People with Disabilities and Social Work: Historical and Contemporary Issues

Author(s): Romel W. Mackelprang and Richard O. Salsgiver

Source: Social Work, Vol. 41, No. 1 (January 1996), pp. 7-14
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/23718240
Accessed: 18-03-2016 20:11 UTC
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People with Disabilities and Social Work:

Historical and Contemporary Issues
Rk mel W. Mackelpratig and Richard O. Salsgiver
From the earlie. t recorded history, people with disabilities have been

ostracized, reje> ted, and discriminated against in society. Although

social work has a history rich in advocacy for oppressed people, the
profession has been hesitant to become involved with people with
disabilities. This article addresses historical and contemporary issues
concerning disability. Recent developments in the disability

movement, including independent living, are discussed and compared

to social work's approaches to disability. Finally, a plea is made to the
social work profession and the disability movement to combine
effort s to enhance the lives of people with disabilities.

Key words: disability; disability movement; independent living;

minority model; strengths perspective

1990 (P.L. 101-336) was a civil rights land

mark for people with disabilities. With the
passage of the ADA, Congress acknowledged that
the 43,000,000 Americans with disabilities have

and the rise of the disability movement. Social

work and independent living approaches to work
ing with people with disabilities are compared and
contrasted, and suggestions for integrating both
approaches are provided. Finally, a plea is made
for social work to re-evaluate its commitment to

The Americans with Disabilities Act (ADA) of

been subjected to serious and pervasive discrimi

nation. Congress also acknowledged that unlike
other populations who have experienced discrimi
nation, people with disabilities have had "no legal
recourse to redress such discrimination." From

people with disabilities.

History of Treatment of People

with Disabilities

the beginning, social work has viewed itself as the

profession with primary responsibility toward
people who are subjected to discrimination and
oppression. However, the profession has not em
braced the causes of people with disabilities as it

Throughout the history of humankind people

with disabilities have been a part of society; ar

has other oppressed groups. Consequently, rela

tively few social workers work with people with
disabilities, few people with disabilities enter the

sponded to people with disabilities based on their

cultural belief systems.

profession, and the profession has done little to

promote disability rights (Mackelprang, 1993;
Mackelprang & Santos, 1992).
This article examines the history of societal
values and attitudes about people with disabilities

chaeologists have repeatedly uncovered evidence

of people with disabilities dating as far back as the
Neanderthal Period. Societies treated and re

Ancient Beliefs

Neolithic tribes perceived people with disabilities

as possessed by spirits. When the spirits were per
ceived as evil, escape routes were fashioned by
drilling holes in the skulls of people who were
CCC Code: 0037-8046/96 $3.00 1996

National Association of Social Workers, Inc.

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people with disabilities decreases the chances of

association, allowing people to deny the eventual
loss of physical integrity and ultimately death.
Livneh also contended that people with disabili

thought to be possessed (Albrecht, 1992). The

Spartans, with their rugged individualism, aban
doned young and old people with disabilities in
the countryside to die. Plato (1991), to whom

Western culture owes much of its ethical frame

ties threaten those without disabilities with the

work, viewed people with disabilities as standing

in the way of a perfect world: "the offspring of the
inferior, or of the better when they chance to be
deformed, will be put away in some mysterious,
unknown place, as they should be" (p. 183). The
Romans, who borrowed the concept of reciprocity
from the Greeks, gave assistance to adult people
with disabilities with the expectation that they
would demonstrate thanks by not rioting. How
ever, like the Greeks the Romans also abandoned
disabled or deformed children to die (Morris,

knowledge that their limber walk, strong muscles,

and sexual prowess are temporary.

