In philosophy of mind, the extended mind thesis says that the mind does not exclusively reside in the brain or even the body, but extends into the physical world. The thesis proposes that some objects in the external environment can be part of a cognitive process and in that way function as extensions of the mind itself. Examples of such objects are written calculations, a diary, or a personal computer; in general, it concerns objects that store information. The hypothesis considers the mind to encompass every level of cognition, including the physical level.
It was proposed by Andy Clark and David Chalmers in "The Extended Mind" (1998). They describe the idea as "active externalism, based on the active role of the environment in driving cognitive processes."
For the matter of personal identity (and the philosophy of self), the EMT has the implication that some parts of a person's identity can be determined by their environment.
"The Extended Mind"
"The Extended Mind" by Andy Clark and David Chalmers (1998) is the paper that originally stated the EMT. Clark and Chalmers present the idea of active externalism (not to be confused with semantic externalism),
in which objects within the environment function as a part of the mind.
They argue that the separation between the mind, the body, and the
environment is an unprincipled distinction. Because external objects
play a significant role in aiding cognitive processes, the mind and the
environment act as a "coupled system" that can be seen as a complete
cognitive system of its own. In this manner, the mind is extended into
the physical world. The main criterion that Clark and Chalmers list for
classifying the use of external objects during cognitive tasks as a part
of an extended cognitive system is that the external objects must
function with the same purpose as the internal processes.
Clark and Chalmers present a thought experiment
to illustrate the environment's role in connection to the mind. The
fictional characters Otto and Inga are both travelling to a museum
simultaneously. Otto has Alzheimer's disease,
and has written all of his directions down in a notebook to serve the
function of his memory. Inga is able to recall the internal directions
within her memory. The argument is that the only difference existing in
these two cases is that Inga's memory is being internally processed by
the brain, while Otto's memory is being served by the notebook. In other
words, Otto's mind has been extended to include the notebook as the
source of his memory. The notebook qualifies as such because it is constantly and immediately accessible to Otto, and it is automatically endorsed
by him. They also suggest Otto's notebook should be considered an
extension of himself; the notebook in a way becomes a "fragile
biological limb or organ" that Otto wants to protect from harm.
The thought experiment has been criticised with the notion that
what happens with Otto is not very similar to what happens with Inga.
This criticism is addressed by Clark in Supersizing the Mind:
[The] claim was not that the processes in Otto and Inga
are identical, or even similar, in terms of their detailed
implementation. It is simply that, with respect to the role that the
long-term encodings play in guiding current response, both modes of
storage can be seen as supporting dispositional beliefs. It is the way
the information is poised to guide reasoning ... and behavior that
counts.
Research
The shared intentionality hypothesis yields yet another perspective to the idea of extended mind. Based on evidence in neuroscience and psychophysiological research, Latvian Researcher Igor Val Danilov proposed that implicit
interpersonal dynamics in groups leads to improved individual
performance. Later in 2024, he argued that an embryo's nervous system
(being a part of the external environment to the mother's nervous system) can take part in the mother's cognitive process and function as an extension of the mother's mind. This neuronal coupling provides social learning during the embryonal period. Indeed, numerous studies on fetal responses to external stimuli have revealed signs of fetal cognition; the movements of the fetuses seem intentional. In 2012, MRI
neuroscience research showed evidence of fetal cognition through
categorization at 33 weeks of gestation, registering responses in the
fetal brain to language and voice stimuli. Specifically, neuronal activity increased in the left temporal lobe
of the fetal brain in response to an unfamiliar female voice compared
with pure tones. Then, a maternal voice elicited significantly more
neuronal activity in the lower bank of the temporal lobe than an
unfamiliar female voice. According to Latvian researcher Igor Val Danilov, a mother–fetus neurocognitive model
provides insights into the emergence of object perception in naive
organisms. Beginning at the cellular level, it explains
neurophysiological processes during fetal neuronal development. In
short, we know that the fetal environment is a cacophony of stimuli:
electromagnetic waves, chemical interactions, and pressure fluctuations.
The binding problem
stands that the relevant stimulus cannot overcome the noise threshold
when it passes through the senses. While the fetal nervous system needs
to integrate stimuli to combine objects, background, and abstract or
emotional features into a single experience for building a
representation of the surrounding reality, it cannot distinguish
relevant sensory stimuli independently to integrate them into object
representations. Therefore, the fetal perception is limited. The
mother-fetus neurocognitive model explains how electromagnetic and
acoustic oscillations of the mother's heart shape an ensemble of
neuronal activity across both nervous systems. During the mother's intentional act with her environment, specifically
the acoustic environment shared with the fetus in the low-frequency
sound band, the brainwave entrainment provides clues to the fetus's nervous system, linking neuronal activity with relevant stimuli.From this perspective, the Mother-fetus neurocognitive model and Shared intentionality approach provide empirical evidence of the extended mind thesis.
