U.S. Social Security & Disability Prejudice, Part II: The Medical Model of Disability
U.S. Social Security & Disability Prejudice, Part II
The Medical Model of Disability
In my post, U.S. Social Security & Disability Prejudice, Part I: My Story, I shared my experience applying for Social Security Disability Insurance (SSDI). I also discussed how SSDI and Supplemental Security Income (SSI) recipients are frequently the targets of negative judgments and prejudices.
Many of these stigma come from how the Social Security Administration’s (SSA) evaluation processes focus almost exclusively on a person’s impairment(s) as the only consideration in what constitutes disability. Without including social, structural, and environmental factors that create disability, SSDI and SSI evaluations are prejudiced in how qualifying disability determinations are made.
The medical emphasis of disability that the SSA uses contradicts contemporary conceptions of disability as multi-factorial (Brandt et al., 2011). The SSA’s definition of disability revolves around whether one’s impairment(s) rises to the level of being unable to perform substantial gainful activity. The current SSA definition of disability is:
[T]he inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. (“Part I,” n.d., para. 4)
The five-stage process used for deciding whether one is eligible for disability benefits also almost exclusively relies on medical evidence (Brandt et al., 2011).
One’s medical diagnoses and conditions must match, equal, or exceed those included in the SSA’s Listings of Impairments (“Part III,” n.d.). Impairment(s):
[M]ust result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. Therefore, a physical or mental impairment must be established by objective medical evidence from an acceptable medical source. We will not use your statement of symptoms, a diagnosis, or a medical opinion to establish the existence of an impairment(s). (“Establishing,” 2017, para. 1)
The burden to substantiate one’s impairment(s) is on the person filing for disability benefits (Brandt et al., 2011).
The emphasis on a medical conception of disability, and the implications this entails such as being put through the task of laying out how incapacitated and deficient one is, can take a great toll on one’s self-worth (Dorfmann, 2015). As I know well, the process of proving to be impaired to a level that satisfies the requirement of being unable to engage in any substantial gainful activity is grueling and deprecating. The expectation that disabled people reduce the whole of themselves to their impairments as determined by medical practitioners as abnormal encourages disabled people to perceive themselves through this lens as well.
Under the medical model, disability is assessed as a binary of a person either meeting the impairment requirements, and thus being considered disabled, or not meeting the requirements and therefore not being considered disabled. There is no accounting for the many factors that influence how much one’s impairments are socially created and variable, and thus how much one’s capacity and functionality may fluctuate.
The difficulty in medically substantiating disability is also increased for those whose conditions do not fall within the Listings of Impairments, including people whose disabilities are not prominent or visible (Dorfmann, 2015). Conditions with origins that are medically clear-cut and show up definitively in biomedical tests are privileged.
Impairments that are more challenging to prove through medically objective evidence, like chronic pain and severe mental health conditions, are subject to medico-legal and public perceptions of being less impactful to one’s daily life. Even for those whose impairments are medically assimilated credible, however, social conceptions that the person is living the easy life by collecting government benefits are pervasive.
Unfounded beliefs like these and political objections to government support for disabled and poor people have greatly contributed to stringent SSDI and SSI determination processes. Furthermore, people like me who receive public assistance are subject to extreme limitations once determined to be eligible for SSDI, SSI, or both.
My next post, “U.S. Social Security & Disability Prejudice, Part III: Anti-Blackness, Racism, and Economic Oppression” will cover more about these oppressive rules and action we can take action to change them. Be sure to check back soon!
To learn about my experience, read U.S. Social Security & Disability Prejudice, Part I: My Story.
For more about the history of Social Security, read my posts:
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Sources
Brandt, D. E., Houtenville, A. J., Huynh, M. T., Chan, L., & Rasch, E. K. (2011). Connecting contemporary paradigms to the Social Security Administration’s Disability Evaluation process. Journal of Disability Policy Studies, 22(2), 116–128. https://doi.org/10.1177/1044207310396509
Dorfman, Doron, Disability Identity in Conflict: Performativity in the U.S. Social
Security Benefits System (October 1, 2016). Thomas Jefferson Law Review, Vol. 38, No. 1, 2015-2016, Available at SSRN: https://ssrn.com/abstract=2874158
Establishing that you have a medically determinable impairment(s). Code of Federal Regulations. (2017, January 18). Retrieved May 15, 2022, from https://www.ssa.gov/OP_Home/cfr20/404/404-1521.htm
Part I - General Information. Disability Evaluation Under Social Security. (n.d.). Retrieved May 16, 2022, from https://www.ssa.gov/disability/professionals/bluebook/general-info.htm
Part III - Listing of Impairments. Disability Evaluation Under Social Security. (n.d.). Retrieved May 16, 2022, from https://www.ssa.gov/disability/professionals/bluebook/listing-impairments.htm
