Epistemic Status: First draft, written quickly because I have to pack for my brother's wedding and want to get this out while it's hot, or at least lukewarm.

Summary:

• This is a tedious, step-by-step rebuttal of Scott Alexander's recent post, Contra the Social Model of Disability.
• The Social Model is similar but not quite the same as "Interactionism with a moral thrust," and it's relevant because some people actually do believe the outdated "Medical Model" of disability, which is appropriately labeled.
• Scott Alexander's recent article is arguing against a straw or weakman, probably the product of his hasty misreading.
• Charity, steelman, call it what you will, it's a good heuristic to assume that if your take is "why would anybody believe this," you should carefully check if maybe, just maybe, you've misunderstood something. That goes double if the people you are so loudly disagreeing with are the exact sort of people you'd expect to have a very thoughtful stance on the subject.
• Rationalists like to coin new terms (or, as rationalists say, come up with "concept handles). Others redefine and thereby distinguish pairs of synonyms, like "impairment" and "disabled," by attaching more specific definitions to them. I think this leads to expectations mismatch and confusion when rationalists read writings by other activists and vice versa.
• We can fault one of these articles for not being careful enough to notice when they're offering multiple conflicting definitions of "impairment."
  • It's actually just quoting the ADA in the intro, not arguing for the ADA's definition of "disability"

In Contra the Social Model of Disability, Scott is attacking the Social Model of Disability. To start, he gives short quotes from 5 respectable authors and institutions describing it. I'll give the original quotes in a bit.

On their own, the quotes describe the Social Model in a way that sounds very unconventional, even downright disturbing. Bear in mind, though, that most of the articles they come from specifically define "disability" in a meaningful but unconventional way, and correctly interpreting these quotes absolutely depends on using their definition of "disability."

The way I'll dissect Scott's article is by starting with the original articles he's misinterpreting, then showing where he's gone wrong.

Defining "Disability"

Three of the five articles Scott references define "impairment" and "disability."

• Impairment: Functional, fundamentally physical limitations, such as the inability to walk.
• Disability: A dysfunctional or inadequate social response to impairment, encompassing:
  • Artificial restriction or form of discrimination imposed by society on people with impairments, such as banning blind people from the Navy.
  • A failure of society to provide reasonable accommodations to people who currently have impairments, such as failing to provide wheelchair ramps in new buildings.
  • Pressure to not offer or to remove accommodations, or an attitude of looking down on or discriminating against the impaired.

In other words, your body has an impairment. You may be disabled by the attitudes, actions and omissions of your society.

Here are the definitions of these two terms offered by the three articles that explicitly distinguish and define them.

Articles that fit the definition I just offered

The Social Model Of Disability Explained

The social model of disability makes an important distinction between “impairments” and “disabilities.” Impairments can be thought of as the functional limitations an individual might face (i.e., not being able to walk). Disabilities, on the other hand, are the disadvantages imposed on individuals by a society that views and treats impairments as abnormal, hence worthy of exclusion.

Physical and mental impairments are a natural and common part of being human that are deserving of accommodations and civil rights protection. They can (and frequently do) happen to anyone at any time via illness, accidents, genetic conditions, aging, and more. If sufficient accommodations are provided, however, impairments do not need to equate to disability. It is only right for society to design its physical and social infrastructure around this fact of life. 

Foundation For People With Learning Disabilities

The distinction is made between ‘impairments’, which are the individual problems which may prevent people from doing something, and ‘disability’, which is the additional disadvantage bestowed by a society which treats these ‘impairments’ as abnormal, thus unnecessarily excluding these people from full participation in society. The social model of disability says that it is society which disables impaired people.

University of California, San Francisco

The interaction between functional limitations or impairments and physical and social barriers to full participation create disabling environments. The social model distinguishes between disabilities and impairments. Disabilities are restrictions imposed by society. Impairments are the effects of any given condition. The solution, according to this model, lies not in fixing the person, but in changing our society. Medical care, for example, should not focus on cures or treatments in order to rid our bodies of functional impairments. Instead, this care should focus on enhancing our daily function in society.

Articles that don't clearly fit the definition, but don't insist on the Social Model

Disability rights group Scope

The model says that people are disabled by barriers in society, not by their impairment or difference. Barriers can be physical, like buildings not having accessible toilets. Or they can be caused by people's attitudes to difference, like assuming disabled people can't do certain things.

The social model helps us recognise barriers that make life harder for disabled people. Removing these barriers creates equality and offers disabled people more independence, choice and control.

