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How Feminist and Disability Theory Come Together

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How Feminist and Disability Theory Come Together

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In a conceptual climate that views men's bodies as the normal and ideal, women are at heightened risk of being segregated and disrespected and being deemed deficient in physical or mental strength or health. Also consequential has been the high frequency of assignment of women (rather than men) to the caretaking of individuals with disabilities, a social arrangement that usually burdens and frequently fails to recognize or materially reward those who must occupy this role and therefore one that unfairly disadvantages women.

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Disability studies has steadily gained prominence over the past half century, moving expeditiously (at least in the United States) into the mainstream in historical and literary scholarship, but not so quickly in philosophy. In the former fields, the components of disability studies are (mainly) two. There are analyses of the real histories of individuals or groups of individuals with disabilities, and there also are readings of representations of disabled people as they appear in literature, cinema, and similar creative work. Integrated with the accounts of real or invented disabled people are interpretations of the social or cultural forces that shaped their lives (in the case of actual individuals with disabilities), or else that shaped their representations in texts, film, and similar symbolic media.

Conducting disability studies in these disciplines has to a large degree been a matter of applying well-known interpretive techniques to subjects whom historical and literary scholarship previously ignored. Thus, for example, most historical scholarship about disability has aimed at reporting about the marginalized lives of individuals with physical, cognitive, or psychological impairments. Historical accounts of how such individuals fared in a particular society and a particular era are informed by familiar theories about the political function of social roles, applied to the status to which disabled people in that historical period were assigned. (To sample a disability studies approach to intellectual history, see Kudlick and Longmore 2006, on how disability shaped Habermas's philosophy.) Similarly, studies of symbolic presentations of disability mostly interpret representations (either fictional or biographical) of individuals whose characterization is inflected by attribution of one or another impairment. Scholarship about what such representations mean in a particular creative work usually is propelled by one or another familiar theory about the aesthetic, psychological, political or other function of symbolic roles, applied to disabled characters and characterizations of their disabilities. (See Silvers 2000 for a discussion of literary theory in disability studies.)

In these disciplines and related ones, consequently, engaging with disability has involved invoking mainstream theoretical presuppositions and principles to explore phenomena associated with certain previously under-theorized or otherwise ignored groups. Not so in philosophy, however, where disability, deformity and illness have appeared to defy application of familiar theoretical presumptions and practices. Examples of the resistance of disability to being subsumed under philosophical theories turn up throughout the discipline's history, from Plato's uncharacteristic emphasis on fleshly ideals in settling the fate of infants with deformities (Garland 1995, 15) to Hume's setting aside the testimony of individuals with illnesses as pertinent to theories of perception (Hume 1757) to Rawls's declaration that justice for disability is a detour that cannot be addressed when basic principles of justice are formulated and therefore must wait for the later, legislative stage. (See Sen 2004 for an analysis of how Rawls's theory fails to respond to the facts of disability, but see also Becker 2005.)

Feminist philosophy, with its methodological reluctance to adopt philosophy's traditional presuppositions without scrutinizing them, initially was the most prominent area within the discipline where disability is taken to be a serious subject for philosophical investigation. According philosophical significance to the state of being disabled is one of the innovations feminist theory has introduced into philosophy. This article therefore explores affinities between feminist philosophy, which is aimed at expanding philosophical inquiry so that it adequately addresses women and their perspectives, and philosophical work with similar aspirations in regard to people with disabilities.

In some respects, disability presents the instances or issues that most intensely and interestingly challenge those traditional philosophical presuppositions and principles against which feminist thought has been inclined to protest. Nevertheless, feminist interests do not always coincide with disability perspectives, and unresolved tensions between feminist philosophy and the philosophy of disability remain. Consequently, this article also explores disability perspectives on feminist philosophy as much as it reports feminist perspectives on disability.

The attitudes and aims that have informed and propelled feminist philosophy have been consequential for the study of disability in philosophy. Asking why women have been excluded from the philosophical tradition, feminist thinkers explicitly have intended to remedy philosophy's prevailing indifference to the way the world is experienced by women, including women with disabilities. (But see Wendell 1989 and 1996 for concerns about feminist theory's disregard of women with disabilities. Despite this criticism, Wendell's remedy for such neglect is propelled by feminist precepts.) In doing so, they have made interventions that have altered the course of philosophy.

Some have argued, for example, that the universality to which philosophical theories traditionally have aspired cannot embrace women without erasing them. Some have questioned whether such a standard discerns, or instead disregards, important dimensions and textures of women's lives. Some also have affirmed differences among different kinds of women that they take to be, if not essential, at least as philosophically significant as the differences between women and men. (See, for example, Spelman 1988, Fuss 1989 and Crenshaw 1991, among many others, for discussions of these matters.)

Such divergence from standard philosophical views invites expanding philosophical theorizing on various topics, including ways of knowing, kinds of being (especially the ontological implications of embodiment and the relationship between body and mind), principles of conduct, intrinsically valuable human properties and ways of life, conceptualization of personal and social identity, and other traditional philosophical topics, by attending to differences occasioned by or associated with disability. Further, biased pretextual and other unjust treatment of women has been traced by some feminist philosophers to their being viewed as impaired and thereby subjected to the usual social practice of devaluing disability and people who are disabled. Some of the initial philosophically influential discussions of disability have to do with how women's physical realities are judged to be inferior because they do not match performances paradigmatic of healthy males. One example is Iris Marion Young's 1980 essay "Throwing Like a Girl," about the prevailing masculinized rendering of women's embodiment that stigmatizes feminine physicality, wrongly construing the female body as fragile and burdensome. As a result, women are inhibited from confidently embracing their own experienced spatial orientation and are induced instead to underestimate their physical capabilities and to deform their gestures and their movements through space. Another is Susan Wendell's 1989 Hypatia article "Toward a feminist theory of disability," wherein feminist philosophy's uncritical, unreflective conflation of healthiness with happiness and productivity is criticized.

In a conceptual climate that affords men's modes of bodily performance ascendancy, women are at heightened risk of being segregated and disrespected in virtue of being deemed deficient in physical or mental strength or health. Also consequential in the development of feminist philosophical treatments of disability has been the high frequency of assignment of women (rather than men) to the caretaking of individuals with disabilities, a social arrangement that usually burdens and frequently fails to recognize or materially reward those who must occupy this role and therefore one that unfairly disadvantages women. Considerations like these helped tie liberatory feminist philosophical work to the development of an insightful philosophy of disability.

Pervading the practice of philosophy, feminists found, are traces of bias that disregards women's interests and oppressively occludes their opportunities. Illuminating the significance of women's experiences of limitation is one of feminism's prominent contributions to philosophy. Early philosophical study of women by feminist scholars examined the limitations that hampered their own lives, and the lives of women generally, asking whether these resulted from alterable social arrangement or immutable biological destiny. (See Section 2.2, "Normative and Descriptive Components," of SEP entry on "Topics in Feminism" for references to scholars who advance variations of these positions on the source(s) of women's subordination.) On the whole (although not for everybody), feminist theory has moved past this issue and now seems to regard the debate about biology versus society as the source of women's limitation as either irresolvable or unimportant.

Nevertheless, the nature of the (in)justice of limitations associated with physical or cognitive impairment remains a concern in the philosophy of disability, including feminist disability theory. Biological difference is a central and undeniable fact of disability, but the impact of biology on the kinds of experiences characteristic of being disabled is much more controversial. There is debate as to whether the functional limitations associated with disability result mainly from biology's going awry and whether, if disability is disadvantageous, it is naturally and immutably so. Or instead whether disabled people's functional limitation should be laid at the door of flawed social practice which rewards the species-typical functioning of so-called normal people and punishes the anomalous functioning of disabled people (Wendell 1996).

Feminist philosophical work has aimed at repairing the imbalance between men's and women's concerns and rectifying the negative depictions of traits viewed as female that are found in traditional philosophical positions, paradigms and methodologies. Feminists have tried to remedy a pervasive narrowness in the usual ways of framing those issues philosophers have considered important enough to command philosophical attention and work-that is, in the benchmarks that signal philosophical considerability. To induce change, feminist philosophers have crafted approaches that draw upon the very limitations they encounter when attempting to pursue women's interests within philosophy. This effort has supplied stimulating ideas to philosophers seeking to import the singular insights and different perspectives of other subordinated groups, such as the disabled, into contemporary philosophy to improve its inclusiveness and extend its scope. Specifically, disabled people's philosophical interests find ready-made conveyances in several of feminist thinking's signature reforms.

For example, feminist epistemology is a philosophically innovative reform movement that can serve as a beacon for the philosophical investigation of disability, although as of this writing the significance of disability for an adequate epistemology has not been much explored in disability scholarship, neither in the philosophical study of disability or in disability studies generally. Some feminist philosophers (and some feminist psychologists as well) have argued that women have ways of knowing that differ from men's. (For psychologists, see Belenky et al. 1986 and Tannen 1990; for philosophers, see Code 1991 and Ruddick 1989) Tannen, for example, adduces evidence from sociolinguistic research to argue that environments conducive to women's learning differ from those appropriate for men. More generally, some theorists influenced by such accounts have characterized women as being alienated, unsatisfied, and unconvinced when held to traditional epistemology's paradigm of the isolated knower, with its detached, universalizing, and controlling approach to knowledge. Dissatisfaction with this kind of view has prompted feminist epistemological insights about the possibilities for achieving objectivity without insisting that cognition works or should work the same way for everyone, as well as about the importance of situating, contextualizing, and nuancing truths, and about the benefits of collaborative practices of achieving knowledge. (See section 2. "Social Models of Knowers" in SEP entry on Feminist Social Epistemology for references.)

In developing their insights, feminist epistemologists have addressed the influence on knowledge of the social situations of knowers. Situatedness cannot be just a matter of the social positioning of knowers, however, or of their histories or cultures. What we know is modulated by how we acquire the elements of knowledge, and these processes are shaped by the condition of the body as well as by social conditions. Cognitive skills are expressions of development in various areas of the brain, which in turn is responsive to the rest of the body. We therefore may expect that people with disabilities, whose bodies diverge from the species-typical kind, also sometimes will develop cognitive approaches and abilities that differ from most other people's. Parenthetically, in one of the exceedingly rare instances of a philosopher treating an impairment as something other than a deficit, the 18th century experimentalist philosopher Denis Diderot investigated blind people's ways of knowing (Diderot 1999 [1749], Curran 2013). Taking a stance that resembles, if not prefigures, recent feminist criticisms of Descartes, Diderot, in his "Letter on the Blind for the Use of Those Who See," describes how blind people know about the world to show the short-comings of Cartesian over-reliance on metaphors that associate reason with light or sight and Cartesian reliance on visual rather than tactile ways of knowing.

