Medical Model of Ability
Medical Model of Disability
FocusDifferences among individuals used to account for differences in learning
Principal MetaphorsDiscourses on ability and disability draw on a wide range of metaphors, but conceptions trend strongly to notions consistent with Folk Theories. Two old, but still prominent metaphors are “ability as capacity (i.e., amount that can be held)” and “ability as speed,” and others are developed more below. Since the mid-1900s, Brain-as-Computer Discourses, especially Cognitivism and Cognitive Processes, have been especially influential in framing the Medical Model of (Dis)Ability, and so the following cluster of metaphors are currently pervasive in discussions of ability and disability.
- Knowledge is … information
- Knowing is … using information
- Learner is … an information processor (individual)
- Learning is … inputting (and associated computer-based notions, such as processing, storing, and retrieving)
- Teaching is … transmission (of information)
- Brightness, Brilliance (Dimness) Metaphor – strongly associated with the Illumination Metaphor, framing intelligence in terms of Brightness (or Dimness) tends to prompt attentions toward accuracy of observation, clarity of expression, and sunniness of disposition
- Capacity Metaphor – having to do with how much a container can hold, an ability-as-capacity metaphor is strongly associated with the Acquisition Metaphor and tends to prompt attention to extents – of memory, focus, endurance, and so on
- Cleverness Metaphor – tracing to the Proto-Indo-European root gleubh- “to tear apart, cleave,” Cleverness likely came into popular use for the same reason as Sharpness (see below)
- Exceptionality Metaphor – a more recent construct that’s based on the Normal Distribution (see below), descriptive of performances that are a predefined “distance” from a Norm
- Genius Metaphor – from the Latin gens “generative power,” Genius presses attentions to abilities to produce new insight and possibility, and is thus frequently aligned with Creativity Discourses
- Giftedness, Endowment (Handicap) Metaphor – reflecting assumptions of Nativism, the metaphor operating here has to do with having been bestowed something – and, in the case of Handicap, that something is an additional burden
- Intelligence Metaphor – derived from the Latin intelligentia “power of discerning,” Intelligence likely came into popular use for the same reason as Sharpness (see below)
- Potential Metaphor – derived from the Latin potens “powerful,” Potential has been taken up in two incompatible ways to refer to ability, one that aligns with Giftedness and Capacity (see above) with a sense of predetermined limits, and the other that aligns more with Strength (see below) and a sense of developable possibility
- Quickness (Delayed; Slowness; Retardation) Metaphor – intelligence and other abilities are often interpreted in terms of speediness (or slowness) in developing competence, thus fitting well with the Attainment Metaphor
- Sharpness, Acuity (Dullness) Metaphor – prompts attentions to one’s ability to notice – that is, to the precision and utility of perceptual discernments
- Smartness Metaphor – derived from the Old English word for “cutting,” Smartness likely came into popular use for the same reason as Sharpness (see above)
- Strength (Weakness) Metaphor – the separation of “strong students” from “weak students” suggests that ability is understood in terms of force, endurance, and focus – and, in some contexts, to the benefits of practice/exercise (i.e., likening the brain to a muscle)
- Talent Metaphor – derived from the Latin talentum “weight, sum,” Talent was originally applied to anything measured or measurable – and so, as a metaphor for ability, it prompts notions of clear definition and quantifiability
- Normal Distribution (Standard Normal Distribution; Standardized Distribution; Bell Curve) – a mathematical model based on two pieces of information: the mean (i.e., the arithmetic average or the Norm, at the center) and the standard deviation (i.e., an indication of how data are spread out). The humped shape of the curve illustrates how, for many phenomena, most data points cluster around the mean and the number quickly drops off as one moves further from the mean.
