From the General introduction
by Wachara Riewpaiboon and Stuart Blume
Disability and rehabilitation in Europe and North America
… starting in the 1970s disabled scholars began to develop a radical critique of dominant conceptions of disability in which medicine played so central a role. For example, in 1990 Michael Oliver published The Politics of Disablement, in which he analysed the ways in which disability was defined as a problem of the individual, subject to the authority of medicine. And at the same time, he questioned the failure of the social sciences critically to address what this medical understanding of disability meant and what it excluded from consideration. Out of the research and writing of critical sociologists in Britain and in the USA (where Irving Zola was a key figure) emerged what is generally called the ‘social model’ of disability.
Over the past twenty years this has generated a substantial literature, much of it making use of the methods of qualitative social research. Narratives and life histories produced by disabled people themselves have a central place in this literature. This work has major implications for professionals in the rehabilitation field, for the social sciences, and – the ultimate goal – for the full integration of disabled people into society. However almost all of it focuses on the traditions, practices and dilemmas of northern countries. There have been few attempts in southern countries to draw on this work, or to establish related traditions of emancipatory research.
Disability and rehabilitation in Asia
In traditional Thai society, powerfully influenced by a Buddhist worldview, most people with disabilities were supported by their families or by charitable organizations. But they had to live their lives quietly with little social integration. Reflecting Buddhist notions of merit making and Karmic theory, people with disabilities were turned into objects of charity rather than being permitted actively to make merit themselves, and so escape from their karma of being disabled. It is significant, and quite contradictory, that people with disabilities (particularly deaf and blind people) were not allowed to be ordained. They sometimes lived their quiet lives in the temple: not as ordained monks but as objects of mercy.
Alongside the traditional Buddhist perspective, new scientific knowledge has also helped shape the lives of people with disabilities. Since the middle of the nineteenth century, Thailand has been engaged in a process of modernisation that has had major implications for the country’s educational and medical systems. When the International Society for Rehabilitation of the Disabled (later Rehabilitation International) was established Thailand joined as a member country in 1945. Yet the consequences of new understandings of disability, embodied in new practices and technologies, could not easily be integrated holistically into the everyday lives of disabled people because local social and cultural contexts were ignored or considered irrelevant.
In Thailand, as in most of Asia, the field of disability continues to be dominated by the biomedical model. Thus, “disability” was defined as an incurable chronic illness and increasingly became an object for medical diagnosis and investigation. As disabilities have been more and more medicalised, a ‘sick role’ was imposed on people with disabilities. They were exempted from regular duties, but at the same time their human rights were usually ignored. While disabilities were perceived as diseases, modern healthcare system provided little in the way of encouraging answers or choices for them.
As part of the flux of western knowledge, many modern assistive technologies have been introduced. Following western rehabilitation discourse, these were claimed to improve the quality of life of disabled people. In making these claims, so much is typically forgotten. Wheelchair technology has been imported for people with restricted mobility, whilst little thought has been given to environmental barriers to wheelchair use. The concept of universal design of the physical environment has not really been understood. Hearing and visual aids have been made available for people with reduced hearing or vision. But little thought has been given to how their use might affect the personal – including the social – lives of people with sensory impairments. The need to evaluate or problematize these technology-driven rehabilitation programmes, the focus of much recent critique in the west, has not been appreciated in Thailand.
During the Asian Pacific Decade of Disabled Persons (1993-2002) much changed…. “Rehabilitation” gradually came to be viewed as a process of personal empowerment. The Thai Rehabilitation Act of 1991 was a major social tool for gaining access to social services, which were regarded as basic human rights. Gradually, many disabled people organizations (DPOs) have redefined their roles, and have joined hands to protect the rights of those with disability.
Although such changes contributed greatly to the improvement of certain aspects of the lives of people with disabilities, it is doubtful whether such an approach can achieve much more than the improvement of physical functioning. The disability development program in Thailand has continued to rely heavily on quantitative approach and biomedical concepts.
In the Asian context Thailand is no exception. Despite the many positive developments, little convergence between disability politics and practice on the one hand, and sociology and anthropology on the other seems to have occurred in any of the Asian countries (with the exception of Japan). Surveying the international literature on disability and rehabilitation, we find that many studies emerging from Asia are designed to measure the extent of (unmet) need, or the impact of services, or attitudes to disabled people. Few of the published studies make use of the innovative, usually qualitative, approaches developed in western countries over the past 20 years.
With this book we hope to introduce readers in Asian countries to the recent disability literature of the west. We also hope to inspire the new thinking among social scientists, rehabilitation professionals, and organizations of disabled people themselves that could lead to a multidisciplinary Disability Studies. Production of the book was supported by the Thai Health Promotion of People with Disabilities Program, which is an active participatory program involving health and social professionals together with people with disabilities and some non-governmental organizations in Thailand. This program has been in operation since 2004 and is funded by the Thai Health Promotion Fund.
The Thai Health Promotion of People with Disabilities Program contracted with Innovia to produce this book. Without the enthusiastic commitment, knowledge and experience of Renu Addlakha (MacArthur Foundation in India, New Delhi), Patrick Devlieger (University of Leuven, Belgium), Nagase Osamu (Research Center for Advanced Science and Technology, University of Tokyo, Japan), and Myriam Winance (Centre de Recherche sur Medicine, Santé et Société, Paris, France) the book could not have been produced.
We hope that it will encourage and inspire disabled people and their organisations, service providers, and researchers from many disciplines to work together.