Traditionally, of course, philosophers have dismissed disabled people's claims to knowledge about subjects touched by the limitations of their particular impairments. A telling illustration is given in the correspondence between philosophers Bryan Magee and Martin Milligan, in which Magee simply dismisses, absent argument, Milligan's report and arguments that, although blind almost from birth and without visual memories of experiencing specific colors, he fully understands the meaning of "red" (Magee and Milligan 1996). Here Magee portrays Milligan as a defective knower because of his blindness, a conclusion Magee advances with assertions that Milligan's experiences with redness are not exactly like Magee's own. Yet it is tendentious to point out that blind-from-birth individuals do not develop visual processing skills, and then to intimate that they must be epistemologically inferior to, or that their modes of knowing cannot rise to the epistemological significance of, sighted people. To the contrary, in some born-blind people, for instance, the area of the brain associated in most other people with visual processing appears instead to be a site for aural processing, meaning that a much larger part of the brain is available for dealing with information obtained through hearing than is the case for sighted people. This biological difference is thought to explain why in many cultures blind individuals are taken to be endowed with legendary skills for remembering and transmitting the spoken word accurately and with heightened understanding of orally transmitted texts, Thus blind bards who preserve and perform lengthy gospels or narratives from an authoritative standpoint are familiar figures in the history of many cultures (O'Neil 2003).

There are other blind people who know objects in their physical environment by echolocation, having cultivated the skill of making clicking noises with their tongues and identifying the different qualities of sounds bounced back toward them (Tresniowski and Arias 2006 [in Other Internet Resources]; see also "Shattering Barriers" at the World Access for the Blind website, in Other Internet Resources). Belgium's police force includes blind detectives who can listen to criminals' recorded conversations and by the reverberations of sound identify what kind of room they occupy, whether they are using a landline or cell phone, and even what kind of car they are traveling in or whether the suspect's Flemish carries an Albanian rather than a Moroccan accent (Soares 2007). Sighted people's typical lack of functional ability to navigate by reverberated sound, and thus their inferior way of knowing the absorption/reflection properties of the physical objects that surround them, and their deafness to nuances of spoken sound, surely should be recognized as a disadvantage. Yet this is almost never so, even where sighted people must find their way in the dark or distinguish among interlocutors beyond their vision.

The experiences of people diagnosed with cognitive impairments also usually are dismissed as epistemologically defective, judged against the philosophical ideal of the rational thinker. Some people described as cognitively impaired have anomalous patterns of cognitive skills, in some ways failing to attain, but in other ways exceeding, levels typical for the species. For example, individuals with Down Syndrome, who think abstractly only with difficulty or not at all, sometimes have greater than usual skills in perceiving, and remembering, the concrete details of what they see or hear. And people with Williams Syndrome quite often have greater social and emotional intelligence than is species-typical for humans, as well as unusual musical facility. This is not even to mention the innovative insightfulness and creativity achieved by individuals with diagnoses of various kinds of psychoses and similar so-called mental disabilities, conditions experienced by many famed artists, writers and musicians.

Such individuals usually are exempted from philosophy's scope as, for example, when epistemological theory discounts the judgments of blind people as irrelevant or unimportant to philosophical accounts of empirical knowledge, as philosopher Magee dismisses philosopher Milligan.. And people who lack abstract thinking skills, thereby diverging from the kind of human capability philosophers themselves exercise so well and enjoy so greatly, usually are dismissed as unimportant, that is, as not rising to philosophical considerability. People whose cognitive anomalies impede them from arriving at and articulating complex and rationalized accounts of their own good very often are not accorded full status, and sometimes even are denied considerability, by moral and political theories, including pluralistic liberal theories committed to respecting citizens' diverse values. (See McMahan 2005 and Kittay 2005) Yet, as Francis and Silvers (Francis and Silvers 2007, Silvers and Francis 2009) have pointed out, normally autonomous individuals do not arrive at, nor do they express, notions of their own good in isolation from, or independent of, their interactions with other people. Conceptualizations of the good of cognitively impaired people, developed through structurally similar collaborative interactions between them and others, deserve equal consideration in moral and political philosophy.

To account for the misfit between philosophical paradigms and their realities, the testimony or example of outliers such as blind people, and people with Down Syndrome or Williams Syndrome, typically is disallowed on the ground that it must be inherently flawed where it challenges or deviates from philosophical theory. Yet to disregard the standpoints, and thereby the performances and reports of the experienced world, of unusual people impoverishes philosophizing by diminishing the epistemological adequacy of philosophical accounts. Further, as an application of Miranda Fricker's analysis of epistemic injustice shows, the practice of systematically discounting belief claims made by people with disabilities should be condemned as testimonial injustice: individuals are wronged based on their disability status when they when they aspire to roles as knowers (see Fricker 2009). Nor, to apply a lesson from feminist philosophy of science, can objective knowledge about disability be produced unless disabled people, including people with cognitive disabilities, are fully respected members of the community of inquirers (see Longino 2001). Francis and Silvers have proposed an approach to constructing ideas of the good with full respect for and inclusion of the viewpoints of severely disabled persons (Francis and Silvers 2006, Silvers and Francis 2009).

Like disabled people as a group, women as a group have been dismissed and displaced, condemned for not complying with biological or social paradigms and therefore denied authorization for the ways of knowing that inform their experiences. What they believe they know often has been rejected as merely epistemologically anomalous. Oppressive policies traditionally were defended with the rationale that "nature" has made women physically, intellectually, and emotionally frail (Miles 1988). In response, feminist epistemology has welcomed recognition of the legitimate influences of social location in arriving at knowledge claims, as well as the centrality of collaborative practices in the pursuit of knowledge.

What is not so clear is whether feminist epistemology is as comfortable with the impact on knowing of other bodily differences. This is a question of whether different biological properties legitimately define different epistemological standpoints. Especially in the last part of the 19 th and the first part of the 20 th centuries, biological determinism was a potent tool used to oppress women through false testimony that science found them to be less capable of survival than men.

Wary of promoting such determinism, feminist philosophy has been more engaged with the social rather than the biological phenomena identified with women. Feminist standpoint theory has been inclined to treat differences in cognitive styles as arising from socially induced gendered identities or roles rather than from biological traits or conditions that differentiate men from women. Some of its proponents argue for the superiority of the styles associated with women. In the main, however, the operative notion for feminist theory is that epistemic authority is the product of a social award; there is no natural order in which the cognition of biologically fit individuals is most attuned to the actualities of the external world and therefore is superior.

To a significant extent, however, standpoints defined in terms of disability are associated with characteristic biological differences. This raises several questions for an epistemology of disability, especially one modeled on feminist theory, to explore. First, is characterizing standpoints with reference to biological differences inherently and onerously deterministic, so that one's body inescapably delineates one's cognitive destiny? Second, does granting equal legitimacy to standpoints defined with reference to biological differences lead to irresolvable and debilitating epistemological relativism? And, third, will acknowledging the range of atypical (for humans) ways of knowing reveal a heretofore unimagined richness in what humans can know the world is like?

The interplay of biological and social identities-whether these be innate, imposed, or embraced-has become a subject of first-order importance in disability studies as well as in feminist theory, and especially in philosophical ventures into disability scholarship. Feminists have been, by far, the most numerous of philosophical writers on the topic of disability identity. They have offered a rich variety of sophisticated approaches to the question of how the sensibilities and histories of people with very different kinds of limitations can be collected into a cohesive philosophical account. Some write from the perspective of a lifelong disability identity, others describe their transition into the world of disability, and still others write about disability without having experienced being disabled themselves.

In view of the relevance of so many different standpoints, feminist philosophy of disability must meet the challenge of constructing an account of disability identity that does not invoke or appeal to "normal" examples of disabled people. Further, no one should claim to be, or speak as or about, the typical disabled person. The enormous diversity among disabled people, and the importance of reflecting all their differences in formulating disability theory, calls for sensitivity to nuance and context. (Re)formulations of feminist identity theory that can accommodate the many ways in which disabled people differ from each other as well as from nondisabled people are of special importance because they may be extrapolated beyond disability theory to illuminate issues about identities shaped by other kinds of differences.

Unlike traditional ideas of race and sex, disability has always been understood to be a permeable classification. Some people have lived at length or lifelong with disability, some are newly so, and others have lived through periods in which they were disabled but now are not so. A large number of us should expect to become disabled later in our lives. And many of us find ourselves intimately involved in the lives of family members or friends who now are disabled or who face a future of disability. Further, as Eva Kittay reminds us, social policies that pertain to disabled people also affect their family members, friends and professional caregivers (Kittay 1998; Kittay 2001). So feminist disability theory should recognize that disability affects the identities of many people beyond the 600 million worldwide who are themselves disabled (Herr, Gostin, and Kuh 2003).

Disability identity may be claimed for a variety of very different reasons. Sometimes the objective is to acquire eligibility for assuming the "sick" role and thereby being relieved of various productivity-related expectations and responsibilities . Sometimes being identified as disabled offers access to government benefits of various kinds. Sometimes being understood to be disabled triggers acceptance of or accommodation to atypical modes of functioning. And sometimes disability identity is claimed as an empowering element of a political process intended to consolidate a group of people sufficiently numerous and vigorous to challenge stigmatization, exploitation, and exclusion based on disability. As the reasons for these disparate purposes for identifying as disabled diverge, so do the criteria or conditions for judging individuals to be disabled, as well as the inducements to individuals to understand themselves primarily in terms relating to disability.

The inclusiveness of the various identity theories promoted in feminist philosophy is of preeminent and persistent concern to women with disabilities. Discussing whether women with disabilities can comfortably be feminists, Anita Silvers has asked whether feminism privileges the functional capabilities and social roles characteristic of "normal" women. She has found some feminist theories guilty of "magnifying these (functional capabilities of typical women) until they become standards of womanhood against which disabled women shrink into invisibility" (1998a).

Feminist philosophy validates and valorizes activities women typically execute and in which they excel, such as theories of maternal ethics that center on mothering as preeminent moral conduct. But not all women are admitted to women's roles. Even in the most progressive contemporary societies, women with disabilities encounter opposition to their maintaining fertility, or accessing reproductive medical technology in achieving fertility, or even retaining custody of the children to which they have given birth. Karin Barron, who has conducted extensive research on the lives of young women with disabilities, observes that we place great value on the womanly art of caring for dependents, but the traditional dependent position of young women with disabilities prevents them from occupying, and therefore from demonstrating any aptitude for, this role (1997). We should be clear that what precluded the young women Barron studied from being homemakers and mothers was not their lack of potential for serving in these roles but, instead, their having been assigned to an alternative social position, one defined in terms of such dependence that their capacity to nurture others became virtually inconceivable.

Licia Carlson has shown that a gendered process of conceptualizing social roles even affected the diagnostic classification of mental retardation. She has explored the complex interconnections that characterize the linked history of cognitive disability and gender oppression. Carlson points out that while superintendents of institutions that warehoused intellectually disabled people were mostly male, women were employed to go out and identify cases of feeblemindedness on the theory that they were more intuitive by nature and therefore better qualified for the job. This was an era when normal women were presumed to have a leading role in defending society against moral weakness of the sorts for which the feebleminded were feared, based on a notion about women's commitment to maintain community virtue for protection of the young. While there is value in acknowledging human vulnerability and dependence, Carlson observes, feminists should be as concerned about placing persons with intellectual disabilities in such mirror roles as about making third world feminism a mirror for Western feminism (Carlson 2009; also see Narayan 1997).