This article implicitly distinguishes between "disability" and "impairment," and I think a reasonable person familiar with these definitions would assume Scope is also intending "disability" to be specifically understood as meaning "barriers imposed by society." That would make the first sentence of this quote a definition of the term, except that it's definiing "disabled" rather than "disability."

There's also a quote in the video transcript that accords well with the new definitions of "impairment" and "disability."

The social model basically says, we are people with impairments and those impairments clearly have an impact on how we live our lives. But the impairments are not the things which disable us.

Scope does not insist on the Social Model:

Not everyone uses the social model and that’s ok. How anyone chooses to talk about their impairment is up to them. 

The American Psychological Association

In the social model, disability is seen as one aspect of a person’s identity, much like race/ethnicity, gender, etc. From this perspective, disability is believed to result from a mismatch between the disabled person and the environment (both physical and social). It is this environment that creates the handicaps and barriers, not the disability. From this perspective, the way to address disability is to change the environment and society, rather than people with disabilities. Negative stereotypes, discrimination and oppression serve as barriers to environmental change and full inclusion.

The article only uses the term "impairment" once, in the section on the Medical Model. I think this is the article that is most incompatible with the definitions I layed out above. But crucially, it advocates for a mixed model and doesn't see any one model as best.

Although students have a tendency to see one model as superior to the others, there are some potential benefits and costs to all of these perspectives. The moral model can bring shame, but also renewed faith. The medical model has spurred tremendous advances in rehabilitation but is paternalistic. The social model fosters community, but systemic ableism can be overwhelming. Probably most people have beliefs in more than one model. But it is hard to know, since currently there is not a well-established measure of the models. More data are needed from disabled persons to get their perspective on the costs and benefits of their particular model of disability.

Taking this into account, its overall perspective seems quite compatible with the definitions I layed out above.

Quotes Out Of Context

Scott Alexander offers quotes from each of these articles.

First, try reading them with the conventional definition of "disability" in mind, where "disability" is a synonym for "impairment" and primarily means "physical impediment, such as being paraplegic or blind." Under this definition, which we've just seen is not the one they use, they sound ridiculous.^[1]

Then, see how the meaning changes using the definition of "disability" these articles actually use, where "disability" specifically means "the things society does to restrict or discriminate against impaired people, or its omissions in enabling impaired people to participate in society." Under this definition, they sound like ways of helping us understand exactly what they mean when they use the term "disability" in this new, more specific way.

The Social Model Of Disability Explained (top Google result for the term):

Individual limitations are not the cause of disability. Rather, it is society’s failure to provide appropriate services and adequately ensure that the needs of disabled people are taken into account in societal organization.

Disability rights group Scope:

The model says that people are disabled by barriers in society, not by their impairment or difference.

The American Psychological Association:

It is [the] environment that creates the handicaps and barriers, not the disability.

From this perspective, the way to address disability is to change the environment and society, rather than people with disabilities.

Foundation For People With Learning Disabilities:

The social model of disability proposes that what makes someone disabled is not their medical condition, but the attitudes and structures of society. 

University of California, San Francisco:

Disabilities are restrictions imposed by society. Impairments are the effects of any given condition. The solution, according to this model, lies not in fixing the person, but in changing our society.

Medical care, for example, should not focus on cures or treatments in order to rid our bodies of functional impairments. Instead, this care should focus on enhancing our daily function in society.

This final quote reads oddly even under our new definition of "disability" and "impairment," until you notice that it's talking specifically about "the solution" to disability, not "the solution" to impairments generally:

Leaders in the disability rights movement have constructed two distinct models of how society views disabilities: the Medical Model and the Social Model. These models provide a framework for how people perceive those of us with disabilities

By definition, a disability is a response to an impairment. You could make a person's experience of disability go away in all cases by medically removing the impairment (and thus cancelling the social response to it), and in some cases by removing the disability directly. I read this last quote from U of C as saying that under the Social Model, our focus on responding to disability should be to change our social response, not to treat the impairment.

As a central example, if a deaf kid is being bullied for using sign language, the solution is not to give him a cochlear implant so he can stop using sign language. It's to stop the bullying. You can also give him a cochlear implant if he wants to be able to hear. But cochlear implants should be a means to the end of treating impediments that the patient wants lessened or removed, not as the primary means to the end of enabling the patient to bypass the disabling attitudes, actions and omissions of society.

And note also that that doesn't have to mean that impaired people should eschew medical treatment for their impairment if they're fed up with the ways society disables them. All but one of these articles accept other perspectives.