Criticism
Philosophical arguments against the extended mind thesis include the following.
When focusing on cognition, the thesis confuses claims about
what is constitutive about the concept of cognition with claims about
causal influences on cognition (the "causal-constitutional fallacy").
For example, Adams and Aizawa (2010) write, "Question: Why did the
pencil think that 2 + 2 = 4?, Clark’s Answer: Because it was coupled to
the mathematician."
It stretches the limits of our ordinary concept of cognition too far
("cognitive bloating"), potentially implying that everything on the
Internet is part of individual cognitive systems.
It uses coarse-grained functionalism about the mind that ignores
plausible differences between internal and external processes, such as
differences between beliefs and external props and devices; or for
creating a notion of cognition too heterogeneous to make up a scientific
natural kind.
Each of these arguments is addressed in Clark (2008), in which he notes:
While coupling is important for cognition, that is not to say
that it is sufficient – coupling must play a functional role in
cognition. Many couplings do not do so and thus would not be
'extensions' (and this is consistent with a strong extended mind
thesis).
Any putative part of a system – internal or external – is unlikely
to yield "cognition" on its own. Thus, examples such as calculators, and
pencils, should be considered in parallel with neural regions. Simply
looking at the part is not enough for cognition.
One can imagine circumstances under which a biological being might
retain information in non-neural ways (a hypothetical Martian with a
bitmap-based memory, or humans with prosthetics to support memory).
Thus, being neural cannot be a necessary condition for being cognitive.
While in Supersizing the Mind Clark defends a strong version of the hypothesis of extended cognition
(contrasted with a hypothesis of embedded cognition) in other work,
some of these objections have inspired more moderate reformulations of
the extended mind thesis. Thus, the extended mind thesis may no longer
depend on the parity considerations of Clark and Chalmers' original
argument but, instead, emphasize the "complementarity" of internal and
external elements of cognitive systems or processes. This version might
be understood as emphasizing the explanatory value of the extended mind
thesis for cognitive science rather than maintaining it as an
ontological claim about the nature of mind or cognition.
Vincent C. Müller
argues that the extended mind "sounds like a substantive thesis, the
truth of which we should investigate. But actually the thesis turns
about to be just a statement on where the demarcations for the 'mental'
are to be set" and that "this discussion about demarcation is merely
verbal and thus to be avoided".
Relation to embodied and enacted cognition
As described by Mark Rowlands, mental processes are:
Embodied involves more than the brain, including a more general involvement of bodily structures and processes.
Embedded functioning only in a related external environment.
Enacted involving not only neural processes but also things an organism does.
Extended into the organism's environment.
This 4E cognition contrasts with the view of the mind as a processing center that creates
mental representations of reality and uses them to control the body's
behaviour. The field of extended cognition focuses upon the processes
involved in this creation and subsumes these processes as part of
consciousness, which is no longer confined to the brain or body but
involves interaction with the environment. At a 'low' level, like motor learning and haptic perception, the body is involved in cognition, but there is a 'high' level where cultural factors play a role. This view of cognition is sometimes referred to as enaction to emphasise the role of interplay between the organism and its environment and the feedback processes involved in developing an awareness of, and a reformation of, the environment. For example, Japyassú and Laland argue that some spider's web is
something between part of its sensory system and an additional part of
its cognitive system.
Neuropsychiatry is a branch of medicine that deals with psychiatry as it relates to neurology, in an effort to understand and attribute behavior to the interaction of neurobiology and social psychological factors. Within neuropsychiatry, the mind is considered "as an emergent property of the brain", whereas other behavioral and neurological specialties might consider the two as separate entities. Those disciplines are typically practiced separately.
The case for the rapprochement of neurology and psychiatry
Given the considerable overlap between behavioral neurology and
neuropsychiatry, there has been a resurgence of interest and debate
relating to neuropsychiatry in academia over the last decade. Most of this work argues for a rapprochement of neurology and
psychiatry, forming a specialty above and beyond a subspecialty of
psychiatry. For example, Professor Joseph B. Martin, former Dean of Harvard Medical School and a neurologist
by training, has summarized the argument for reunion: "the separation
of the two categories is arbitrary, often influenced by beliefs rather
than proven scientific observations. And the fact that the brain and
mind are one makes the separation artificial anyway." These points and some of the other major arguments are detailed below.
