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Attitudes Towards the Disabled: “Disabled Doesn’t Mean Unable”
by Miriam Struck
Miriam Struck is a long term member of Science for the People. She is an occupational therapist currently working with high risk infants and developmentally disabled adolescents in Washington, D. C.
Disabled people are handicapped not by their limitations, but by attitudes of able bodied people. Attitudinal barriers are, as one disabled person has said, “the worst barrier that I have had to overcome.”‘ They are the most formidable because they are expressed in every day experiences with the able bodied and in the services provided to the disabled.
Disabled people have been called the hidden minority.1 There are an estimated 36 million disabled people in this country according to the 1970 U.S. Census. This includes children and adults, the physically disabled, the mentally ill, the mentally retarded, the visually impaired, the hearing impaired, the temporarily injured, and those with chronic disorders.
This article will provide an introduction to disabled people’s struggle to live full lives. As an able bodied therapist, I cannot know what it is like to be disabled in a society that requires normality. I can, however, try to understand. Most of my experiences with disabled people have been within the context of services provided in hospitals and schools for disabled children. This article will discuss the medicalization of services for the disabled. In particular, it will emphasize the negative attitudes of many health care professionals and how they affect integration of the disabled into society. Finally, it will provide examples of struggles of disabled people in the social sphere.
Social Attitudes Towards Disabled People
The disabled can best describe what it is like to be discriminated against because of disability. The following are a few personal accounts:
Fifty-five years of my life have been spent on crutches and at times in a wheelchair. Access to public and private places has always presented untold problems.2
I went to a restaurant and was seated in a banquet room by myself. I said, ‘Gee, I’d kind of like to be in the other room with the rest of the people, it wasn’t crowded in there. I always wanted to be honored at a banquet, but it loses something without the audience.’ The manager made this crack that, well, he didn’t want the other customers to be frightened.3
Nothing angers me more than when I’m clothes shopping and the sales lady doesn’t talk to me but will talk to my mother. People do that constantly to me. They think I can’t talk and am not responsible for myself.
As a disabled individual, I learned quickly that acceptance of myself depended on how well I could assimilate into a non-disabled world. I felt isolated and insecure when I met with situations in which I couldn’t compete and win in the same ways that other people did.4
The few disabled individuals who make it in the able-bodied world are greeted with patronizing praise–despite their disability they accomplished something. Helen Keller is a good example. Few people know that she was exploited. For a period in her life she was forced to make a living as a vaudeville act. Her political convictions and tireless crusading for socialism are seldom recognized. She wrote books and articles on socialism, notably, Out of the Dark, now long out of print. Yet those facts are obscured by the media; Helen Keller is portrayed as yet another courageous disabled person struggling to overcome her limitations.
The majority of disabled people are not ”success stories.” They are just people trying to survive in an able-bodied world.
Surviving in the Medical System
The medical system impacts upon every aspect of a disabled person’s life. A medical diagnosis and determination of future problems, for example, are often required for an individual to qualify for state vocational rehabilitation services. These examinations are also absolute requirements for consideration for Social Security Disability (SSDI) Benefits. Often, a person trying to keep their SSDI must submit to dehumanizing medical evaluations.
The medical model of treatment in which a patient enters sick, allows things to be done to them, and leaves cured, does not fit with disability.5 This model of treatment fits best with acute, life threatening illnesses. Nonetheless, the model is often applied to the disabled. The disabled do not “get well.” They are not cured.
Services for the disabled are usually provided within the confines of rehabilitation units in hospitals or centers sponsored by hospitals. Treatment is typically organized into a hierarchical team with a doctor as prescriber and director of treatment and allied health personnel, such as physical therapists, occupational therapists, nurses, and social workers as providers of direct treatment.6
A typical length of stay in a rehabilitation unit is three months. This is due to funding restrictions of third party payers, such as commercial health insurance companies and Medicare. Experiences vary from person to person and center to center. Usually a client is assigned a treatment team on their first day in the unit. Treatment is geared toward enabling the client either to become more manageable for others or to take care of their every day needs such as feeding, dressing and operating a wheelchair. Each team member provides bits of training to meet these goals. Nurses usually take care of the client’s medication and personal care such as hygiene. The physical therapist can provide strengthening exercises for mobility. The occupational therapist generally concentrates on promoting strength and coordination of the arms and hands. In addition, she/he retrains the patient in activities necessary for daily life, such as dressing, feeding and cooking. Three months of lifting weights, sanding blocks, taking off and putting on one’s shirt, and stacking cones everyday can be monotonous and boring. As one client told me:
I found occupational therapy a waste of time, I guess, because it was so frustrating. I couldn’t see results fast enough. I couldn’t see I was getting better.7
Attitudes in the Rehabilitation Unit
Attitudes toward the disabled affect the relationship between therapist and client which affects the services provided. The attitudes of fifty rehabilitation professionals were surveyed by Singleton, Cole and Long.8 The sample included nurses, psychiatrists, and occupational therapy professionals and fifteen spinal cord injured patients. The respondents were asked to rate their own attitudes toward spinal cord injured individuals and to rate perceived attitudes of members of each discipline. The results showed that the negative attitudes toward the disabled that are evident in society are also held by rehabilitation professionals. However, these professionals do not perceive themselves or their colleagues to be generating negative attitudes. They think the problem is in other disciplines and in the general public. A professional who has negative attitudes toward disabled people will probably not participate in programs to change treatment approaches or public attitudes.