- Norm – mathematically, an average or mean – and so, in the context of the Medical Model of (Dis)Ability, the standard, typical, or expected (i.e., at the center of the Normal Distribution)
- Normal (Normality) – conforming to a Norm – and so, in the context of the Medical Model of (Dis)Ability, typically defined as being within one standard deviation of the Norm (i.e., the dark grey region of the above image)
- Abnormal (Abnormality) – departing from a Norm – which, in the context of the Medical Model of (Dis)Ability, is often defined as more than two standard deviations from the mean (i.e., the lightest shaded regions in the above image)
- Normative (Normativity) – the imposition of a standard, based on an assumed and/or dominant conception of Normal – typically, in ignorance of cultural, racial, social, gender, or other considerations of difference
- Normalism (Normism) – Used by some in philosophy as a synonym to Realism, in education, Normalism is an ambiguous term that, depending on context, can refer to the state of being Normal, the process of returning to Normality, or the imposition of some Normative
SynopsisWithin education, the Medical Model of (Dis)Ability tends overwhelmingly to be framed in terms of diagnosis and remediation – that is, academic ability and disability are usually treated as analogous to physical prowess and physical weakness. Traits and performances, whether perceived as outstanding or problematic, are thus attributed solely to the individual. Accordingly, interventions to supplement excellence and to remediate inadequacy are focused on the person. (Contrast: Social Model of (Dis)Ability and Neurodiversity.) Relevant constructs and resources include:
- Diagnosis and Remediation – metaphors borrowed from medicine and applied uncritically to contexts of learning – not to understand or take advantage of differences among learners, but in efforts to be rid of such differences
- Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychological Association, currently in its 5th edition, 2013) – an intended-to-be comprehensive manual covering the classification, diagnosis, and treatment of mental disorders, as interpreted through a medical model
Sampling of Models and Types of Intelligence (listed in chronological order, by decade)
- g Factor (General Intelligence Factor; General Mental Ability) (Charles Spearman, 1900s): derived from factor analyses of correlations among different IQ tests, the g Factor was postulated as the core human intelligence that plays a role in all cognitive tasks
- Intelligence Quotient (IQ) (William Stern, 1910s): a numerical rating of intelligence originally defined as the ratio of one’s mental age to one’s chronological age, and now defined by normed referencing to others who’ve been tested
- General Intelligence (Raymond Cattell, 1960s): a combination of Fluid Intelligence (ability to solve new reasoning problems, making minimal demands on prior learnings) and Crystallized Intelligence (ability to apply prior learnings)
- Emotional Intelligence (Emotional Intelligence Quotient, Emotional Leadership, Emotional Quotient; Michael Beldoch, 1960s): ability to recognize one’s own and others’ emotions, to use those recognitions effectively, and to manage one’s own emotions in enabling ways
- PASS Theory of Intelligence (A.R. Luria, 1960s): model of cognition based on four brain-based processes (planning, attention, simultaneous processing, successive processing)
- Social Intelligence (Joy Paul Guildford, Nicholas Humphrey; Ross Honeywell, 1960s): of self- and social-awareness along couple with ability to effect social change; argued by some as the intelligence that defines humans (vs. IQ)
- Structure of Intellect Theory (Joy Paul Guilford, 1960s): a model of up to 180 intellectual abilities, organized along the three dimensions of operations (cognition, memory recording, retention, divergent production, convergent production, evaluation), content (figural, symbolic, semantic, behavioral) and product (units, classes, relations, systems, transformation, implications)
- Dual-Process Theory of Intelligence (Jonathan Evans, 1970s): a two-factor model (explicit, goal-directed, controlled, conscious processes; implicit, spontaneous, automatic, unconscious processes)
- Level I–Level II Theory (Arthur Jenson, 1970s) – a division of cognitive abilities into two hierarchical categories: Level I, Associative Processing (e.g., rote learning and short-term recall) and Level II, Conceptual Processing (e.g., categorizing, abstraction, reasoning)
- Spatial Ability / Spatial Reasoning (Visuo-Spatial Ability; diverse authorship, 1980s): the ability to extend understanding and memories of spatial relations (among objects or space) and orientations (of the actions) into useful strategies and tools for reasoning
- Cattell–Horn–Carroll Theory (Raymond B. Cattell, John L. Horn, John B. Carroll, 1990s): a model of intelligence divided into 10 broad abilities (fluid intelligence, crystalized intelligence, quantitative reasoning, reading & writing ability, short-term memory, long-term storage & retrieval, visual processing, auditory processing, processing speed, decision/reaction time/speed) and 70 narrow abilities
- Three-Stratum Theory (John Carroll; 1990s): a mash-up of g Factor and Generalized Intelligence (see above), in which intelligence is described as a three-layer hierarchy. Stratum III is the g Factor, which is seen to emerge from the eight broad abilities of Stratum II (fluid intelligence, crystallized intelligence, general memory and learning, broad visual perception, broad auditory perception, broad retrieval ability, broad cognitive speediness, processing speed), which in turn emerge from many and diverse specific factors that constitute Stratum I.
