This paper provides a philosophical analysis of the ontology of impairment, in part social and in part not. The analysis is based on the division between two categories of facts concerning the world we live in: “brute” and institutional facts. Brute facts are those that require no human institution for their existence. To state a brute fact requires naturally the institution of language, but the fact stated is not the same as the statement of it. For example, regardless of any human institution or opinion, the presence of an extra chromosome 21 is a brute fact, and despite of people’s constructions or deconstructions, this fact remains. As for the lives of people with extra chromosome 21, the social reality and human institutions enter the picture. The social and moral status of these people is never a matter of brute fact.
- disability studies
- John Searle
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Nowadays, it is widely acknowledged that disability is not merely a matter of biological impairment but, also, and perhaps primarily, a social phenomenon; disablement cannot be explained and understood simply in terms of people’s impairment but, rather, in terms of social arrangements. In other words, it is not individuals and their alleged incapacities that explain the limited opportunities of people with impairments; society is partly to be blamed, too. This perspective has been represented and promoted by disability studies, and has had major influence on other disciplines (like medicine) as well.1 2
The disability studies perspective typically rejects essentialistic views of human beings. What is considered as characteristically ‘human’ or ‘normal’ physical or mental make-up of beings, does not depend on human essence (whatever that might be), but on culturally produced norms. Humanity and normality are socially constructed. Accordingly, as much as bodies and impairments are biological entities, they are also cultural and social entities: “the impaired body has a history and is as much a cultural phenomenon as it is a biological entity.”3
We have no quarrel whatsoever with a position building on the (not very extreme) basic idea of disability as a social category and social construction. However, a lot of what some disability scholars have said about impairment on the basis of postmodern ideas, and the entailments thereof, seem much more radical. According to these views, impairments are not primarily or even secondarily biological facts. Rather, these entities (ie impairments) are historically contingent effects of modern power: “impairment and its materiality are naturalised effects of disciplinary knowledge/power.”4 Also, some authors seem to suggest that intellectual impairments, for instance, do not have a biological grounding prior to representation: “without the prior existence of language, such ‘psychological’ things as ‘intellectual (dis)abilities’, ‘syndromes’ (…) can, quite literally, not sensibly be talked of.”5 In other words, impairments can and should be placed in apostrophes; they are not pure biological entities, but matters of representation, discourse and social construction. In line with this kind of thinking D Goodley and M Rapley state in challenging tone that “Impairment in the modern, materialist world remains characteristically biological and not an aspect of disabled people’s lives that can or should be changed.”5 6 It seems as if Goodley and Rapley are suggesting that the alleged impairment and the possible incompetence related to, for example, Down syndrome can and should be abolished merely by re- and deconstructing the impairment.
We address here some epistemological and ontological questions of impairment. Is a discursive body, “one whose matter really doesn’t matter at all”,7 all there is to it? What is impairment really all about? Is it just biological or just social? Or is it both? In discussing these issues we draw heavily on John Searle’s ideas concerning the ontological nature of institutional facts developed in his The Construction of Social Reality (without committing ourselves to his account in detail). Searle provides an account of institutional facts that is compatible with naturalist ontology, and thus provides a good grounding for our position in the debate concerning the nature of impairment. In our view, impairment includes both a social and biological dimension. In accordance with Searle’s account of institutional facts we argue that impairments have a grounding in physical facts (or not socially constructed facts, if you like) which, in fact, is a necessary condition for any social functions of impairment.
