination Act (DDA), was widely criticised as both narrow and toothless. New Labour’s landslide election in 1997 led to a new Disability Rights Commission (DRC), which the government pledged would publicise, strengthen and enforce the DDA. The DRC successfully absorbed much of the remaining leadership of the disability movement. [25] The truth is that few activists had an alternative strategy.
The alliance with the charities and New Labour seemed for many disabled people the only way to achieve broader social change. Single impairment charities had long been a vital source of welfare support or social networks. To many, disability was simply a human rights issue: “The principal thing is that we’re getting together ... to make it different in terms of the politics of disability, which is about the rights of individuals; it is about the right to control our own lives”. [26] Many activists saw “able-bodied society” in general as the problem, believing that people who were disabled had different and separate interests from those who were not. DAN activists were most explicitly separatist, seeing all able-bodied people as oppressors. This led to even more divisive notions such as who was “really disabled”. Meanwhile, blacks, gays and women pointed to discrimination against them by fellow disabled activists.
New Labour’s promised reforms effectively neutered the movement. [27] As Oliver and Barnes put it at the time:
[We have seen] the growing professionalisation of disability rights and the wilful decimation of organisations controlled and run by disabled people at the local and national level by successive government policies despite rhetoric to the contrary. As a result we no longer have a strong and powerful disabled people’s movement ... Since the late 1990s the combination of government and the big charities have successfully adopted the big ideas of the disabled people’s movement, usurped its language, and undertaken further initiatives which promise much yet deliver little. [28]
The crucial difficulty, however, was that the disability movement grew in Britain (and elsewhere) during and after a period of defeats for the working class, when other movements of the oppressed had already passed into decline (a fact reflected in the title of one early history, “The Last Civil Rights Movement”). [29] Few activists saw any evidence then that the working class could successfully unite struggles of the oppressed with a shared interest in more fundamental change. As left and right alike within the movement agreed that disabled people needed firstly to organise for themselves, it was inevitable that the politics of identity would increasingly come to dominate those of class.
All this said, the disability movement helped win a wider understanding of the inequalities faced by disabled people, and in doing so achieved legislation addressing that inequality. How successful were these reforms in achieving this aim?
The most significant and best-known anti-discrimination laws of the last 20 years are the Americans with Disabilities Act (ADA) of 1990 and in Britain the Disability Discrimination Act (DDA) of 1995 (with its subsequent amendments). However, the record since their implementation is not impressive. One US observer noted in 1999 that “the unemployment rate of disabled people has barely budged from its chronic 65–71 percent ... in the first eight years [of the ADA], defendant-employers prevailed in more than 93 percent of reported ADA employment discrimination cases decided at the trial court level”. [30]
In 2005 Tony Blair went so far as to pledge full equality for all disabled people within 20 years. [31] Two years later – and 12 years after the passage of the original DDA – the UK government had to acknowledge continuing and “unacceptable” levels of inequality among disabled people. It found that disabled workers earn between 6 and 17 percent less than non-disabled workers. [32] More recent government figures show that among those of working age, fully 50 percent of disabled people are unemployed (compared with 20 percent of non-disabled people) and 23 percent have no qualifications (compared with 9 percent of non-disabled people). People with mental health problems have the lowest employment rates of all impairment categories, at only 20 percent. [33]
The ADA and the DDA share key weaknesses. Both require individuals wishing to pursue a legal complaint to prove first that they have a recognised impairment, with tribunals placing a primacy on medical evidence. Both also place the onus on individual disabled people pursuing – usually at their own expense – court cases which carry no guarantee of success, far less legally binding change.
The fault did not and does not lie solely in the legislation. A report produced by the Public Interest Research Unit on the effectiveness of the DRC found that “neglect of its enforcement powers, along with the difficulties individuals face in taking action themselves, has helped ensure that the majority of discriminators have got away with committing unlawful acts”. [34] There is little evidence that the DRC’s successor, the Equality and Human Rights Commission (EHRC), has performed any better. When Trevor Phillips (notorious for his claims that multiculturalism in Britain was not working) was reappointed as EHRC chair in July 2009, six board members resigned, several blaming the new body’s ineffectiveness under his leadership. [35]
We are often told that the gains of the post-war years have led to “a demographic time bomb”. That so many people are now living longer lives should be a cause for celebration. However, the concern to capital is that a rising proportion of the population cannot be exploited, and constitute a growing economic burden. The huge public spending cuts expected in the wake of the current recession are therefore likely to include further attacks on the living standards – and lives – of old age pensioners, who comprise by far the biggest proportion of the disabled population.
