The Idealized Norm: The Systemic Impact of Ableism on Human Service Fields

Take a moment and consider the prevailing culture cultivated in the United States. How is our society structured, and how do these dominant norms affect disabled people? A clear pattern emerges from objective analysis of our most prevalent societal and cultural norms, one which emphasizes the collective ‘way’. Therefore, it's not a stretch to assume that everyone should think, learn, experience, and interact with the world in pretty much the same way. We know this can't be true, but it's a message deliberately transmitted in the name of our utilitarian ideals. Unfortunately, this narrative steers the sour social systems, driving structural oppression in its various forms. It is a mindset that generalizes, relying upon conformity to serve the majority of people who fall within its parameters. But in reality, this systemic real-world analog of a keyboard shortcut only serves to undermine the very principles western culture idealizes; freedom, choice, difference, and crafting one’s own narrative. 

From a disability perspective, the systems which perpetuate these false narratives are quintessentially ableist. They demand a deficit-based lens that ignores the natural variation of humanity, instead upholding a consensus ideal, a measuring stick of what a person should be. These narratives and socially constructed expectations illustrate the idea of ableism. Ableism is systemic discrimination and social prejudice against people on the basis of disability. The concept of disability has emerged from the interaction between ableism and perceived differences in body and mind. Ableism breeds inequity, and as such, it is a systemic, structural, and societal issue.

 Ableism in Practice

 To understand how the culture of ableism has a stranglehold on many of the systems we navigate daily, look no further than America’s public schools. The first thing to acknowledge is that ableism takes many forms. In schools, language is often purposefully leveraged to drive division between those with disabilities, and those without (aka those who don't fit the mold and those who fit). Terms like ‘special’, ‘exceptional’, and ‘differently abled’ do nothing more than divide the disabled from the non-disabled, furthering inequitable power dynamics and denying the reality of disability. Because these people do not fit the norm, we label them with euphemisms that are more palatable to those who are non-disabled, and in the process deny disabled people of their inherent dignity and worth.

The influence of ableism is subtle, nuanced, and pervasive; so much so that we often fail to recognize its presence. Because ableism is inherently embedded in society, it has insidiously woven the very fields/professions which are supposed to support and ally with disabled people (education, human services, healthcare, etc.). This is why it's vital we practice critical reflexivity and question the status quo in the pursuit of truth. 

 The Idealized Norm

One of the most concrete ways ableism takes form is in the advancement of the idealized norm. This norm is culturally and socially constructed, and designed to represent the majority of persons in a particular human-inhabited environment. The promotion and maintenance of a false ideal is damaging in many ways because it refuses to acknowledge the natural variation of humanity. Essentially, it ignores intersectionality, diminishing the individualized nature of each person and their experiences. 

In its very nature, maintenance of the idealized norm does not provide space for different ways of learning, being, and doing. In education, human services, and healthcare fields it is common practice to present information in only one way, expecting comprehension. Also, there often appears to be an expectation of how the individual is ‘supposed’ to listen. This expectation takes form in the promotion of upright seating, eye contact, and not stimming or fidgeting. The expectations are damaging because communication and learning are not monolithic constructs, we each benefit from individualized approaches. 

Furthermore, in these settings, we typically employ frames of reference or strategies which are deficit-based and/or ableist in nature. However, the landscape surrounding disability is changing. As we begin to adopt perspectives that promote positive disability identity, we must utilize strategies/frameworks that have the flexibility to responsively evolve. Sensory integration is an excellent example of a frame of reference which has some good pieces but is typically used in a way which ignores individual differences and promotes false normative standards. Sensory integration's strengths lie within its conceptualization and comprehension of individual sensory systems. Understanding one’s sensory profile is immensely valuable, especially when used in identity-affirming ways. For neurodivergent people, this knowledge may serve as a gateway to the development of self-identified strategies, or exploration of sensory preferences. 