Mind/brain monism
Neurologists have focused objectively on organic nervous system pathology, especially of the brain, whereas psychiatrists have laid claim to illnesses of the mind. This antipodal
distinction between brain and mind as two different entities has
characterized many of the differences between the two specialties.
However, it has been argued that this division is fictional; evidence
from the last century of research has shown that our mental life has its
roots in the brain. Brain and mind have been argued not to be discrete entities but just different ways of looking at the same system. It has been argued that embracing this mind/brain monism
may be useful for several reasons. First, rejecting dualism implies
that all mentation is biological, which provides a common research
framework in which understanding and treatment of mental disorders can
be advanced. Second, it mitigates widespread confusion about the
legitimacy of mental illness by suggesting that all disorders should
have a footprint in the brain.
In sum, a reason for the division between psychiatry and neurology
was the distinction between mind or first-person experience and the
brain. That this difference is taken to be artificial by proponents of
mind/brain monism supports a merge between these specialties. These specialities are different but rely on each other.
Causal pluralism
One of the reasons for the divide is that neurology traditionally looks at the causes of disorders from an "inside-the-skin" perspective (neuropathology, genetics) whereas psychiatry looks at "outside-the-skin" causation (personal, interpersonal, cultural). This dichotomy is argued not to be instructive and authors have argued
that it is better conceptualized as two ends of a causal continuum. The benefits of this position are: firstly, understanding of etiology will be enriched, in particular between brain and environment. One example is eating disorders, which have been found to have some neuropathology but also show increased incidence in rural Fijian school girls after exposure to television. Another example is schizophrenia, the risk for which may be considerably reduced in a healthy family environment.
It is also argued that this augmented understanding of etiology
will lead to better remediation and rehabilitation strategies through an
understanding of the different levels in the causal process where one
can intervene. It may be that non-organic interventions, like cognitive behavioral therapy (CBT), better attenuate disorders alone or in conjunction with drugs. Linden's demonstration of how psychotherapy has neurobiological commonalities with pharmacotherapy
is a pertinent example of this and is encouraging from a patient
perspective as the potentiality for pernicious side effects is decreased
while self-efficacy is increased.
In sum, the argument is that an understanding of the mental
disorders must not only have a specific knowledge of brain constituents
and genetics (inside-the-skin) but also the context (outside-the-skin)
in which these parts operate. Only by joining neurology and psychiatry, it is argued, can this nexus be used to reduce human suffering. Combining these subjects would help improve patient care and reduce stigma.
Organic basis
To further sketch psychiatry's history shows a departure from structural neuropathology, relying more upon ideology. One example of this is Tourette syndrome, which Sándor Ferenczi, although never having seen a patient with Tourette syndrome, suggested was the symbolic expression of masturbation caused by sexual repression. However, starting with the efficacy of neuroleptic drugs in attenuating symptoms the syndrome has gained pathophysiological support and is hypothesized to have a genetic basis too, based on its high inheritability. This trend can be seen for many hitherto traditionally psychiatric disorders (see table) and is argued to support reuniting neurology and psychiatry because both are dealing with disorders of the same system.
Linking traditional psychiatric symptoms or disorders to brain structures and genetic abnormalities. (This table is in not exhaustive but provides some psychodynamic and neurological bases to psychiatric symptoms.)
Atypical serotonin system, right frontal and temporal lobe dysfunction, changes to mesolimbic dopamine pathways
Improved patient care
Further, it is argued that this nexus will allow a more refined nosology of mental illness to emerge thus helping to improve remediation and rehabilitation
strategies beyond current ones that lump together ranges of symptoms.
However, it cuts both ways: traditionally neurological disorders, like Parkinson's disease, are being recognized for their high incidence of traditionally psychiatric symptoms, like psychosis and depression. These symptoms, which are largely ignored in neurology, can be addressed by neuropsychiatry and lead to improved patient care.
In sum, it is argued that patients from both traditional psychiatry and
neurology departments will see their care improved following a reuniting
of the specialties.
Better management model
Psychiatrist Randolph B. Schiffer, pediatrician Daniel L. Hurst,
neuropsychiatrist Walter Lajara-Nanson, and psychiatrist Russell C.
