ICF/ICIDH-2 crit [rebalance]
The original enquiry from Masakuni Tagaki (18 Nov 01) asked if any
criticism of ICF was available, and that was what I had primarily in mind
when posting on 21 Nov.
However, it occurred to me that a majority of current list members might
not have had occasion to examine relevant documents i.e. ICIDH-2 (at any
recent stage) or the book on Disability & Culture etc (isbn 088937239X);
while most participants in ICIDH-2 revisions, WHO deliberations, and orgs
of rehab professionals, are probably not regular readers of this list. So,
apart from the sketch already made of some crits of ICF / ICIDH-2, a brief
run through some points on the other side may be needed for balance
(especially for people who wearied of trying to reach the article on the
disabilityworld site, which was inoperative until my third attempt at
posting the URL!)
The aim and intention of revising ICIDH was not unreasonable. Quite some
useful mileage had been got from the 1980 ICIDH, but it did need review and
it needed some recognition of views from disabled peoples' orgs.
WHO allocated a lot of time and some resources for consulting with
interested parties, through collaborating centres in major regions.
Further, the aim of conducting studies in culturally diverse countries, to
develop better evidence for the range, diversity (and possible convergence)
of concepts of disability and attitudes towards disabled persons was quite
sensible and necessary, toward the goal of making ICIDH more culturally
workable across the world.
Thirdly, there was a good deal of debate over the years. The WHO team
(which altogether has included dozens of people around the world, with a
core of players at Geneva) has been faced with a great variety of views,
some more cogently expressed than others. Some people of course have been
implacably against ICIDH on principle; others have felt that any 'WHO team'
must inevitably be committed to certain 'medical', 'professional'
(and 'male', 'western' or 'westernised') objectives, and so was hopelessly
compromised. Whatever the strengths or weaknesses of these viewpoints, the
people who agreed to do the various sorts of ICIDH revision work cannot be
blamed for failing to curl up and die in the face of contrary opinions. Had
they done so, it's unlikely that any progress would have been made.
There was a good deal of flexibility in the earlier years of the revision
process, trying to incorporate at least a weak version of 'social model'
thinking in order to placate Disabled People's Orgs. One cost of
flexibility was the loss of rigour in defining what it was that should be
classified. In a war context, the production of a 'good diplomatic fudge'
means that each party can report home that they won the game, and there a
lack of precision may be okay. But lack of precise definition (or the
substitution of circular definitions) is a problem if one is trying to
prepare a global terminology and classification. (See: C. Rossignol, La
classification internationale des altérations corporelles, invalidités et
handicap: approche linguistique d'un débat terminologique. Prévenir
2000 /07-12, No.39 pp. 35-47).
The main problem, as I see it, was that the whole thing got seriously out
of hand. During the 1980s and 1990s, 'disability' was becoming a
significantly politicised and conflict-bearing area, and this spread across
the economically strong and transitional countries. At least two underlying
(and radically conflicting) currents contributed to the sharpening process.
One was and is postmodernism, which assisted the loss of confidence in, and
authority of, medical / welfare professionals and their paradigms, and
is/was allied to a sense of loosening or emptying of meaning from words.
Opposed to this was the (selective, urban) globalisation of a kind of
convergent 'scientific fundamentalism' mentality, i.e. that there is a best
way, an evidence-based scientifically-proven best way, to define
everything, fix everything, do everything; and 'we' can discover this way,
and when 'we' have done so and have got it right it is then entirely
legitimate for 'us' to enforce it on everyone else, for their own good,
because it will be the only correct way of doing things. (Pretty similar to
various earlier fundamentalisms; but this one is hooked into the
triumphalist arrogance of western cultural imperialism plus media
globalisation, which makes it rather formidable).
Older participants may recall the Navy classification of chamber pots
issued to sailors for the evacuation of their bladders and bowels, as
necessary. It made pretty clear what you were getting, what it was made of,
what it looked like, and who was entitled to perform upon each pot issued.
The classification went something like this:
Pots, chamber, round, china, white, plain, ranks for the use of.
Pots, chamber, round, china, white, fluted, officers.
Pots, chamber, round, china, white, fluted, with admiral's monogram.
Pots, chamber, round, rubber, lunatic.
The world has become more complex since those days.
Anyhow, the people involved with ICIDH-2 revision made prodigious efforts
with the best of intentions, but got caught short on an impossible
treadmill. The attempted classification of disability in its many aspects,
with the (probably legitimate) hope that solutions could then more easily
be shared and compared since trials in one place could accurately be
compared with trials in any other place, got royally and increasingly
confused by the growing unwillingness of disabled people to lie down
quietly and be defined and measured up, down and across. Attempts to
reconceptualise disability as a social phenomenon had also to take into
account huge annual increments in knowledge about health conditions
associated with impairments, and everything from environmental to genetic
factors influencing self-perceptions and 'being oneself', plus the large
variations in all these factors in different parts of the world (which were
no longer simply lying back and waiting for the Americans to arrive and
sort it all out).
The ICIDH-2 revision came unstuck because it was trying to do far too many
mutually incompatible things, and the amount of time in which they had to
be done was shortening as the complexity of demands and ambitions from all
sides increased. Given these problems, it's surprising how interesting the
final document turned out to be. It's well worth looking at. If it's still
not the answer to anything, that's mainly because what was being asked was
everything.
Multi-limbed, inter-cultural and basically impossible schemes like this
soon develop a life of their own, far beyond the control of the individuals
engaged in them. Of course none of the people centrally involved is
actually round, rubber or lunatic; nor is any of them incompetent in their
own field of specialisation. But what they found themselves attempting was
a task that had grown and morphed into something that could not be
accomplished with the time and means available. (It's doubtful whether it
can be done at all, even with another 30 years' work; but some of the
participants argue strongly that it can be done, and shall be done. We
shall see in due course).
This piece was supposed to be something of a rebalance, but I realise that
my scepticism has rapidly got the upper hand!
m99m
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