Let me learn you a thing. Often when we think of the word “disability” we’re filtering through the classical “medical model” of disability. In very simplified and reductionist terms, the medical model states that disability arises from conditions and disease. Boom, here’s some schizophrenia. Congratulations, you’re disabled. No shade to the medical model (some of my best friends are medical models) but this framework can be marginalizing, stigmatizing, and disempowering.
In the 1970s, an American psychiatrist named George Engel began to think about a new way of examining health (specifically mental health) as the “bio-psycho-social model.” And of course, he did. He was working as the liaison with general medicine and the psychiatry departments at the University of Rochester. So, bridging these areas, he began to see “health” as a combination of the biological factors that the medical model really focused primarily on, with the addition of what is happening psychologically and socially for the individual.
Here’s what that means for our old friend: the concept of disability. What if disability doesn’t come from a diagnosis, but from the challenges in function that result from the gap between the individual’s capabilities and their environment’s ability to work with those capabilities? Are you shaking with excitement like I am? If you’re a visual person like me here’s what I’m talking about using the illustrative allegory of gears in a system:
The gap between those two gears means that no matter how hard or fast those gear spins, they’re not going to work in harmony. The gap, or the disability, is not the “fault” of either gear or system. The environment (western society, family units, our physical surroundings, the larger culture, etc.) can be “blamed” for not being able to meet the individual just as much as the individual’s challenges.
An example I often use is that if I spontaneously combusted in the presence of any snow, this would be a major disability working on a Ranch in Vermont. However, if I lived in the Sahara Desert, it probably wouldn’t be any issue. In other words, the disability doesn’t come from hearing voices, but from struggles in coping with an environment that is not conducive to voice-hearers.
“So why are you talking about this, Derrick” I hear you asking through the computer/phone, “What does this have to do with the Ranch? Do you really spontaneously combust in the presence of snow?” Great questions, imaginary audience! At the Ranch we use the Milieu model. For the sense of this rambling blog post, the Milieu is a substitute for the environment. When someone comes to us, we try our hardest to bring that milieu to meet the individual where they need to be met. To continue that confusing visual metaphor and stress my artistic skills:
Wow! Look at how that milieu grew and met the individual where they needed to be met! Let’s ignore the amateur graphic design and marvel at the ingenuity of the visual metaphor! Impressive!
“But, Derrick!” I hear you interrupt, “What happens after they leave the warm, comforting embrace of the milieu?” What an intelligent and enraptured audience I have here! The idea is that through the experience of exposure to the milieu and continuous challenging in the therapeutic work program, independent living, community, therapy, nutritional education, and medication management, residents are being challenged in real world situations without real world consequences. This allows the resident to grow to meet the environment through coping skills, practice, and social learning of being in a pro-social and supportive environment. Let’s learn what goes into that gap and how we can bridge that gap.
Residents learn to embrace their superpower and figure out how to function outside of themselves. We hope that as they work through the program, they move towards finding the accommodations, adaptions, and skills needed to function more effectively in a post-Ranch environment. Here comes the gears again:
Our hope in working with our residents is to turn disability into ‘dat-ability. Dat ability to work more effectively within the confines of their environment.
Further reading on George Engel and his work:
Engel G. L. (1980). The clinical application of the biopsychosocial model. The American journal of psychiatry, 137(5), 535–544. https://doi.org/10.1176/ajp.137.5.535
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