g-VPR Model (Wendy Johnson, Thomas J. Bouchard Jr.; 2000s): a model of intelligence that describes it as a four-layer hierarchy. The fourth stratum is the g Factor, which is seen to emerge from the verbal, perceptual, and rotation factors that constitute third stratum, which in turn emerges from many and diverse narrow abilities that constitute second stratum, which arises from the first stratum that comprises primary traits.
Sampling of Measures of Ability and Aptitude (listed in chronological order of original development, by decade)(Contrast with Norm-Referenced Assessments, under Assessment and Evaluation)
- Raven’s Progressive Matrices (Raven’s Matrices; RPM) (John C. Raven, 1930s): a non-verbal, 60-item, multiple-choice, group-administered test requiring takers to look for and apply one or more relationships among spatially organized objects. For ages 5 through elderly.
- Wechsler Intelligence Scales for Children, Fifth Edition (WISC-V) (David Wechsler; originally developed in 1940s; most recently revised in 2010s): an hour-long test that produces both a general intelligence score and scores in five cognitive domains (Verbal Comprehension Index, Visual Spatial Index, Fluid Reasoning Index, Working Memory Index, Processing Speed Index). Supplementary subtests can be used to assess Learning Disabilities. For ages 6 to 16.
- Stanford–Binet Intelligence Scale, Fifth Edition (SB5) (originally developed by Alfred Binet in 1905; further developed by Lewis Terman in the 1950s; most recently revised in 2000s): an individually administered test comprising ten subtests, used to diagnose learning, developmental, and intellectual problems in young children across five factors (Knowledge, Quantitative Reasoning, Visual-Spatial Processing, Working Memory, Fluid Reasoning). For ages as young as 2.
- Cattell Culture Fair Intelligence Test (CFIT) (Raymond Cattell; 1940s): an effort to construct an intelligence test that is free of sociocultural and environmental influences – a goal that sociologists, anthropologists, and others have since argued to be all but impossible … and not especially desirable. It comprises three scales with non-verbal visul puzzles.
- Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) (David Wechsler; originally developed in 1950s; most recently revised in 2000s): a battery comprising ten core subtests and five supplemental subtests that generate two broad scores on general intellectual ability (Full Scale IQ, General Ability Index) and four index scores (Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index, Processing Speed Index). For ages 16 to 90.
- Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) (David Wechsler; originally developed in 1960s; most recently revised in 2010s): a 30–60-minute test comprising 14 subtests that can be used to assess general intellectual functioning, identify giftedness, and identify learning difficulties. For ages 2.5 to 7.5, with three indexes for younger children (Verbal Comprehension Index, Visual Spatial Index, Working Memory Index) and two more for older children (Fluid Reasoning Index, Processing Speed Index).
- Woodcock–Johnson Tests of Cognitive Abilities, Fourth Edition (WJ-IV) (Richard Woodcock, Mary E. Bonner Johnson; originally developed in 1970s, most recently revised in 2010s): comprising a standard battery of 10 tests, an extended battery of 10 more, and a diagnostic supplement with 11 more, the WJ-IV assesses nine broad-stratum abilities (Auditory Processing, Comprehension–Knowledge, Fluid Reasoning, Long-Term Memory, Processing Speed, Quantitative Knowledge, Reading–Writing, Short-Term Memory, Visual-Spatial Thinking). It is normed for ages 2 through the 90s.
- Developmental NEuroPSYchological Assessment, Second Edition (NEPSY-II) (Marit Korkman, Ursula Kirk, Sally Kemp; originally developed in Finnish in 1980s; most recently revised in 2000s): used to assess abilities related to cognitive disorders that are usually diagnosed in childhood. It comprises 25 subtests across six domains (Attention and Executive Functions, Language and Communication, Sensorimotor Functions, Visuospatial Functions, Learning and Memory, Social Perception). For ages 3 to 16.