Carlson's analysis should compel feminist philosophers to reconsider their understanding of cognitive disability. Feminist philosophers are not immunized by their philosophical persuasion against their having limitations such as ignorance of the lived realities of people with intellectual disabilities, the nature of intellectual disability, and the historical basis of this category (Carlson 2009,2010). As feminists have questioned the privileged status of masculine ways of thinking, Carlson questions whether some feminists privilege their own modes and levels of cognition (Carlson 2001). They should, further, ask whether they have constructed feminist philosophizing in terms that make intellectual endeavor too central an undertaking. Eva Kittay makes this point penetrating, poignant, and personal when she describes the transformative insight occasioned by being told that her child is congenitally mentally retarded:

the worst anticipation was that her handicap involved her intellectual faculties. .... I was committed to a life of the mind. ... How was I to raise a daughter that would have no part of this? If my life took its meaning from thought, what kind of meaning would her life have? .... [W]e already knew that we had learned something. That which we believed we valued, what we-I-thought was at the center of humanity-the capacity for thought for reason, was not it, not it at all. (Kittay 1998, 150)

A somewhat similar dilemma about the preeminent value of intellectual skills may confront people who acquire a cognitive disability later in their lives. Kate Lindemann (2001) and Ann Davis (2005) both write about the effects that experiencing the sequelae of head injuries had on their beliefs about cognition. Lindemann's critique points to radical and profound ways in which feminist appreciation of the diverse workings of mind can enlarge philosophical inquiry. Feminist theory stands to gain by paying new attention to philosophical issues that should be rethought to reflect the situation of adults with brain injuries: personal identity, mind-body dualism, conceptions of the self, and philosophical psychology.

Recognizing that some individuals have invisible disabilities should remind us, Davis observes, of the extent to which we always are epistemologically dependent on people's disclosures of their own identities. Davis rejects the presumption that we can clearly separate voluntary from inadvertent limitations. Many cognitive and psychological limitations cannot be documented by reference to physical anomalies. Yet, Davis rightly says, experiences of them are no less real. She rejects the conviction that we can find physical correlates of anomalous cognitive or psychological functioning. Policies demanding that these kinds of cognitive and psychological limitations be documented by public demonstration or third-party confirmation should be abandoned, for they rely on mere faith in their having physical causes rather than on factual evidence that they do.

These personalized experiences of limitation should not be discounted. The philosophy of disability suggests that we need to recalibrate our sensibilities to honor the evidence of other people's senses, especially of their own embodiment. People's testimony about their own limitations and incapacities deserves respect even if uncorroborated by biological confirmation. Such experienced limitations may place the individual at activity-impeding, pain-inducing or life-threatening risk. As Davis argues eloquently, we improperly burden people whose limitations we cannot directly see, and aren't sufficiently knowledgeable to appreciate, by constantly challenging them to prove their disabilities.

Feminist scholars have explored how corporeal or biological distinctiveness mediates daily activities so that self-identification and social experience act on, and become attuned to, each other. Feminist research such as that of Susan Sherwin (1992) shows that medicine has treated women as if they were disabled people, intervening in their bodies to eliminate or discipline (to use Foucault's term) those parts that mark their identification with a purportedly inferior group. Medicine has, in particular, been dismissive of women's emotional lives. The history of how medicine has addressed disabled people is similar. It is a history of the repression and rejection of bodies and minds that diverge from the supposed paradigm or norm provided by healthy young males.

Enlightened by these parallels with their own history, some early disability studies scholars rejected medical practices directed at altering themselves. They characterized the medical model of disability, which takes disability to be a problem requiring medical rather than social intervention and as both the prerogative and the responsibility of medical professionals to fix, as oppressive. They saw medicine itself as a coercive instrument that subordinates disabled people, not the least by inducing feelings of inadequacy and self-hate in them. (See UPIAS 1978; Finkelstein 1980; Oliver 1983.)

Just as biological sex, and the division of humans into two sexes, initially were taken as givens in feminist theory, so early disability studies scholars proposed to treat impairments such as being unable to hear, see, walk, talk, or execute cognitive activities as biological givens, and disabilities as social interpretations of impairments. On such accounts, the properties of bodies (including brains) are supposed to be pre-social. According to these accounts, it is socially constructed interpretations and valuations of the powers of neutral corporeal properties that consign people with various kinds of bodies to advantageous or detrimental social roles.

Jenny Morris, a leader of the disabled women's movement, proposes that the social model of disability enables disabled people to define their own bodies and their differences in terms of personal experience and self-authorization, free of detached diagnoses imposed by medical authorities. The social model construes the limitations of people with disabilities as a social problem rooted in the imposition of practices that are biased against the disabled. Once understood as products of bias rather than biology, disabled people's disadvantages can be remedied through the pursuit of justice to reform the practices that oppress them. According to Morris, adopting the social model of disability makes it possible to talk about addressing the limitations of disabled people's functioning without condemning, or requiring improvements in, the state of their bodies (or, for that matter, their minds) (Morris 2001).

Better informed, more sophisticated recognition of and reflection on the facts about sex and gender have complicated the picture for both feminist and disability scholarship. There are, for example, intersexed people, born with the biological markers of both female and male. A socially imposed allegiance to sexual dualism demands they be submitted to medical intervention that (usually through amputation) presses their bodies into one or the other sexual mold. Yet having a woman's body does not necessarily suit a person for feminine roles, nor do all those with men's bodies find themselves fitting comfortably into masculine roles. The materiality of sexual characteristics does not make them unbreachable constants. There are individuals who adapt with facility to gendered roles that are not traditional for their particular bodily configurations.

Others, however, find their sexual characteristics too restricting for the roles they adopt and consequently seek to change these elements of their bodies through surgical and chemical intervention. The way transgendered people see themselves in the world indicates that the body's limitations cannot always be discounted. While some people do not think their corporeal alteration is required to comfortably fit into opposite gendered roles, others seek medical intervention to facilitate their transgendering. Thus, the experiences of transgendered people suggest that there are circumstances in which altering one's body to better execute preferred social roles can be an affirming, rather than a degrading, choice.

These considerations show not only the error in supposing that the natural and social dimensions of embodiment can be cleanly dichotomized, but also the superficiality of thinking that we always should take bodies as they come. Extrapolating this insight to disability helps us to see the over-simplification in condemning medical transformations of the body as being expressions of self-hatred. There is no phenomenological firewall separating our awareness of our biological properties from our social experiences. How our own bodies feel to us is shaped by social discourse.

In a documentary film presenting conversations with leading philosophers, feminist theorist Judith Butler learns about the social model of disability from artist and disability activist Sunaura Taylor (Taylor, 2009). The social model is compatible with Butler's own theory of embodiment. Butler observes that everyone, whether or not disabled, requires support for bodily activities from various kinds of things that are external to their bodies. Every body is permeable in the sense of being vulnerable to being impinged upon by others. People who violently target and victimize the disabled are managing their own permeability by abusing individuals who appear to be more dependent than most and thus more vulnerable. Violent acts against the disabled foreground their permeability and thereby, according to Butler, give the perpetrators the illusion of being themselves exempt from permeability.

Applying Butler's ideas about embodiment, which emphasize the inconstancy of conceptualizations of bodily kinds, feminist legal scholar Kathryn Abrams contends that one reason the Americans with Disabilities Act (ADA) has had trouble in the courts, with most plaintiffs losing their cases (at least under Title I - Employment), is because the social model disrupts a premise of mainstream jurisprudence. The legal norm presumes that human bodies are biological objects of fixed kinds, whereas on Butler's theory bodies are contingently constituted by transient social interactions (Abrams 2011:76). However, not all judicial thinking has been so narrow. For example, in 2006 a pre-surgery transexual individual's denial of employment suit was allowed to proceed, despite the defendant's claim that Title VII did not apply because the plaintiff was not a woman; in supporting the plaintiff, the court invoked the factual complexities that underlie human sexual identity and explained that these complexities are occasioned by how biological sexuality interacts with social, physiological, and legal conceptions of gender (see Schroer v. Billington 2006, 2009).

Our bodies' responses and responsiveness inflect in turn the social as well as the solitary aspects of our experiences. Nor is social practice isolated from, or prior to, materiality. An individual's impairments are no more neutral than her sexual characteristics are, for they mediate much of the content of her consciousness of the world with which she interacts. Performing major life functions such as mobilizing, hearing, seeing, communicating and understanding are such intimate elements of the fabric of our experience that what we view as within our reach in the world around us-and thereby what we take as the objects of our ambition-arises out of the scope and facility of our biological functioning.

Considering whether the experiences of women are sufficiently acknowledged in disability studies, Susan Wendell points to masculinist influences on the field's standard model of disability (1996). Wendell offers a refreshing look at the disability politics of promoting an image of the healthy disabled, which is similar to the feminist politics of excluding disabled women altogether in an effort to advance more appealing and powerful icons. She argues that the social model of disability, which until recently has been the preeminent theoretical inspiration for disability studies, tends to obscure the frequency with which disability is tied to illness (Wendell 2001).

Opponents of the medical model of disability urged the disentanglement of disability from illness, pointing out that many individuals with disabilities are as strong and capable of productivity as nondisabled people, and therefore should not be consigned to the limitations of the "sick" role (Amundson 1992). This strategy also promotes self-reliance over dependence and replaces trust in the expertise of medical and social service professionals with strategies to let disabled people take control of their own lives. The useful point of such emphasis for disabled individuals, Wendell acknowledges, is that by getting their political position about subordination to medicalization right, they affirm rather than devalue their own bodies.

Yet, Wendell adds, political correctness will not always make people feel right about our bodies or make their bodies feel right. Illness is itself disabling, and chronically ill individuals constitute a prominent part of the population considered to be disabled. Making healthy rather than ill disabled people paradigmatic of the disability category may obscure some disabled people's important differences. Worse, doing so may perpetuate our culture's devaluing of dependency and inflating of the value of self-sufficiency. Wendell argues for reforming disability studies through a more inclusive feminist approach to disablement, namely, one that does not exaggerate the value of strength and independence as she believes masculinist influenced theorizing tends to do (Wendell 1996).

Wendell also proposes that feminist disability politics consider the implications of chronic illnesses that mark the unhealthy disabled's experience of embodiment (Wendell 2001). One such implication concerns the appropriate reaction to suffering. Many chronically ill people feel pain, fatigue, feebleness, and disorientation to a degree that forestalls productivity, saps self-sufficiency, and even may alienate them from their own bodies or minds. The social response in both mainstream society and disability circles is to support cures for chronic illnesses, as though the suffering caused by illnesses renders these conditions irrelevant to how disabled individuals form their identities. Yet some disabled individuals, at least, reject medical interventions aimed at a cure on the ground that they do not wish to become different from whom they are. To the contrary, Wendell thinks, an adequate philosophical account of embodiment will appreciate identities inflected by suffering without glorifying or sugar-coating the debilitating dimensions of perpetual exhaustion and discomfort.