17th-Century Beliefs
The rise of capitalism during the Industrial Era
presented unprecedented labor needs and social
problems. With the codification of the Elizabe
than Poor Laws in 1601, England endeavored to
deal with the dilemma of caring for needy people
while maintaining a labor force for its developing
industries. Stone (1984) suggested that the Poor
Laws were England's attempt to reconcile this di
lemma by creating a "system of categorical ex
emption" (p. 51) by classifying poor people into
deserving and nondeserving categories. Or
phaned, blind, and "crippled" people were
deemed deserving and received charity less be
grudgingly than so-called nondeserving poor

1986).
Judeo-Christian Beliefs
Judeo-Christian tradition, prevalent among Euro
peans during and after the Middle Ages, taught
that people with disabilities were expressions of
God's displeasure (Livneh, 1982). Although
Judeo-Christian philosophy did not advocate kill
ing, people with disabilities were ostracized and
stereotyped. Disability signified "sinner" to the
ancient Hebrews, and people with disabilities were
thought to be possessed by evil demons. People
who were deformed, "crippled," or of short stat
ure were forbidden to become priests. The Old
Testament forbade people who were blind or lame
from entering the houses of believers (Wright,
1960). In the New Testament, people with mental
disorders were believed to be possessed. It was
thought that people with disabilities had them
because of their own or their parents' sins. Treat
ment centered on spiritual redemption (Albrecht,

people.
18th-Century Beliefs
By the mid-1770s, a new perspective on the hu
man situation, the Enlightenment, was making its
impact on Europeans and Americans. Out of the
tenets of the era came the idea that perhaps hu
mans could be perfected. Within this environ
ment, a model of treatment began to emerge that
defined people with disabilities by their biological
inadequacies. In the United States, institutions
dedicated to perfecting the imperfect sprang up
(Rothman, 1971) with the hope that professional
intervention could cure these inadequacies. When
a cure was not possible, people with disabilities
could at least be trained to become functional

1992).

Judeo-Christian thought, on which much of

Western culture is based, has also taught that hu
mans are made in God's image and are different
from and superior to the rest of the animal king
dom. Livneh (1980) contended that people with
disabilities remind those without disabilities of

enough to "perform socially or vocationally in an

acceptable manner" (Longmore, 1987b, p. 355).

19th-century Beliefs
The 1800s began with the continuing belief that
humans could change. Professionals held great
hope that "deviants," which included people with
disabilities, could be molded into assimilated, less

humankind's link with the rest of the animal king

dom and of their own fallibility.
Similarly, Western culture has engaged in a
collective denial of aging and death. People with
serious or terminal illnesses challenge that denial
and thus tend to be avoided (Becker, 1966), a de

threatening, more acceptable people (Rothman,

1971).
However, by the end of the 19th century, the
ominous philosophy of social Darwinism and eu
genics came to prominence. Deutsch (1949)

nial that generalizes to those with disabilities.

Livneh ( 1982) believed that the segregation of

Soc/fl/ IVor/c / Volume 41, Number 1 / January 1996

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through the 1950s (Longmore, 1987b). During

the second half of the 20th century the ideas of
past eras continued to influence professional
practice.
Mental health practice has focused on indi
vidual weakness and pathology. The DSM-IV
(American Psychological Association, 1994), the

quoted Darwin's cousin Frances Faltin, who de

scribed eugenics as "the study of the agencies un
der social control that may improve or impair
the racial qualities of future generations either
physically or mentally" (p. 358). Rhodes (1993)
concluded, "the movement emphasized the
dominance of heredity and sought to encourage
the reproduction of socially desirable individuals
(positive eugenics) and discourage the repro
duction of the undesirable (negative eugenics)"

major diagnostic tool of mental health practition

ers, is devoted to the diagnosis of pathology, with
almost no attention given to strengths. Similarly,
medical evaluations measure pathology and the

(p. 6).

lack of pathology but rarely measure strengths.

Diagnoses within these settings also focus exclu
sively on the individuals being diagnosed, neglect
ing social, environmental, and contextual factors
that influence people's situations.