An example of negative attitudes of rehabilitation personnel is the interpretation of a patient’s refusal to participate in predetermined treatment programs. They label them “noncompliant,” “hostile,” “unmotivated,” or “disinterested.” The rehabilitation personnel interpret lack of motivation as something internal to the individual, a personality trait. They do not examine the few rewards they offer in the rehabilitation setting.
The organization of the hospital is a deterrent to patient motivation and participation. The hospital system prevents patient participation in decision-making and allows little automomous, self-directed behavior. Within the hospital, motivation is often synonymous with cooperation with staff-determined goals.
By continually planning for the rehabilitation client, not completely informing them of their options and conditions, professionals place the patients in a position analogous to childhood.9 Every aspect of the clients’ lives are subject to therapeutic control, inspection and interpretation. The hospital environment is essentially one of deprivation. The patient is put through the motions of habit training within a social vacuum. The rehabilitation client becomes frustrated at the double message given by rehabilitation personnel–we make the decisions but you have to be independent. Some clients are not given complete information on their disabilities and their treatment program. Overtly, they are expected to accept responsibility for self-care, yet covertly they are not included in the decision-making process regarding their own bodies.
Some rehabilitation personnel make the erroneous assumption that complaints concerning treatment emanate from individuals denying their disability and displacing their hostility onto the rehabilitation system. But these people have accepted responsibility for their own lives and rightfully resent any efforts to interfere with them.10 A patient who rebels against treatment is highly motivated.
Rehabilitation programs are viewed by rehabilitation personnel as preparation for community life. Frequently, disabled people are sent back into a world which does not care about them and is not designed for them. This world prevents them from doing some of the most simple activities of daily life.
The Employment Blues
Occupational therapists know how important work is to their client’s self-esteem, social status and economic independence. Yet we can do little to help them get a job. Vocational services are poorly funded or nonexistent. At this writing, the recent budget cuts have completely eliminated all funds for vocational rehabilitation. Job training cannot be adequately provided in the hospital. To compound problems, attitudes and economic conditions make the disabled unlikely to be hired
A quadriplegic woman described her employment problems this way:
I would like to work but there are so many barriers that I have to overcome first. I’d need someone here every day to help me get up, dressed and toileted. I would need an attendant at work to take me to the bathroom and feed me. I would lose my social security and Medicaid. Transportation is also a problem. My vocational counselor actually said to me, ‘Are you able to do it?’ Well, that depressed me even more.11
Surveys done in 1972 by the Social Security Administration showed that only 6% of the severely disabled were employed full time. Severely disabled men had a one in five chance of securing part-time employment, and less than one in seven chance of securing full time employment. Only one in ten women were working full time.12 Labor market success is further reduced for the following reasons: employer preference for the able bodied when available; employer belief that the disabled create higher costs for medical premiums and worker’s compensation; employer fear of involuntary absenteeism and turnover; and social stereotypes of the disabled. These conditions force the disabled to compete among themselves for the limited number of jobs available to them. Macroeconomic conditions have a tremendous impact on an entire population trying to secure jobs. The health of the economy affects everyone, but the impact is greatest for those groups in the labor force that are least prepared for work and least desired by employers.
The contradiction of this discrimination became evident during World War II. Disabled workers were recruited and hired to take the place of able bodied workers who were off fighting. An estimated 80% of U.S. industries hired the disabled. Lower turnover and absenteeism, fewer accidents and higher production rates were reported for this period. Nonetheless, the disabled were quickly fired and replaced with able-bodied veterans at the end of the war.13
Over the last twenty years some legislative changes have facilitated disabled entrance into the workplace. The Architectural Barrier Act of 1968 and the Rehabilitation Act of 1973 and its Section 504 provide some rights and protection against abuses of the past. The disabled should be credited for their struggles and protests to get these bills passed.