With the closure of the hated institutions and the onset of community care, subsequent debates have focused on how appropriate care can be provided at home, and how disabled people can get more control over the services they use. The disability movement therefore campaigned for government policies based on this philosophy.
John Major’s dying government conceded a system of “direct payments” alongside the DDA in the mid-1990s. The scheme was championed by figures such as Colin Barnes and Jenny Morris, on the basis that disabled people must have choice over how their personal care needs are met – even if this meant further privatisation. [36] Low take-up by local authorities, however, led to a rebranding under New Labour. “Personalisation” obliged the former, from 2003 onwards, to offer “individual budgets” to any applicants for disability-related services. Hopes that user-led organisations controlled by disabled people, particularly Centres for Independent Living, would provide the infrastructure and expertise to help run these schemes proved unfounded. Contracts have instead gone mainly to local authorities, charities or the private sector. [37]
These initiatives have so far led to little real change. One 2009 study found that 60 percent of disabled people with social care needs rely on informal help from relatives or friends to meet those needs. [38]
Over 70 percent of local authorities provide services only to those whose needs are considered “critical or substantial”; the rest are left to go it alone. While our politicians have adopted the language of the Independent Living Movement, users receiving services are lucky to get anything extending beyond being washed and fed. [39]
Labour’s approach has been adopted with a vengeance by the new government. In a keynote speech in July 2010 health secretary Andrew Lansley adopted a familiar slogan of the disability movement: “[Our] guiding principle will be ‘no decision about me without me’ ... We will extend personal budgets, giving patients with long-term conditions real choices about their care”. [40] But the rhetoric is accompanied by budget cuts which threaten the widespread closure of existing services such as day centres and respite care. The cuts are also likely to mean that “the trend towards narrowing the eligibility criteria for support will continue, as demand for social care grows and budgets are increasingly restricted”. [41] Many local care agencies have already been privatised, staffed by typically low-paid and unskilled workers. With further restrictions on disability benefits, individual budgets and/or personalisation are likely to promise meaningful choice or independence only to those who can afford to pay. For most disabled people, they offer instead an increasingly impoverished existence, atomised and isolated in their own homes. [42]
Health and social care services are increasingly provided by “third sector” bodies (voluntary organisations, charities and businesses), with government funding of around £7 billion a year. In 2008 Barnardo’s total income was £253 million, while in 2008–9 Scope received over £100 million and Leonard Cheshire (running care homes and supported accommodation) over £145 million. [43] But these figures are dwarfed by public sector spending: the NHS budget in 2008–9 alone was £100 billion. [44] The fact that most welfare services in Britain are still both free at point of use and (in the main) universally available is considered a major problem by many in the ruling class. The neoliberal solution, which US writer Marta Russell has aptly called “free market civil rights”, is a society of individualised consumers forced to shop around for services no longer run by public authorities, but by charities or private businesses. Much of the present UK cabinet may favour this solution – but they are a long way yet from achieving it.
The pioneering distinction between impairment and disability was first made explicit by a group of disabled socialists in 1976, including anti-apartheid activist Vic Finkelstein. The tiny Union of the Physically Impaired Against Segregation (UPIAS) declared that disability, far from being biologically determined, was a social creation that could be challenged and eliminated:
In our view, it is society which disables physically impaired people. Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and excluded from full participation in society. Disabled people are therefore an oppressed group in society.