The Social Model Of Disability Explained

Ultimately, how a person with a disability chooses to view or talk about their impairment—whether in line with the medical model of disability or the social model of disability—is up to them

Disability rights group Scope

Not everyone uses the social model and that’s ok. How anyone chooses to talk about their impairment is up to them. 

Foundation For People With Learning Disabilities

The academic Tom Shakespeare writes on the need to reject treating the social model as a ‘sacred cow’ that must not be challenged, instead proposing a movement towards a medical and social continuum, with the central argument that as we are all ‘impaired’ in some manner, it is not the core component of disability.  The impact of the body on one’s life is thus included, without needing to divide between ‘disabled’ and ‘non-disabled’ people. 

We already covered the APA's article above.

The exception is University of California, San Francisco

Leaders in the disability rights movement have constructed two distinct models of how society views disabilities: the Medical Model and the Social Model. These models provide a framework for how people perceive those of us with disabilities. While the Medical Model is a helpful way of understanding illness and loss of function, people in the disability community have largely rejected it in favor of the Social Model.

This article clearly rejects the one proposed alternative to the Social Model, but it also is one of those that carefully defines its terms and specifically is addressing socially-imposed disability and solutions to it.

Scott Appears Not To Have Noticed the Definition of Disability

Scott's arguments against the Social Model throughout the article are attacking a misunderstanding of it, in which his own, conventional definition of disability - as a functional inability to do certain activities - is mapped onto the term "disability" as presented in quotes from the articles he referenced.

The examples he gives of activities that are impossible or unreasonable to expect society to accommodate for impaired people (or "disabled" people as he, but not the Social Model articles he linked, defines the term) include: 

• Work on a submarine
• Survive on a desert island
• Drive a car
• Climb Mount Everest
• Piloting a spaceship
• Seeing a sunset, rainbow, or beautiful artwork

It's entirely true, of course, that physical impairments make many of these activities either:

• Impossible to accommodate without medical treatment (i.e. seeing a sunset)
• Impossible to accommodate without unreasonable expense (i.e. making submarines fully wheelchair compatible) and/or the destruction of other important values (i.e. the current aesthetic on the slopes of Mount Everest)

But again, that's fully compatible with the definition of "disability" that the articles he linked to are using. Impaired people's inability to do most of these specific activities is caused not by society disabling them, but due to the direct physical consequences of their impairment. We can argue with how much expense is practical (or what's an efficient allocation of funds to improve accessibility vs. other expenditures on social wellbeing),  or to what extent we ought to prioritize accessibility over other values.

This becomes particularly relevant because some proponents of the Social Model, including in the articles he linked, do propose very costly accessibility interventions. It may be that they're meant to be illustrative only, but that's not always emphasized. For example:

The Social Model Of Disability Explained

In a Forbes article titled, “We Have Been Disabled: How The Pandemic Has Proven The Social Model Of Disability,” psychologist Dr. Nancy Doyle outlines what she describes as “the responsibility that society holds for the disablement of others.” She writes, “If everyone was taught sign language at an early age, a deaf person would no longer be disadvantaged. If towns were built and planned with physical disabilities in mind and there was no social stigma attached to looking or sounding different, then having a physical impairment would no longer be disabling.”

Obviously, it is not possible us to accommodate all linguistic barriers by teaching everybody every language, and alternatives exist for overcoming linguistic barriers. It's equally plausible to argue that everybody should speak a one or more foreign languages (perhaps the second-most-common language in one's area, for example). In some countries, people do routinely speak two or more languages. But not everybody learns every skill that would accommodate other people in these ways - choices must be made and costs accounted for.

However, most of the examples of socially-imposed disabilities are pretty mainstream - failure to install wheelchair ramps, failure to recognize that impaired people can have sex lives, job discrimination when the job is well within the impaired person's ability.

It's key to note that Scott's not just using some convenient quotes to react to what he's experienced in the classroom or among his medical colleagues. He's arguing, falsely, that his misunderstanding of the Social Model is in fact the correct and universally taught version of the Social Model. 

In fact, I’ve never heard anyone willing to defend the actual Social Model the way it’s taught in every course, written on every website, and defined by every government agency.

Note that Scott misrepresents the content of the articles he quotes when he says:

Is it possible that people mean the Social Model and the Medical Model are both okay, and the truth lies somewhere in between? “All models are wrong, some are useful”, that kind of thing? I think this is an okay motte. But the topic is taught in a way that only occasionally nods to such a compromise; more often the Medical Model is condemned as outdated and bigoted, and the Social Model introduced as the new, acceptable version that people should use.

