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What I have tried to do in this talk is demystify 'the specialness' of disability. By seeing people with a disability as very different with very special needs, wants and rights in this currently perceived world of finite resources, they are pitted against the needs, wants and rights of the rest of the population such as those who are ageing (Stone 1984). Only when we acknowledge the near universality of disability and its non-medical dimensions will it be possible fully to appreciate how public policy affects this issue. Such a turn-around is easier said than done (Milio 1981).

It is not common to think of the problems of health, disease, and disability on a truly social-political-economic level. While it has long been recognised that access to certain health resources will be affected by social, political, and economic factors, it is less accepted that the very health problems themselves may be created (Navarro 1976; Waitzkin 1983) and even perpetuated (Illich 1976; Illich et al. 1976) by those same forces. It is thus no accident that medicine as an institution (Starr 1982) and medicalisation as process (Conrad and Schneider 1980; Zola 1983) hold such sway in the 20th century. For the focus on the individual disease, the individual patient, the individual treatment becomes at the same time a powerful depoliticiser of all the other external forces (Crawford 1977, 1979; Zola 1972).

The power of an institution is often reflected not in the possession of formal power but in the influence they hold in the minds of the population (Zola 1983). Thus after contact with medical institutions, people, both in and out of hospitals, tend to think of themselves and be thought of by others in terms of their diseases and disabilities (Gartner and Joe 1987; Zola 1986). The first step to changing this situation is when the people themselves begin to question such images and such institutions. The Independent Living Movement (Scoth 1984) has been in place for over a decade, but the first evidence for a changing consciousness on the part of a larger population is only now at hand. In the US the Louis Harris Poll (1986) of a national sample of people with disabilities indicated for the first time the beginning of a kinship across disabilities, the identification with the minority status of black and Hispanics, and a recognition of the long-term denial of their civil rights. I have no idea how widespread such a feeling is but the movement has gone cross-cultural with the formation of Disabled People's International in the early 1980s.

There is at long last a growing recognition from providers of service themselves (Katz 1984; Osberg 1983) and designers of the environment (Lifchez and Winslow 1979; Lifchez 1987) of their role in the creation of past problems and their necessary role in future solutions. Lifchez addresses this issue in architecture but he could as well be speaking to all of us.

Renovating society's house, which is one way to perceive the built environment is a profound work. To restructure the environment so that it responds better to the needs of all people -- not only architects but clients and managers and all others who are concerned with the built environment -- re-evaluate their thinking. All must come to believe that an environment that is more responsive to the needs of 'real people' is not only possible but desirable. Designers operate within a political context, and in order to implement real change, they must be prepared to point out to clients in the public and private sectors that the new standards and provisions for accessibility should not be perceived as unusual or burdensome but rather as the latest requirement placed by consensus on the environment. The architect as visionary must remind others that architecture reflects how society feels about itself, that creating an environment is a dynamic process, and that architecture should express a society's highest aspirations and ideals (Lifchez 1987, pp. 49-50).

Thus to re-examine policy means to re-examine our basic values (Borgatla and Montgomery 1987a, b). The way a society treats its disabled members may be a mark of the quality of life in that society for all its citizens. What such a society need look like is provided in a Swedish plan, aptly called A Caring Society (Secretariat for Future Studies 1982). This is one which emphasises our interdependence while recognising each person's uniqueness and promulgates a concept of special needs which is not based on breaking the rules of order for the few but a designing flexible world for many (Orleans and Orleans 1985). Thus to conclude what is done in the name of disability today will have meaning for all of society's tomorrows.

Abel-Smith, B. (1974), 'Value for Money in Health Services', Social Security Bulletin, Vol. 37, pp. 17-28.

Bernstein, R. A. (1986), 'Backward Thinking about Disability', New York Times, February 8.

Blanpain, J. E. (guest ed.) (1985), 'Advanced Technology and Health Care in the Home', Special Section, International Journal of Technology Assessment in Health Care, Vol. 1, No. 2, pp. 271-393.