Tom Shakespeare’s important new book1 includes, among other subjects, a sustained and vigorous critique of the social model of disability. The most-well-known proponent of the model is Michael Oliver.2 According to Oliver, the causes of disability lie in the social environment, not in the individual. Thus, remove the obstacles that prevent disabled people from participation in social life and disability evaporates. In his book, Shakespeare highlights what he sees as the distorting aspect of the social model, and its negative impact upon research about disability, theorising about disability and, ultimately, the experiences of disabled people. For example, the social model has had a negative effect upon research, since it has led to a neglect of the phenomenon of impairment and the effects this can have upon the lives of disabled people. Thus, if a person is unable to walk because of a spinal problem, and this problem causes constant, chronic pain for the person, that is an important range of phenomena for researchers into disability to explore. But the social model’s emphasis upon the social environment has tended to direct attention away from the individual and onto the environment. This ultimately has implications for the lives of disabled people, since key areas of research concerning important aspects of their lives are not enquired into.

Taken as a whole, Shakespeare’s critique of the social model is a persuasive one. But there is one important component of it that is less convincing. It may be useful to try to set out the less successful part of his critique, in order that defenders of the social model might try to exploit it, and also in order that Shakespeare himself may respond to it. It is worth adding that the critique of this part of Shakespeare’s discussion to be offered here also highlights a problem with his claim to exploit a critical realist perspective in his overall strategy. So if the arguments to be presented here are sound, then some further reconsideration of the advisability of his adoption of a critical realist stance may also be required.

The main focus of my discussion will be on Shakespeare’s discussion of the impairment/disability distinction. As he says, the robustness of this distinction is fundamental to any credible defence of the social model. This is because it rests upon a distinction between those properties of an individual that can be attributed to the person without necessary reference to social phenomena and those properties of an individual that can be attributed to the person only with some reference to social phenomena (even if such reference is implied rather than explicit). The former kinds of properties are claimed to be impairments, and the latter, to be disabilities. Shakespeare tries to show how such a distinction is seriously flawed. How strong are his arguments? He offers three main arguments (on pages 34 and 35).

The first argument begins with the assertion that “There can be no impairment without society …” (p34).1 It continues by pointing out that impairments are necessary (though not sufficient) conditions of disability, thus establishing a close conceptual connection between disability and impairment. The significance of this move in terms of the critique of the social model is that, contrary to what is claimed by proponents of that model, it is not just disability but impairment, too, that has a social component. This I take to be the significance of the assertion from page 34 just quoted.

In response to this first argument, it must be said that a great deal hinges on the definition of impairment that is being discussed. Shakespeare runs through the main candidates prior to his discussion on pages 34–35. From what he says about these, it is reasonable to suppose that his understanding of impairment is something close to that defined by the World Health Organization (WHO).3 4 (Note also Shakespeare’s general approval (p59) of the The international classification of functioning, disability and health (ICF)).3 The WHO definition runs as follows: “Impairment is a loss or abnormality in body structure or physiological function (including mental functions). Abnormality here is used strictly to refer to a significant variation from established statistical norms …” (p190).3

Shakespeare’s claim, recall, is “There can be no impairment without society” (p34). But surely this is far too strong a claim. Suppose human beings existed as lone hunters, or only in isolated pairs, and happened not to congregate in social groupings. In spite of this, it would remain possible to distinguish those human beings who have impairments from those who do not. This is because the definition of impairment, as seen, defines them by reference to statistical variation from biological norms. So if a human being lacked a leg, it would follow that this person had an impairment, since it is statistically normal for members of the species Homo sapiens to have two legs and not one. This is surely a case in which a human being has an impairment but where there is no such thing as “society”. So, the first argument seems to fail.

The second argument suggests that “impairments are often caused by social arrangements” (p34).1 What Shakespeare has in mind here are impairments “generated by poverty, malnutrition, war” (and so on) (p34).1 Hence, contrary to what is asserted in the social model, impairments are not “insulated” from the social domain in the way in which that model assumes.

However, it is not clear that Shakespeare’s argument here undermines the coherence of impairments conceived of as properties of individuals attributable to them without necessary reference to the social environment. For surely it can easily be acknowledged that impairments may be caused by events beyond the body of the individual. For example, malnutrition may lead to degeneration of the optic nerve, causing blindness. The impairment in such a case is the damaged optic nerve. Here the impairment itself can again be defined by reference to statistical norms, and no reference need be made to the cause of the impairment. So the fact that some impairments may be caused by adverse social conditions does not impugn the integrity of the concept of an impairment, where this is definable without necessary reference to social factors. Thus it seems to me that this argument fails, too.

What of the third argument? This is that “what counts as an impairment is a social judgement” (p35).1 And, further, “the visibility and salience of impairment depend on the expectations and arrangements in a particular society” (p35).1

The response to this, though, is to reiterate the last-quoted passage. For it can surely be true that the saliency and visibility of a phenomenon can be dependent upon events around it, but it does not follow from this that a phenomenon exists only if it is salient and visible. To illustrate: consider that a gold bar is buried in the sand. The tide washes the sand away and the gold bar is now visible, indeed, salient; moreover, it plainly existed even when it was not so visible and salient. One is drawn to observe that the same applies in the case of impairments.

In commenting upon the three arguments that he advances in this part of his book, Shakespeare reiterates the point that “impairment is always already social”. But the responses to the arguments just discussed seem to call his view seriously into question. He does, on the same page, consider briefly the possibility that impairments might be “biological” (p35)—perhaps in a way in which they are conceived of in the WHO definitions. But this is rejected on grounds that are not clear to me. Here is what appears in the text: “If disability is defined as social, while impairment is defined as biological, there is a risk of leaving impairment as an essentialist category” (p35). Unfortunately, why this is so and what exactly would be objectionable about doing so are not explained—as far as I am able to judge. So it seems fair to conclude that the arguments offered here against the impairment/disability distinction, as this is conceived of within the social model, do not succeed.

Before closing, it is worth drawing attention to the adoption of a critical realist perspective in the book. It is stated, “I find the critical realist perspective to be the most helpful and straightforward way of understanding the social world” (p54).1 And in elaboration of what Shakespeare understands by such a perspective, he continues, “Critical realists distinguish between ontology (what exists) and epistemology (our ideas about what exists) … labels describe, rather than constitute, disease” (p54).1

I think this is an accurate portrayal of critical realism, and it is a perspective with which I, too, have expressed sympathy.5 But it seems to me that it is the responses given above to Shakespeare’s arguments against the impairment/disability distinction that reflect a critical realist perspective and that his own arguments are advanced from a position that is not a critical realist one. To see this, note that the objections to his arguments advanced above are consistent with the view that “labels describe, rather than constitute, [impairments]”. But Shakespeare’s own arguments are not consistent with such a view, because they see impairments as dependent upon social phenomena (social arrangements, values) in a way that conflicts with a critical realist ontology, or so I claim.

This response to Shakespeare’s book has focused on a small part of it—though a crucial part—and I doubt that the majority of the book is vulnerable to criticism in the way in which this small part of it appears to be. The book itself is an extremely important contribution to disability studies that takes that subject many strides onward from where it stood hitherto. The critical remarks offered here are intended as a stimulus for further debate and clarification concerning the position Tom Shakespeare would wish to endorse.