INTRINSIC AND OBSERVER-RELATIVE FEATURES OF THE WORLD
Goodley and Rapley, as quoted above, seem to argue that things such as syndromes or intellectual disabilities do not exist prior to language; they come into being when they are articulated, defined and represented.5 Before we can judge the justification of a notion such as this, a conceptual clarification is in order. First, there is an important epistemological and ontological distinction between the “objective” and “subjective”. Epistemic sense of objective–subjective distinction refers simply to discussions about our judgments of how things are in the world and their truth (or credibility). A judgment is subjective if its truth (or correctness) depends on the attitudes, feelings, or points of view of the maker and the hearer of the judgment. An example of such a judgment could be “CS Lewis is a better writer than JRR Tolkien.” A judgment is objective if its truth is settled by facts in the world that are independent of the maker and hearer of the judgment. In other words, if a statement is objective in the epistemic sense then there is an objective fact in the world which makes it true. Such a statement would be, for instance, “CS Lewis was born on 1898 in Belfast.” The contrast between epistemic objectivity and epistemic subjectivity is a matter of degree (Searle, p8).8
In the ontological sense, objective and subjective are predicates of the entities in the world, types of entities, and their mode of existence. Objective entities exist independently of any perceiver or mental state whereas subjective entities are dependent on perceivers and mental states. So, in the ontological sense, pains are subjective entities because their existence depends on the subject’s experience. But mountains, for example, are ontologically objective because their mode of existence is independent of any perceiver; mountains would stay in the world even if all the humans and other subjects with senses disappeared from the earth. Here we need to distinguish between the senses of objective and subjective, that is, we can make epistemically subjective statements about entities that are ontologically objective, and similarly, we can make epistemically objective statements about entities that are ontologically subjective. For example, the statement “It is better not to have an extra chromosome 21 than to have it” is about ontologically objective entity, but makes a subjective judgment about it. On the other hand, the statement “The fact that my child has an extra chromosome 21 causes me emotional distress” reports an epistemically objective fact in the sense that it is made true by the existence of an actual fact that is not dependent on any opinion of observers. Nevertheless, the phenomenon itself, the actual emotional distress, has a subjective mode of existence (Searle, p8–9).8
Another crucial distinction related to things existing prior to representation is between intrinsic and observer-relative features of the world. Let us imagine, for example, an object that a friend of mine sits on. The object has a certain mass and a certain chemical composition. It is made of metal, plastic and rubber (and perhaps of some other materials) which all are composed of certain molecules. All these features are undoubtedly intrinsic. However, it is also true to say of the very same object that it is a wheelchair. When we describe it as a wheelchair, we are specifying a feature of the object that is observer or user relative. It is a wheelchair only because people use it as a wheelchair. The mere concept of wheelchair implies a certain user-relative function and purpose of the object. The observer-relative features of the world do not add any material objects to reality, but they can add epistemically objective features to reality where the features in question exist relative to observers and users. In other words, it is an epistemically objective feature of this object that it is a wheelchair, but since that feature exists only relative to observers and users, the feature is ontologically subjective (Searle, p9–10).8 Searle sums up the thesis in the following way: “Observer-relative features exist only relative to the attitudes of observers. Intrinsic features don’t give a damn about observers and exist independently of observers.” (Searle, p11)8
IMPAIRMENTS: BRUTE FACTS OR INSTITUTIONAL FACTS?
Before the issue of impairments, syndromes and the like existing prior to representation can be settled, a few more considerations concerning conceptual distinctions are in order. Searle argues that there are features of the world that are matters of brute physics and biology and, on the other hand, features that are matters of culture and society. Although these two dimensions are in relation to each other, to some extent, however, they can and should be separated. Brute facts, such as the fact that Mount Everest has snow and ice near the summit, are those that require no human institution for their existence, whereas institutional facts can exist only within human institutions, such as the fact that Joseph Ratzinger is Benedict XVI, the current Pope of the Catholic church. To state a brute fact requires naturally the institution of language, but the fact stated is not the same as the statement of it. (Searle, p27)8 Thus, the statement that someone has appendicitis requires an institution of language and an institution of identifying organic functions and their outcomes (ie medicine), but the fact stated, the fact that someone’s appendix becomes inflamed, exists independently of language or any other institution.
So, brute facts do not require language or representation for their existence, whereas institutional facts do. One obvious example of a class of such facts is declarations, speech acts in which “the state of affairs represented by the propositional content of the speech act is brought into existence by the successful performance of that very speech act.”(Searle p34)8 Institutional facts can thus be created with the performative utterance of such sentences as “I pronounce you husband and wife” or “War is hereby declared.” An example of such a performative utterance in disability context would be that of diagnosis; someone’s impairment starts to exist institutionally when a doctor diagnosis it. In the case of most institutional facts, the linguistic element appears to be partly constitutive of the fact. We could not have presidents, queens, husbands, wives or, let alone, disabled people, unless we had the apparatus necessary to represent some people as, for example, presidents or disabled. (Searle, p37)8
But before we can name or agree upon on any facts, that is, institutional facts, we have to have brute facts. In order to have money, games, schools, medical diagnoses or any other human institution, there must be some physical realisation for each, some brute fact on which we can impose its social function. All sorts of substances can be money, whether it is bits of metal or pieces of paper or magnetic traces on plastic cards, it has to exist in some physical form or other. Or more precisely, all institutional facts require, in part for epistemic reasons, a physical grounding; it is constitutive for an institutional status that it can be recognised as such. (Searle, p34-5)8
Thus, the brute level of facts is the necessary foundation of institutional facts. However, institutional facts cannot exist without social conventions and without representation. (Searle, p68)8 Social phenomena inevitably have a social history. Hughes and Paterson, for instance, are quite right for criticising accounts that construct body and impairment purely in biological terms. 9 But this does not mean that impairment is wholly socially produced. The diagnosis of Trisomy 21 (or Down syndrome) has a social history and it has had various social consequences to the lives of those with that diagnosis. However, despite the fact that Trisomy 21 is a construction, an invented term for a certain phenomenon, it is a term for an existing physical fact. Irrespective of any construction or representation, someone either has or has not an extra chromosome 21. And the fact that someone has an extra chromosome 21 does not have a social history, it has a mere biological history. In other words, the diagnosis “Down syndrome” is not a sole creation of anatomy and physiology whereas the existence of an extra chromosome 21 is.