Eugenics became a convenient explanation for

the ills of society and cast people with disabilities
in a frightening light, making them extremely vul
nerable. Professionals lost confidence in their

ability to perfect people with disabilities, conclud

ing that they were innately un- The medical model views
productive and thus endemi- physicians as treatment direc
cally without worth. No inter- tors and nurses, therapists,

vention could bring about The Stereotype of people social workers, and other

change because the laws of na- . , ,. ...... health care professionals as

ture deemed people with dis- With disabilities dS assistants who help direct pa
abilities unfit (Longmore, nonproductive and socially tients' lives. Patients are pas
1987a). People with disabilities abject was prominent sive recipients of treatments

were to be prevented from mar- , , , lozn that are dispensed by profes

rying or having children for fear roug e S. sionals who are experts. The
of propagating their imperfec- experts make the decisions

tions. As the 19th century pro- and inform patients of those

gressed, institutions to deal with decisions (Trieschmann,

1980). If people with disabilities who use profes

sional services attempt to become active consum
ers and control their care, they become vulner
able to the withdrawal of help from providers
who do not like having their authority ques
tioned. This dependence forced on people with
disabilities by professionals and society as a whole
has led to great dissatisfaction. Thus, in the last
decade of the 20th century, people with disabili
ties have demanded the right to take control of

the threat and nuisance of people with disabilities

increased dramatically, and they were increasingly
isolated and institutionalized, sometimes in sub
human conditions.

20th-century Beliefs
Early 20th-century America offered little attitudi
nal progress. People with disabilities were objects
of shame and disgrace. Parents, often on the ad
vice of professionals, hid disabled children from
society in their homes or in institutions. Gallagher
(1985) recounted the prevailing attitudes of the
time in the experiences of President Franklin D.
Roosevelt as a person with a disability. Roosevelt
was continually forced to compensate for

their lives.

Independent Living and the Minority Model

The birth of disability consciousness in the United
States arose out of the turbulence of the 1960s, a

decade of re-examination, challenge, analysis, and

society's attitudes and to hide his disability from

the public.
World War I and World War II marked super

change. For the first time in U.S. history, perhaps

even in Western history, significant numbers of

people with disabilities demanded access to the

mainstream of society.
The disability movement matured with the de
velopment of the independent living concept in
the early 1970s. Initially led by people such as Lex

ficial advancement for people with disabilities.

Federal rehabilitation legislation produced money
for treatment of veterans disabled by war. How
ever, the stereotype of people with disabilities as

nonproductive and socially abject was prominent

Mackelprang and Salsgiver /People with Disabilities and Social Work: Historical and Contemporary Issues

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for an ever-eroding baseline of services and are

relegated to subsistence-level living. At the same
time, the social welfare system creates pervasive
disincentives to work and reinforces the idea that

Frieden, Judy Heumann, and Ed Roberts, inde

pendent living applied the minority model as the
foundation of the political process of gaining the
civil rights of people with disabilities (Berkowitz,
1987). Whereas traditional Judeo-Christian cul

people with disabilities do not need to work. For

example, if people receiving Social Security Dis
ability and Medicare return to work, they will lose
not only their payments but also their medical
coverage, which would be financially devastating
and potentially life threatening. The minority
model views the lack of work options as repressive

ture and traditional models of professional treat

ment focused on individual pathology (Weick,
Rapp, Sullivan, & Kisthardt, 1989), independent
living focused on societal responses and discrimi
nation as the primary barriers to civil rights.
The independent living perspective views
people with disabilities not as patients or clients
but as active and responsible consumers. Indepen
dent living proponents reject traditional treat
ment approaches as offensive and disenfranchis
ing and demand control over their own lives. For
example, when people with physical disabilities
have needed physical assistance with self-care,
that care is primarily provided by licensed profes
sionals assigned through formal agencies. In con
trast, independent living proponents retain their
own personal responsibility to hire and fire people
who provide attendant care. They eschew the need
for licensed providers such as registered nurses to
provide care, favoring instead attendants who are
trained by the individuals with disabilities them

and decries this discrimination.

