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The concept ‘normality’ is complex.

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    Stuart Johnson
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    Learning Disability people are among those that are vulnerable and socially excluded, thus, this essay will give a brief definition of normality and discuss the concept of Learning Disabilities. The essay will explore normalisation which will be illustrated by examples and studies of people with Learning Disabilities living within their community and attaining to have a normal lifestyle. The essay will consider the arguments of the social and medical model which was introduced to explain and comprehend disability and its functioning. The essay will explore the positive and negative issue on those with a Learning Disability possessing a label. Additionally the essay will link and discuss social work theories and sociologist perspectives on normality and people with Learning Disabilities, furthermore, the media perception on those with Learning Disabilities.

    According to dictionary.com normality is defined as “the state or fact of being normal…” It goes on to say that normality is “being within certain limits that define the range of normal functioning…” (2007) 

    Learning Difficulties is a term used indicating intellectual impairment. The name ‘learning difficulty’ replaced the term mental handicap; this was a way of referring to individuals with intellectual impairments (Pierson & Thomas, 2002).

    In the UK People with Learning Difficulties are being moved out of long-stay hospitals as a result of targets both the 1990 NHS and Community Care Act and the 2001 white paper Valuing People. The government pushed back the target date to 2006 having failed to meet its’ initial target to move all people with Learning Difficulty out of such long-stay hospitals by 2004. Currently, just over two hundred people with Learning Difficulty remain in 10 NHS long-stay hospitals (Turning Point 2003).

    A number of Learning Disability adults are users of day centres, which are poorly represented within the UK, additionally access by people with a Learning Disability to mainstream education, and leisure are limited (Pierson & Thomas, 2002). Therefore, the concept of ‘Normalisation’, and ‘Social Role Valorisation’ (SRV) both derived by Wolfensberger, had an impact on professionals which made a transfer for deinstitutionalisation for individuals with Learning Disabilities that influenced several factors (Cullen, 1991). This highlights that people with Learning Disabilities are supported to have inclusion in ‘normal’ everyday living, which they can value.

    A response to this move was that this notion failed to take into account the attitude and practices of others towards those with Learning Disabilities. It is perceived uncritically that service users should adopt customary norms of behaviour so they could be recognised (Pierson & Thomas, 2002). Normalisation refers to a set of objectives and techniques adopted by provisions for people with Learning Disabilities. Normalisation principles are to ensure that people with Learning Disabilities have shared choices, dignity and lifestyle as those who is not disabled (Brown and Smith 1992). SRV is defined as:
    “The enhancement of the social role of persons or groups at risk of social devaluation . . . It is important to distinguish between the valorisation of the role of the person, and the valuing (or valorisation) of the person him/herself (Cullen, 1991 pg 177).

    However, there have been challenges which entail social acceptability or making sure that the services are meeting the needs of their sexual orientation, gender and ethnicity.

    Rather than struggling for normalisation by service users, it was introduced by service providers. Nevertheless, “the principles on community presence, community participation, choice competence and respect” (Pierson & Thomas, 2002 pg 253), that associates with normalisation, has shaped a progressive service settings which support individuals to gain skills, take part in community life and make choices (Pierson & Thomas, 2002).

    One have gained personal experience working with Learning Disability adults in a statutory organisation project, providing a service for those with, complex needs, and individuals with Autism Spectrum Disorders in the borough of Enfield. Service users are supported to lead an ordinary independent life by aiding them to leave the institutions whereby they lived; then supported to live in their own flat within their community. Additionally the users are supported to be integrated in their community, and to carry out every day activities. By doing this, one is enabling and aiding the service users to have a ‘normal’ lifestyle that they can value.

    At times some of the project neighbours of the service users are oppressive towards the users by making complaints to staff saying, that the users are mad and should not be living in the community, and should be locked up in institutions. This is because the users may at times become frustrated with certain circumstances and then take their frustrations out in the flat, by banging and screaming. When the neighbours hear this and see this through the user’s window they believe that the users are a danger to the community. They have also threatened to speak to the media to ‘expose’ this perceived threat and danger.