Thus we define impairment as lacking all or part of a limb, organ or mechanism of the body; and disability as the disadvantage or restriction of activity caused by a contemporary social organisation which takes little or no account of people who have physical impairments and thus excludes them from the mainstream of social activities. [45]
These “Fundamental Principles” were later developed, principally by Oliver, into the social model of disability. He described it as a “tool for action” rather than a thoroughgoing theory:
[If disability] is seen as a tragedy, then disabled people will be treated as if they are the victims of some tragic happening or circumstance. This treatment will ... be translated into social policies which will attempt to compensate these victims for the tragedies that have befallen them ... If disability is defined as social oppression, then disabled people will be seen as the collective victims of an uncaring or unknowing society ... Such a view will be translated into social policies geared towards alleviating oppression rather than compensating individuals. [46]
As he put it later, this oppression “is ultimately due to our continued exclusion from the processes of production ... The social model of disability is concerned with the personal and collective experiences of disabling social barriers and how its application might influence professional practice and shape political action”. [47]
These ideas turned received wisdom on its head and had a hugely liberating impact on many disabled individuals. The social model played an important role in helping activists, particularly in Britain, understand and challenge discrimination. It won widespread acceptance as the disability movement grew under the Tory governments of the 1980s until the mid-1990s. [48] As the movement receded, however, and hopes increasingly centred on a future New Labour government, the social model of disability began to be identified with a “rights” model centred on achieving legislative change. This “reclaiming” or “rectifying” of the social model often turned into its outright rejection, not least in the growing academia of Disability Studies departments.
The social model met increasing criticism (largely, it is true, from the right) on the grounds that it ignores impairment, a problem claimed to be at least as important, if not more than discrimination in the lives of disabled people. Oliver replied that the social model is “a campaigning aid concentrating on the collective experience of disablement, not the individual experience of impairment”. This wish to avoid divisions is understandable. Drawing on the precedents of the struggles for black, gay and women’s liberation, and rejecting biological explanations of social inequality, Oliver insists that “there is no causal relationship between impairment and disability”. [49]
In his influential book The Politics of Disablement, Oliver attacks the “medicalisation” of disability. This refers to the way disabled people have for many decades been made the objects of oppressive medical practice and research, focused on individual cures and treatment. Refusing to integrate impairment into the social model, Oliver argues the former is a less useful campaigning focus. However, this is to overlook struggles such as those in South Africa for affordable drugs to combat AIDS, as well as others against drugs such as thalidomide or ritalin, which have actually caused impairment. There continue to be fierce debates on the subject of medical cures or therapy among disabled people. The point here is that they are neither the whole answer to impairment nor “incompatible with social change and civil rights”, but that each should be taken on its merits. [50]
Other critiques of the social model highlight its lack of relevance to other forms of oppression, cultural issues or those of representation. These arguments miss the central issue – the social model’s aim was to outline a materialist understanding of disability as a form of oppression that could be fought against and overcome. [51] It dealt a huge blow to the idea that disability was simply about personal tragedy or individual medical conditions. It pointed to major social and economic change as the cause of disability and to further change as its solution. It is therefore on this basis – as a starting point in any theory of disability liberation – that the social model should be examined.
The idea that disabled people are less productive and “able”, and more dependent in general remains common sense, and in capitalist terms is largely correct. Without some form of assistance to compensate for the particular impairment or lack of function, many disabled people are likely to be less economically productive as individuals.
The advanced capitalist societies invest heavily in health, education and social services that help reproduce the labour force (keeping workers skilled, fit and healthy enough to work). Rehabilitating back into the workforce people with short-term impairments or illnesses is relatively inexpensive. But those with more severe long-term illnesses or impairments receive far less priority, as meeting their needs often carries no guarantee of future profits.
All forms of oppression share similarities but also important differences. Discrimination against black people, women, or gays and lesbians is not directly rooted in the way work is organised. Gender, ethnic origin and sexual orientation have no direct bearing on how productive individuals are under capitalism. Other oppressed groups were not and often still are not considered capable of particular kinds of work. But this is not the same as employers wishing to avoid paying the additional costs of hiring a disabled worker, whether in the form of work station adaptations, interpreters, readers, environmental modifications or liability insurance:
[The] root of our oppression is the fact that capitalism sees everything in terms of profit and profitability – and this colours how capitalists view disabled workers. Most employers see disabled employees as a “problem” – something difficult, something different, something that will cost them more to employ. That isn’t to say that capitalists are incapable of realising that disabled people can be a source of cheap labour. So the oppression of disabled people is a reflection of the way in which capitalism reduces everything to profit – effectively, capitalism says disabled people are surplus to requirements. This is especially true in periods of economic crisis – provision for disabled people is always one of the first things to be hit. [52]
Disability discrimination is a distinct but complex form of oppression, based on the (negligibly to substantially) greater expense to capital of the labour power of impaired people. This oppression was not particular to the Industrial Revolution. Disability continues to be rooted in the way the capitalist mode of production subordinates concrete labour (and the concrete labourer) to abstract, interchangeable and homogeneous labour. The very nature of work in capitalist society constantly undercuts any potential for liberation.
