When I was in college in the mid-1980s, it was common practice to speak of the “differently abled” rather than the “disabled.” We joked about the “differently gruntled” and the “differently agreeable.” These days, if you talk about an autistic child, he differs from “typical” children, while a dwarf differs from “average” people. You are never to use the word normal, and you are certainly never to use the word abnormal. In the vast literature about disability rights, scholars stress the separation between impairment, the organic consequence of a condition, and disability, the result of social context. Being unable to move your legs, for example, is an impairment, but being unable to enter the public library is a disability.
An extreme version of the social model of disability is summarized by the British academic Michael Oliver: “Disability has nothing to do with the body, it is a consequence of social oppression.” This is untrue, even specious, but it contains a valid challenge to revise the prevalent opposite assumption that disability resides entirely in the mind or body of the disabled person. Ability is a tyranny of the majority. If most people could flap their arms and fly, the inability to do so would be a disability. If most people were geniuses, those of moderate intelligence would be disastrously disadvantaged. There is no ontological truth enshrined in what we think of as good health; it is merely a convention, one that has been strikingly inflated in the past century. In 1912, an American who lived until the age of fifty-five had had a good, long life; now, death at fifty-five is considered a tragedy. Because most people can walk, being unable to walk is a disability; so is being unable to hear; and so is being unable to decipher social cues. It’s a matter of votes, and the disabled question these majority decisions.
Medical advances allow parents to avoid producing certain kinds of disabled children; many disabilities may be ameliorated. It is not easy to determine when to exploit these options. Ruth Hubbard, an emerita professor of biology at Harvard, maintains that expectant parents who test for Huntington’s because they have a family history of the disease are in a quandary: “If they decide on abortion, they are as much as saying that a life lived in the knowledge that one will eventually die of Huntington’s disease is not worth living. What does that say about their own life and the lives of their family members who now know that they have the gene for Huntington’s disease?” The philosopher Philip Kitcher has referred to genetic screening as “laissez-faire eugenics.” Marsha Saxton, a lecturer at Berkeley who has spina bifida, writes, “Those of us with screenable conditions represent living adult fetuses that didn’t get aborted. Our resistance to the systematic abortion of ‘our young’ is a challenge to the ‘nonhumanness,’ the nonstatus of the fetus.” Snyder and Mitchell speak of how the elimination of disability marks “the completion of modernity as a cultural project.”
Some in the disability rights camp urge acceptance of whatever child you conceive, as though it were immoral not to conform to reproductive destiny. This is what the bioethicist William Ruddick calls the “‘hospitality’ view of women,” which finds anyone who terminates a pregnancy nonmaternal, ungenerous, and unwelcoming. In fact, prospective parents are dealing in the abstract with something that could become tangible, and that’s never an informed way to make a choice: the idea of a child or a disability is extremely different from the reality.
There is a problematic collision between feminism’s prioritizing of legal abortion and the disability rights movement’s opposition to any social system that devalues difference. “The fears are genuine, rational, and terrifying,” the disability activist Laura Hershey wrote. “We all face the prospect that what is supposed to be a private decision—the termination of a pregnancy—might become the first step in a campaign to eliminate people with disabilities.” She may be naïve about the motive, but correct about the result. Most Chinese people don’t hate girls, and no one in China is pursuing a campaign to eliminate women. But couples have been legally limited to one child since 1978, and because many prefer a boy, they give the girls up for adoption or abandon them. Although prospective parents may not be out to eliminate people with disabilities, medical advances giving them the ability to make radical decisions could undoubtedly reduce the disabled population considerably. “In this liberal and individualistic society, there may be no need for eugenic legislation,” Hubbard wrote. “Physicians and scientists need merely provide the techniques that make individual women, and parents, responsible for implementing the society’s prejudices by choice.”
Some activists have argued against the entire Human Genome Project, maintaining that it implies the existence of a perfect genome. The Genome Project has been construed this way partly because its authors pitched it to funders as a way to cure maladies, without acknowledging that there is no universal standard of well-being. Disability advocates argue that in nature, variation is the only invariable. Donna Haraway, who teaches feminist and cultural studies, has described the project as an “act of canonization” that could be used to establish ever-narrower standards. Michel Foucault, writing before the mapping of the genome was feasible, described how “a technology of abnormal individuals appears precisely when a regular network of knowledge and power has been established.” In other words, the spectrum of normality gets constrained when those in power consolidate their privilege. In Foucault’s view, the idea of normality “claimed to ensure the physical vigor and the moral cleanliness of the social body; it promised to eliminate defective individuals, degenerate and bastardized populations. In the name of biological and historical urgency, it justified the racisms of the state.” It thus encouraged people outside normality to perceive themselves as helpless and inadequate. If, as Foucault had also argued, “life is what is capable of error” and error itself is “at the root of what makes human thought and its history,” then to prohibit error would be to end evolution. Error lifted us out of the primordial slime.