Packard argue that there are good management and financial reasons for
rapprochement.
US institutions
"Behavioral Neurology & Neuropsychiatry" fellowships are
accredited by the United Council for Neurologic Subspecialties (UCNS; www.ucns.org), in a manner analogous to the accreditation of psychiatry and neurology residencies in the United States by the American Board of Psychiatry and Neurology (ABPN).
The American Neuropsychiatric Association
(ANPA) was established in 1988 and is the American medical subspecialty
society for neuropsychiatrists. ANPA holds an annual meeting and offers
other forums for education and professional networking amongst
subspecialists in behavioral neurology and neuropsychiatry as well as
clinicians, scientists, and educators in related fields. American
Psychiatric Publishing, Inc. publishes the peer-reviewed Journal of Neuropsychiatry and Clinical Neurosciences, which is the official journal of ANPA.
International organizations
The International Neuropsychiatric Association was established in 1996. INA holds congresses biennially in countries around the world and
partners with regional neuropsychiatric associations around the world to
support regional neuropsychiatric conferences and to facilitate the
development of neuropsychiatry in the countries/regions where those
conferences are held. Prof. Robert Haim Belmaker is the current president of the organization whereas Prof. Ennapadam S Krishnamoorthy serves as President-Elect with Dr. Gilberto Brofman as Secretary-Treasurer.
The British NeuroPsychiatry Association (BNPA) was founded in 1987 and is the leading academic and professional body for medical
practitioners and professionals allied to medicine in the UK working at
the interface of the clinical and cognitive neurosciences and
psychiatry.
In 2011, a non-profit professional society named Neuropsychiatric Forum
(NPF) was founded. NPF aims to support effective communication and
interdisciplinary collaboration, develop education schemes and research
projects, organize neuropsychiatric conferences and seminars.
Antipsychiatry is a political movement based mostly in philosophy
(postmodern neo-Marxism) and hermeneutics (interpretative story telling)
which denies the existence of psychiatric illnesses ignoring what most
patients say. Fernando Vidal and Francisco Ortega argue that
neuropsychiatry strengthens the conception of mental suffering as a
product of individual irresponsibility yet neuropsychiatrists say the opposite. In Capitalist Realism, Mark Fisher states that when depression is made to be a consequence of individual biochemical imbalance, social causation is ruled out. This uses a neo-Marxist perspective with chemical imbalance a straw man
argument. Social factors contribute to all illnesses, but social
factors are not an exclusive cause for severe illnesses. In contrast,
everyday unhappiness is extremely common and not a medical illness.
Ableism (/ˈeɪbəlɪzəm/; also known as ablism, disablism [in British English], anapirophobia, anapirism, and disability discrimination) is discrimination and social prejudice against physically or mentally disabled
people. Ableism characterizes people as they are defined by their
disabilities and also classifies disabled people as being inferior to
non-disabled people. On this basis, people are assigned or denied certain perceived abilities, skills, or character orientations. Ableism perpetuates false ideas about individuals and groups with disabilities.
There are stereotypes
which are either associated with disability in general, or they are
associated with specific impairments or chronic health conditions (e.g.,
the presumption that all disabled people want to be cured, the false
belief that wheelchair users also have an intellectual disability, or the assumption that blind people have some special form of insight). These stereotypes, in turn, serve as a justification for discriminatory practices, and reinforce discriminatory attitudes and behaviors toward people who are disabled. Labeling affects people when it limits their options for action or changes their identity.
In ableist societies, the lives of disabled people are considered
less worth living, or disabled people less valuable, even sometimes
expendable. The eugenics movement of the early 20th century is considered an expression of widespread ableism.
Ableism can be further understood by reading literature which is
written and published by those who experience disability and ableism
first-hand. Disability studies
is an academic discipline which is also beneficial when non-disabled
people pursue it in order to gain a better understanding of ableism.
Originating from -able (in disable, disabled) with influence of able (ultimately from Latin habilis) and -ism (in racism, sexism); first recorded in 1981.
A poster of the British suffrage movement, attacking the fact that women were placed next to "lunatics" and convicts in being unable to vote. Ableist and eugenicist ideas were often found in suffrage rhetoric.
In the UK, disability discrimination became unlawful as a result of the Disability Discrimination Act 1995, and the Disability Discrimination Act 2005. These were later superseded, retaining the substantive law, by the Equality Act 2010.
