Special? Disability and the Politics of Medico-Legal Classification

• In Event: Disability and Its Challenges to Democratic Inclusion

Abstract

In 1973, gay rights activist Ron Gold asked an audience of psychiatric professionals to: “Stop it, you’re making me sick.” At the time, homosexuality was classified as a mental illness by the Diagnostic and Statistical Manual of Mental Disorders (DSM), frequently known as the psychiatric “Bible.” After years of protests by advocates such as Gold, as well as support from sympathetic psychiatric professionals, the APA declassified homosexuality as a mental illness in 1973.

The APA’s decision to declassify homosexuality in the DSM, undoing a harm of its own making, is not anomalous. The declassification of homosexuality from the DSM was not the only mass “cure” in 1973 alone. That same year, millions of children were “cured” of their “mental retardation” overnight when the American Association on Mental Disability (AAMD), as it was known, lowered the IQ threshold for mental retardation from 85 to 70. Suddenly, only 2.5 percent of the population was considered “mentally retarded,” as opposed to sixteen percent. The AAMD’s decision responded to advocates’ claims that its present standards for “mental retardation” disproportionately funneled Black students into segregated, special education classrooms where they had fewer opportunities to learn on an equal basis with their peers.

This paper analyzes decisions like the APA’s and the AAMD’s— decisions that impose medical classifications on groups of people. These classifications are often based in scientific mores that are value-laden, fraught, and subject to change. Yet at the time they are rendered, they are viewed as authoritative and often given the force of law. I look at the legal consequences of shifting diagnostic categories via statutes, regulations, court documents, and case law. I consider how medical categories become imbued with formal state power— that is, how disability becomes a method of governance. How do medical categories become entrenched in the law? How then do those categories and the laws that grow around them structure people’s relationships with the state, including their rights, responsibilities, and lived experiences of citizenship?

Medico-legal categories of disability are often a path to benefits and supports that people need to survive. Being classified as “disabled” can grant people access to an otherwise austere welfare state. “Qualified individual[s] with disabilities” receive civil rights protections. Parents of children with disabilities may use their child’s status to claim educational opportunities for them. Yet all of these benefits come at a steep price. The price disabled people pay for social recognition and basic necessities is the core concern of this paper. To view disability as a “privileged” social status flattens the relationship between the legal category of disability and governance. The central claim of this paper is that legal disability classifications represent a Faustian bargain. Disabled people trade their dignity, privacy, autonomy, and fundamental rights for the resources they need to survive in a world that is not built with them in mind. This Faustian bargain manifests via what I call the “politics of classification.” When I use the term “politics of classification,” I am referring to the method of governance that places people in binary categories of “disabled” or “non-disabled” based on bureaucratic or court-sanctioned assessments of their medical impairments or functional limitations.

Using the welfare state as a case study, I argue that from the moment someone decides to pursue a disability classification, they face an ecosystem of injustices. I suggest that the politics of classification subjects people seeking the law’s protection to two “waves” of injustices. First, disability laws require people to “prove” their disability status, which often subjects them to a series of administrative burdens and epistemic injustices due to aggressive gatekeeping. Medical proof is difficult and expensive to procure in a society without universal health care, and many disabled people find themselves needing to “perform” the role of an ideal patient to receive the appropriate diagnosis. People must again “perform” a “deserving” beneficiary to gain access to disability programs and supports. Then, once people gain access to programs, protections, and supports, benefits and supports often come at the cost of increased surveillance and a loss of autonomy. For example, disabled Supplemental Security Income (SSI) recipients frequently cannot marry (or even behave as though they are married) for fear of losing benefits. Moreover, the state strictly monitors their assets. They are also more likely to be penalized by the family policing system and have their parental rights revoked. This project seeks to show that this state of affairs is neither desirable nor inevitable by showing that an alternative politics of disability that does not rely as extensively on classification is possible.

Author

• Heather Ann Swadley, Lehigh University