ICF / ICIDH-2 critique
There has been little overt reaction as yet, to the ICIDH-2 (renamed ICF
for International Classification of Functioning), which was nodded through
in May 01 along with piles of other stuff by the World Health Assembly, a
bunch of medical worthies many of whom would have been capable of reading
the entire ICF but very few of whom can be expected to have done so.
A brief critique entitled "ICIDH meets Postmodernism, or 'Incredulity
toward Meta-Terminology'" appeared in May 01 at:
http://disabilityworld.org/03-04_01/resources/icidh.htm
(Also in print: International Rehabilitation Review 51 (1) (August) 32-36.
This article pointed out that the ICIDH revision team had tried to combine
medical and social models into a "biopsychosocial" approach in order to
deflect the expected abreactions on various sides; but in the final year of
revision, time was running short while delusions of grandeur were
lengthening. The final product is presented as an Answer To Everything,
expected to revolutionise the 'care' of disabled people. In fact, ICIDH-2
(ICF) looks remarkably like a camel, and this impression is reinforced by
it being available in short or long versions (one or two humps). But the
Geneva team attempted to divert the critical gaze from this unprepossessing
appearance by drawing attention to its speed over various sorts of sand,
snow, water, earth, fire; and the fact that, in a tight corner, you can
obtain a refrigerated beer and sandwich out of the humps.
This fairly mild critique elicited a learned response from a French
heavyweight, Dr Christian Rossignol of the Laboratoire Langue et Parole,
Centre National de Recherche Scientifique, Aix en Provence, who provided
two lengthy, unpublished reports (one in English, the other French)
evaluating ICIDH-2 at different stages in its evolution. These reports give
a devastating, line-by-line, paragraph by paragraph demonstration and
denunciation of incompetence and technical failure by the WHO team working
on ICIDH-2. Had the team paid any attention to this work (commissioned by
the French collaborating centre as a contribution to the revision process),
it seems likely that they would have had to resign, to admit that vast sums
of public money and effort had been wasted, and to let WHO begin again,
hiring consultants with some knowledge of taxonomy and principles of
classification. (No. They didn't.)
When I wrote my little DisabilityWorld crit, I had been uneasy about many
of the linguistic points which, as later I learnt, Rossignol had nailed
through the heart; but I did not have the expertise to state exactly why
they were wrong. It turns out that at the time he did the two critical
evaluations, Rossignol was completing his Doctorat d'Etat precisely in the
field of terminologies and classifications of disablement, so he was in a
strong position to know exactly what was wrong with the WHO effort, and
what would be needed to put it right. (The French Doctorat d'Etat is in a
different league from the piffling 3-year anglo-saxon PhD -- it's more like
a ten- or twelve-year struggle, two separate theses, something to which the
Brit DSc might sometimes be compared, i.e. summing up a substantial period
of research by an advanced researcher, and examined in a lengthy public
grilling by a board of equally serious academics).
Earlier criticisms of ICIDH-2 may be traced through the website of the
Dutch collaborative centre, which archives the newsletter chronicling the
revision efforts over some years, and listing about 2000 published items
concerned with ICIDH:
http://www.rivm.nl/publichealth/whocc-icidh/
Some further published fall-out from ICF can certainly be expected, but the
formal disability journals don't have a fast turn-around, so another 6-12
months may be needed. An allied work produced by the WHO team in 2001 is a
book called "Disability and Culture, universalism and diversity" (Hogrefe &
Huber, isbn 088937239X), which purports to describe a "research basis" for
the universal application of ICF. In fact, it describes some amateurish
studies held in a dozen or so countries, in which small groups of
professionals, disabled people and others, played some party games
(e.g. 'pile sorting' - a sort of Rorschach Blot Meets Solitaire kind of
thing) and gave their opinions on what they thought might be popular
attitudes to people with disabilities or with various illness, in different
situations. Some of the country research efforts seem to have attained the
level of good first year undergraduate projects around 1975; others
apparently did not.
Various chapters in the book (including the Japanese chapter by M. Tazaki
and Y. Nakane) frankly admit that there were considerable problems in
translating the ICIDH-2 terminology into national languages and conceptual
forms. However, the conclusion is breezily optimistic about overcoming
these linguistic and cross-cultural difficulties.
(Well… if problems continue, maybe a few thousand daisy-cutters could be
dropped onto populations that have been slow to comply with the Global Way
of Thinking).
m99m
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