The social model’s weakness in relation to impairment needs to be addressed. Limitations or lack of “part of a limb, organ or mechanism of the body” or mental function are the raw material on which disability discrimination works, and as such cannot be divorced from the latter. We have seen how disability is historically and socially determined. But this is also true of impairment. The “particular social and historical context ... determines its nature ... Where a given impairment may be prevented, eradicated or its effects significantly ameliorated, it can no longer be regarded as a simple natural phenomenon”. [53]
The nature and heterogeneity of impairment distinguishes disability from other forms of oppression. Impairments may be physical or mental (or both), single or multiple, temporary or permanent, and acquired before or after birth. They may be mostly invisible, severely disfiguring or incapacitating, painful or even terminal. “The limitations which individual bodies or minds impose ... vary from the trivial to the profound ... The majority of disabled people do not have stable, congenital impairments ... or sudden traumatic lesions (such as spinal cord injury), but instead have rheumatism or cardio-vascular disease or other chronic degenerative conditions associated with ageing”. [54]
Most people don’t fit neatly into two categories of able-bodied or disabled. People with slight visual or hearing defects, for example, can render these almost irrelevant by using spectacles or hearing aids (although they may need to pay for them), but those who are completely blind or deaf face far greater obstacles to social integration. The most severely impaired people are highly dependent on able-bodied support, provided in Britain by six million carers.
Finkelstein raises an associated problem. Disabled people “constantly fear that they may become associated with those that they see as less employable and more dependent. By trying to distance themselves from groups that they see as more disabled than themselves they can hope to maintain their claim to economic independence and an acceptable status in the community”. [55] A more recent study shows that “[both] disabled and non-disabled people regard those with a learning disability or a mental illness as the least desirable groups”. [56]
The issue of who is “really” disabled can be highly divisive. Mike Barratt of the NLBD recalls being told that blind people are not disabled. [57] The disability movement in Britain primarily organised around a fairly narrow stratum of physical impairment and was led mainly by wheelchair users. [58] As one activist with learning difficulties complained, “We are always asked to talk about advocacy and our impairments as though our barriers aren’t disabling in the same way”. [59]
Most disabled people do not actually consider themselves disabled. Department of Work and Pensions research in 2006 found this was true of “around half of those covered by the DDA”. [60] Deaf people pose a particular problem in these terms. Many whose first language is sign see themselves as a linguistic minority, and regard integration as a threat to a history and culture at least 250 years old. [61] Other disabled people may see themselves as impaired, for example, some of those identified as having behavioural or mental health problems who arguably are not, but still suffer discrimination. This highly subjective element is partly why disability, to use a cliché, means different things to different people.
The extent and nature of these differences are other reasons (besides the more fundamental one of timing) why the disability movement attracted neither the opposition nor the scale of mobilisations and involvement experienced by other movements of the oppressed. Disability has no comparable equivalent to Stonewall or the great marches for black civil rights.
Capitalism in general does not scapegoat disabled people in order to divide and rule in the way it does with other forms of oppression. Such discrimination plays a less central ideological role than that of homophobia, women’s oppression or racism. Neither is it generally popular. A recent UK survey, for example, found that 91 percent of people believe disabled people should have the same opportunities as everyone else. [62] Disabled people are often the victims of prejudice and ignorance, but they are rarely targeted solely because of their impairment. Even where this was true, for example, with the mass murder of disabled people in Hitler’s gas chambers, this was not central to the Nazi movement in the way that scapegoating the Jews was. Similarly, bigotry against those with AIDS remains largely linked to anti-gay prejudice. Disability is fundamentally about neglect and marginalisation. Those who defend it ultimately do so using a much more central ideology – capitalism’s need to extract the maximum profit from labour with the minimum possible expense.