On a pure biological level, the existence of a certain chromosome is not in any way dependent of representation. But naming this particular biological phenomenon as an “extra” chromosome 21, we shift from a brute level to an institutional level. This is because defining some entity as “extra” implies that it is seen vis-è-vis statistical typicality and the way organisms of this kind usually are. Most of all, however, the definition of this syndrome (like all other syndromes) is related to the functions we have set upon organs and organisms. For example, we are aware of certain causal processes in human bodies having to do with the survival of the organism. When we say “The heart pumps blood” we are recording an intrinsic, brute fact. But when we say “The function of the heart is to pump blood”, we are situating this intrinsic fact to a system of values that we hold. When we assign a function to something it means that to us humans this substance has a task to fulfil, or it is a means to something: “Functions, in short, are never intrinsic but are always observer relative.” (Searle, p14) 8 When we have assigned a function to a heart or any other organ, we can use the vocabulary of success in relation to them—that is, we can speak of malfunction, or better and worse hearts. This we could not do if we talked about simple brute facts of nature.
Thus, the condition named extra chromosome 21 or Down syndrome, includes a brute fact of nature. However, it also includes an institutional level, not just epistemically (which is always tied to representation) but also ontologically. This is because this condition is very much related to the values and ends that we have assigned to different organs (as in relation to the ends of human bodies and minds). Extra chromosome 21 is an example of a brute fact that is identified and understood in relation to a system of values. It has been recognised that this brute fact is statistically in connection to certain biological features. But it is seen to imply some social consequences as well. In fact, Down syndrome is very much a social category. The need to define and identify this condition in newborn babies and fetuses is based on social expectations that can be seen as two-fold: (1) expectations of how human beings ought to develop and to what kinds of beings they should develop into, and (2) expectations for individuals with Down syndrome likely not to develop in the way that is desirable.
Also, recognising an extra chromosome 21 in some individuals has major social consequences to their lives as well (or in other words, identifying brute facts may have major institutional outcomes to people). The crucial outcome is that these individuals will be seen by most people primarily in relation to their biological condition. We have developed various institutions for these people: we have highly advanced techniques to detect this brute fact in individuals before they are even born in order to prevent their birth (in fact, preventing the birth of such children has turned into a massive endeavour and an institution of its own in Western medical practice). We have also constructed institutions specifically for children with these kinds of conditions to rear and educate them. We have various procedures to prevent them from breeding (in the case of their biological condition not preventing it), from participating in social and professional life, and so on and so forth.10–12 In other words, the brute fact of a body often determines an individual’s institutional life in a way that can be depicted as brutal.
Medicine has traditionally recognised one-sidedly the brute level of impairments whereas disability studies has concentrated merely on the institutional level and ignored, chiefly for political reasons, the biological facts related to disablement.13 14 The medical community has now acknowledged, at least partly in official documents such as the International Classification of Functioning, Disability and Health (ICF), the nature of disability as a social phenomenon.15 However, for disability studies the recognition of impairment, its nature and effects on people’s lives, still seems to be a nut too hard to crack. The close relationship of the brute (biological) level with the institutional (social) level is something which the disability studies perspective should finally recognise, accept, and deal with.
Talk about oppression has become a sort of unquestioned mantra in disability studies—there seems to be no context where you could not accuse someone of oppressing disabled people, and the burden of proof is always on those who question this notion. One example of such tendency is the following quote by Goodley and Rapley who claim that “naturalised views of impairment are at the core of oppression.”5 However, to hold a naturalised view of impairment does not imply oppression of disabled people. Quite the opposite; ontology based on facts rather than representations is also better in political terms. A view that acknowledges the material basis of impairments is useful and, indeed, necessary for individuals with these conditions because their conditions have a physical grounding that require a physical response. There are cases where people do need the medical model of impairment; they need facts about the physical consequences of impairment or any other medical conditions they may have (though not all impairments are medical conditions in the sense that they would require medical attention). In plain English, people need pills, operations, therapies, rehabilitation, and other remedies that should be based on medical facts. Millions of competing texts, discourses and representations are not much of a comfort for people who are in pain.
To conclude, there is nothing oppressive in admitting that impairment includes both physical and social dimensions. Just as a broken leg is a medical matter and the moving around of a person with a broken leg is both a medical and a political matter, impairment in general is often both a brute fact and institutional fact.
Competing interests: None.