One of the “main ideas” in disability studies is the concept that “disability,” or marginalization in the social sphere, is distinct from “impairment,” or medical limitations. “Disability” becomes the category for things that prevent differently-bodied/differently-brained people from participating in “normal” society, like a lack of curb cuts or intolerance for alternative communication styles like typing or sign language – things that are understood to be changeable (and thus to be the fault of society for not changing). “Impairment,” by contrast, typically describes the underlying body/brain difference that makes the disability relevant, like lower-limb paralysis (thus a need for curb cuts) or deafness (thus a need for communication alternatives to spoken/heard language).
A lot of critics and activists like this distinction. It allows them to advocate for changes without tangling with messy ideas, like challenging our cultural 1:1 correlation between body/brain function and economic value. Getting a curb cut installed feels like real, concrete (pun intended) progress – the further into abstraction we go, the harder “real change” seems to grasp.
My autism would respectfully like to announce that your disability/impairment categories are useless.
Or, if not useless, incoherent. Because here is what I cannot figure out and what more thinking has only made muddier, not clearer: are the body/brain differences we lump under my diagnostic label of “autism” disabilities (social oppressions) or impairments (inherent problems)?
For example: this past summer, I began to learn how to run. Unlike most kids, I didn’t pick this up naturally in childhood, for reasons I suspect fall under the category “autism.” If so, the disability-studies “disability/impairment” approach ought to apply; that is, I ought to be able to determine which reasons-I-never-learned-to-run are social barriers and which are medical “realities.”
But I can’t.
For example: part of the reason I never learned how to run as a child was that my motor coordination and spatial senses were so poor that I couldn’t pull all my disparate, flailing body parts together into a single, working unit. Probably an “impairment,” right?
But this same flailing was also a problem in learning to swim…yet I learned to swim by the time I was twelve years old. I learned to swim when I didn’t learn to run in large part because my cousins, who lived in an apartment complex with a pool and who went to summer camp with me every year, encouraged me to learn to swim. I had social support and positive reinforcement when trying to swim. Running, by contrast, happened almost entirely in school P.E. classes, where I got nothing but scorn from my peers and teachers. This seems like it should fall in the “disability” category: social barriers (ostracism) prevented me from learning to run when social support (encouragement) helped me learn to swim.
But the same cousins who had me swimming by age 12 utterly failed in their attempts to teach me how to dance, despite the same positive attitude and persistence. I didn’t learn to coordinate dance movements or pick up choreography until my mid-20s, despite constant lessons in one style or another beginning at age 6. This is the same time I started trying to run on my own…but running didn’t “kick in” until I was 31.
Which is it?
I have the same questions about language. I’ve written before about the many hurdles to getting words out. But whether not-talking falls under “disability” or “impairment” seems to depend not on the functional difficulty with wording or wordmeaning, but with context. Here, even “impairment” seems to be a category fraught with cultural and political meaning (meanings usually reserved for “disabilities”): is being unable to speak a medical, biological “impairment” when I have no need to desire to speak? Does it matter if I can’t do a thing if I have no need or desire to do the thing?
And if it does matter – if the “problem” is my failure to live up to some human-function “standard,” not whether I can meet my own need/desire – then is not the category of “impairment” defined by the failure to live up to that “standard” not, itself, socially imposed (“disability”)?
And then, if I have a need or desire to do the thing, is my inability to do it a medical “impairment,” or is it a social hurdle? What, for instance, is the role of the “disability as social impairment” category in a situation where I need to communicate versus a situation where I need to speak? The first would seem to be addressable by the “disability” model: a more capacious society would make room for non-speech-based communication, thus meeting my need/desire to communicate without demanding mouthnoises. But a situation where I need, specifically, to produce mouthnoises would seem to fall outside “disability”‘s purview and in “impairment”‘s: no amount of social reorganization is going to help me make mouthnoises if mouthnoises are alien to my brain/body’s sphere of function.
(And, again, if mouthnoises are alien to my brain/body’s sphere of function, is my inability to produce them an “impairment” if there is no external category of “normal” against which that inability is measured? If the only measure is my brain/body’s sphere of function, inability to mouthnoise would seem to be normal, not an impairment. But external functional measures are inescapably social/cultural in nature!)