The Equality Act 2010 brought together protections against multiple
areas of discriminatory behavior (disability, race, religion and belief,
sex, sexual orientation, gender identity, age and pregnancy – the
so-called "protected characteristics").
Under the Equality Act 2010, there are prohibitions addressing
several forms of discrimination including direct discrimination (s.13),
indirect discrimination (s.6, s.19), harassment (s.26), victimisation (s.27), discrimination arising from disability (s.15), and failure to make reasonable adjustments (s.20).
Part 2, chapter 1, section 6, of the Equality Act 2010 states
that "A person (P) has a disability if (a) P has a physical or mental
impairment, and (b) the impairment has a substantial and long-term
adverse effect on P's ability to carry out normal day-to-day
activities."
United States
Much like many minority groups, disabled Americans were often segregated and denied certain rights for a majority of American history. In the 1800s, a shift from a religious view to a more scientific view took place. Public stigma began to change after World War II when many Americans returned home with disabilities. In the 1960s, following the civil rights movement in America, the world began the disabled rights movement.
The movement was intended to give all individuals with disabilities
equal rights and opportunities. Until the 1970s, ableism in the United
States was often codified into law. For example, in many jurisdictions,
so-called "ugly laws" barred people from appearing in public if they had diseases or disfigurements that were considered unsightly.
Japan
Society and culture in Japan are influenced by the culture of conformity represented by the character Wa (和). Central to Wa
is the integration of individuals into a harmonic system that treats
societies not as a collection of individuals, but as a singular entity. Individuals are expected to conform to this concept for the benefit of society, even if it means sacrificing individuality. As a result, disability in Japan is seen as a break in conformity and
therefore faces challenges in terms of acceptance into Japan's
homogenous culture. For example, children in Japanese elementary schools
are subject to the concept of mimamori; the practice of watching over
children protectively while granting them autonomy in their actions,
specifically interactions with other children and their physical
activities. This approach to education leaves children with disabilities subject to
peers who are more socially adept than them, with no attempt made by
teachers to interfere because of mimamori's stance on autonomy.
Japanese educators emphasize protecting disabled children from social
stigma, along with following the guardian's wishes for how to guide
their child.
On July 26, 2016,
26-year-old former care-home worker Satoshi Uematsu drove to the Tsukui
Yamayuri-en care facility in Sagamihara, Japan, and killed 19 residents
and injured 25 others, all of whom possessed disabilities. Uematsu later drove to the Tsukui police station, where he was detained by law enforcement. Uematsu's motivations for the attack were later released to the public
by police in a letter he had written to the speaker of the lower house
of parliament, where Uematsu wished for the euthanization of disabled
people if unable to contribute to society. Although not representative of Japan's attitude towards disabled
people, Uematsu's stabbings are an example of how strong attitudes
toward conformity in Japan are towards disabled people.
Despite these attitudes, Japan has taken legislative action in
the past two decades delineating the definitions and protections for
disabled people. In 2012, Japan ratified the UN Convention on the Rights
of People with Disabilities which laid the groundwork for an official
definition of disability and equitable treatment in Japan. In 2013, Japan added two core principles of the UN convention into law, prohibition of discrimination (sabetsu kinshi) and reasonable accommodation (gōriteki hairyo). Japan's addition of reasonable accommodation was based on the U.S.
model of reasonable accommodation, which furthered efforts for equity
for disabled people by adapting environments and situations for
individual needs. In April 2024, Japan's amendments for the Act for
Eliminating Discrimination against Persons with Disabilities took
effect, mandating that all government, public, and private companies
must provide reasonable accommodation for those with disabilities.
International law
In May 2012, the UN
Convention on the Rights of Persons with Disabilities was ratified. The
document establishes the inadmissibility of discrimination on the basis
of disability, including in employment.
In addition, the amendments create a legal basis for significantly
expanding opportunities to protect the rights of persons with
disabilities, including in the administrative procedure and in court.
The law defined specific obligations that all owners of facilities and
service providers must fulfill to create conditions for disabled people
equal to the rest.
Workplace
In 1990, the Americans with Disabilities Act
was put in place to prohibit private employers, state and local
government, employment agencies and labor unions from discrimination
against qualified disabled people in job applications, when hiring,
firing, advancement in workplace, compensation, training, and on other
terms, conditions and privileges of employment. The U.S. Equal Employment Opportunity Commission
(EEOC) plays a part in fighting against ableism by being responsible
for enforcing federal laws that make it illegal to discriminate against a
job applicant or an employee because of the person's race, color,
religion, sex (including pregnancy, gender identity, and sexual
orientation), national origin, age (40 or older), disability or genetic
information.