- Kaufman Assessment Battery for Children, Second Edition (KABC-II) (Alan S. Kaufman, Nadeen L. Kaufman; originally developed in 1980s; most recently revised in 2000s): an individually administered test comprising 18 subtests, yielding two general intelligence composite scores (Mental Processing Index, Fluid-Crystallised Index). For ages 3 to 18.
- Luria-Nebraska Neuropsychological Battery (LNNB) (Charles Golden; 1980s): a 2–3-hour, individually administered test comprising 14 scales (motor, rhythm, tactile, visual, receptive speech, expressive speech, writing, reading, arithmetic, memory, intellectual processes, pathognomonic, left hemisphere, right hemisphere), used to assess neurological issues. For ages 15 and up.
- Das–Naglieri Cognitive Assessment System (Cognitive Assessment System; CAS) (J.P. Das, Jack Naglieri; 1990s): an individually administered test based on the PASS Theory of Intelligence, aimed as assessing four brain-based processes (Planning, Attention, Simultaneous processing,Successive processing). For ages 5 to 17.
- Differential Ability Scales (DAS): an individually administered, nationally normed (USA) (Colin D. Elliot; 1990s): test comprising 20 subtests, aimed at measuring verbal and visual working memory, immediate and delayed recall, visual recognition and matching, processing and naming speed, phonological processing, and basic number understanding. For ages 2.5 to 17.
- Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) (Gerard A. Gioia, Peter K. Isquith, Steven C. Guy, Lauren Kenworthy; originally developed in the 2000s, revised in the 2010s): a 10-minute, 86-item, individually administered questionnaire assesses impairment of executive function. For ages 5 to 18.
- Reynolds Intellectual Assessment Scales (RIAS) (Randy Reynolds, Cecil Kamphaus; 2000s): an individually administered test comprising four subtests measuring verbal intelligence and non-verbal intelligence, will a supplementary measure of memory. Normed for ages 3 to 94.
- Multidimensional Aptitude Battery II (MAB II) (Douglas N. Jackson; 2010s): a group-administered test comprising 10 subtests to assess verbal ability, performance capacity, and full-scale IQ. Intended for professional and employment setting, it is for ages 16 and up.
Sampling of Types of Disabilities
- Intellectual Disability (General Learning Disability; Cognitive Impairment; Mental Retardation; diverse authorship, first records date back more than 2500 years): neurodevelopmental disorder associated with low IQ (<70) and inability to cope with multiple everyday living requirements
- Learning Disability (diverse authorship, 1880s): official clinical diagnosis of problems, usually assumed to be rooted in atypical brain organization or function. Some LDs are:
- Dyslexia – difficulty with symbolic forms, especially reading
- Dysgraphia – difficulty with fine-motor skills, especially affecting writing
- Dyscalculia – difficulty with arithmetic
- Dyspraxia – difficulty with purposive actions
- Dysnomia – difficulty finding and expressing words.
