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The Oration: Ageing And Disability: Toward A Unifying Agenda

From: Australian Disability Review
Creator: Irving Kenneth Zola (author)
Date: 1988
Publication: Australian Disability Review
Source: Available at selected libraries

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Implicit in all that I have said so far is the notion that disabling conditions are not merely the result of some physical or mental impairment, but rather of the fit of such impairments with the social, attitudinal, architectural, and even political environment. In recent years The Independent Living Movement has grown around this thesis, and its adherents have begun to delineate its implications for social policy (Hahn 1985; Stone 1984). Simply put, some physical differences become important only in certain social environments (reading and writing difficulties in a literate environment, mobility impairments in a sports-oriented society) or at certain times of life (sexual and reproductive issues are less important for the very young and very old, and some for only one gender). The life-cycle theorists are quite aware of this and postulate different issues we must contend with and the resulting disablement if we do not. Yet, many of these theories and the resulting social policies are locked into a grid where the 'final' stage of life begins around age 65. This might have been at least logical when the general lifespan was must shorter; then, each stage took about ten years. But what does it imply when the 'last' stage continues far beyond a decade, with some estimating it could reach well over a hundred. Surely neither society in general nor the individuals involved will tolerate one stage of life that covers half of the lifespan. My sense is that later life is an uncharted map that will inevitably bring new challenges requiring different capacities and evaluations, but also involving new diseases and disabilities.


Thus, while today's chronic conditions may be around for longer periods of time, their quality, scope and dimensions will not be permanent.

The Technological Fix: How much can it help in regard to disability?

There is a premise in the western world (raised, some would argue, to the level of an absolute in the United States and exported to the rest) that with great effort and the right technique, there is no mountain that cannot be levelled, no body of water that cannot be shifted, no force of nature unharnessed. Where medicine was concerned, this philosophy took wing in the age of magic bullets which cured and prevented a large number of infectious disease. The diseases of the late twentieth century do not seem to yield to such once and for all solutions. Medical miracles continue to occur but take more the form of life-extending technologies (Dychtwald 1985). In recent decades these have included organ transplants, bionic and genetic engineering, and enhanced pharmacopeia. One does not have to have been a fan of television's The Six Million Dollar Man' or 'The Bionic Woman' to realise that we are entering an era where almost every human body part and function becomes replaceable, or, at least, assistable by some technical device (Cavalier 1987; McMurray 1987).


The 'societal' commitment to such technologies has some inevitable costs. The publicity generated by artificial heart transplants and electrical stimulation for spinal cord injuries cannot help but divert economic and psychological resources. The glamour of such high tech solutions detracts from the importance of necessary improvements in such low technology aids as wheelchairs and crutches (Dixon and Enders1984; office of technology Assessment 1983), and even hampers the development of ones necessary to daily existence (Enders 1984, 1986). Too often forgotten also is the very long lead-time between the development of these devices or procedures and their eventual wider and cheaper dissemination. Thus, it is unlikely that any of the techniques currently in their earliest phase of development will ever be of use in the lives of the majority of those who currently have major heart conditions or spinal cord injuries. In short, such people need to adapt to their limitations, to enhance their functional capacities, and make changes in their social and physical environment (Bernstein 1986).


Faith in the technological fix encourages belief in the fallacy that all problems have a technical solution, and creates a bias in favour of short-term gains over long-term consequences. It also creates a preference for solving problems that can be measured and described in objective terms over those with more social and phychological -sic- dimensions.


In the most concrete terms this perspective can affect 'independence', the traditional hallmark of success in rehabilitation. This has often been measured by functional performance -- self care, toileting, dressing -- often called 'activities in daily living,' and its philosophy embedded in the instruction to 'use it or lose it' and to push oneself to the limits of one's physical capacity. But living by this measure of independence means engaging in activities only when they can be done under one's own steam. This may be a definition of 'mainstreaming', but it is not necessarily one of 'independence'. Many people with hand-propelled wheelchairs may limit their social activities to those that can be conducted with a range of a few hundred yards, while with an electronic chair their mobility and thus their social life can be measured in miles. The same rationale applies to doing certain tasks by oneself, or with help, or not at all. The Independent Living Movement crystalises very well in this issue (Crewe and Zola 1983; DeJong 1983). Its very philosophy proclaims a new notion of independence, measured not by the mundane physical tasks one can do but by the personal and economic decisions one can make; not by the quantity of tasks one can perform without assistance but the quality of life one can live with help.

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