Similarly in the UK, the Equality Act 2010
was put in place and provides legislation that there should be no
workplace discrimination. Under the act, all employers have a duty to
make reasonable adjustments for their disabled employees to help them
overcome any disadvantages resulting from the impairment. Failure to
carry out reasonable adjustment amounts to disability discrimination.
Healthcare
Clinical settings
These "disability-specific barriers" to seeking health care also
expand into, "physical barriers (e.g., lack of accessible entrances and
wayfinding assistance at treatment facilities), transportation barriers
(e.g., shortage of accessible, reliable, and affordable transit
options), and information barriers (e.g., inaccessible intake paperwork,
after-visit summaries, and online patient portals)." Each of these circumstances represent ableism in the healthcare system that prevents people from getting the care they require.
In June 2020, near the start of the COVID-19 pandemic,
a 46-year-old quadriplegic in Austin, Texas named Michael Hickson was
denied treatment for COVID-19, sepsis, and a urinary tract infection and
died 6 days after treatment was withheld. His physician was quoted as having said that he had a "preference to
treat patients who can walk and talk." The physician also had stated his
belief that Hickson's brain injury made him have not much of a quality
of life. Several complaints have since been filed with the Texas Office
of Civil Rights and many disability advocacy groups have become involved
in the case.
Several states, including Alabama, Arizona, Kansas, Pennsylvania,
Tennessee, Utah, and Washington allow healthcare providers, in times of
crisis, to triage based on the perceived quality of life of the
patients, which tends to be perceived as lower for those with
disabilities. In Alabama, a ventilator-rationing scheme put in place during the
pandemic enabled healthcare providers to exclude patients with
disabilities from treatment; such patients were those who required
assistance with various activities of daily living, had certain mental conditions (varying degrees of intellectual disability or moderate-to-severe dementia) or other preexisting conditions categorized as disabilities.
Instances of ableism in healthcare like those described above are
especially dangerous because they are often regarded to simply be
"common sense". This "common sense" mentally means that, "often results in the
application of a utilitarian approach to defining 'extraordinary,'
'heroic' and 'futile' measures that may be employed to preserve or
prolong human life." This creates additional issues, as activities or practices that
disabled people often engage in can seem like indicators of poor health
for medical professionals which can lead to improper treatment or biased
treatment.
Criminal justice settings
The provision of effective healthcare for people with disabilities in
criminal justice institutions is an important issue because the
percentage of disabled people in such facilities has been shown to be
larger than the percentage in the general population. A lack of prioritization on working to incorporate efficient and
quality medical support into prison structures endangers the health and
safety of disabled prisoners.
Limited access to medical care in prisons consists of long
waiting times to meet with physicians and to consistently receive
treatment, as well as the absence of harm reduction
measures and updated healthcare protocols. Discriminatory medical
treatment also takes place through the withholding of proper diets,
medications, and assistance (equipment and interpreters), in addition to
failures to adequately train prison staff. Insufficient medical
accommodations can worsen prisoners' health conditions through greater
risks of depression, HIV/AIDS and Hepatitis C transmission, and unsafe drug injections.
In Canada, the usage of prisons as psychiatric facilities may
involve issues concerning inadequate access to medical support,
particularly mental health
counseling, and the inability of prisoners to take part in
decision-making regarding their medical treatment. The usage of
psychologists employed by the correctional services organization and the
lack of confidentiality in therapeutic sessions also present barriers
for disabled prisoners. That makes it more difficult for prisoners with
disabilities to express discontentment about problems in the available
healthcare since it may later complicate their release from the prison.
In the United States, the population of older adults in the
criminal justice system is growing rapidly, but older prisoners'
healthcare needs are not being sufficiently met. One specific issue includes a lack of preparation for correctional officers to be able to identify geriatric disability.
Regarding that underrecognition of disability, further
improvement is needed in training programs to allow officers to learn
when and how to provide proper healthcare intervention and treatment for
older adult prisoners.
Healthcare policy
Ableism has long been a serious concern in healthcare policy, and the
COVID-19 pandemic has greatly exaggerated and highlighted the
prevalence of this serious concern. Studies frequently show what a
"headache" patients with disabilities are for the healthcare system. In a
2020 study, 83.6% of healthcare providers preferred patients without
disabilities to those with disabilities. This policy is especially concerning since according to the CDC, people
with disabilities are at a heightened risk for contracting COVID-19. Additionally, in the second wave of the COVID-19 pandemic in the UK,
people with intellectual disabilities were told that they will not be
resuscitated if they become ill with COVID-19.