    There are several studies which have looked at different community feelings and thoughts to people with Learning Disabilities, such as Mc-Conkey et al (1993); and Sinson (1993). Out of their studies, there have been various patterns of reaction that have surface. A few responses were: hostility towards the thought of individuals with Learning Disabilities living in the community; additionally a lack of knowledge that there are people with Learning Disabilities in the community (Myers F, et al 1998).

    However, previous studies suggest some community have an eagerness to engage with those with Learning Disabilities as a value. Studies by various people have showed that theses communities are seen as benefactors’, and viewed as ‘competent others’. However, the community could involve individuals to engage inaccepting relationships’ and ‘making friends’ (Myers F, et al 1998). These positive thoughts are the objectives of the person centred approach theory that was developed by Karl Rogers, and the person centred planning principles, which were first developed among those with physical disabilities. Rogers was convinced that there is a tendency towards growth and change, and given the right environment in a therapeutic relationship, individuals can discover and employ their personal power.

    The goal of the approach is to integrate individual’s ambitions and aspiration, and allow the person to obtain their independence by enabling the individual growth towards actualization (Trevithick 2005). Within Rogers’s theory there are shortcomings, because of its optimism and belief in the capacity of human beings to accept difficult experiences, to take hold of their lives and to move forward.

    The 2001 White Paper ‘Valuing People’ states that: “Person Centred Planning will play a significant role in assisting (Partnership) Boards to bring about the necessary shifts in culture and practice so that people can lead the lives they want within their communities”. Little change is happening for many people with Learning Disabilities. A checklist produced by Paradigm and the Valuing People Support Team highlights the basic change that needs to happen in small, medium and large agencies– if person centred planning is going to direct real change and ensure that people with Learning Disabilities get the lives that they want.
    The paper aimed at promoting social inclusion which is an essential component of this change. This has resulted, in agencies looking towards “social inclusion advocates and social ‘capitalists’ for a comprehensive and detailed conceptual framework” (Bates & Davis, 2004 pg 197), in order to plan and manage certain changes. However, particular services do often segregate Learning Disability groups, especially those who do not have the ability to articulate their interest. Thus Learning Disability individuals are supported to take on employment, and participate within their community, by becoming a volunteer, studying or pursing leisure activity (Bates & Davis, 2004).

    One Learning Disability adult within the project in Enfield wanted a job; now he is employed by Tosco packing shelves. He said he enjoys working, getting paid, and gets on well with his work colleagues. This illustrate that he has made reciprocal relationships with community members within his workplace. Thus advocates of social inclusion have emphasised the importance of paid employment as a path to status and relationships, whilst social capitalist highlights an informal role and relationships (Bates & Davis, 2004).

    It is important that social workers working with Learning Disability people help build and use informal networks to increase access to resources, work collaboratively, and inspire people as well as promote the person centred approach. Additionally, it is vital to place the focus on further change to facilitate people to determine their own lives and be integrated in their local communities to have a ‘normal’ lifestyle and develop people’s attention to a strategic approach to change, which is all apart of social work values.

    There are a number of significant factors above which are associated with the medical and social model in relation to the social care of people with particular support needs. (Williams & Heslop, 2005).

    “According to the medical model of disability; disability is a ‘natural’ problem of the person, directly caused by the person’s mental or physical impairments” (Ho 2004 pg 88). The management of the disability is designed to change and adjust the individual’s behaviour. Medical care is deemed as the primary concern. The medical model focuses on the biophysical abnormality and does take into consideration the experience that those with impairments may differ depending on their culture and social structure. Challengers dispute that the medical model perceives that those diagnosed with Learning Disabilities are abnormal and naturally inferior to those that do not have such diagnosis. In the case of a child who is at school, the medical model of disability is incompetent when attempting to “explain the experience of children with Learning Difficulties or promoting equal educational opportunities for all children” (Ho 2004 pg 88).

