The Moral Model of Disability Is Alive and Well

By Courtney Jost

Ways of thinking about disability differ across cultures and can be classified into three general models: the moral model, the medical model, and the social model (Olkin & Pledger, 2003). Under the moral model, people are thought to be morally responsible or to blame for their disability, as a retribution for sin or a manifestation of evil. The medical model characterizes disability as an abnormality of the mind or body intrinsic to the individual. However, the medical model frames disability as an individual problem and does not recognize the role of social and cultural factors. In response, the social model, used by many disability scholars and activists, defines disability as a consequence of social organization and the built environment. This model shifts the focus from changing the individual to creating an inclusive social environment. Although disability researchers rarely discuss the moral model, we must not forget that is the most common way of thinking about disability worldwide. Current research in rural Botswana verifies that the moral model is prevalent in regions where disability education is limited (Jost, MacDonald, & Khanna, 2021).

Community members in rural Botswana.

Source: Courtney Jost

The Moral Model of Disability in Rural Botswana

In the summer of 2019, my research team and I partnered with community members in rural Botswana to learn about local disability resources and inclusion practices. Through qualitative research methods, we examined participants' attitudes, perceptions, and experiences of community members with and without disabilities, and how they influenced access to resources and inclusion opportunities for community members with disabilities. Our research team discovered that stigma toward people with disabilities was strongly influenced by cultural beliefs that adhered to the moral model of disability (Jost, MacDonald, & Khanna, 2021).

In rural Botswana, it is a common belief that the birth of a disabled child is evidence of godlike retribution. Community leaders in rural Botswana (families, health care professionals, social workers, etc.) affirm that these local ideologies attribute disability to infidelity or a punishment placed upon the family for the sins of a previous life. Not only can this perceived punishment pose social barriers and perpetuate damaging stigma to the individual with the disability, but this belief targets the entire family, often leading to acts of oppression and prejudice from members of the surrounding community.

In a series of interviews, our research participants in rural Botswana described their perceptions of disability:

“Disability is associated with infidelity. If a mother has a child with a disability, then it is thought that the parents slept around while they were pregnant. They are paying for family sins.” (Rural Health Post Nurse, personal communication, July 2019)

“When I was young it was common to hide people with disabilities because it’s disgraced. It is a sign of evil. Families don’t want people to see them as evil.” (Rural Community Member, personal communication, July 2019)

The moral model of disability can also perpetuate the idea that disabilities are contagious. Some members of the community expressed that they do not want to interact with disabled people for fear of contracting the disability or further spreading the associated evil.

“When it comes to kitchen utensils, they will not allow him [child with a disability] to share with anyone else. They won’t allow themselves to touch or have a bond with these people because they believe that the disability will be passed along. They think they can contract the same illness.” (Rural Caregiver, personal communication, July 2019)

Attributing disability to moral responsibility often leads to explicit stigma and discrimination toward both individuals with disabilities and their families, severely limiting their access to education, health, and social resources. Consequences of these traditional beliefs can lead to internalized stigma by both the individual and their family. Because disability is seen as a divine punishment, the very presence of the child with the disability can be something the family is ashamed of. Abandonment and neglect of family members with disabilities are common (Groce & Zola, 1993).

The Moral Model Across Cultures

The moral model of disability varies from culture to culture and can manifest in different ways. Other regions of Botswana and Northern Mexico, for example, view a disabled child as a gift from God (Drum, Krahn, & Bersani, 2009). Disability still results from a higher spirit or godlike power; however, the connotation shifts to a more positive light—yet still elicits stigmatizing undertones. Folklore now links the birth of a disabled child to God’s trust in the family. A higher power trusts that the family can care for a delicate child based on their history of kindness toward people with disabilities (Groce & Zola, 1993).

In Western cultures, we see manifestations of the moral model of disability in the media. Both physical disabilities and mental illnesses have been used by Hollywood to perpetuate cultural associations between disability and evil. For example, The Joker from the film The Dark Knight and Kevin Crumb from the film Split are both characters whose mental illness is a symbol of evil. Many disability advocates have argued that Disney is also guilty of perpetuating such stereotypes by naming villains after their physical differences, like Captain Hook from the film Peter Pan. Using the moral model of disability in fiction may distance Westerners from recognizing that we are still influenced by it. But evidence suggests that these portrayals implicitly fuel moral model stereotypes that perpetuate ableism.

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How Can We Promote Equity in Cultures Adhering to the Moral Model of Disability?

To minimize ableism and associated stigma, we need to bring disability to the forefront of discussion, collaboratively implement community-driven solutions, and learn how one’s cultural identity influences understanding of disability.

1. Bring disability to the forefront of discussion. In some communities, disability is overlooked and not openly discussed. We must partner with local disability advocates and work alongside the disabled population to initiate discussions between people with and without disabilities. If direct contact between people with and without disabilities is not feasible, positive representations of disabled people counter to local stereotypical perceptions (known in research as indirect intergroup contact) should be explored. Using indirect intergroup contact can introduce the topic of disability without placing the burden on the disabled individual.
2. Collaboratively implement community-driven solutions. Build relationships with community leaders and together develop and implement community-driven, culturally sensitive solutions. As an example, my research team and I are developing culturally-tailored disability education programs to be implemented across three vocational and community groups in rural Botswana: (1) educators, (2) healthcare workers, and (3) general community members. This comprehensive disability awareness program is based on themes identified by the people of Botswana who identify as having a disability or work closely with disabled individuals. These themes include: (1) cultural stigma/stereotypes, (2) determinants of disability, (3) access to resources, and (4) effective systems integration. The program is comprised of 10 tenets representing attributes of the rural community, including their ties to the moral model of disability (example of topics: universal design and inclusion, culturally appropriate communication, and safeguarding public confidence). Our goal is to work alongside community leaders to introduce these topics through a series of workshops for community members with and without disabilities. Prioritizing collaborative partnerships to find community-based solutions can not only improve the well-being of persons with disabilities but also promote social equity and sustainability.
3. Learn how one’s cultural identity influences understanding of disability. Everyone has a core set of foundational beliefs. Some of these beliefs are largely influenced by the culture in which we grew up. Understanding differences in cultural identity and valued attributes are useful in understanding behavior. Doing so can help us develop cross-cultural relationships and minimize misunderstandings due to communication across different cultural groups. Adopting a cross-cultural view of human interaction and disability encourages us to look at how personal beliefs and perspectives affect how people interact and how they view the world. Not only does this help us better understand others, but it can also help us identify our own implicit biases.

Acknowledging the moral model of disability and the cultural factors that impact beliefs about disability are instrumental in initiating both personal and systematic change. We must identify these foundational components rooted in cultural and contextual factors to promote equitable and sustainable solutions.

Courtney Jost, MPH is a graduate student in the College of Public Health and Human Sciences at Oregon State University and an alumna of Dr. Bogart’s Graduate Psychology Seminar on Ableism.