Healthcare research
The concept of ableism is often misused in medical research and
population health research, which causes issues in understanding the
impact of ableism. Such research also typically does not consult with
actual disabled individuals enough to understand their experiences
outside of a clinical, medical sense. In other words, there is a lack of
understanding of "disabled people to be reliable narrators of their
experiences in clinical settings." These circumstances can lead to a narrow understanding of disabilities
and ableism in medical population health research. Solutions proposed
for the pervasive issues on disability and ableism research includes
focus on the challenges to "traditional and often unarticulated
assumptions" about disability and ableism. Research needs to emphasize on lived experiences of disabled people
outside the healthcare system, in order to gain a deeper understanding
of those disabilities, but also of the ableism that may be impacting
individual experiences.
Education
Ableism often makes the world inaccessible to disabled people, especially in schools. Within education systems, the use of the medical model of disability and social model of disability contributes to the divide between students within special education
and general education classrooms. Oftentimes, the medical model of
disability portrays the overarching idea that disability can be
corrected and diminished at the result of removing children from general
education classrooms. This model of disability suggests that the
impairment is more important than the person, who is helpless and should
be separated from those who are not disabled.
The social model of disability suggests that people with
impairments are disabled at the result of the way society acts. When
students with disabilities are pulled out of their classrooms to receive
the support that they need, that often leads their peers to socially
reject them because they don't form relationships with them in the
classroom. By using the social model of disability, inclusive schools
where the social norm is not to alienate students can promote more
teamwork and less division throughout their campuses.
Implementing the social model within modern forms of inclusive
education provides children of all abilities with the role of changing
discriminatory attitudes within the school system. For example, a
disabled student may need to read text instead of listening to a tape
recording of the text. In the past, schools have focused on fixing the
disability, but progressive reforms make schools now focused on
minimizing the impact of a student's disability and giving support.
Moreover, schools are required to maximize access to their entire
community. In 2004, U.S. Congress made into law the Individuals with Disabilities Education Act,
which states that free and appropriate education is eligible to
children with disabilities with insurance of necessary services. Congress later amended the law, in 2015, to include the Every Student Succeeds Act,
which guarantees equal opportunity for people with disabilities full
participation in society, and the tools for overall independent success.
These common ways of framing disability are heavily criticized for
being dehumanizing and failing to place importance on the perspectives
of disabled people.
Disabled villain
One common form of media depiction of disability is to portray
villains with a mental or physical disability. Lindsey Row-Heyveld
notes, for instance, "that villainous pirates are scraggly, wizened and
inevitably kitted out with a peg leg, eye patch or hook hand, whereas
heroic pirates look like Johnny Depp's Jack Sparrow". The disability of the villain is meant to separate them from the
average viewer and dehumanize the antagonist. As a result, stigma forms
surrounding the disability and the individuals that live with it.
There are many instances in literature where the antagonist is
depicted as having a disability or mental illness. Some common examples
include Captain Hook, Darth Vader and the Joker. Captain Hook is notorious for having a hook as a hand and seeks revenge on Peter Pan for his lost hand. Darth Vader's situation is unique because Luke Skywalker
is also disabled. Luke's prosthetic hand looks lifelike, whereas Darth
Vader appears robotic and emotionless because his appearance does not
resemble humans and takes away human emotions. The Joker is a villain
with a mental illness, and he is an example of the typical depiction of
associating mental illness with violence.
Inspiration porn
Australian Paralympic team member Michelle Errichiello (1024) at the 2012 Summer Paralympic Games
in London. Along with United States' Katy Sullivan (1418) and Germany's
Vanessa Low (1181). Seen competing in the Women's 100-meter sprint.
Inspiration porn is the use of disabled people performing ordinary tasks as a form of inspiration. Criticisms of inspiration porn say that it distances disabled people
from individuals who are not disabled and portrays disability as an
obstacle to overcome or rehab.
One of the most common examples of inspiration porn includes the Paralympics.
Athletes with disabilities often get praised as inspirational because
of their athletic accomplishments. Critics of this type of inspiration
porn have said, "athletic accomplishments by these athletes are
oversimplified as 'inspirational' because they're such a surprise."