Contributing to the belief that people with dis

abilities should not work is the role of sick people
in Western culture. People with disabilities, whom
society assumes are "sick," are expected to fill this
role even when they are perfectly healthy. As with
those who are sick, people with disabilities are to
be taken care of and to be provided for. Their only
obligation is to be grateful for the help given them
(Devore & Schlesinger, 1987), thus subjecting
them to a form of benevolent oppression.
When the expectations that people with dis

abilities should not work and should fulfill the

sick role are foisted on people for their lifetimes,

they invariably believe those messages and act ac
cordingly. Also, people with disabilities have been
given few opportunities to develop skills associ
ated with independence and self-sufficiency. At
tributions of personal unworthiness based on
spiritual beliefs further promulgate oppression

selves. Social workers become involved with these

individuals only by request.

Traditional medical paradigms define the na
ture of disability by individual deficiencies and
biology. For example, justifications for keeping
children with disabilities out of regular public
schools have centered on their impairments. Pro
ponents of independent living contend that chil

and isolation.

The behavior, self-concept, educational

achievement, and economic success of people
with disabilities can be understood only by view
ing people with disabilities as a minority group
who are subjected to discrimination found in
their social environments (Fine 8c Asch, 1988).

dren with disabilities have not been allowed to

attend regular schools because of physical, attitu

dinal, and legal barriers and not because of indi
vidual incapabilities. As a groupas a minority
these children have been denied their right to

Independent living encourages people with dis

abilities to begin to assert their capabilities per
sonally and in the political arena.

education (Meyerson, 1988).

The minority model asserts that discrimination
against people with disabilities is rooted in the
beliefs and values of the culture. The most funda

Social Work, Independent Living,

and Disability

mental belief is that people with disabilities can

not and should not work or otherwise be produc
tive. For example, Stone (1984) stressed that
residual benefits of the Elizabethan Poor Laws are

Social work philosophy shares many similarities

with the minority model of viewing people ancf
their environments. Social workers use a systems
perspective, acknowledging the influences of the
environment on personal functioning. However,
the person-in-environment perspective differs
from independent living in that it maintains a
heavy emphasis on Freudian and neo-Freudian

the ensured support and services to people with

disabilities in the current welfare state. What

Stone and others failed to recognize is that catego

rizing people with disabilities as deserving of char
ity creates a dubious benefit wherein they qualify

Social Work / Volume 41, Number I / January 1996

10

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physical disabilities attempting to live indepen

dently: "severely disabled adults ... must spend
their lives confined to families' homes or impris

philosophy (Hepworth & Larsen, 1993). With the

emergence and expansion of other trends of
thought in recent decades, the importance of sys
tems, culture, and social supports has become in
creasingly emphasized. Ecological systems theory
has been a natural outgrowth and synthesis of
these trends (Hepworth & Larsen, 1993).
As social work matured from a person-in-envi
ronment to an ecological systems approach, a ma
jor method of practice evolved from casework to
case management. Moore (1990) contended that
"case management" is a new name for traditional
social work practice; however, case management
has a stronger emphasis on professionals interact

oned in institutions.... The very agencies sup

posedly designed to enable severely physically

handicapped adults ... to achieve independence

and productivity in the community become yet
another massive hurdle they must repeatedly
battle but can never finally defeat" (p. 153).
Longmore also offered illustrations of the cata
strophic effects of public social policies in the lives
of people with disabilities. When social workers
are identified as the professionals who implement
and enforce such policies and regulations, they are
viewed with skepticism and distrust.
Empowerment has been a guiding tenet of
both social work and independent living. How
ever, independent living views empowerment
from a different perspective than social work.
Whereas social work envisions professionals in

ing with multiple systems that affect clients. In

addition, case management emphasizes the use of

a number of roles from counselor to advocate to

educator to mediator. Social workers also "em

power clients to become active participants and

decision makers in all phases of their lives"
(Sheafor, Horejsi, & Horejsi, 1991, p. 64) and help
people find the power within themselves
(Saleebey, 1992). This practice perspective is fur
ther reinforced by the strengths-based practice