David Cameron’s government echoes its predecessor in its approach to “equalities” with a “corporate approach to diversity” which projects an inclusive image but in reality changes little. [63] The DRC, before its recent demise, largely portrayed discrimination in terms of unacceptable attitudes (for example, “See the person not the disability” advertisements). Many disabled people also see individual prejudice and social barriers as the central problem. Some believe further progress depends on strategies such as cultivating “disability pride” or urging more people to “come out” as disabled.
If disability is rooted in the economic organisation of society, real change must involve a new economic organisation of society. If it is not primarily a political or ideological construct, the key cannot be to change attitudes or language, important as these are. Achieving real change requires a power which disabled people alone do not possess.
While the differences may be significant, the experience of other social movements has shown that the common and fundamental problem in attempting to unite an oppressed group is the issue of class. The huge struggles for black liberation turned into demands for black businesses, while the fight against sexism has been appropriated by raunch culture on the one hand and concerns about the “glass ceiling” for a minority of high-achieving women on the other. For gays and lesbians too, genuine equality, despite (as well as because of) the rise of the “pink economy”, remains elusive. Despite legislation outlawing discrimination against these oppressed groups, inequality remains deeply entrenched within the system.
Like its counterparts in the US ruling class, the Economist complained about the potential costs of anti-discrimination legislation:
Everyone agrees that it is desirable to cater for [disabled people’s] needs. But if those needs are treated as rights, the obligation to help them could become limitless ... Rights for the disabled must be balanced against the goal of a competitive economy. [64]
After these initial warnings about its alleged unaffordability, objections to anti-discrimination legislation focused on limiting its provisions, excluding “scroungers” (including alcoholics or drug addicts) and “fakers” deemed undeserving of rights or benefits. This issue of cost underpins most debates about disability, as well as those more generally around the “social costs of labour”. [65] British capitalism needs some social spending in order to compete on the world market. But in recessions this conflicts with demands for reductions in spending, leading to arguments over what and how much is to be cut. [66]
Disability does not impact on all individuals equally. The incidence of impairment is much higher in poorer families. [67] In England people living in the poorest neighbourhoods die on average seven years earlier than those in the richest. The average difference in impairment-free life expectancy is 17 years. So working class people not only die sooner, but will also spend more of their shorter lives as disabled. [68] Secondly, wealthy disabled people can afford to pay for goods and services to compensate for the effects of oppression, in the same way that rich women employ nannies or cleaners. The majority of disabled people have no such option. Their lives are dominated by poverty, poor education and housing – as is the case for most other workers. As Glynn Vernon once said, “[My main problem is] I don’t have enough money, and I don’t have enough sex”. [69]
The greater visibility of disabled people in the labour force means they are more likely to be accepted as workmates, rather than social or economic burdens. In Britain the first disability trade union conference (organised by Nalgo, one of Unison’s predecessors) took place in Hull in 1988. Today disabled members’ sections exist in most British trade unions, with notable efforts to unite able-bodied and disabled workers. Recent trade union campaigns (for example, the PCS’s Public Services Not Private Profit campaign and Unison’s against the Private Finance Initiative/Public Private Partnerships), as well as others such as Keep Our NHS Public or Defend Council Housing, have brought unions together with service providers and user groups, including those of disabled people.
Aids and adaptations originally designed for disabled people have often proved to have much wider benefits. The typewriter, for example, was first invented over two centuries ago to help blind individuals communicate more effectively, while e-mail and internet chat rooms originated with inventions made for the deaf in the 1960s and 1970s. Today dropped kerbs on pavements benefit parents with pushchairs or shoppers with trolleys, closed captions on TV allow hearing viewers to watch in silence, and automatic doors in local supermarkets make access easier, not just for wheelchair users, but for everyone. [70] The principles of “universal design” (products and environments usable by all which need no adaptations) are now increasingly popular in education. [71]
Disability rights for socialists must be part of building a collective working class consciousness. The provision of aids and adaptations in schools, universities and workplaces both helps disabled individuals to participate on an equal basis and builds unity in practice. This means ensuring, for example, that the Disability Equality Duty (DED), limited as its provisions may be, is fully implemented wherever possible. [72] It may also mean defending sheltered workshops such as Remploy, even though we oppose segregation, and defending “special needs” education against cuts, though we believe everyone’s needs are special. [73] Social reforms must be defended – not least in order to show the possibility of winning greater change in the future – but without illusions. Working class disabled people cannot afford to pay for their rights, either in the form of services or legal proceedings to secure access to them. While individual rights are important, they are in the final instance no substitute for collective liberation.