Pitied character
In many forms of media such as films and articles a disabled person
is portrayed as a character who is viewed as less than able, different,
and an "outcast." Hayes and Black (2003) explore Hollywood films as the
discourse of pity towards disability as a problem of social, physical,
and emotional confinement. The aspect of pity is heightened through the storylines of media
focusing on the individual's weaknesses as opposed to strengths and
therefore leaving audiences a negative and ableist portrayal towards
disability.
Supercrip stereotype
The supercrip narrative is generally a story of a person with an
apparent disability who is able to "overcome" their physical differences
and accomplish an impressive task. Professor Thomas Hehir's
"Eliminating Ableism in Education" gives the story of a blind man who climbs Mount Everest, Erik Weihenmayer, as an example of the supercrip narrative.
The Paralympics
are another example of the supercrip stereotype since they generate a
large amount of media attention and demonstrate disabled people doing
extremely strenuous physical tasks. Although that may appear inspiring
at face value, Hehir explains that many people with disabilities view
those news stories as setting unrealistic expectations. Additionally, Hehir mentions that supercrip stories imply that disabled
people are required to perform those impressive tasks to be seen as an
equal and to avoid pity from those without disabilities.
The disability studies scholar Alison Kafer
describes how those narratives reinforce the problematic idea that
disability can be overcome by an individual's hard work, in contrast to
other theories, such as those that view disability as the result of societal structure. Supercrip stories reinforce ableism by emphasizing independence,
reliance on one's body, and the role of individual will in self-cure.
Other examples of the supercrip narrative include the stories of Rachael Scdoris, the first blind woman to race in the Iditarod, and Aron Ralston, who has continued to climb after the amputation of his arm.
Environmental and outdoor recreation media
Disability has often been used as a short-hand in environmental
literature for representing distance from nature, in what Sarah Jaquette
Ray calls the "disability-equals-alienation-from-nature trope." An example of this trope can be seen in Moby Dick, as Captain Ahab's lost leg symbolizes his exploitative relationship with nature. Additionally, in canonical environmental thought, figures such as Ralph Waldo Emerson and Edward Abbey wrote using metaphors of disability to describe relationships between nature, technology, and the individual.
Ableism in outdoor media can also be seen in promotional materials from the outdoor recreation industry: Alison Kafer highlighted a 2000 Nike advertisement, which ran in eleven outdoor magazines promoting a pair of running shoes. Kafer alleged that the advertisement depicted a person with a spinal cord injury and a wheelchair user as a "drooling, misshapen, non-extreme-trail-running husk of [their] former self", and said that the advertisement promised non-disabled runners and
hikers the ability to protect their bodies against disability by
purchasing the pair of shoes. The advertisement was withdrawn after the company received over six
hundred complaints in the first two days after its publication, and Nike
apologized.
Types of ableism
Physical ableism is hate or discrimination based on physical disability.
Sanism, or mental ableism, is discrimination based on mental health conditions and cognitive disabilities.
Medical ableism exists both interpersonally (as healthcare providers
can be ableist) and systemically, as decisions determined by medical
institutions and caregivers may prevent the exercise of rights from
disabled patients like autonomy and making decisions. The medical model of disability can be used to justify medical ableism.
Structural ableism is failing to provide accessibility tools: ramps, wheelchairs, special education equipments, etc. (Which is often also an example of Hostile architecture.)
Cultural ableism is behavioural, cultural, attitudinal and social
patterns that may discriminate against disabled people, including by
denying, dismissing or invisibilising disabled people, and by making
accessibility and support unattainable.
Internalised ableism
is a disabled person discriminating against themself and other disabled
people by holding the view that disability is something to be ashamed
of or something to hide or by refusing accessibility or support.
Internalised ableism may be a result of mistreatment of disabled
individuals.
Hostile ableism is a cultural or social kind of ableism where people
are hostile towards symptoms of a disability or phenotypes of the
disabled person.
Benevolent ableism is when people treat the disabled person well but like a child (infantilization), instead of considering them full grown adults. Examples include ignoring disabilities (such as the RNIB's "See the person" campaign), not respecting the life experiences of the disabled person, microaggression,
not considering the opinion of the disabled person in important
decision making, invasion of privacy or personal boundaries, forced
corrective measures, unwanted help, not listening to the disabled
person, etc.
Ambivalent ableism can be characterized as somewhere in between hostile and benevolent ableism.
Ableism may have evolutionary and existential origins (fear of
contagion, fear of death). It may also be rooted in belief systems (social Darwinism, meritocracy), language (such as "suffering from" disability), or unconscious biases.
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