Deborah Kent is a congenitally blind woman who has written about the pain that society’s prejudice against blindness has caused her. Describing a level of self-acceptance that was almost unheard of before the disability rights movement came into its own, Kent has said that her blindness is, to her, a neutral trait like her brown hair. “I didn’t long for sight any more than I yearned for a pair of wings,” she wrote in an essay in 2000. “Blindness presented occasional complications, but it seldom kept me from anything I wanted to do.” Then she and her husband, Dick, decided to have a baby, and she was shocked that he wanted their child to be seeing. “I believed that my life could not have turned out any better if I had been fully sighted. If my child were blind, I would try to ensure it every chance to become a self-fulfilled, contributing member of society. Dick said he agreed with me completely. But he was more troubled than he wished me to know. If he could accept blindness in me, why would it be devastating to him, even for a moment, if our child were blind as well?” Deborah entered into conception with grave concern. “I did not know if I could bear his devastation if our baby turned out to be blind like me.”
After their daughter was born, Deborah’s mother also expressed fear that the baby might be blind. “I was stunned,” Deborah wrote. “My parents raised all three of their children, including my blind brother and me, with sensitivity and unwavering love. In all of us they tried to nurture confidence, ambition, and self-respect. Yet blindness had never become neutral for them, any more than it had for Dick.” The baby turned out to be seeing, as Dick discovered by getting her to track his movements. He called his in-laws to tell them the news; he has since reminisced about the day his daughter turned to watch his moving fingers. “In his voice, I hear an echo of the excitement and relief that were so vivid for him on that long-ago morning,” Deborah wrote. “Each time I hear the story I feel a twinge of the old pain, and for a few moments I am very much alone again.”
Her aloneness reflects a disjunction between her own perception—that being blind is an identity—and her husband’s—that it is an illness. I am both sympathetic to her poi
nt of view and perturbed by it. I imagine how I would feel if my brother were to announce a fervent wish that my nephews be straight and call everyone to revel if it turned out to be true. It would hurt me. Being blind and being gay are different, but having a selfhood that others perceive as undesirable is identical. But our decisions to maximize health (however complicated a category that word may reference) and avoid illness (ditto) do not necessarily devalue those who are sick or otherwise different. My own battles with depression have contributed to a meaningful identity for me, but if I were choosing between a depression-prone child and one who would never suffer such ravages, I’d go with option B in a heartbeat. Even though the illness would probably become a locus of intimacy for us, I still wouldn’t want it to happen.
Most adults with horizontal identities do not want to be pitied or admired; they simply want to get on with their lives without being stared at. Many dislike Jerry Lewis’s use of pathetic children to get funds for genetic research. The NBC news correspondent John Hockenberry, who has a spinal injury, said, “‘Jerry’s kids’ are people in wheelchairs on television raising money to find a way to prevent their ever having been born.” The anger is pervasive. “Adults responded to my difference by helping me, but some of my schoolmates responded by calling me names,” wrote Rod Michalko, who is blind. “Only much later did I realize that helping and name-calling amounted to the same thing.” Arlene Mayerson, an expert in disability rights law, contends that benevolence and good intentions have been among disabled people’s worst enemies throughout history. The able-bodied can be generous narcissists: they eagerly bestow what they feel good about giving without considering how it will be received.
Conversely, the social model of disability demands that society modify the way business is done to empower people with disabilities, and we make such adjustments only when lawmakers accept that life can be painful for those who live at the margins. Patronizing gestures can be justly scorned, but increased empathy is often a precondition of political acceptance and an engine of reform. Many disabled people say that the social disapprobation they experience is much more burdensome than the disability from which they suffer, maintaining simultaneously that they suffer only because society treats them badly, and that they have unique experiences that set them apart from the world—that they are eminently special and in no way different.
A study that sought to determine whether money correlated with happiness revealed that poverty is connected to despair, but that once one gets out of poverty, wealth has little effect on happiness. What does correlate is how much money a person has compared to his social group. There is much scope to thrive on downward comparisons. Wealth and ability are both relative concepts. There are broad spectra in all these areas, and wide, shadowy borderlands in mental and physical disability as there are in socioeconomic status. A broad range of people can feel rich—or able—in relation to the context they live in. When a condition is not stigmatized, the comparisons are less oppressive.
Nonetheless, at the far end of the disability spectrum is a zone that corresponds to poverty, a place of severe privation, where rhetoric cannot make things better. The disability poverty line varies from one community to another, but it does exist. To deny the medical realities such people negotiate is equivalent to denying the financial realities of the slum child. The body and the mind can be agonizingly broken. Many disabled people experience debilitating pain, struggle with intellectual incapacities, and live in permanent proximity to death.
Repairing the body and repairing entrenched social prejudice are objectives that dance a troubling waltz; either fix can have unwelcome consequences. A repaired body may have been achieved through brutal trauma and in response to unfair social pressures; a repaired prejudice can eliminate the rights that its existence had called into being. The question of what constitutes any protected difference carries enormous political weight. Disabled people are protected by fragile laws, and if they are judged to have an identity rather than an illness, they may forfeit those safeguards.