Other social movements helped achieve important legal change, while leaving intact fundamental inequalities. Over three decades after the British Equal Pay Act women’s earnings are still on average 21 percent less than men’s. [74] Disability discrimination too can never be simply legislated away, because, like women’s oppression, it is embedded deeply in the structures of capitalist society.
In its earlier days the disability movement represented and organised those who saw social change – no matter how narrowly conceived – as the key to a better life for all. As UPIAS recognised, disabled people are a minority in society who lack the power to achieve lasting change on their own. Disabled people often in practice express a broader political or class identity, rather than one based purely on disability. The biggest demonstrations on record, the huge mobilisations against the Iraq war, were also the biggest demonstrations of disabled people.
The “festival of the oppressed” has been a feature of every major period of working class struggle, where previously demonised or marginalised groups have championed a common cause. Immigrant workers helped lead movements such as the Chartists and the Wobblies. At the peak of the struggle in Poland in 1980 one hospital doctor related how working class patients discharged themselves, suddenly well enough to join the Solidarność workers’ movement. [75] The Russian Revolution of 1917, which saw women and Jews elected as its leaders, producing new ideas about disability many decades ahead of its time. [76] Just as oppressed minorities rose to the forefront of these struggles, disabled people will be among those leading the revolutions of the 21st century.
The horrors of the past are not simply abstract history lessons. The assumptions of eugenics are still present in claims that human society and behaviour are determined by our genes. Discussing online the death of David Cameron’s disabled son Ivan, senior British National Party activist Jeffrey Marshall complained about “an excess of sentimentality towards the weak and unproductive”, adding later that “there is not a great deal of point in keeping these people alive”. [77] Although such ideas remain largely confined to the margins, this can change quickly. [78] Cuts on a scale unseen since the 1930s are likely to rapidly polarise society, as the media and the government round on the latest scapegoats for the crisis. The coalition’s plans to privatise workplace safety inspections, increase its predecessor’s restrictions on disability benefits and promote the expansion of “special” (segregated) schools will create more impairment and more disability. But attacks on social services, pensions and benefits risk provoking generalised resistance.
From Mumbai to Mexico City, slums similar to those Marx, Engels and Dickens exposed 150 years ago now house an estimated 1 billion people, with poverty creating more disease and opening pathways for epidemics like HIV/Aids. Much of modern capitalism, with its ageing population, service industries and technological advances, differs markedly from the Industrial Revolution. Today’s workforce is as likely to be affected by repetitive strain injury or depression as by other workplace injuries. But the remorseless global drive to accumulate continues to cause disabling accidents and conditions at an unprecedented rate. The essence of humanity, our capacity to reshape ourselves and our world through social labour, remains controlled by a small minority whose sole interest in production is profit. The removal of this exploitation – the most fundamental divide in society – is a prerequisite if humanity is to achieve its liberation.
Marx provided a new definition of meaningful labour:
In a higher phase of communist society, after the enslaving subordination of individuals under division of labour, and therewith also the antithesis between mental and physical labour, has vanished; after labour, from a mere means of life, has become the prime necessity of life ... society [can] inscribe on its banner: from each according to his abilities, to each according to his needs. [79]
A socialist society will not liberate disabled people from their impairments. But eradicating competitive accumulation, the basis for capitalism’s wars, waste and pollution, will also eradicate the source of so much impairment. Simple measures implemented globally, for example, could prevent or cure the vast majority of all visual defects and blindness. [80] In an economy planned and controlled by the majority, science, medicine and social care will be socialised and restructured by providers and users alike. Cooperation on a scale unprecedented in history will provide the basis for a real individualism celebrating diversity difference, and mutual interdependence. Only such a society can significantly reduce both the causes and the effects of impairment – as well as providing an end to disability.