Sampling of Types of Learning and Developmental Disorders (listed in chronological order, by decade)
- Learning Disorder (Learning Difficulty; diverse authorship; mid-1800s): inadequate (i.e., below norms) development of specific language or academic skills, but not severe enough to warrant disability diagnosis
- Developmental Disorder (Developmental Disability; diverse authorship; late 1800s) – a chronic condition that impairs mental and/or physical function in ways that significantly limit one or more capacities necessary for major life activities
- Anxiety Disorders (diverse authorship, 1890s): an array of mental conditions that manifest as debilitating anxieties and fears
- Obsessive–Compulsive Disorder (C. Westphal, 1890s): condition characterized by repetition – checking things, performing routines/rituals, and/or thinking certain thoughts
- Autism Spectrum Disorder (Autism Spectrum Condition; E. Bleuler, 1910): a range of neurodevelopmental disorders, manifesting as problems with social engagement and/or repetitive patterns of interest or activity
- Auditory Processing Disorder (S.J. Kopetzsky, 1948): difficulties distinguishing, locating, isolating, and interpreting sounds
- Sensory Processing Disorder (Sensory Integration Dysfunction; A.J. Ayres, 1940s): inadequate coordination of senses, resulting in difficulties in functioning in specific contexts
- Antisocial Personality Disorder (Dissocial Personality Disorder; Anti-Social Behavior Disorder; DSM, 1952): general and persistent ignorance of social norms and morals, along with others’ feelings and rights
- Intermittent Explosive Disorder (DSM, 1952): intermittent and unpremeditated explosive outbursts that are disproportionate to the situation
- Language Processing Disorder (diverse authorship, 1950s): difficulties in parsing and interpreting words, sentences and stories
- Attention-Deficit Hyperactivity Disorder (diverse authorship, 1960s): neurodevelopmental issue manifesting as excessive activity, poor self-control, and difficulties with attention
- Conduct Disorder (diverse authorship, 1960s): violation of age-appropriate norms through persistent and repetitive infringements on others’ rights
- Nonverbal Learning Disorder (Helmer Myklebust; 1970s)– limited critical thinking skills and difficulties with nonverbal information
- Oppositional Defiant Disorder (DSM-3, 1980): pattern of irritable, argumentative, and/or vindictive behavior in children and adolescents
- Stereotypic Movement Disorder (DSM-5, 2013): motor condition involving repetitive and disruptive physical actions
Sampling of Sorts of Response/Intervention
- Tracking (Streaming; Phasing) – separating learners according to ability and/or performance – typically undertaken on the school level and maintained over years. (Contrast with Ability Grouping, below.)
- Ability Grouping – separating learners according to ability and/or performance – typically undertaken on the classroom level and over a relatively short term (of less than a school year) (Contrast with Tracking, above.)
- Special Education – formal schooling structures intended to accommodate the particular needs of students with diagnosed learning issues. Most often Special Education involves some manner of segregation
- Mixed Ability (Differently Abled) – proposed in response to the negative connotations of such labels as “abnormal,” “disabled,” and “handicapped,” Mixed Ability (and Differently Abled) is sometimes used to describe a person with a different physical, emotional, and/or learning ability.
- Mixed Ability Grouping – the opposite of Tracking (above) and Ability Grouping (above), Mixed Ability Grouping involves teaching individuals with diverse abilities together (Contrast with Diversity Education and Inclusive Education, included as subdiscourses of Activist Discourses.)
CommentaryWhile it might appear that the above entries present a great deal of conceptual diversity, with regard to implicit assumptions on and metaphors of learning, they are surprisingly similar. – as we have attempted to demonstrate with the list of metaphors near the start of this entry. For the most part, the Medical Model of (Dis)Ability is closely aligned with Correspondence Discourses. For example, a majority assume such dualisms as inside/outside, mental/physical, self/other, and individual/collective. As well, most explicit references to learning invoke Folk Theories (e.g., the Acquisition Metaphor, the Attainment Metaphor, the Illumination Metaphor) or Brain-as-Computer Discourses. Given the strong tendencies toward the sorts of metaphors identified above, it should perhaps not be surprising that the Medical Model of (Dis)Ability is usually associated with strategies to measure and rank. (That is, the above metaphors are readily interpreted in terms of physics, and thus lend themselves to acts of quantification and comparison.) By contrast, conceptions of (dis)ability associated with Coherence Discourses tend to be framed more in terms of growth, expansive possibility, and fitness as they reject the dualisms that infuse the above models. By way of illustration, a Neurodiversity critique of disability and disorder frames has risen to prominence over the past few decades. It rejects the “deficit model” of the learner assumed across most constructs associated with the Medical Model of (Dis)Ability, and it argues that perceived (dis)abilities are indicative of a pool of diversity that is necessary for the survival of the species. That perspective is bolstered by observations that definitions and classifications of (dis)ability vary dramatically across cultures. Some psychologists have responded by tweaking definitions of (dis)ability to include consideration of situation. However, so far, few of those revisions interrogate foundational metaphors and assumed dualisms. Additionally, the simple fact that the multi-billion-dollar industry of intelligence testing is regularly compelled to recalibrate its measures is often cited as an indication of flawed and constrained thinking. Consider, e.g.,
- Flynn Effect (James R. Flynn, Richard Herrnstein, Charles Murray; 2000s): the multi-decade, transcultural phenomenon of steady and substantial increases in scores on intelligence tests through the 20th century (of about 3 points per decade on a normed 100-point scale)
Authors and/or Prominent InfluencesDiffuse
Status as a Theory of LearningFor the most part, the Medical Model of (Dis)Ability is deployed as a cluster of perspectives of learning.
