The Social Model of Disability and Eating Disorders
Author: Shira Collings, MS, NCC (she/they)
As providers, it can be important to take a step back from our day-to-day work and explore how we view and conceptualize the challenges that we provide support around. Many conversations in provider spaces focus on what treatment approaches or modalities are most effective. However, we sometimes forget to ask broader questions about how to think about the problems that we aim to address.One tool that can be helpful for exploring these questions from a broader perspective is developing an understanding of the different models that scholars, activists, and practitioners use to conceptualize disability. While numerous models of disability have been developed, this article will introduce readers to two of the most commonly utilized models of disability: the medical model and the social model.
Defining the Medical and Social Models
Most providers are likely already familiar with the medical model of disability, as it is the model most dominant in healthcare settings and is prevalent in western culture more generally. The medical model of disability views disability as a problem located within an individual and directly caused by disease, illness, trauma, or another health condition. According to the medical model of disability, disabilities require medical and/or psychological treatment to be managed. Adherents to this model typically seek to cure or treat disability through medical intervention and/or behavioral change. The goal of the medical model of disability is to come as close as possible to eliminating an individual’s health condition.
A model of disability that is much less commonly heard of is the social model. This model views disability not as a problem located in the individual but rather located in the individual’s social and cultural context. Adherents to the social model do not conceptualize illnesses, diseases, or health conditions as necessarily problems in and of themselves. Instead, what causes disability is societal barriers and exclusion that people with these health conditions face. The goal of the social model of disability is to build a more accessible, inclusive society in which individuals are given the accommodations and acceptance necessary to live fulfilling lives.
To illustrate the differences between these models, let’s take the example of hearing impairment. While the medical model typically seeks to cure hearing impairment through interventions such as cochlear implants, the social model would approach this through advocating for accommodations that make the world accessible for individuals with hearing impairments, such as readily available ASL interpretation and closed captioning.
Conceptualizing Eating Disorders
Like other disabilities, eating disorders are very commonly conceptualized under the medical model of disability. Most providers view eating disorders as individual issues that need to be treated through medical care, dietary guidance, and therapy aimed at cognitive and behavioral change. The goal is to support people in attaining complete recovery from their disorder, which is often defined as the absence of eating disorder behaviors and reduction and management of eating disorder thoughts.
I believe there can be a great deal of value in applying the medical model of disability to eating disorders. Eating disorders can have complex medical consequences that can result in suffering, and it is important to support people in accessing care for this. There are also many benefits to high quality psychological and nutritional counseling aimed at reducing eating disorder symptoms.
Additionally, I feel that applying the medical model of disability to eating disorders can be an important act of resistance in our incredibly fatphobic, healthist, nutritionist culture and healthcare system. When thinness, restrictive eating, and exercising as punishment are idealized and held up as representative of health and wellness within medical and cultural contexts, it can be very healing to name the real, impactful medical consequences of weight suppression, restriction, and compulsive exercise. And it can be powerful to reclaim the definition of health and recovery from illness as involving weight restoration (which may include fatness for many people), unrestricted eating, and rest. This is often especially true for people in larger bodies, who are disproportionately harmed by medical fatphobia.
However, in my own professional work and personal experiences of recovery from disordered eating, I have also found it tremendously valuable to apply concepts from the social model of disability to eating disorders. The fact that diet culture and weight stigma are such major contributors to eating disorders shows that eating disorders are heavily influenced by contextual factors. Research also shows that many other systems of oppression including white supremacy, patriarchy, heteronormativity, cisnormativity, and ableism contribute to eating disorders. It therefore is often not enough to change an individual’s cognitive thought processes, behaviors, or dietary and exercise habits; we must create change in the social and cultural environment as well.
Applying the Social Model to Eating Disorders
In my clinical work, one of the questions I am constantly asking myself and exploring with clients is, “What social, cultural, and environmental factors are keeping this eating disorder in place?” Is someone in a school or workplace that promotes weight stigma by teaching that fat bodies are inherently unhealthy or encouraging participation in programs that reward weight loss? Is someone’s family member constantly shaming them for eating particular food groups? Is someone being denied access to medical care due to the size that their body needs to be in order for them to be in recovery? If so, recovery - which involves accepting one’s body at any size, tolerating weight gain, and unconditional permission to eat all foods - would be quite inaccessible.