1. Keller, 1913, quoted in Crow, 2000. An iconic figure in the disability movement, Helen Keller is better known for her deafblindness and disability activism than for her revolutionary politics-see Davis, 2003. Thanks for help and comments are due to Iain Ferguson, John Parrington, Julie Devaney, Keir McKechnie, Nicola Owen, Paul Brown, Richard Moth, Rob Murthwaite, Simon Behrman and, in particular, Gareth Jenkins, Joseph Choonara and Pat Stack. I did not always follow their advice, and responsibility for content lies solely, of course, with me. Special thanks to Daniela for her patience and encouragement. This article is dedicated to the memory of Elaine White and Gary Kelly.
2. Independent, 28 December 2009. The report, by Leonard Cheshire Disability, shows disabled people as particularly vulnerable to cuts in public services, both as employees (one in three disabled workers are in the public sector) and as service users. See Disability and the downturn, Leonard Cheshire Disability (4 January).
3. A study by the Institute for Fiscal Studies estimates that benefits reforms will cost 20 percent of current DLA recipients their entitlement. See www.ifs.org.uk/publications/5246
4. Violence and injury prevention, WHO Website.
5. This distinction informs the terms used throughout this article, except where quotes are used. In preferring the term “disabled people”, for example, to “people with disabilities” (the term most used in the US), disability is seen primarily as a social phenomenon rather than something directly arising from each individual’s impairment.
6. Violence and injury prevention, WHO Website.
7. Finkelstein, 1981.
8. Finkelstein, 1981.
9. Russell and Malhotra, 2002.
10. Barnes, 1991.
11. Stratford, 1989, chapter 4. Although a reformer, Langdon Down’s views were shaped by Victorian prejudices. He followed his predecessors in identifying those with Down’s Syndrome as “Mongolians”, a supposed racial group considered “degenerate” by those running the British Empire.
12. Appignanesi, 2008, p. 25. A recent TV documentary put the total UK figure for 1958 at over 150,000. See Mental: A History of the Madhouse, BBC Four, 17 May 2010.
13. Marx, 2003, p. 795.
14. The NLBD merged with the old ISTC trade union in 2000 to form Community.
15. Campbell and Oliver, 1996, p. 40.
16. Russell and Malhotra, 2002. Sweden’s sterilisation programme was only ended in 1975.
17. Disability Rights Advocates, 2001.
18. Finkelstein, 1981.
19. Kovic, subject of his autobiography and Oliver Stone’s film Born on the Fourth of July, has been a key figure in the US anti-war movement for over 40 years.
20. For an accessible history of the disability movement in the US, see Shapiro, 1994.
21. Driedger, 1989, p. 36.
22. Driedger, 1989, p. 89.
23. According to former BCODP director Richard Wood-Campbell and Oliver, 1996, p. 188.
24. The BCODP merged a number of existing disability organisations, and is now the UK Disabled People’s Council. See www.ukdpc.net.
25. Including Jane Campbell and Bert Massie, well-known figures in disability politics. Massie (who had already joined the Tories’ Disability Task Force in 1994) chaired the DRC from 2000 until its disbandment in 2007.
26. Campbell and Oliver, 1996, p. 101.
27. Which is not to suggest there has been no further significant activism. For example, several thousand deaf people marched on parliament in 2003, winning full government recognition of British Sign Language.
28. Oliver and Barnes, 2006.
29. Driedger, 1989.
30. Russell, 1999.
31. Prime Minister’s Strategy Unit, 2005.
33. Office for National Statistics Labour Force Survey, January–March 2009. See Disability and employment statistics, Shaw Trust – Ability at Work Website.
34. Public Interest Research Unit, 2004. An even more damning report on all three equality commissions prior to the EHRC can be found at www.leeds.ac.uk/disability-studies/archiveuk/harwood/tuwnov9.pdf. [No longer available online]
35. Those who resigned included Sir Bert Massie and Baroness Jane Campbell. The remaining members of the board include a CB, another baroness, two CBEs and two OBEs.
36. Barnes, 2007, and Morris, 2005.
37. Contracts to provide services replaced grants as the basis for funding at local and national level. This led to the collapse of many campaigning groups of disabled people (eg Greater London Action on Disability, Greater Manchester Coalition of Disabled People and Derbyshire Coalition of Disabled People). Some turned themselves into service providers, particularly Centres for Independent Living, in an attempt to survive.