    Although diagnosis for those with Learning Disabilities can offer a range of benefits and legal protections, there are particular reasons why those with a disability can defy the label ‘Learning Disabilities’, one reason being that:
    “Not everyone appreciates Learning Disabilities or takes these diagnoses as morally neutral. Given the historical oppression on disabled people, some may not want to think of or label their child or themselves as being disabled” (Ho 2004 pg 87)

    Michel Foucault a seminal social constructionist writer, notion on the medical model was that medicine as a practice and profession constructs its own objects of inquiry and looks for ways for people to fit the expected norms. However, the application of medicine to disability and normal/abnormal labels that occur in society are mutually constitutive. Therefore, the medical model is complicit with society definitions of normality. And this complicity has little ethical concern with the quality and value of disabled people’s lives given that they are pre-judged as abnormal (Foucault, 1973).

    Goffman (1963) developed what is known as Goffman’s Stigma Theory. In this society’s attention are focussed on the attribute of a disabled individual that is seen to be inferior. This particular attribute is assigned a ‘master status’ and the resulting label dominates all other possible characteristics. The need of society for people to have an acceptable ‘normal’ image creates problems for the disabled as in many cases the disability ‘leaks out’. For example, one of the service users from the project makes unfamiliar noises, and has an unusual walk. Goffman argued that medicine is interested in controlling or covering up the abnormal, i.e. the project neighbours within the community, appears to want to have a perfect neighbourhood in their perceptions as ‘normal’, without engaging in abnormality.

    A challenge to the medical model has always been the public’s increasing lay knowledge of science and health and the increasing popularity of complementary and alternative medicines. The new community-based approach to working with people with Learning Disabilities shows signs of this widened scope of understanding in that it takes a more holistic view of the lives of Learning Disability people. There are many families who have sought treatments and forms of care and support that are not wholly supported by medicine at all. I.e. The Lovas approach – Son Rise, disregards the focus on the body in order to focus on the individual cognitive functioning i.e. the TEACCH and ABA programme.

    Conversely, the social model surfaced because of the cause of those with physical and sensory impairments. The model differentiates between impairment and disability. The social model compares with the usual customs of comprehending disability which find the problem of disability in an impaired person. It perceives problems as inevitable consequences of impairment. Therefore, those who are disabled are perceived to need: “a multitude of professionals and services to enable them to come to terms with their impairments, rehabilitate them into non-disabled society or remove them from it” (Chappell A.L, et al 2001 pg 46).
    The social model stresses the importance of collective action. There are emphases made for individuals and societal members to disintegrate disablement, and advocate for an active and inclusive culture: “The social model should promise much for people with Learning Difficulties in terms of its analysis of their experience and its strategies for change” (Chappell, et al 2001 pg 46). However, this promise has not been recognised. The challenge to the model is ensure that supporters, professionals, and those with and without Learning Disabilities, identify the significance of the social model to disabled people, additionally, the factors which should articulated.

    Those who have a label are officially protected by various disability mandates; however, there are still various negative social and political connotations that connect to the label. This is due to society creating a ‘normal’ group and then labelling those who are ‘deviant’ (Ho 2004). Becker (1966 in Henslin 2002 pg 130) identified deviance as “not the act itself, but the reactions to the act, that makes something deviant”. Various groups have diverse norms. What maybe deviant to one may not be deviant to another. Acts that maybe acceptable to one society groups maybe thought as deviant to other groups within the same society. This implies that people behaviour maybe represented as ‘normal’ to particular groups.

    Although the disability term approved individuals to arrange together with others through the self-advocacy movement and bureaucracy, the conception of ‘Learning Disabilities’ are diverse (Goodley, 2001). Certain individuals may at times feel that by having a disability label they are different and can be frequently “understood to be inferior and not fit to be part of the ‘normal’ population” (Ho 2004 pg 87). This can be seen as a social problem which can be linked to social justice and social order.