All kinds of attributes make one less able. Illiteracy and poverty are disabilities, and so are stupidity, obesity, and boringness. Extreme age and extreme youth are both disabilities. Faith is a disability insofar as it constrains you from self-interest; atheism is a disability inasmuch as it shields you from hope. One might see power as a disability, too, for the isolation in which it imprisons those who wield it. The disability scholar Steven R. Smith posited, “A completely painless existence could also quite plausibly be seen as deficient for most people.” Likewise, any of these characteristics can embody strength, some more easily than others. We are all differently abled from one another, and context—which is socially constructed—often decides what will be protected and indulged. Being gay was a disability in the nineteenth century in a way that it isn’t now; and it is now a disability in some locations in a way that it isn’t in others; and it was a disability for me when I was young and it isn’t one for me today. The whole matter is intensely unstable. No one has ever suggested legal protections for ugly people to make up for the misaligned features that will compromise their personal and professional lives. For people disabled by inherent moral perplexity, we offer not support but imprisonment.
Because there is not yet a coherent understanding of horizontal identities as a collective category, those who strive for horizontal rights often rely on the disability movement’s methodical rejection of illness models. Insofar as these conceptualizations of rights are about identity, they draw on the model of Alcoholics Anonymous and other 12-step recovery groups. AA was the first to suggest managing a disease by claiming it as an identity and drawing on the support of peers with a similar condition—that according meaning to a problem was crucial to resolving it. In a way, this near-paradox can be reduced to the last clause of Reinhold Niebuhr’s Serenity Prayer, which is a tenet of the recovery movement: “Father, give us courage to change what must be altered, serenity to accept what cannot be helped, and the insight to know the one from the other.”
Although we have moved in recent decades away from illness models and toward identity models, such a shift is not always ethically defensible. After I had come to see deafness and dwarfism and autism and transgenderism as identities worthy of appreciation, I came up against the pro-ana and pro-mia movements, which seek to remove the negative associations around anorexia and bulimia, promoting them as lifestyle choices rather than illnesses. Pro-ana and pro-mia websites offer “thinspiration” tips on crash diets, review use of emetics and laxatives, and validate competitive weight-loss postings. People who follow the advice on such sites may die: Anorexia has the highest mortality rate of any mental illness. To propose that anorexics are merely exploring an identity is as morally lax as accepting the belief of gang members that they are merely pursuing an identity that happens to entail killing people. It’s clear that identity is a finite concept. What’s not clear is the location of its boundaries. In my own life, dyslexia is an illness, while being gay is an identity. I wonder, though, whether it would have been the other way around if my parents had failed to help me compensate for the dyslexia, but had achieved the goal of altering my sexuality.
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The wish to fix people reflects pessimism about their condition and optimism about the method of repair. In Autobiography of a Face, Lucy Grealy describes the childhood cancer of the jaw that left her permanently disfigured—and, to her mind, grotesque. I knew Lucy, though not well, and I didn’t find her ugly. I always wondered where the deep conviction of her own repulsiveness came from because it informed everything she did, no matter how her charm distracted from her missing jaw. She wrote about how she prepared for one of her innumerable unsuccessful reconstructive surgeries and thought, “Maybe this wasn’t my actual face at all but the face of some interloper, some ugly intruder, and my ‘real’ face, the one I was meant to have all along, was within reach. I began to imagine my ‘original’ face, the one free from all deviation, all error. I bel
ieved that if none of this had happened to me, I would have been beautiful.” Lucy’s death of a drug overdose at thirty-nine testifies in part to the oppressive costs by which anomalous people make their way through endless processes of repair.
If the surgeries had worked, Lucy might have had a happy life, just as good as if she’d come to ease with her appearance. That her face turned out to be irremediable makes one wonder whether her mind would have been similarly beyond mending. What might have happened if her energy had been focused on the singular intelligence that produced such a chronicle of intractable despair? I, too, would have tried the things Lucy did—possibly with the same result; I have always tried to mend whatever can be fixed and tend to accept only the inevitable. Her dream of vanquishing her problem, which was for decades sustained by doctors, did her in. Recent academic work suggests that people who know their condition to be irreversible are happier than those who believe their condition may be ameliorated. In such cases, ironically, hope may be the cornerstone of misery.
In 2003, a suit was brought in England against a doctor who had performed a late-stage abortion on a woman who would have given birth to a child with a cleft palate. Such abortions are legal for women likely to produce a child with a severe genetic defect, and the question was whether this defect fit that definition. Court filings quoted another mother whose son had a congenital cleft palate attesting, “I definitely would not have had a termination even if this baby had a cleft palate or lip, these days it can be repaired to such a high standard. It is not a disability.” An untreated severe cleft palate can have dire consequences and is undeniably a disability. But there is no simple equation whereby the existence of the fix means that the condition is no longer a disability; rectifying a condition is not the same thing as forestalling it. Bruce Bauer, chief of plastic surgery at Children’s Memorial Hospital in Chicago, who corrects facial deformities, said the children on whom he operates deserve “the chance to look like what they truly are—no different from anyone else.” But whether the surgical fix makes them “no different” or permanently disguises their difference is a loaded question with broad ramifications.
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