Section 504 stipulates the hiring of, “qualified handicapped individuals who are capable of performing activities required by the job with reasonable accommodation. – 14Reasonable accommodations can include making the building accessible with ramps and elevators, lowering drinking fountains, rearranging work stations, and providing readers or interpreters. Many employers resist these modifications. They claim it will cost too much or cause their able bodied workers to leave. A study by Du Pont in 1973 disputed these beliefs. The study showed that: the cost in adjusting work areas was minimal, the accident rate did not go up, able bodied employees did not resent the “special” treatment the disabled received, attendance was high, and job performance was better or average as compared with able bodied employees.15 Rosanne Bright, a physically disabled woman, writes:
It is apparent that (abled bodied employers) do not realize that many of us cannot function in their world without reasonable accommodation. The great question is, does society want to pay us to be non-contributors because of the things we cannot do (SSI, food stamps, etc.) or are they willing to pay us for the contributions that we can make?16
These acts are under threat of repeal because of the antiregulatory fever in Washington. The Architecture and Transportation Barriers Compliance Board, that was created to set and enforce general standards for compliance, is slated for extinction by the Office of Management and Budget. Recently, the board was pressured by the Administration to throw out the guidelines they have been working on for the last 20 months. The Administration won. A representative for the disabled on the board angrily said:
There is no difference between putting up a sign that says ‘Whites Only’ and putting steps up, effectively saying ‘Able Bodied Only’ … I guess the federal members of this board are prepared to let into federal buildings only those handicapped people who can climb Mount Ranier.17
The Education for All Handicapped Children Act of 1975 (P.L. 94-142) placed disabled children in class rooms with able bodied children. The advantages are great for both groups. Disabled children are not institutionalized and are provided with “free and appropriate education in the least restrictive environment.”18 They are thus provided with the knowledge and experiences necessary to live productive lives. Able bodied children learn that the disabled are not freaks and are not to be feared. Yet, for all its advantages, P.L. 94-142 is threatened with repeal and drastic reduction in funding.
Reaching Across the Barriers
For those of us who are able bodied, we can try to understand and support the struggles of the disabled. I would like to see rehabilitation workers get involved in alternative forms of services. One example of this is the new community adjustment program provided by United Cerebral Palsy of Pittsburgh. At this program, disabled people both teach and take classes from each other to develop skills to survive in an able bodied world. At this writing, the program is threatened by the recent budget cuts.
Able bodied people should take the advice given by one disabled woman:
Nondisabled people must move beyond their fears and hesitations about building warm, close relationships with disabled people. They must begin to ask the questions that will provide them with the answers and the information needed to understand disabilities and disabled people who have the same needs, desires, goals and fears as they do.19
Although negative attitudes towards the disabled constitute ominous barriers, changing those attitudes is not easy, and is not enough. Those attitudes have a long history and they are the consequence of economic and political decisions. Eliminating requirements to make transportation systems and buildings accessible automatically isolates the disabled, forcing them back into the attic. Denying them job protection and educational and medical benefits perpetrates their economic oppression.
Political activism on the part of the disabled and able bodied rehabilitation professionals and friends of the movement is critical. Only through such activism can we force society to accept responsibility for the disabled.
- Kleinfield, S. The Hidden Minority-America’s Handicapped. New York: Barnes and Noble, 1979.
- Alden, P. Letters to the Editor. Washington Post June 11, 1981.
- Kleinfield, S. op. cit. p. 13.
- Summers, L. Letters to the Editor. Washington Post June 17, 1981.
- Meyers, J .K. “Consequences and Prognosis of Disability,” in Sussman, M. (ed.) Sociology and Rehabilitation. Washington, D.C.: American Sociological Association, 1965.
- Bloom, S. W. “Rehabilitation as an Interpersonal Process,” in Sussman, M. (ed.) Sociology and Rehabilitation. Washington, D.C.: American Sociological Association, 1965.
- Struck, M. op. cit. p. 74.
- Singleton, G.W., Cole, J.A. and Long, M. “Attitudes of Rehabilitation Professionals, Their Colleagues and Other Disciplines.” Unpublished Manuscript presented at a conference on physical medicine and rehabilitation, 1979.
- Roth, J. and Eddy, E.M. Rehabilitation for the Unwanted. New York: Atherton Press, 1967.
- Treischmann, R.B. “The Psychological, Social and Vocational Adjustment in Spinal Cord Injury: A Strategy for Research.” (Final Report, Grant No. 13-B-59011/9-01) Los Angeles: Rehabilitation Services Administration and the Easter Seal Society of Los Angeles County, April, 1978.
- Struck, M. op. cit. p. 95-96.
- Taggart, R. and Levitans, A. Jobs for the Disabled. Baltimore: Johns Hopkins University Press, 1977.
- Towes, S.A. “Commemorative for the Year of the Disabled.” New York Times (July 5, 1981): D27.
- Hull, K. The Rights of Physically Disabled People. New York: Avon Books, 1979.
- Koester, F.A. “Jobs for Handicapped Persons.” New York: Public Affairs Pamphlet #557, Presidents Committee on Employment of the Handicapped, 1978.
- Bright, R.V. “Qualifications No Help for Handicapped.” Handicapped Unlimited of Virginia Review 1 (1981):9.
- Barringer, F. “Handicapped Barriers.” Washington Post (July 11, 1981):1.
- Hull, K. op. cit. p. 122.
- Summers, L. op. cit.