    Within Britain the Disability Discrimination Act (1995) identifies disability utilising the medical model. However, it the responsibility of managers as well as service providers to ensure that there are equitable adjustments to their policies, practices, and physical aspects of their premises, which pursue the social model. As a result of adjustments being made, employers and service providers should ensure that barriers are eliminated, which according to the social model, are effectively eradicating an individual disability (Chappell, et al 2001).
    Consequently, although particular mandates are complied with by various organisations in making employment decisions, the legislations around disabilities within certain countries that have been developed to protect those who are disabled from discrimination, have not tackled certain discriminatory attitude and responses universally (Ho 2004).

    When linking a social justice theory to the remit of normalisation it is important there is a right theory of social justice. If the question was asked, what is the subject of social justice? Answers can be found in John Rawls study, which described ‘A Theory of Justice’, as a basic structure of society. The basic structure can be represented by the major institutions which allocate rights, opportunities and resources (Barry 2005).

    Institutions play an important part in providing individuals with different life chances which are significant in understanding social justice. To an extent, they have vital factors that can transform passing laws. Institutions are not an end in themselves; they are a way of getting things done. In order to know how far a society’s institutions collaborate in unity to generate social justice, there must be considerations on “the distribution of individual rights, opportunities and resources” (Barry 2005 pg 17) that the institutions bring.

    There are requirements for social justice to be ‘just’, but this can be resulted to incompetence of liberal justice. “…The foundation of the liberal conception of justice is that all citizens should be treated equally” (Barry 2005 pg 23). A number of Learning Disabilities adults who live within communities are treated as second class citizens because they are seen as ‘abnormal’; they are socially excluded and face oppression because of their label. Furthermore, they are unable to access their rights in particular situations, because of their social class and the way community members perceive them.

    Karl Marx a sociologist sees two classes- those who owns the means of production and those who do not. Most sociologists oppose this notion, as it categorises too many people together. Many sociologists concur with Max Webber, that there is more to social class than just a person relationship to the means of production. Therefore, a majority of sociologist utilise the elements Webber identified and define social class as “a large group of people who rank closely to one another in wealth, power and prestige” (Henslin 2002, pg 178). These components segregate individuals into different lifestyles, offer various life chances and allow people to look at themselves and the world in distinctive ways. Through having social ranking and social class, there are inequality of justice and order.

    Within the media, those with Learning Disabilities are scarcely featured on television, radio or in newspapers. There are several companies investigating how people with Learning Disabilities are seen in the media. Recently various papers such as the Guardian all displayed people with Learning Disabilities positively. Films such as Afterlife, and Radio 4’s live programme, ‘Does He Take Sugar?’ Have featured actors with a Learning Disability However, Media groups recognise that they need to do more for people with Learning Disabilities, nevertheless changes have been slow (Topham & Fawcett, 2005).

    Since Learning Disabilities people were brought out of long-stay hospitals and into the community and particular things have changed including person-centred planning being adopted as a tool of practice, there is a more mutual relationship between a Learning Disability person and the professional where both are afforded some expertise. Social workers now act as their care managers rather than psychiatrists and nurses. There is a different balance of power as social workers don’t have the all-controlling power of doctors. Some have regarded this as a ‘therapeutic alliance’ between the social worker and service user. There is a need to collaborate together to be successful. It is important that social workers enable that there is equality and justice when working with Learning Disability people.

    In conclusion the concept of normality is complex in relation to people with Learning Disabilities as it takes into consideration a number of dimensions medically and socially. It is significant for all social workers to be careful in what they may identify as what is normal. What one may think is normal; another person may perceive as abnormal, therefore, it is vital that social workers work fairly enabling people to have respect for whoever the service users are.

    The Media is a powerful tool in breaking down stereotypes and oppression faced by those with Learning Difficulties. The media voice can inform society of the social problems, helping to change people’s perception via using pictures of people with learning disabilities illustrating their potential, i.e. employment or volunteering.

    In order for the social justice and social order inequalities not exist, it is important for people with Learning Disabilities no longer be marginalised or excluded, but have entitlement to first class citizenship through social class, have autonomy, and equal rights. The political forces need to require, and enforce changes that are required to carry over advance justice in other ways, so that everyone in society is valued.

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