volving clients or patients in prescribed care or

treatment plans, independent living views social
workers and other professionals as consultants

only. Even when individuals have severe disabili

ties that limit learning and decision-making capa
bilities, social workers and other professionals
teach skills and facilitate self-management but do
not assume responsibility or control over people.
In this manner people's capacities are maximized
and abuses of power (for example, inappropriate
institutionalization, involuntary sterilization, co
erced treatments) are prevented.
Independent living proponents believe that the
greatest constraints on people with disabilities are
environmental and social. Social work, while ac

model (Rapp, 1992). Weick et al. (1989) empha

sized that assessment and intervention based on

the strengths of individuals is the cornerstone of

empowerment: "Focusing on human strengths is
one significant strategy for helping people reclaim
a measure of personal power in their lives" (p.
354). The ecological systems perspective com
bined with a strengths-based case management
approach that uses the principle of empowerment
is a departure from the medical model and is a
step toward the minority model.
However, the profession has not shown a con
sistent commitment to people with disabilities.
The numbers of social work students and educa

knowledging the multiple systems that affect

people, often focuses on individual factors that
contribute to client problems. Social work's ten
dency to intervene in personal problems without
being asked is rejected by independent living pro
ponents as intrusive.
Although social work has pioneered efforts to
encourage the use of natural helpers in people's
environments, departing from traditional reliance

tors who have a disability are low, there are few

disability-related articles in the social work litera
ture, and social work conferences are nearly bereft

of presentations on disability (Mackelprang,

1993). Likewise, people with disabilities have not
regularly sought social work services (Servoss,
1983). One reason may be that social workers of
ten practice in organizations such as hospitals and
mental health centers in which professionals make

on professionals used in the medical model, inde

pendent living proponents assert that the informal
support model still breeds dependence, shifting
control from formal providers to informal provid

the decisions, thus relegating clients to passive,

ers (Dejong, Batavia, 8c McKnew, 1992). Indepen

receiving roles. Many social work jobs are also

located in public-sector settings that are bureau

dent living espouses a philosophy that advocates

natural support systems under the direction of the

cratic and cumbersome. Longmore (1987a) re

consumer.

counted the experiences of people with severe

Mackelprang and Salsgiver / People with Disabilities and Social Work: Historical and Contemporary Issues

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Social Work and Independent Living:

Forging a Partnership

attendants rather than having nurses and aides

assigned to her. Sharon developed the knowledge
and skills to direct her own personal care, includ
ing hiring, firing, and money management, essen
tially reclaiming control over her life.

The lack of social work involvement in the inde

pendent living movement is disturbing because

both have much to offer each other.

The social worker viewed her interventions on

Sharon's behalf as client centered and empower

ing. She took control in the immediate weeks and
months after Sharon's accident because "to ask

Benefits to Social Work

Social work can benefit greatly from a shift in fo

cus from case management in which clients are
labeled "cases" to a consumer-driven model of

Sharon to do so would be overwhelming because

Sharon needed time to adjust" to her injury. As
time progressed, the social worker maintained her
involvement level because working with so many

practice that acknowledges self-developed

empowerment and not empowerment bestowed
from others. The independent living movement
has more than 20 years of experience developing
and refining this approach. The following example

agencies was "complicated." Her actions empow

ered Sharon because she was able to access nu

merous services. The social worker always informed

illustrates the differences. Sharon of her plans to assist

Sharon, age 32, received so- Sharon, and Sharon often re

cial work case management ser- quested the services the social
vices after an automobile acci- The lack of SOCil Work worker provided. The social
dent caused a spinal cord injury invnlvpmpnt in thp worker cited her close relation
that resulted in quadriplegia. . _ . ship with Sharon and Sharon's