A related implication concerns the reaction to emotional or psychiatric suffering. Unlike feminist literary scholarship, where studies of madness are well represented, feminist philosophers have shown comparatively little interest in addressing the phenomena of neurodiversity. Feminist and disability studies theorists who are undermining the domination of paradigms of youth and health should extend their efforts so as to liberate psychiatrically disabled people from the idealization of the neurotypical mind. Andrea Nicki argues that feminists ordinarily do not think of anger and aggression as being valuable because they are emotions of competition rather than cooperation. But, Nicki thinks, these feelings may serve as morally valuable-because liberating-expressions for some neurodiverse people, especially for emotionally abused individuals (2001).

The powerfully negative meanings evoked by the prevailing conceptualization of disability may overwhelm both the equality of opportunity and the moral respect that disabled people's exercise of autonomy or independence should command. Thus, even healthy people with disabilities often are stigmatized because their embodied modes of functioning strike others as disruptive, however adeptly adaptive and independent these may be. And individuals with genetic vulnerabilities that put them at more than species-typical risk for illness are also at risk of such stigmatization. People who test positive for alleles associated with disease may encounter discrimination in employment and other areas of civic and commercial life, even though they never become symptomatic (Silvers and Stein 2003). Feminist and gender studies already have shown that atypical, and thereby transgressive, modes of corporeal functioning offer a rich resource for developing more adequate concepts of the materiality of human experience and of our personhood (Clare 1999). Yet, whether in illness or in health, the lives of disabled people largely have been ignored when these concepts are explored, to the detriment of moral and political philosophy generally.

People who talk or read with their fingers, walk using their arms and hands, categorically recoil from other people's touches, or float through the day on analgesics that suppress waves of pain, often develop resilient and innovative approaches to fleshly function. Further, disabled people often are the first to incorporate adaptive technology into their lives. From machines that write (typewriters were invented to permit blind people to write) to machines that speak (computerized speech output was invented to permit blind people to read), disabled people have piloted the use of mechanical devices that now are integral to so many lives. Adaptive technology combines with fleshly effort to secure their basic capabilities: they hear with amplifiers, breath with respirators, mobilize in wheelchairs that they guard with more concern than the care they give their bodies.

A supportive intimacy of machine with flesh thus is a feature of many disabled people's lives, but one that can distance them from the nondisabled. Alison Kafer criticizes ecofeminism for assuming that authentic engagements with nature are possible only through purely natural immersion experiences from which use of manufactured products, including the assistive and prosthetic devices that distinguish some disabled people's embodiment, are banned. Ecofeminism remains bound by the traditional dualism of human artifice versus nature, Kafer argues, in part because of mistakenly equating species-typical bodies with naturalness. Species-typicality remains a presumption of feminism, she says (Kafer 2005). Such a standard disregards or devalues people with disabilities whose functioning integrates their fleshly parts with mechanical components or other technologies. (See Kafer 2013 for a more general theory that intersects feminist, disability, and queer theory approached to embodiment.)

Although ordinarily considered unfit to participate in competitive schemes, when disabled people with prostheses function well, their supposed cyborgian advantages create another reason for their being shunned. In a case that went to the United States Supreme Court, the Professional Golf Association unsuccessfully attempted to ban an otherwise qualified individual because a physical anomaly prevented him from walking for a full eighteen holes. The PGA invoked the specter of a Frankensteinian slippery slope: if an anomalous golfer could mobilize with a golf cart while normal golfers walked, what would prevent a future contender, an upper limb amputee, from strapping on a bionic arm that can drive a golf ball more than two miles (PGA Tour, Inc. v. Martin (00-24) 532 U.S. 661 (2001) 204 F. 3d 994)?

Lower leg amputees used to be excluded from competitive running because their prostheses made them run too slowly. Now new materials and designs have created specially springy sports feet that permit their wearers, when very skilled and talented, to run as fast as can be done with fleshly feet. A hit-and-run driver's victim, Dory Selinger now bicycles with a cleated peg replacing an amputated foot. Because it does not flex, the peg is more efficient at pedaling than a fleshly foot. Selinger's best time is only four seconds off the longstanding world record for "normal" racers (Squatrighlia 2001).

The South African track star Oscar Pistorius, whose congenitally anomalous feet were amputated in childhood, uses modern alloy artificial feet that return almost as much energy as the runner's weight loads. Racing officials opposed Pistorius's competing against nondisabled athletes, invoking objections running from fears of his falling on other athletes, through his violating the rules because he has no fleshly foot to touch the starting block, to his very presence corrupting the purity of the sport, and the extravagantly dire prediction that able-bodied athletes would amputate their own fleshly feet to gain advantages derived from prosthetics. Pistorius appears to use about one-fourth less lower leg energy when matched with runners with fleshly feet because his prosthetic ankles are more efficient than fleshly ankles, and initially he was banned from the Olympics due to the claim (subsequently overturned by the International Court of Arbitration for Sport) that his artificial feet gave him an unfair advantage. (See Silvers and Wasserman 2000 for a general discussion of fairness in regard to accommodating people with disabilities in competitive sport and Silvers 2008 in regard to enhanced embodiment.)

Arguably, it is unfair to exclude racers with disabilities on the ground that crude prosthetics render unable to be competitive, and then also to exclude them when better prosthetics make them highly competitive. Such a practice of limiting eligibility to typically embodied competitors narrows social opportunity for whoever does not conform to the conventional rules of embodiment. And it is precisely because of the ease with which such rules of competition can be rigged to favor some so-called normal modes of functioning over other seemingly anomalous ones that feminists rightly have been suspicious of invoking rules derived from models of competitive recreation as relevant to and regulative of social justice.

Traditional approaches to justice often take competition for resources or position to be fundamental to social and political relationships, which consequently puts an emphasis on fairly managing socially bestowed or artificially achieved advantage, somewhat as the rules of games control the deployment of inside information, equipment, pharmaceuticals and other such performance enhancers. On the other hand, feminist theories of justice achieved through inclusiveness, such as Iris Young's (1990) and Martha Nussbaum's (2006), cast interdependence rather than rivalry as the social and political relationship with which justice should be more concerned. In contrast to traditional justice theory's worries about disruptive embodiment's impact on practice, policy and principle (for example, see Rawls's well-known exclusion of disabled people on this ground, 1985 p. 234), such feminist theories condemn, and try to overcome, the omission or interdiction from practice, policy and principles of justice of people with anomalous bodies or minds.

In general, people with physical and mental disabilities have at least their experiences of social exclusion in common. Exclusion looms large in many disabled people's lives and shapes their expectations and aspirations. This is a familiar story in the life histories of many individuals who are identified with non-dominant groups.

Presumptions about biological unfitness and burdensomeness often have been invoked to engineer enforced segregation of parts of the population. Courts have endorsed the separation of people identified as being of different races by advancing the rationale that segregating social schemes merely acknowledge "natural" affinities among people of the same race and "natural" antipathies among people of different races. The supposed benefits of biological separatism also have been cited to deny women employment that would place them in the company of men. For example, when a state law denying women the opportunity to be employed as bartenders was appealed to the U.S. Supreme Court as a violation of the constitutional guarantee of equal protection, the Court declared the exclusion to be constitutional because of the "real" differences between men and women. The majority opinion explicitly affirmed that women's presence "naturally" incites males to lust and violence, and that women do not have the physical ability to impose orderly behavior on the rowdy patrons of a bar (Silvers and Stein 2002).

Similarly, people with disabilities have been characterized as being biologically unfit to execute the responsibilities and thereby to enjoy the privileges of citizenship, to work and play with nondisabled people, and to be permitted reproductive freedom. For example, people with mental retardation, cerebral palsy, blindness, and deafness all have suffered the state's sterilizing them, removing their children from their custody based only on their disability, denying them access to public education on the ground that their presence harmed other children, and institutionalizing them to protect citizens who function in species-typical ways from having to have contact with them (Lombardo, 2008). Similar legally endorsed harm is a familiar theme in the history of women, racial minorities, native people, and gays and lesbians.

Searching for ethical grounds to condemn the kinds of exclusions to which women have been subjected, feminist thinkers have been disappointed by traditional metaethical, moral and political analyses. Feminists have found traditional moral philosophy suspect for inflating typical male behaviors into paradigmatic moral actions and traditional political philosophy equally suspect for being bereft of remedies for the moral and political challenges posed by such biased and pretextual exclusion. Although standard ethical and political theorizing claims as a matter of principle to embrace everyone alike, feminist critiques have shown that their presumptions often exclude devalued kinds of people from significant moral, political and social roles (for example, Putnam 1993 draws attention to Rawls' exclusion of people with serious disabilities from the basic level of formulation of principles of justice). Consequently, feminist philosophers such as Annette Baier (1986, 1987), Eva Kittay (1998), Martha Nussbaum (2001, 2006), and Iris Marion Young (1990a; 1990b) have pioneered the exploration of more inclusive alternative theories (to mention just a few leading feminists whose theories have been influenced by a concern to address the phenomena of disability adequately). They have relocated the search for an adequate center for moral and political philosophy to, for example, the ethics and politics of trust and care, the virtues of dependency, the sustenance of capabilities fundamental to human life, and the establishment of moralized interconnectedness among people who do not occupy similar positions in life. Albeit differing from one another in their approaches to feminist ethical and political theory, all build in concern for achieving adequate philosophical treatment to address problematic kinds of interactions between people with disabilities and the nondisabled, or to illuminate ways of framing distributive policies that are equal to the situations of both nondisabled and disabled individuals. (For another explicitly feminist example of the former, see Mahowald in Silvers, Wasserman and Mahowald 1998 and for a feminism compatible example of the latter, see Becker 2012.)

Two main approaches to addressing the social exclusion of disabled people have surfaced in the philosophical literature that refers to them. Some writers focus foremost on procedural justice to open up disabled people's opportunities for social participation (Young 1992; Silvers 1998b; Anderson 1999; Silvers and Francis 2005). Anderson urges that everyone be guaranteed effective access to the social conditions of their freedom in virtue of their equality, not their inferiority. To illustrate, she notes that what Deaf people object to is not their lack of hearing but that "everyone else has rigged the means of communication in ways that leave them out of the conversation. One can detect this injustice without investigating anyone's preferences or subjective states" (Anderson 1999, 334). Silvers proposes a procedure called historical counterfactualizing to identify practices catering to the nondisabled majority that unjustly exclude people with disabilities (Silvers 1998b; Hoffman 2003).

Others take the answer to lie first of all in distributive justice to increase provision of resources to the disabled and to families caring for the disabled (Kittay 1998; Kittay 2001; Nussbaum 2006). Nussbaum, for example, begins with a comprehensive idea of the good to guide justice. She develops a list of capabilities necessary to live with dignity and holds that people with disabilities deserve support to achieve threshold levels of these capabilities, if they can do so, even if more resources must be deployed to assist them than other people need to reach the same level. Kittay, another example, seeks supportive conditions for those who interact in dependency relations, both dependents and their caregivers, arguing that both must be assisted in order to achieve good care, and therefore justice, for the dependent. To effect such an outcome through justice, Kittay believes, requires maintaining a social order that secures care for dependents as a main purpose of formulating fundamental principles of justice and a theoretical basis that downgrades the value of independence, at least for disabled people (Kittay 2011). Although many commentators endorse the prominence Kittay assigns to (re)organizing society to provide various kinds of care and to protect care workers, Kittay's understanding of how her view relates to liberal political has been questioned. One problem has to do with Kittay's assumptions about how reciprocity functions in liberal theory, and another is about the role of reciprocating relationships on her view (Whitney 2011). Another is abut whether the vulnerability of utter dependents is sufficiently similar to other kinds of vulnerability, such as that of care workers, to warrant taking the support relationship needed by utter dependents as the basic model for social affiliation and obligation (Bhandary 2010).

