The perception and understanding of disability has changed dramatically in the last century. Traditionally, the focus of a disability has been on the individual – and that means, the focus has been on the impairment.
So let us begin with – what is an impairment? In the context of mental health, we would identify the impairment to be a ‘mental disorder’ of some kind – not limited to the common diagnoses that we know, but also anything which falls into the definition of what a mental disorder would be – a definition which is by no means, settled. Take definition in the Diagnostic and Statistical Manual’s Fifth Edition, for example:
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (for example, political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”
If we accept this as the understanding of the impairment of a mental disorder, this, in itself, is not a disability. Disability is not an inherent condition, but it is a result of the interaction of two things – the impairment itself, and the barriers that exist around it. What are these barriers? Clearly, every person faces various barriers in their everyday life, it is rare to find an individual with enough privilege to claim otherwise. Is every person, therefore, a person with a disability?
The barriers that are relevant here are those that, firstly, interact with the person’s impairment. What barriers could a person with a mental disorder face? Access to care may be one of them. A lack of understanding of family members and employers may be another. Crowded and cramped public transport may be one as well. These relate directly to the impairment that a person has.
Secondly, these barriers must result in a situation where the person is unable to enjoy full and effective participation in society on an equal basis with others. A lack of access to care means that one is unable to manage their condition in order to function to their own satisfaction, unlike other people who require care for other conditions. A lack of understanding means that a person is not given the accommodation and the space that they may need to function at par with their family members and colleagues. Crowded and cramped public transport means that they have to pay additional costs for private transport unlike everyone else.
This is the social model of disability, which places the focus not on the individual with the impairment, but on the barriers – societal and others – which prohibit the person from living their life in a manner of their choosing on an equal basis with others. Therefore, the focus is not on ‘fixing’ the person’s impairment, but accepting it as part of human diversity, and working on ways to accommodate the individual’s requirements, again, putting them at the centre of such decision making.
Amba Salelkar is a lawyer based in Chennai, with a special interest in disability law and policy