During Sharon's hospitaliza- independent living

appreciation of her efforts as

tion her social worker facili- movement S disturbing evidence of the effectiveness
tated the procurement of Med- because both have much to ofth,ei,r relationship,

icaid, ordered medical equip- ,, , , Although the social

ment such as a wheelchair, pro- Offer each Other. worker's activities helped

cured the services of a home Sharon, the social worker un

health agency for home nurs- intentionally encouraged de

ing visits, arranged for voca- pendence and impeded

Sharon's self-determination. The independent

living counselor, on the other hand, saw her role
as facilitating Sharon's self-determination, and
she did not consider directly intervening in activi
ties Sharon was capable of. Through mutual ex
ploration with the counselor, Sharon was able to
greatly enhance her independence in several areas.

tional rehabilitation services, and worked with

Sharon's family to prepare for her discharge from

the hospital. Similar case management services
were provided for six months after discharge; the
social worker generally informed Sharon of the
services she would be providing, and Sharon also
made requests for services.
Six months after discharge from the hospital,
Sharon became involved with a local independent

Benefits to the Independent Living Approach

If the person-in-environment approach can be
criticized for being too intrapsychic, the indepen
dent living approach can be criticized as viewing
problems too much from an external perspective.
Independent living may be too quick to assume

living center for peer counseling and independent

living training. When Sharon began to have
trouble with Medicaid, she asked the independent
living counselor to intervene on her behalf. Simi
larly, she asked the counselor to procure a com
mode chair. Rather than meet her requests as the
social worker had done, the independent living
counselor taught Sharon to self-advocate with
Medicaid and guided her through the process of
ordering medical equipment so Sharon could do
so in the future. In addition, the counselor in

that consumers already have knowledge and abili

ties rather than recognizing that they may need
assistance to develop their strengths. The follow
ing example illustrates the differences.
Jim, age 28, had a traumatic brain injury. He
sought assistance with budgeting and financial
difficulties at an independent living center. The
independent living counselor, who was also an

formed Sharon how she could gain access to a

program in which she could hire and direct her

Social Work / Volume 41, Number 1 / January 1996

12

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MSW student in practicum, helped Jim develop a

budget and strategies to deal with creditors. Dur
ing the sessions with Jim, it became apparent that
his head injury was also a contributing factor to
significant marital and family difficulties. How
ever, because these problems were not problems
identified by Jim, the counselor felt constrained
from intervening in this area.

Jim seemed relatively unconcerned by his

marital situation (almost certainly because of lack
of insight as a result of his head injury). However,
his wife and adolescent daughter were in signifi
cant distress. Competent counseling was available
at the independent living center but was inacces
sible unless Jim identified problems and requested
help. Although his family could seek counseling at
a mental health center, this center did not employ
people who understood the implications of brain
injury. Therefore, no marriage reconciliation ser
vices were provided. Jim and his wife later sepa
rated and divorced, and Jim's wife maintained
primary responsibility for their child. By the time

Jim became responsive to the need for help, it was

too late to save his marriage.
In Jim's case, the independent living approach
resulted in a lack of intervention, which ultimately
had negative effects on Jim and his family, in part
because independent living's narrow view of the
consumer does not include the family. This case
also illustrates the conflict between absolute self

determination and the need to sometimes impose

professional intervention. Although some would
argue against any change in Jim's intervention, a
social work approach would have allowed for
broader intervention and ultimately may have
been more empowering to Jim and his family.

empower oppressed and devalued groups, and

understand the needs of people with disabilities. It
is a partnership that is long overdue.
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Mackelprang and Salsgiver / People with Disabilities and Social Work: Historical and Contemporary Issues

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disability. Faculty Development Institute presented

Romel W. Mackelpratig, DSW, CSW, is associate

at the Annual Program Meeting of the Council of

professor, Inland Empire School of Social Work and

Human Services, Eastern Washington University,
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Richard O. Salsgiver, MSW, DA, is associate pro

Social Work Education, Kansas City, MO.

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