Neither of these approaches to justice-one foregrounding procedural reform and the other revising resource distribution - denies the importance of the other's objectives. In great part, they diverge on matters of practical priorities, but also on matters of whether moral priority should be given to agreement about what is right, or instead about what is good. However, some feminist thinkers who have questioned the ability of traditional moral theories to take account of the needs and experiences of both care-receivers and care-givers are inclined to portray caring conduct as inspired not by duty but by the compelling recognition of another's need and of one's own capacity to relieve that person's need. Consequently, they have criticized rights-based and obligation-catering procedural theories for abstracting excessively from experienced encounters with dependents who need protection and support (Kittay, 1998, for example). Other feminist philosophers, such as Baier and Nussbaum, have raised a different question about the adequacy of traditional moral theories to address the phenomena of interdependency. Their issue is about validation rather than motivation. They have queried whether approaches centered on independent individuals contracting freely and reciprocally with one another for mutual benefit can give plausible accounts of obligations to people who are, temporarily or permanently, greatly dependent on others for physical, cognitive or emotional support.

Nussbaum (2006) suggests that the source of political philosophy's ignoring the disabled lies in a foundational assumption of social contract theory. She criticizes Rawls for casting citizens in the role of rough equals who relate because they can benefit each other, saying "Instead of picturing one another as rough equals making a bargain, we may be better off thinking of one another as people with varying degrees of capacity and disability, in a variety of different relationships of interdependency with one another" (2001, B9). Construing reciprocal bargaining as the foundational and therefore paradigmatic social connection among citizens "effaces the more asymmetrical forms of dependency that human life contains: the need for care in infancy, extreme age, and periods of severe illness or a lifetime of severe disability," she objects (2001, B9).

Nussbaum thinks traditional social contract theory is misguided in testing basic conceptions of justice against self-regarding reasons, thereby assigning self-regarding reasons preeminence over other-regarding ones. And surely it is hard to see how a conception that derives justice from decisions featuring self-regard (such as whether particular formulations of principle would benefit one's self regardless of one's circumstances) can provide adequately protective principles for each individual in relation to others, especially in view of the vulnerabilities individuals accept as the price of being part of cooperative schemes.

Stimulated by Nussbaum's critique, Silvers and Francis (2005) return to Baier's insights about the centrality of trust in moral interaction. They propose extrapolating principles of justice from practices that facilitate people's relying on, and thereby making themselves vulnerable to, each other. Practices that nourish such trust are crucial components of social cooperation. Moreover, unlike bargaining, which requires strategizing and therefore complex high-order cognitive skills, trusting is conduct that people without disabilities and people with almost every kind of disability equally can engage in. People who cannot articulate their decisions, and who may not even be able to arrive at decisions, nevertheless may express bestowal or withdrawal of their trust. As a mode of relating to one another, trust is par excellence suited to facilitating interactions between individuals who in various respects are asymmetrically positioned in regard to one another. Silvers and Francis argue that building trust is a more inclusive process than bargaining about principles of justice. Building trust therefore offers a more adequate practice for achieving justice for both disabled and nondisabled people than the reciprocating exchanges called for in strategic contracting.

By clearing away some biased approaches to moral and political theorizing, the work of feminist philosophers has greatly and beneficially influenced the philosophy of disability. Nevertheless, because feminist philosophy is woman-centered, and most women do not identify as being disabled themselves, the interests and emphases of feminist thinkers are not always congruent with those of activists aspiring to liberate the disabled from oppressive social arrangements or of scholars formulating liberatory theories that guide and justify doing so. Two conversations where the alliance between feminist philosophy and the philosophy of disability is strained relate to women's liberty to shape their own relationships, and their liberty to reproduce. Although disability activists and scholars never deny that women should be thoroughly free, some have concerns about women's exercising their freedom in ways that curtail or dismiss disabled people's freedom.

Women are more likely to remain in relationships with ill or disabled dependents-partners, children, or elders-than are men (Cohen 1996). Possibly, fewer men than women consider caregiving as a self-affirming role. Women therefore contribute a very large proportion of society's caregiving, but may be harmfully confined and disadvantaged by this role unless their contributions as carers are adequately acknowledged, appreciated and compensated. Emphasized in feminist literature and by the women's movement, this issue is a touchstone for many feminist philosophers in judging the adequacy of moral and political theories.

Analyses and assessments of the moral dimensions of how caregivers relate to dependent disabled individuals, as well as to disabled people who do not need extraordinary levels of care, would benefit from nuanced collaboration attention by feminist and disability scholars. Even where helping relationships are voluntary, they risk being asymmetrically so, with the dependent feeling coerced into receiving assistance in the proffered rather than in a preferred form, or the dependency worker feeling imprisoned by the relationship. Help-givers choose how they will help, but help-takers cannot choose how they will be helped, for if one's connection to others is as the recipient of help, rejecting others' choice of proffered help leaves one solitary (Silvers 1995). Joan Tronto finds that the power imbalance between care givers and care receivers carries with it a potential for oppression (Tronto 1987; Tronto 1993).

Nussbaum rightly observes that we must preserve the self-respect of dependents without exploiting caregivers. Morris argues that the solution lies in eliminating the presumptions about normate embodiment and normal functioning that now pervade the way caregivers and care receivers usually are conceptualized by ethics of care. Proponents of the ethics of care could profit from recognizing that many disabled people, men as well as women, are caregivers for themselves and therefore are crucially positioned to understand how giving care best connects to receiving it (Morris 2001). Working out better understanding of the moral, political, and social dimensions of caregiving relationships is of crucial importance not only to disabled people themselves, but also to families who are as dependent on securing care for their dependent members as their dependents are on them.

Bioethics is another area of applied philosophy where feminist thinking, while making its mark, at least initially occluded disability perspectives. Feminist bioethicists most often have aligned with the principle that women are owed control of their own bodies. While this idea may appear compatible with the value of self-determination promoted by much disability philosophy, some bioethicists, including some who are feminists, have adopted medicalized views of disability and, in doing so, have argued that the prospect of bearing a disabled child justifies, or even obligates, termination of the pregnancy (Purdy 1995; see also McMahan 1998 and McMahan 2005). A related but not identical position challenges "Baby Doe" laws that prohibit hospitals from denying neonates with disabilities effective life-saving treatment, arguing that parents should be free to decide whether their child's life will be worth living (Paris et al. 2005).

Feminist bioethicist Adrienne Asch has carefully distinguished between a woman's right to terminate her pregnancy and the moral constraints on her terminating the life of her new-born child. Disability does not diminish the claims of neonates, nor of other individuals with disabilities, to the necessities of life (Asch 1990 2002; Asch and Geller 1996; Asch, Gostin and Johnson 2003; Kittay 2005). Disability scholars generally have objected to the unfounded presumption that being disabled makes life not worth living, or at least makes the lives of people with disabilities less gratifying and valuable than those of nondisabled people. The social isolation to which disabled individuals often are condemned results in nondisabled people being misinformed about their potential for satisfying lives. Terminating a pregnancy because the resulting child may have an impairment reduces the individual to the disability, but people with disabilities are as much a sum of many different strengths and flaws as nondisabled people are (Parens and Asch 1999). Like Asch, Carlson urges feminists to be wary of women's being induced to accept social roles in which they devalue individuals who are disabled. She notes that feminist programs for the availability of birth control often invoked fears of perpetuating feeblemindedness to support their case. Carlson warns that genetic counseling, which also is work done primarily by women, may function in a similar gatekeeping role (Carlson 2010).

The objectionable presumptive devaluing of life with a disability is not compatible with a full and equitable commitment to reproductive liberty. Philosophers as well as policy makers have invoked the supposed inescapable suffering of disabled people as a reason for barring deaf women and women with dwarfism from using reproductive technology (for example, pre-implantation genetic diagnosis) to bear children like themselves, narrowing these women's reproductive choices. An additional consistency challenge emerges in regard to the influence that the prospect of a sad or bad life should have on the reproductive liberty to bear children who may or will have disabilities. Feminists condemn the practice of aborting female fetuses and of female infanticide, even where women lead inescapably miserable lives. It is difficult to see what, other than the influence of the prevailing social biases against disability, would lead those who regard the termination of females this way from extending their objection to the termination of other devalued kinds of people (Asch 1999; Asch and Geller 1996).

For more than two decades, feminist philosophy has had a productive but sometimes uneasy engagement with the facts and theory of disability. Some feminists who view feminist theorizing from a disability perspective, such as Morris and Wendell, are disturbed by evidence that feminism has not overcome a residual allegiance to normalcy. And indeed some discussions of disability by feminists seem to proceed by laying aside feminism's own affiliations with liberation, self-affirmation, and inclusiveness. In general, however, philosophy has benefited from applying feminism's theoretical lenses to better understand disability. Polishing those lenses with the cloth of which disabled people's lives are made promises to achieve more finely nuanced and perspicacious philosophical accounts, and theories broader in scope and farther seeing, than during the centuries when philosophy overlooked disability.

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Disability studies has steadily gained prominence over the past half century, moving expeditiously (at least in the United States) into the mainstream in historical and literary scholarship, but not so quickly in philosophy. In the former fields, the components of disability studies are (mainly) two.

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What is Feminist Disability Theory? And Why is it Important?

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What is Feminist Disability Theory? And Why is it Important?

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Feminist disability studies reimagines

disability. Feminism challenges the belief that femaleness is a natural form of physical and mental deficiency or constitutional unruliness. Feminist disability studies similarly questions our assumptions that disability is a flaw, lack, or excess. To do so, it defines disability broadly from a social rather than a medical perspective.

Just as feminism questions the assumption that femaleness constitutes a natural physical and mental inferiority, disability studies challenges social constructions that deem disability a natural deficiency. Like gender, disability pervades cultural practices, politics, social structures and social identities. Both disability studies and feminist theory address reproductive rights, bodily difference, medicalisation of the body and the politics of appearance to name a few. Therefore, integrating disability into feminist theory challenges our assumptions of the body and enriches our understandings of human diversity.

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I am currently undertaking my MSc Applied Gender Studies and Research Methods with a focus on feminism and disability. I have a particular interest in invisible disabilities such as chronic fatigue syndrome as this mostly affects women and challenges our assumptions about disability. Reading and writing about constructions of gender and constructions of disability has been liberating and I thought I would write about this topic in a blog post.