He goes on to quote The Social Model Explained, Scope and UCSF. UCSF is the only one of these three that insists on the Social Model, but again, Scott is misunderstanding how UCSF is defining and using "disability."

Scott says

I’m hammering this in because people really like saying nice things about the Social Model of Disability, and they really want to rescue it as saying or meaning something different than its explicit text.

Well, I'm saying that the "rescue" operation I'm performing here isn't any such thing. I'm just pointing out what the explicit text actually is. It's Scott who's failed to notice.

The Interactionist Model Is Not Identical To The Social Model

Scott also argues that when people are trying to rescue the Social Model from the wacky-sounding version of it that he has constructed with his misunderstanding of how it defines "disability," they fall back on saying it's the same as the sensible-sounding Interactionist Model:

The Social Model’s main competitor is the Interactionist Model Of Disability, which says that disability is caused by an interaction of disease and society, and that it can be addressed by either treating the underlying condition or by adding social accommodations...

I’ve never heard anyone willing to defend the actual Social Model the way it’s taught in every course, written on every website, and defined by every government agency. Everyone says they mean the Interactionist Model.

None of the articles he quotes mentions the Interactionist Model, although one of them explicitly refers to the interaction between impairment and social response or environment:

The Social Model takes a different approach. This model states that disability is the inability to participate fully in home and community life. The interaction between functional limitations or impairments and physical and social barriers to full participation create disabling environments.

So none of his sources here literally say that they mean the Interactionist Model, but that's probably taking Scott overly literally here - unfortunately, I can't vet his statements because he doesn't give any sources.

The Interactionist model is pretty close to the Social Model, and I expect they come to pretty much the same conclusions. But they define "disability" differently, with the Interactionist Model using it to refer basically to outcomes of the interaction between physical impairment and the social/built environment, and the Social Model using it to refer specifically to the effects of the social/built environment on people with physical impairments.

The Interactionist Model's definition of "disability" is pretty close to being strictly empirical and value-free. As presented in Scott's language, it has nothing directly to say about whether or not we should care about the outcomes of this interaction on disabled people, or how we should respond to them. It is descriptive only.

By contrast, the Social Model's definition of "disability" depends on value judgments. It doesn't make claims directly about where to draw the line between a reasonable and unreasonable accommodation, or an ableist and nonableist society. But it does claim that some accommodations are morally required, and that some attitudes, actions and omissions are morally wrong. Figuring out exactly where to draw these lines is something that it can't intrinsically do.

Complicating this is that activists who are advocating for drawing these lines in new places - perhaps increasing the amount of accommodation we make, or even in reinventing the fundamental values and culture of society in truly radical ways - may also be advocates for the Social Model. The illustrative examples they give may reflect where they'd personally choose to draw these lines. That can give the impression that the Social Model itself is to blame when those lines are drawn in places that seem unreasonable or extreme to most other people.

A further complication is that the Social Model is only really relevant when compared to its foil, the Medical Model. I'm not going to give quotes, but the articles linked largely describe it as a model in which the negative effects of society's reaction to impairment are best dealt with by medically treating the impairment itself.

Here are some fictional examples ChatGPT came up with to illustrate a Medical Model attitude:

Dr. Victor, a leading orthopedic surgeon, opines, "Instead of wasting resources on ramps and elevators, wouldn't it be more beneficial to invest in advanced prosthetics that can help people walk again?"

Mia, a dedicated teacher, comments, "I believe we should focus more on curing or managing autism medically, rather than making significant changes to our teaching methods and curriculum."

George, a renowned architect, muses, "Why adapt buildings to suit people with disabilities when we could invest more in medical technology to make them able-bodied?"

Eva, a city council member, suggests during a meeting, "Instead of funding sign language interpreters for public events, shouldn't we be investing that money in research for hearing restoration treatments?"

Robert, a successful businessman, states in a board meeting, "I believe that by investing more in medical research to fix disabilities, we can eliminate the need for special accommodations in the workplace."

Scott says:

 The Medical Model is “disability is only caused by disease , society never contributes in any way, and nobody should ever accommodate it at all . . . ” Then the people describing it add “. . . and also, it says disabled people should be stigmatized, and not treated as real humans, and denied basic rights”. Why does the first part imply the second? It doesn’t matter, because “the Medical Model” was invented as a bogeyman to force people to run screaming into the outstretched arms of the Social Model.

But are the fictional ChatGPT examples above really so unthinkably rare? I do think that there are plenty of real and influential people who subscribe to the Medical Model, and given their existence and influence, the Social Model has great utility articulating the commonsense alternative that I expect most readers of this post subscribe to. The Medical Model isn't just a "bogeyman." It's a real set of attitudes - and indeed, these articles largely accept it as part of a mixed model, or make room for people who hold models other than the Social Model.

