On the importance of correct terminology around disability, impairment and handicap

March 1981 – LINK Magazine article

In order for us to make progress in disability, we need to build a clear consensus about terms that matter. The choice between the terms: ‘impairment’, ‘disability’ and ‘handicap’ hinges around the concept of perceived responsibility. The past mismatching of definition and responsibility has led to a great deal of confusion and interchangeability when describing people who have or have had long-term medical impairments.

The following definitions are proposed:

  • IMPAIRMENT; Anatomical loss or loss of bodily or mental function for which the management responsibility lies within the medical arena.
  • DISABILITY: The measurable long-term/permanent functional loss or limitation resulting from a medical impairment for which the management responsibility lies with the individual.
  • HANDICAP: A social consequence caused by environmental or social conditions which prevent a person from achieving the maximum potential they seek for which the management responsibility lies with the community.

Impairment

Under this definition, the perceived responsibility for an ‘impairment’ then rests within the medical parameter. It includes people who are ‘sick’, undergoing treatment, have been born with impairments, or those who are undergoing an intensive medical or psychiatric rehabilitation or therapeutic process up to the point where the person’s condition is considered chronic.

Disability

Once the resulting condition has stabilised or been assessed as chronic, it is the responsibility of the individual concerned to live with that loss or difference of ability. The way each person lives with his/her disability will of course vary enormously; it may even have different consequences for different individuals. One possible exception of personal responsibility for disability is a mentally impaired person whose disability is so severe as to make it necessary for a guardian to retain legal responsibility.

‘Disability’ is both a description and a fact, undeniable and measurable against a ‘normal’ human being. In this context, it is objectively connected to medical impairment only as the functional measurable disability remains constant and therefore acts as an objective measuring stick. It has nothing to do with subjective abilities such as the ability to work, study, socialise, etc., which compose the separate arena of disadvantage of handicap.

Handicap

The word ‘handicap’ is almost superfluous in this debate and would perhaps be better exchanged for the word ‘disadvantage’. Handicaps or disadvantages result from social or environmental conditions – physical, legal, attitudinal – which reflect community decisions about participation of its members. Any person can have handicaps for shorter or longer times in attempting to participate as they would like, which is a normal state outside of Utopia.

People with disabilities may find that they have more than the usual number of handicaps when faced with social/environmental barriers which make their participation more difficult. However, given appropriate tools which compensate for the consequences of their disability, there is no logical reason why a ‘disabled’ person must be ‘handicapped’.

Society handicaps or not

The origin of the word ‘handicap’ reflects an historical context when community decision sanctioned charitable benevolence for its disabled members. The derivation of handicap or ‘cap-in-hand’ is descriptive of the action required of disabled and other disadvantaged people in begging for a handout with cap doffed submissively. It has connotations of begging that none of us today want to associate with.

Handicap is the responsibility of society and the decision to enable disabled people with appropriate tools, including access to adequate income levels, opportunities for education, community living, employment and decision-making, is one for the community to make.

Definitions matter

Why is all this concentration on words so important? Choosing the most descriptive and definitive word is always important for clear, direct action to follow. This is particularly essential in legislation where bureaucratic structures require explicit guidelines. Community pressures will always try to extend the boundaries of legislative proscription. Accountability will only be inbuilt into any system where legislators choose words carefully, which clearly delineate intended targets.

At present, accountability comes mainly through the vehicle of limited resources, the funding pie of ‘x’ dollars. The more the pie is cut, the smaller each segment becomes. If other interests who have extended the boundaries of eligibility are allowed to consume the funds of a segment, the original target group will eventually have nothing. Those of us who seek change caution governments to be very careful in choice of terms around disability in designing new programs and services.

Legacy of poor disability definitions

In the area of funds for disabled people, the Handicapped Persons Assistance Act 1974 exemplifies this problem. The Act was framed with words in common usage, at a time when unemployment was not such an issue. People who were working for restricted wages in sheltered workshops were called ‘handicapped’ but they were in fact, the more severely mentally and physically disabled members of our communities.

Today the word ‘handicapped’ has been extended to include slow learners and other socially disadvantaged people to the point where the original severely disabled and therefore less productive people have been virtually excluded from sheltered workshops and even activity therapy centres.

Definitions drive action

A further misnomer of the Handicapped Persons Assistance Act title is the emphasis on ‘Persons’, when other wording in the Act excludes individuals from funds. All assistance is funneled via organisations who serve a particular client group, so people tend to be segmented via their type of impairment or disability. Perhaps the reason for this was that at the time of its drafting, disabled people were expected to be in institutions and to receive their welfare assistance via organisations.

To return to the proposed definitions, ‘disabled’ is a definable word which enables accountability and delineated boundaries. It also defines the responsibility to the individual and not the community or an organisation. Had legislators in 1974 paid more attention to the words they used to name this Act, the more severely disabled members of our community may not have been at the bottom of the barrel situation in which most now find themselves.