The Link Between Feminism and Disability

In the past, older women and disabled women were largely left out of feminist theory. Feminism even reinforced derogatory perceptions of disability by using disability as a metaphor to illustrate the "crippling" impact of patriarchy on women. More recently, disability has become increasingly acknowledged in feminist theories that highlight diversity. However, simply including disability in a list of differences is not enough. Disability requires a more integrated analysis.

Key thinkers in feminist disability studies such as Rosemarie Garland-Thomson and Susan Wendell (linked below) show that social constructions of gender and disability intertwine. Just as feminism questions the assumption that femaleness constitutes a natural physical and mental inferiority, disability studies challenges social constructions that deem disability a natural deficiency. Like gender, disability pervades cultural practices, politics, social structures and social identities. Both disability studies and feminist theory address reproductive rights, bodily difference, medicalisation of the body and the politics of appearance to name a few. Therefore, integrating disability into feminist theory challenges our assumptions of the body and enriches our understandings of human diversity.

Disability is considered a social construct among many activists and academics. This means that disability is not considered natural but rather, dominant ideas in a given society construct our perceptions of what counts as a "normal" body in regards to functionality and intelligence. For instance, queer and disability theorist, Robert McRuer (2006) (linked below) discussed "compulsory able-bodiedness". That is, able-bodiedness is perceived to be the norm and disability is "abnormal". According to McRuer:

being able-bodied means being capable of the normal physical exertions required in a particular system of labour
(Disability Studies Reader, p.303)

Our culture presumes that able-bodied lives are more enjoyable, their perspectives preferable and that everyone must strive to always be "able-bodied". However, it is impossible to consistently be able-bodied. Everyone succumbs to disability temporarily or permanently through illness, accident or old age, yet disability is considered "abnormal" and largely oppressed.

One thing we must remain aware of when discussing disability is: who counts as disabled? Often when we think about disability, we conjure up an image of visible impairment which can reinforce a narrow perception of disability. Therefore, I am particularly interested in highlighting the experiences of disabled people who can "pass" for able-bodied and the radical challenges invisible identities pose to dominant binaries.

Passing for Able-bodied

Many disabilities are invisible meaning that some disabled people "pass" as able-bodied by default unless they verbally "come out". This is difficult as it creates an inner conflict about whether to reveal oneself as disabled or not. As impairment is assumed to be visible, many people with invisible disabilities who "come out" face scepticism. Therefore, those with invisible disabilities live with an underlying fear of being disbelieved should they reveal their disability. This can impact both men and women with invisible conditions but women are more likely to live with unexplainable, invisible disabilities such as chronic fatigue syndrome or chronic pain conditions. Women living with such conditions are often told their symptoms are in their head which reinforces negative stereotypes of women as "hysterical". Particularly, these conditions pose a challenge to abled/disabled binaries.

Today's society tends to enforce binary thinking: male/female, heterosexual/homosexual, abled/disabled. Firstly, this is problematic because the latter of the binary is usually considered inferior. Secondly, it is problematic for those who struggle to fit into the binary. For instance, those with invisible disabilities often feel they have to justify themselves more when applying for benefits because they do not meet conventional views of disability. Even workplace accommodations designed to help disabled people are often not enough to account for the fluctuating and unpredictable nature of many invisible disabilities and many face disbelief and judgement from co-workers who cannot "see" their disability. Therefore, by striving to categorise disability, measure it and "see" it, invisible disability is often not seen as disabled "enough" which impacts people's access to necessary housing and workplace accommodations and even benefit support.

Invisible disability can be challenging. However, from reading work by incredible disability scholars (linked below), I can now see how "passing" can be a subversive act and even emancipatory in a system that relies so much on binary logic. The very act of "passing" reveals the instability of identity. Dominant categories are weakened by an individual's inability to be categorised. This is not only illustrated by those who are both able-bodied and disabled but it is also exemplified in queer theory. For instance, the term "lesbian femme" refers to people who do not fit the lesbian stereotype as they appear feminine and can pass as heterosexual. Hirshmann (2013) highlights that lesbian femmes do not display the expected markings of sexuality while invisibly disabled people do not display the expected markings of disability. Therefore, invisibility provides lesbian femmes and disabled people with the power to dismantle norms and expectations of "heterosexuality" and "able-bodiedness". Invisibility can, thus, be a political strategy and prevents the ability for dominant groups to police "their" community.

Conclusion

I would love to live in a world where people no longer fear judgement or oppression because their body functions in a certain way. Accepting the fragility of the body could open our world to so many different ways of living. Disabled people have vast experiences and ways of living that dominant groups may never have considered. Disabled people can provide knowledge on how to navigate life, how to deal with crisis and different ways of bringing happiness into our lives. Imagine how much knowledge we could gain if we embraced the richness and diversity of human experience.

Resources

Nancy Hirshmann - Queer/Fear: Disability, Sexuality and the Other . Avialable here: https://link.springer.com/content/pdf/10.1007/s10912-013-9208-x.pdf

The following articles are all available in the Disability Studies Reader:

Rosmarie Garland-Thomson - "Integrating Disability, Transforming Feminist Theory".

Robert McRuer - "Compulsory Able-Bodiedness and Queer/Disabled Existence"

Susan Wendell - "Toward a Feminist Theory of Disability".

The Disability Studies Reader is available here : https://uniteyouthdublin.files.wordpress.com/2015/01/lennard_davis_the_disability_studies_reader_secbookzz-org.pdf

The following recommendations are available in the Glasgow Women's Library:

Alison Kafer: "Feminist, Crip, Queer"

Simi Linton: "My Body Politic: A Memoir"

Jenny Morris: "Encounters with Strangers: Feminism and Disability"

Jenny Morris: "Pride and Prejudice: A Personal Politics of Disability"

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Invisible Disability and Feminism | Glasgow Women's Library

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I am currently undertaking my MSc Applied Gender Studies and Research Methods with a focus on feminism and disability. I have a particular interest in invisible disabilities such as chronic fatigue syndrome as this mostly affects women and challenges our assumptions about disability.

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In the civil rights movement era, feminist and disability approaches to architectural design emerged to address the problems of spatial segregation. Activists argued that inaccessible built environments—such as segregated lunch counters, workplaces without childcare, suburban single-family homes, and buildings with stairs and without ramps—made oppressed people less visible and, therefore, less likely to receive legislative protections Throughout the 60s and 70s, disability activists physically occupied public buildings in order to demonstrate that law and society had failed to include them. The efforts of these activists resulted in the passage of federal civil rights legislation that aspired to protect the access of people with disabilities to the built environment

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Designing Collective Access: A Feminist Disability Theory of Universal Design | Disability Studies Quarterly

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In the civil rights movement era, feminist and disability approaches to architectural design emerged to address the problems of spatial segregation. Activists argued that inaccessible built environments—such as segregated lunch counters, workplaces without childcare, suburban single-family homes, and buildings with stairs and without ramps—made oppressed people less visible and, therefore, less likely to receive legislative protections (Steinfeld and Maisel 2012, 13-15). Throughout the 1960s and 70s, disability activists physically occupied public buildings in order to demonstrate that law and society had failed to include them (Nielsen 2012, 168). The efforts of these activists resulted in the passage of federal civil rights legislation that aspired to protect the access of people with disabilities to the built environment. The term barrier-free design emerged to describe the architectural strategies that underlie these legislative gains.

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 Accessibility and Universal Design in Feminist Disability Theory

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 Accessibility and Universal Design in Feminist Disability Theory

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Some relevent conterversy in feminist disability theory has been architcturural design and how that perpetrates these systems of oppression for anyone who isn't considered to have the standard body. Supposedly neutral design often privileges the most common bodies through the "normative template" of which the majority of architecture is designed around which caters to white, male, cisgender, heterosexual, able-bodied, and middle-class bodies. When the normate serves as a neutral template for design, what emerges is a built environment that is accessible only to certain bodies. Intersectionality must consider how the normate template for the built environment is a system of exclusion that segregates spaces and people along the axes of disability, race, class, and gender.

Acessible design is something that makes this topic important to me as a designer myself I want to make sure that the things that I design are able to be beneficial and enjoyed by all people which means taking disability into account.

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Designing Collective Access: A Feminist Disability Theory of Universal Design | Disability Studies Quarterly

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In the civil rights movement era, feminist and disability approaches to architectural design emerged to address the problems of spatial segregation. Activists argued that inaccessible built environments—such as segregated lunch counters, workplaces without childcare, suburban single-family homes, and buildings with stairs and without ramps—made oppressed people less visible and, therefore, less likely to receive legislative protections (Steinfeld and Maisel 2012, 13-15). Throughout the 1960s and 70s, disability activists physically occupied public buildings in order to demonstrate that law and society had failed to include them (Nielsen 2012, 168). The efforts of these activists resulted in the passage of federal civil rights legislation that aspired to protect the access of people with disabilities to the built environment. The term barrier-free design emerged to describe the architectural strategies that underlie these legislative gains.

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One thing we must remain aware of when discussing disability is: who counts as disabled? Often when we think about disability, we conjure up an image of visible impairment which can reinforce a narrow perception of disability.

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Rosemarie Garland-Thomson is a disability justice and culture thought leader, bioethicist, teacher, and humanities scholar. Her 2016 editorial, “Becoming Disabled,” was the inauguralarticle in the ongoing weekly series in the New York Times about disability by people living with disabilities.Her book Extraordinary Bodies, published in 1997, is a founding text in the disability studies canon.

She is a professor of English and bioethics at Emory University, where she teaches disability studies, bioethics, American literature and culture, and feminist theory. Her work develops the field of critical disability studies in the health humanities to bring forward disability access, inclusion, and identity to a broad range of institutions and communities.

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Rosemarie Garland-Thomson is a bioethicist, author, educator, humanities scholar, and thought leader in disability justice and culture.

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Susan Wendell is Associate Professor of Women's Studies at Simon Fraser University, British Columbia. Susan Wendell has lived with Chronic Fatigue Syndrome since 1985. In her book The Rejected Body, she connects her own experience of illness to feminist theory and the literature of disability. The Rejected Body argues that feminist theorizing has been skewed toward non-disabled experience, and that the knowledge of people with disabilities must be integrated into feminist ethics, discussions of bodily life, and the criticism of the cognitive and social authority of medicine.

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The rejected body : feminist philosophical reflections on disability / Susan Wendell.

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Susan Wendell has lived with Chronic Fatigue Syndrome (Myalgic Encephalomyelitis) since 1985. In The Rejected Body, she connects her own experience of illness to feminist theory and the literature of disability. The Rejected Body argues that feminist theorizing has been skewed toward non-disabled experience, and that the knowledge of people with disabilities must be integrated into feminist ethics, discussions of bodily life, and the criticism of the cognitive and social authority of medicine.

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Disability as a category of identity is often omitted in rhetoric about intersectionality, which usually considers race and gender, with some consideration of other identities. However, disability like other identities is socially constructed, and liable to misrepresentation and is often siloed from other issues and experiences. Someone identifying as disabled may not be recognised by those around them as having other identities too.

Disabled women may also feel that they are not welcomed in women's organisations or events. Then in a vicious circle which reinforces their otherness, this perpetuates the exclusion of their perspectives from the conversations these other women are having. Because they are invisible the fact that their perspectives are missing is not noticed.