Conclusion

I don't know if I've dealt perfectly with Scott's post, but it's time to wrap things up because I have a ferry to catch and a wedding speech to give!

My guess is that Scott's mainly reacting to what he's experienced in real life or on Twitter, and didn't quite notice that the articles he was pulling from don't actually support the case he's making when they're read accurately.

It's an odd mistake for Scott to make. He's clearly capable of reading deeply into much more difficult material that he disagrees with, and he also tends to give extra credence to people who are experts writing about their own field or who are directly dealing with problems in their daily life. In this case, the articles are written by people who are one or more of medical doctors, academics focused on the experience of disability, and impaired/disabled people. So I would have expected Scott to start by assuming that the articles were basically smart and sensible, and to have reacted to his first impression that they're not by taking a second look and making sure he hadn't misunderstood something.

He might have even appreciated that they'd expanded the English language's ability to encompass new ideas by taking a pair of useless synonyms and giving them new, conceptually distinct definitions to give us words for more things.

Of course, Scott also says in the Top Posts section of his old blog:

Although I acknowledge the importance and danger of racism and sexism, I also think a lot of the social justice movement as it currently exists is an attempt to sanctify ad hominem arguments and poor epistemology that can be used by a would-be cognitive elite to abuse and humiliate anyone who disagrees with them. 

So maybe if you're predisposed to see social justice articles as abusive, humiliating, and full of ad hominems and poor epistomology, then maybe it's natural to just react negatively when you see them using language in ridiculous ways that fit with your prior assumptions.

I also think that the rationalist community has a different approach to dealing with gaps in the English language than the social justice movement, and this cultural difference can lead to acrimony and confusion. When they want to talk about a new idea, Scott and other rationalists tend to coin new terms, then define them as best they can. An example Scott uses in the article I'm criticizing is bravery debate.

By contrast, the social justice movement often seems to work by redefining terms. Is that always done in consistent, explicit, durable ways, so that we can simply learn, adopt and use the new definition indefinitely into the future? That hasn't been my experience -but then again, that's not just true of the social justice community. Many people mix up definitions, or ultimately rely on insistence that "you know what I mean."

And we do that all the time, in non-political occasions. At a recent party for a friend in med school residency, his wife told me a story about his encounter with an administrator. He has a heart defect and was required to take yoga as a wellness module. He chose to do Shivasana (laying down on the floor) instead of some of the yoga postures as a response to the functional impairment caused by his heart defect. His yoga instructor reported him for not participating, and his administrator questioned whether "medical school was for him."

This story offers a neat illustration of the difference between an impairment and a disability, but it's not the point. The point is that I responded to this story by asking her something along the lines of, "Are you sure that the administrator was being a jerk? Maybe he was just concerned about your husband's health."

She told me no, he definitely wasn't.

Point being - her husband experienced this encounter, and he's a socially adept person. He told her about it, and I think it's safe to assume he framed the social undercurrent accurately when he told the story to her. She in turn relayed that accurately to me. If I was a better listener, I'd have taken that into account and updated more confidently that the administrator was being an ableist jerk, not showing concern for her husband's health. On some level, accurately understanding her story depended on me "knowing what she meant," using context to inform my understanding of her words.

That context is likewise key to understanding what people mean when they're trying to find new words to express concepts that are important to them, such as the distinction between physical impairment and society's response to it. This is a real, lived experience and important, commonsense distinction that many disabled people have had. They use the Social Model to articulate it.

Why insist they switch to the Interactionist Model's clinical, morally abstinent description disability? Not everybody has Scott's facility with language, and there's apparently a half-century of tradition behind the definition of disability as used by the Social Model. And not everybody wants to adopt weird new coinages ("concept handles" in rationalist jargon) for new concepts.

And my guess is that if you were part of the disabled community, and in particular part of the activist and/or highly educated disabled community, you'd be familiar enough with the Social Model to both use the terms "impairment" and "disability" accurately according to these new definitions, and to determine when somebody is using the term "disability" as a synonym for "impairment." It would be a fine solution to the problem of needing to express an epistemic and moral difference between physically-caused impairment and socially-caused disability. This is a Chesterton's Fence that Scott shouldn't be tearing down.

1. ^{^}

   I would not be surprised if Scott read these articles quickly, or didn't even read them and just grabbed the first quote that seemed to fit the point he was trying to make. I don't think he is trying to mislead his readers about the argument they are making.