 Unfortunately, like many of its counterparts, sensory integration is a business first and a guiding framework second. This is clearly illustrated in the way that sensory interventions are prescribed to students in the schools. The student is viewed less as an individual and more as a puzzle. It feels like each person is no more than an amalgamation of sensory inputs and solutions which help them regulate and modulate, hence we encourage overly prescriptive methods like “sensory diets.” The goal in these efforts is less about individual understanding and exploration; instead centering on the alteration of neurodivergent ways of sensory processing to ‘fit in’.

 Choice and Consent

Another prominent way ableism shows up in daily life is what I call ‘power flexing’. Due to the mismatch between the person and environment, disabled individuals are constantly navigating inequitable social power dynamics. Unfortunately, these existing power dynamics are frequently leveraged to produce oppression and victimization. 

 A common example of power flexing is withholding the right to consent or dignity of choice. Restricted choice is a common experience for the disabled because dependence is a part of the disabled experience. This directly stems from the inaccessibility inherent to our everyday systems and environments. Restriction of choice furthers dependency as it teaches individuals that other people know better, creating a potentially false trust which is built upon hegemony. 

 Hand over hand is a common practice in a variety of therapeutic areas which demonstrates this concept. Hand over hand describes situations in which the practitioner physically moves the client's body to reinforce a movement pattern or manipulate something. This technique is common practice in various settings (feeding, hospitals, OT, special education, etc.). It can be very effective, particularly in the medical arena, but it is a very slippery slope. Before using hand over hand, some important questions must be answered. 

First, why do you feel the need to resort to a form of prompting which can diminish autonomy? Oftentimes, therapists, educators, and medical professionals have their own vision of what a positive session outcome looks like, and they do what's needed to meet it. It is vital to refrain from projecting our expectations upon others in these settings. Client choice and freedom over their own body far outweigh ‘ideal’ outcomes, efficiency, or meeting productivity standards. Unfortunately, consent is commonly overlooked by those who use hand over hand techniques.

Another question is whether you are using hand over hand because you are trying to teach the ‘correct’ way of doing something. Certainly, there are effective and less effective ways of doing something, but to reinforce one correct approach is to fall into the ableist trap of the idealized norm. Furthermore, hand over hand can be triggering for individuals with sensory differences or those with past traumas. If used, hand over hand should be a last resort, deemed necessary for the wellness of the individual (e.g. they are physically at risk otherwise). More importantly, it must never be attempted without obtaining consent. And, even when consent is obtained it must be in situations where a strong relationship of trust has been developed between the parties. This ensures an individual is not providing consent provided on the basis of false trust or because they feel coerced.

Action Steps

These are just a few of the ways ableism has infiltrated the health and human services fields. In its very nature, ableism is both brash and subtle, malicious and inadvertent. Therefore, it may not always be easy to catch, but there are some things you can do to avoid the pitfalls.

General Best Practice

Idealized Norm

Restricted Choice/Consent

  • Promote choice and agency

  • Always obtain consent

  • Build genuine trust

  • Acknowledge and shift power dynamics in your interactions with disabled people

  • Promote equity and inclusion

Finally, adopting a skeptics mindset and amplifying the voices of the disabled are essential to this work. Change is hard, the pathway to allyship is not linear, so allow me to leave you with the wise words of the great Maya Angelou. “Do the best you can until you know better. When you know better, do better.”

Author: Greg Boheler, MSOT, OTR/L

Greg is an autistic OT and disability justice activist from Chapel Hill, North Carolina. A skeptic by nature, Greg believes in the importance of questioning the way things have always been done and challenging ableist assumptions embedded within society. Greg celebrates different ways of doing and being in his work, whether it be in his community oriented OT role, his non-profit work with B3 Coffee, or his advocacy work through OTs for Neurodiversity.

            Contact Info                                                                            Other Projects

Email: gboheler7@gmail.com OT’s for Neuro: @neurodiversity_ot

Insta: @renaissance_ot                                                         B3 Coffee: https://b3coffee.org/

 

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