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Disability and other identities?—how do they intersect?

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This paper addresses intersectionality and disability in global contexts. Disability as a category of identity is often omitted in rhetoric about intersectionality, which usually considers race and gender, with some consideration of other…

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Lack of Laws adressing Sexual Violence and Disabled Women

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Lack of Laws adressing Sexual Violence and Disabled Women

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Women with disabilities may be at greater risk of sexual violence due to other factors such as social isolation, limited sexual education, dependence on others, including for intimate hygiene, reduced physical defenses, and communication barriers that prevent disclosure of the abuse. When disabled women, particularly those with intellectual disabilities, are victims of sexual crimes, offenders tend to be regarded in a more lenient way when judgment is passed.

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Abstract

A growing number of large-scale studies suggest that people with disabilities are at greater risk of sexual victimization than nondisabled individuals. However, certain results are inconsistent and whether potential moderators explain this variability in previous findings remain to be considered. This meta-analysis aimed to determine the magnitude of the difference in risk of being sexually victimized based on the presence of a disability. An additional objective was to evaluate the relative influence of gender, age, type of disability, type of sexual violence, and relationship with the perpetrator on the association between the presence of a disability and sexual victimization. Studies were searched using pertinent databases and retained if they included a group with a disability, provided data that quantify the occurrence of abuse, indicated the type of sexual violence, and was published between 1970 and 2018 in French or English. A total of 68 studies, allowing 84 independent samples and 12,427 participants, were included. Individuals with disabilities were at significantly higher risk of sexual victimization than persons without disabilities (odds ratio = 2.27). The risk of sexual victimization among individuals with a disability was significantly higher in adult participants compared with the risk in minor participants. Sensory impairment was the type of disability associated with the highest risk of sexual victimization. Odds of sexual victimization among individuals with a disability were significantly higher in African countries compared with all others, and odds in Western Europe were significantly lower than in the United States. No significant differences emerged across eras.

Keywords: disability, sexual violence, victimization, meta-analysis

Sexual violence is a major public health concern and a violation of human rights that has well-established long-lasting detrimental consequences ( World Health Organization, 2013). Sexual violence is defined as any sexual act that is committed or attempted by another person without freely given consent of the victim or against someone who is unable to consent or refuse ( Basile et al., 2014). It includes forced or alcohol/drug-facilitated penetration of a victim (rape), forced or alcohol/drug-facilitated incidents in which the victim was made to penetrate a perpetrator or someone else (ordered rape), nonphysically pressured unwanted penetration (i.e., being worn down by someone who repeatedly asked for sex or showed they were unhappy, feeling pressured by being lied to, being told promises that were untrue, having someone threaten to end a relationship or spread rumors, and sexual pressure due to someone using their influence or authority), unwanted sexual contact (i.e., having sexual body parts fondled or grabbed and being kissed in a sexual way), and noncontact unwanted sexual experience (i.e., someone exposing his or her sexual body parts, flashing, or masturbating in front of the victim, someone making a victim look at or participate in sexual photos or videos, or someone harassing the victim in a public place in a way that made the victim feel unsafe; Basile et al., 2016). Inability to consent is defined as an impossibility to give a free agreement to this sexual act because of age, illness, mental or physical disability, being asleep or unconscious, intoxication through voluntary or involuntary use of alcohol or drugs, and misuse of authority or threats ( Basile et al., 2014; Krug et al., 2002).

Sexual violence is widespread globally and affects men and women across the life span from childhood to adulthood. Research indicates that particular groups are at significantly greater risks of being the victim of sexual violence (e.g., women, children, racial/ethnic minorities, sexual, and gender minorities; Black et al., 2011; Breiding et al., 2014; Conroy & Cotter, 2017). Still, a growing number of comparative large-scale studies suggest that people with disabilities are at even greater risk of sexual victimization across their life span than nondisabled individuals (e.g., Basile et al., 2016; Beadle-Brown et al., 2010; Casteel et al., 2008; Cohen et al., 2006; Cotter, 2018; Grossman & Lundy, 2008; Harrell, 2017; Haydon et al., 2011; Khalifeh et al., 2013; Krnjacki et al., 2016; Martin et al., 2006; Mitra et al., 2016; Nixon et al., 2017). However, these studies are based on heterogeneous definitions of disability (physical, intellectual, sensory, and developmental), sexual violence (e.g., with or without contact; by spouse vs. stranger), and varying timing of abuse (e.g., before age of 12, before age of 18, during adulthood, lifetime, during the previous 12 months), often mixing them together. Therefore, the results need to be untangled as it remains difficult to estimate the prevalence of sexual violence reported by persons with different types of disability. The aim of the present meta-analysis was to quantify available evidence concerning the risk of sexual violence against individuals with disabilities compared with individuals without disabilities and to evaluate statistically the influence of potential moderators such as gender, age at first abuse, type of disability, type of sexual violence, and relationship with the perpetrator.

Based on 2010 global population estimates, about 15% of the world's population have some form of disability ( World Health Organization, 2011). Individuals with disabilities is a broad term that encompasses everyone with a long-term physical, intellectual, or sensory impairment which, in interaction with contextual factors (environmental and personal factors), may hinder their full and effective participation in society on an equal basis with others ( United Nations, 2006; World Health Organization, 2011). Individuals with disabilities are thus heterogeneous in their health conditions and their degree of limitation but are often lumped together without consideration for these differences. In addition to risk factors already present in the general population (e.g., women, sexual minority), people with disabilities may be at greater risk of sexual violence due to other factors such as social isolation, limited sexual education, dependence on others including for intimate hygiene, reduced physical defenses, and communication barriers that prevent disclosure of the abuse ( Barron et al., 2019; Briggs, 2006; Hollomotz, 2009). Some disabilities may also limit the individual's capacity to consent (or withdraw a previous consent) to sexual activity as defined by law ( Murphy & O'Callaghan, 2004; Nosek et al., 2001; O'Callaghan & Murphy, 2007).

Given these considerable vulnerabilities that place individuals with disabilities at risk of sexual violence, an increasing amount of research has been done to quantify the risk in this population. In a sample of 5,326 women, those who considered themselves as having a disability were more than 4 times (odds ratio [ OR] = 4.89) more likely to report a sexual assault in the previous year ( Martin et al., 2006). In a nationally representative survey of 11,878 young adults (aged 26-32) in the United States, women with physical disabilities, compared to women without physical disabilities, had greater odds of reporting physically forced but not coerced (defined as being forced in a nonphysical way; e.g., through verbal pressure, threats, or being given alcohol or drugs) sexual activity, whereas the opposite pattern was observed in men with physical disabilities, who had greater odds of reporting coerced but not physically forced sexual activities compared to those without physical disabilities ( Haydon et al., 2011). According to the 2010 U.S. National Intimate Partner and Sexual Violence Survey (based on 16,507 respondents), both women and men with a self-reported disability (defined as physical, mental, or emotional problems) were at significantly increased risk of sexual coercion (same definition) and noncontact unwanted sexual experiences during the previous 12 months ( Basile et al., 2016). Similar results were obtained for sexual abuse in the past 12 months and since the age of 15, especially in women (the Australian Personal Safety Survey, N = 17,050 adults; Krnjacki et al., 2016). In Canada, results from the General Social Survey on Victimization showed that women with a disability were nearly twice as likely as women who did not have a disability to have been sexually assaulted in the previous 12 months ( Cotter, 2018). Accordingly, lifetime prevalence of sexual violence victimization was significantly higher for both men and women with disabilities compared to adults without disability in the American Behavioral Risk Factor Surveillance System Survey ( N = 25,756; Mitra et al., 2016; Smith, 2008). Rates of sexual violence victimization are also significantly higher for high-school and college students (both girls and boys) with a disability compared to those without disability ( Alriksson-Schmidt et al., 2010; Findley et al., 2016; Mitra et al., 2016). In fact, men and women with a disability from all age strata from 12 to 65 years are at significantly higher risks to be victimized from serious sexual violence than persons without a disability in the United States ( Harrell, 2017).

It is worth noting that some studies failed to find significantly different rates of sexual violence between subgroups of persons with versus without disability ( Haydon et al., 2011; Khalifeh et al., 2013; Mueller-Johnson et al., 2014; Young et al., 1997). Generally, these subgroups represent specific demographic strata based on age and gender, that is, young women. This lack of between-group difference seems to be due to high base rates of sexual abuse victimization among young women in the general population (21% coerced sex victimization among young female adults in Haydon et al., 2011; e.g., 21% victimized from contact and 39% from noncontact sexual aggressions among ninth-grade girls without physical disability in Mueller-Johnson et al., 2014). Therefore, both age and gender represent good moderator candidates in the relation between disabilities and odds of sexual violence victimization. Wide definitions of disability (e.g., "long-standing physical or mental health conditions or disabilities limiting day to day activities") might be too inclusive, lowering the mean prevalence of sexual violence in the subgroup, generating statistically negative results ( Khalifeh et al., 2013). Another potentially significant moderator is the type of disability. Although most studies on sexual victimization among persons with disability grouped together several types of conditions, results from the National Crime Victimization Survey of the American Bureau of Statistics ( Harrell, 2017) indicated that certain types of disabilities (e.g., hearing defect) are significantly less associated with violent crime victimization than others (e.g., intellectual deficiency). It remains to be seen whether similar conclusions apply to sexual violence. Finally, different culture or publication time might generate different results. In Canada, for instance, rates of sexual offenses reported to the police significantly increased after the #MeToo movement ( Moreau, 2019).

Overall, discrepancies in these studies may be at least partly attributable to the population sampled (e.g., women only, youth), the time of occurrence of the victimization (e.g., childhood vs. past 12 months), differences in the disability examined (e.g., sensorial, physical, intellectual, all combined), the type of sexual violence assessed (e.g., penetration or noncontact abuse), the relationship with the perpetrator, the publishing epoch (e.g., 1970 vs. 2015), and the country of data collection (e.g., with a high vs. low gender gap index; from Global North vs. Global South). In view of these somewhat mixed findings, scholars have begun to synthesize available research. Older systematic reviews stressed that literature on the link between physical disabilities and sexual violence was extremely sparse ( Curry et al., 2001), even questioning the validity of the association ( Govindshenoy & Spencer, 2007). More recent systematic reviews concluded that although the literature is still plagued by methodological shortcomings, it suggests that children ( McEachern, 2012; Stalker & McArthur, 2012) and adults ( Stone, 2018), men and women ( Hughes et al., 2011; Plummer & Findley, 2012), with physical, developmental ( Mahoney & Poling, 2011), or intellectual ( Byrne, 2018) disabilities are at higher risk of sexual violence. However, the strength of the association between disability and sexual violence has rarely been quantitatively synthesized.