Status as a Theory of TeachingIn general, the Medical Model of (Dis)Ability is not explicit identified as a discourse on teaching, but most of its associated discourses and constructs are routinely invoked to inform or justify pedagogical approaches and curriculum emphases.
Status as a Scientific TheoryDespite the fact that massive research and marketing industries have arisen around the Medical Model of (Dis)Ability, the general failure to interrogate foundational assumptions means that the model itself and few of its associated discourses meet our criteria for scientific theories.
- Ability Grouping
- Abnormal (Abnormality)
- Antisocial Personality Disorder
- Anxiety Disorder
- Attention-Deficit Disorder
- Auditory Processing Disorder
- Autism Spectrum Disorder
- Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2)
- Brightness, Brilliance (Dimness) Metaphor
- Capacity Metaphor
- Cattell Culture Fair Intelligence Test (CFIT)
- Cattell–Horm–Carroll Theory
- Cleverness Metaphor
- Conduct Disorder
- Creative Intelligence
- Das–Naglieri Cognitive Assessment System (Cognitive Assessment System; CAS)
- Developmental Disorder (Developmental Disability)
- Developmental Neuropsychological Assessment, Second Edition (NEPSY-II)
- Diagnosis and Remediation
- Diagnostic and Statistical Manual of Mental Disorders (DSM)
- Differential Ability Scales (DAS)
- Dual-Process Theory of Intelligence
- Emotional Intelligence
- Exceptionality Metaphor
- Flynn Effect
- g Factor (General Intelligence Factor)
- g-VPR Model
- General Intelligence
- Genius Metaphor
- Giftedness Metaphor
- Intellectual Disability
- Intelligence Metaphor
- Intelligence Quotient
- Intermittent Explosive Disorder
- Intrapersonal Intelligence
- Kaufman Assessment Battery for Children, Second Edition (KABC-II)
- Language Processing Disorder
- Learning Disability
- Learning Disorder (Learning Difficulty)
- Level I–Level II Theory
- Luria-Nebraska Neuropsychological Battery (LNNB)
- Mixed Ability (Differently Abled)
- Mixed Ability Grouping
- Multidimensional Aptitude Battery II (MAB II)
- Nonverbal Learning Disorder
- Normal (Normality)
- Normal Distribution (Standard Normal Distribution; Standardized Distribution; Bell Curve)
- Normalism (Normism)
- Normative (Normativity)
- Oppositional Defiance Disorder
- PASS Theory of Intelligence
- Potential Metaphor
- Quickness (Delayed; Slowness; Retardation) Metaphor
- Raven’s Progressive Matrices (RPM)
- Reynolds Intellectual Assessment Scales (RIAS)
- Sensory Processing Disorder
- Sharpness, Acuity (Dullness) Metaphor
- Smartness Metaphor
- Social Intelligence
- Spatial Ability / Spatial Reasoning
- Special Education
- Stanford–Binet Intelligence Scale, Fifth Edition (SB5)
- Stereotypic Movement Disorder
- Strength (Weakness) Metaphor
- Structure of Intellect Theory
- Talent Metaphor
- Three-Stratum Theory
- Tracking (Streaming; Phasing)
- Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV)
- Wechsler Intelligence Scales for Children, Fifth Edition (WISC-V)
- Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV)
- Woodcock–Johnson Tests of Cognitive Abilities, Fourth Edition (WJ-IV)
Please cite this article as:
Davis, B., & Francis, K. (2021). “Medical Model of (Dis)Ability” in Discourses on Learning in Education. https://learningdiscourses.com.
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