38. 2009 Disability Review, Leonard Cheshire.
39. Campbell, 2008.
40. Speech on NHS reforms, 16 July 2010. See Andrew Lansley, Equity and excellence: Liberating the NHS
41. Beresford, 2008.
42. For a more detailed critique of personalisation, see Ferguson, 2007.
43. See About charities
44. Government figures – About the NHS – Both these figures are set to fall significantly with government cuts.
45. UPIAS, 1997.
46. Oliver, 1990, p. 2.
47. Oliver, 1996.
48. Internationally, terminology and detail of definitions have varied and continue to vary. That adopted by the DPI at its 1982 World Council was “a. Disability is the functional limitation within the individual caused by physical, mental or sensory impairment, and b. handicap is the loss or limitation of opportunities to take part in the normal life of the community on an equal level with others due to physical and social barriers” – Driedger, 1989, p. 92.
49. Oliver, 1996.
50. Shakespeare, 2006, p109. Previously a passionate advocate of the social model, Shakespeare became one of its main critics, especially in this nevertheless useful book.
51. Although Oliver himself has stressed that the social model is “not a substitute for social theory” or a “materialist history of disability” – Oliver, 1996.
52. Stack, 2007.
53. Abberley, 1996, pp. 61–79.
54. Shakespeare, 2002.
55. Finkelstein, 1993.
56. Guardian, 21 March 2007. See Research Page.
57. Campbell and Oliver, 1996, p. 96.
58. Campbell and Oliver write that this is because “the obstacles to political participation ... are less severe than for people with other impairments” – Campbell and Oliver, 1996, p. 96.
59. Campbell and Oliver, 1996, p. 97. The issues around mental impairment are complex, and can only be touched on in this article.
60. Quoted in Time to drop the ‘disabled’ label?, Disability Now, November 2006, p. 28.
61. Campbell and Oliver 1996, p. 120. Sacks, 1990, provides a fascinating introduction to the history of sign language and deafness, as well as addressing the issue of deaf people as a linguistic minority. I see no contradiction between accepting this view and still seeing deaf people’s social exclusion as a disability.
62. Much was made of the report’s other main finding-that “90 percent of Britons have never had a disabled person in their house for a social occasion”. While it is true that many disabled people remain socially marginalised, this finding could equally be held to demonstrate how hidden or unacknowledged disability can be. See Disabled people invisible in Britain today, 1 September 2010.
63. Younge, 2010.
64. The price of rights, Economist, 13 August 1994.
65. This is reflected in the DDA itself, with the mainly cost-based justifications for refusing “reasonable adjustments”.
66. At time of writing these have led to government U-turns over axeing free milk for under-fives and the freeze on school rebuilding programmes.
67. Clare M. Blackburn, Nick J. Spencer and Janet M. Read, Guardian, 21 April 2010. See Research article Prevalence of childhood disability and the characteristics and circumstances of disabled children in the UK: secondary analysis of the Family Resources Survey
68. Fair Society, Healthy Lives: A Strategic Review of Health Inequalities in England Post-2010, February 2010.
69. Vernon was the subject of the excellent disability awareness film Stand Up the Real Glynn Vernon (1988).
70. Johnson, 2003, pp. 214–217. Johnson describes the US backlash against disability rights since the ADA.
71. Center for Universal Design, NC State University: Environments and Products for all People.
72. The DED requires that all public bodies “give due regard” to the promotion of disability equality. See www.dotheduty.org. It is as yet unclear how the DED will be affected by the new Equality Act.
73. This is a hotly debated area. The socialist principle is that every need can be fully provided for through fully resourced mainstream education-an important building block towards a properly integrated society.
74. Fawcett Society report quoted in the Guardian, 30 October 2009.
75. Barker and Weber, 1982, p. 148.
76. Vygotsky’s pioneering and influential work, for example, on the education of disabled children.
77. Observer, 31 May 2009.
78. BBC Radio 4 recently hosted a debate featuring arch-reactionary David Marsland proposing that “The morally and mentally unfit should be sterilised” – Iconoclasts, 25 August 2010.
79. Marx, 1875.
80. For the measures and the figures, see Visual impairment and blindness, WHO Website, May 2009.
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