The social model of disability examines how we can make the world a more accessible place. What does this look like for eating disorders? For some people, this may include requesting formal accommodations from their workplace or school. Accommodations could include being excused from any discussions or programs focused on weight loss or nutrition, a boundary around any diet talk or weight talk, as well as any accommodations needed to be able to complete work responsibilities or school assignments with the cognitive, emotional, and physical challenges caused by malnourishment. For others in eating disorder recovery, accessibility may include self-advocacy in healthcare settings such as refusing to be weighed, providing education about Health At Every Size to people in their lives, and finding spaces that feel inclusive and safe to them. For people in larger bodies, this may involve advocating for accessible seating in workplaces, schools, and healthcare settings, as well as access to clothing. Providers can support clients in exploring what changes to their environment would make recovery accessible.
Addressing Concerns About the Social Model
One concern that often comes up around applying the social model of disability to eating disorders is the social model’s conceptualization of disability as not inherently negative, and not necessarily in need of treatment or a cure. Often, disabled people who adhere to the social model of disability feel that being disabled is an important part of their identity. Rather than something that should be cured or managed with medical treatment, they may view disability as a trait that should be accepted and even valued.
This can be very different when it comes to eating disorders given that unlike other disabilities, eating disorders are already lauded, praised, and valued in society. Many people feel that their eating disorders have resulted from societal pressure and coercion to pursue thinness at the cost of well-being. In this sense, being in eating disorder recovery is often what is more stigmatized and pathologized by our culture. It may be helpful to conceptualize the identity of being a person in recovery from an eating disorder as the identity to embrace and ask for accommodations around.
Many people in recovery feel that it is important to separate their eating disorder from who they are and not identify with this. I believe that this is a worthy goal that is often very beneficial to support clients in pursuing. However, eating disorders often develop in part as a result of personality traits or dispositions that may be a more permanent and/or central part of someone’s identity. For example, people with eating disorders may be highly sensitive and perceptive to fatphobia and weight stigma in the environment, and this is something that could be important to accommodate long-term. People with eating disorders are also often more anxious than average and may need accommodations around this, such as the ability to take regular breaks from school or work, extended time for assignments/tasks, and having a support person available in various settings. Even if eating disorder behaviors are no longer present, these dispositions may be part of individuals’ experiences, and having accommodations for them can be supportive of recovery.
Another concern that sometimes comes up around applying the social model of disability to eating disorders is that not everyone feels comfortable identifying as disabled or having a disability. It is of course important to respect people’s identities and preferences around how they want to conceptualize their eating disorder. It can sometimes be valuable to point out that the social model of disability is less focused on whether a particular individual has a specific disability or diagnosis, and more focused on making the environment accessible to people with all types of conditions and meeting everyone’s needs. Many disability scholars and activists have noted that accommodations made to an environment taking into consideration a specific diagnosis often benefit even people without that diagnosis. (For example, closed captioning can help everyone better understand auditory speech, not just those with hearing impairments.) Whether or not someone identifies as disabled, applying principles and concepts from the social model of disability can be valuable.
Because of the highly complex nature of eating disorders, I feel that it often does not make sense to only utilize one model of disability to conceptualize these conditions. Drawing from both the medical model and the social model can strengthen our approach to addressing the multifaceted biological, psychological, social, and cultural aspects of disordered eating and recovery.
For more information about the medical, social, and other models of disability, click here.
Author: Shira Collings, MS, NCC (she/they)
Shira is a pre-licensed counselor in the Philadelphia area. She primarily works with people with eating disorders, disordered eating, body image distress, and those breaking free from diet culture. As a neurodivergent diet culture dropout themself, they are especially passionate about supporting neurodivergent folx in finding freedom with food. Click here to learn more about their services.