A meta-analysis of studies published between 1990 and 2010 reported a pooled prevalence estimates of 13.7% for sexual violence against children with disabilities ( k = 15, n = 14,675) and a risk 2.9 higher ( k = 9) of reporting sexual violence than nondisabled children ( Jones et al., 2012). Another meta-analysis of studies published between 1990 and 2010 examining violence against adults with disabilities reported that there was only a sufficient number of studies focusing on mental illnesses as a disability, as opposed to studies on physical, sensory, or intellectual disabilities, to estimate a pooled prevalence of sexual violence. Thus, combining four studies ( n = 2,230), the pooled prevalence of sexual violence in the previous 12 months was 5.5% in adults with mental illnesses ( Hughes et al., 2012). To our knowledge, no meta-analysis combined studies on sexual violence across the life span (i.e., childhood and adulthood, lifetime prevalence, and not just recent abuse) and included physical, intellectual, and sensory disabilities. These limitations lead to concerns about estimates of the true magnitude of the risk of sexual violence against individuals with disabilities. A clearer picture of this risk could ensure that individuals with disabilities are included in sexual violence prevention and intervention programs, if needed. With a more detailed meta-analysis encompassing all disabilities (i.e., physical, intellectual, and sensory) and all types of sexual violence across the life span, it would be possible to combine and contrast estimates across these different studies to determine whether some moderators explain the variability in previous findings. For example, it has not yet been determined whether a specific disability is most strongly related to sexual violence or whether individuals with disabilities are at greater risk of a specific type of sexual violence or from a specific perpetrator. Most studies also seem to rely on samples from high-income countries, thus we know little about sexual victimization of persons with disabilities in low-middle-income countries and how disparities between countries may affect the pooled risk of sexual violence against individuals with disabilities compared to individuals without disabilities. Identification of particularly vulnerable subgroups would enrich our understanding and help tailor prevention programs to target individuals with disabilities with the greatest need.

Objective of the Current Study

The main goal of this study was to determine the relative risk of sexual violence against individuals with disabilities compared to individuals without disabilities. An additional goal was to assess the possible moderating effect of gender, age, type of disability, type of sexual violence, relationship with perpetrator, country of data collection, and year of publication.

Method

Inclusion and Exclusion Criteria

To be included in this meta-analysis, studies had to (1) include at least one group with an intellectual, physical, or sensory disability; (2) provide data that could be used to quantify the frequency of abuse; (3) indicate the type of sexual violence (e.g., with or without physical contact); (4) cover a period between 1970 and December 2018; and (5) be written in English or French.

Literature Search Strategy

We searched PsycINFO, CINAHL, and MEDLINE for published studies and ProQuest and Statistics Canada for unpublished documents. The key words used in both cases were ( Prevalence) AND ( Sex Offense* OR Sexual Coercion OR Sexual Violence* OR Sexual Abuse* OR Sexual harassment OR Sexual Assault OR Adult Survivors of Child Abuse OR Child Abuse OR Incest OR Rape OR Completed nonconsensual sex OR Attempted nonconsensual sex) AND ( Disabilities OR Disabled Person OR Disabled Child OR Person with Disabilit* OR People with Disabilit* OR Handicapped OR Handicapped Children OR Cognitive impairment* OR Mental retardation* OR Intellectual deficit* OR Autis* OR Physically Handicapped OR Physically Challenged). We carefully analyzed the reference lists of articles identified in the first step to ensure that no relevant study was missed in the review. The same procedure was followed for articles identified manually.

Data Extraction

Two of the researchers extracted the data independently. They coded the articles based on the following elements: type of disability (autism/developmental/ intellectual/learning disorder, neurological, physical, sensory, and mixed), type of sexual violence, sexual violence, proportion of women, average age at which the first sexual violence occurred which was codified into minor versus adult (i.e., below vs. equal or higher than 21 years old), relationship with the perpetrator, year of publication, and country in which the study was conducted. For studies without control (nondisabled) group, the population-based statistics on sexual violence of Pereda and colleagues (2009) were used. Studies concerning psychological or emotional disability exclusively were not included in the meta-analysis (e.g., Rees et al., 2011). However, these types of disabilities were entered separately in the database when they were parts of studies including other types of disabilities to assess the magnitude of the effect related with them (e.g., Ballan et al., 2014; Blum et al., 2001; Turner et al., 2011). Learning disabilities as well as intellectual, developmental, and neurological disabilities were pooled in the analyses to form the broader category of intellectual/developmental disabilities to limit the number of categories. For studies that examined more than one type of sexual violence (e.g., sexual with and without physical contact), we used only the more severe category, which is rape (e.g., Basile et al., 2016; Dickman & Roux, 2005) or forced sexual intercourse (e.g., Kvam, 2004; Puri et al., 2015) to ensure that severity of sexual violence would be similar across studies and that participants victimized from multiple types of sexual violence (e.g., rape and harassment) would not be considered twice or more (overlap avoidance; Lipsey & Wilson, 2001). This strategy prevents comparisons between subtypes of sexual violence (e.g., with vs. without contact). When both lifetime and past year prevalence of sexual violence were reported ( Devries et al., 2014; Mitra et al., 2011), only lifetime prevalence was considered.

Statistical Analyses

This meta-analysis was conducted using Comprehensive Meta-Analysis Version 2.0 ( Borenstein et al., 2005). For each study, a measure of effect size was calculated from the occurrence of sexual violence for individuals with and without disabilities to obtain an OR. An OR of 1 indicates no difference between the two groups with respect to the risk of sexual victimization. If the OR is less than 1, it means that individuals with disabilities have less risk of being sexually abused than those without disabilities and, if greater than 1, the former have more risk of being sexually abused than people without disabilities. The software assigns a relative weight to each study based on sample size.

Analysis of the Risk of Bias Across Studies

To ensure that a bias was not present in our data, we created a funnel plot illustrating the dispersion of studies, including the effect size according to the standard error. As studies with a smaller effect size (larger standard error) have more variation in the estimate of their effect size, especially since random variations have a greater impact in such studies, the plot was expected to be shaped like a funnel; conversely, studies with larger samples have less variation in their effect size ( Duval & Tweedie, 2000). The presence of a publication bias was illustrated by the presence of asymmetry in the dispersion of effect sizes ( Borenstein, 2009).

For each study, a Z score (Fisher's Z) was calculated as a normally distributed equivalent of Cohen's d. The standardized Z score was used to verify the presence of extreme values. In this meta-analysis, however, we did not find any extreme values, that is, Z below −3.29 or above 3.29 ( Tabachnik & Fidell, 2001).

Effect Sizes

In the studies analyzed, data on the prevalence of sexual violence were generally dichotomous and were transformed into OR s. Combined effect sizes were then calculated. Significance tests and analyses based on the various moderators were done using a random effects approach, which assumes that the studies were not necessarily conducted in the same way and that some methodological differences were present. Unlike a fixed effect model, calculation of the significance test is based on the number of studies and not the total number of participants, which reduces the statistical power and increases the weight given to small studies relative to the others. However, generalization of the results is better using a random effects approach.

Results

Study Selection

In the literature search, 409 studies were found. Based on the title and abstract, 103 studies met the inclusion criteria. After a closer examination, 18 studies were excluded for various reasons (e.g., literature review and not an original study, statistics not usable, sample overlap between two different articles). When the same sample was used in two separate studies, we retained only the study with the larger sample to avoid duplicating participants. This meta-analysis included 68 articles involving 84 independent samples, for a total of 12,427 participants with disabilities. The characteristics of the selected studies are shown in Table 1.

Main Analysis

The results of this meta-analysis show that individuals with disabilities are at significantly higher risk of being sexually victimized in their lifetime than people without disabilities ( OR = 2.27, p < .001, Q = 3,143.32, k = 84).

Visual examination of the funnel plot of this meta-analysis suggests that there is a publication bias in favor of studies reporting positive results ( Figure 1). The trim-and-fill method ( Duval & Tweedie, 2000) was used to calculate the effect of a potential publication bias. Eighteen studies were identified as not being symmetrically matched and requiring a corrective adjustment, that is, by calculating an effect size and adjusted confidence interval (CI). The new effect size was adjusted downward ( OR = 1.49; 95% CI [1.27, 1.76]). Although smaller than the original overall effect size ( OR = 2.27), this adjusted effect size confirms that individuals with disabilities have a higher risk of being sexually abused than people without disabilities.

Figure 1.

Forest plot.

Analyses of Moderators

Because the measure of heterogeneity (the Q statistic) was significant ( p < .001; Q = 3,143.32), the moderators were considered for further analyses (i.e., gender, age, type of disability, type of sexual violence, relationship with perpetrator, year of publication, and country in which the study was conducted). As shown in Table 2, persons with a disability are at significantly higher risk than those without disability to be sexually victimized both when they are minors (aged under 21; OR = 1.40, p = .02, k = 30) or adult (age of 21 or higher; OR = 2.84, p < .001, k = 54). This variable has a significant moderating effect: Compared with the general population, odds of being sexually victimized are significantly higher for adults than for minors with a disability ( Q' = 8.21, p = .004).

The type of disability also had a significant moderating effect ( Q' = 41.11, p < .001), although the number of studies about autism and language impairment were insufficient ( k < 4) to be considered. Taking separately, intellectual deficits ( OR = 1.81, p = .011, k = 24), physical disability ( OR = 1.71, p = .007, k = 16), sensory disability ( OR = 7.57, p < .001, k = 12), and mixed types of disability ( OR = 1.76, p < .001, k = 28) were all associated with significantly higher risk of being sexually victimized than the general population ( Table 2). The highest risk was associated with sensory disability ( Table 2). Studies including participants with a psychological or emotional disability among their disability sample yielded OR similar ( OR = 2.54, p < .001, k = 7) to studies without psychological or emotional disability ( OR = 2.22, p < .001, k = 77), as the difference between these OR was nonsignificant ( Q = 1.09, p = .296).

Significantly higher risk of sexual victimization for persons with a disability are observed in most countries or continents of the world (Canada, United States, and Western Europe), although studies based in Australia, Israel, and Asia are still insufficient ( k < 4) to be included in the analyses ( Table 2). The moderating effect of the country where the study was conducted was significant ( Q' = 126.63, p < .001), with odds of sexual victimization being higher in African countries in comparison with all other countries and being lower in Western Europe ( Q' = 4.37, p = .037) in comparison with the United States ( Table 2).

No significant difference was found for the size of the effect size as a function of publication year ( Table 2). The differential effect between men and women could not be examined as most studies did not report the prevalence separately between genders. The effect of relationship with the abuser could not be assessed because such information was lacking in most primary studies.

Discussion

The main goal of this meta-analysis was to evaluate the risk of sexual violence against persons with disabilities compared to nondisabled individuals. Results showed that individuals with disabilities of all ages are twice as likely to be the victim of sexual violence during their lifetime than the general population. This rate is a little lower than the one reported in another meta-analysis focusing specifically on sexual violence against children ( OR = 2.9, k = 9; Jones et al., 2012). As this meta-analysis included both sexual violence in childhood and adulthood, our results may be more representative of the true magnitude of the risk of sexual violence against persons with disabilities across their lifetime. This finding shows that sexual violence is a major problem for persons with disabilities as they are at increased risk. Sexual violence prevention and education curriculum should be offered specifically for this vulnerable population ( Barger et al., 2009).

A second objective was to determine whether that rate is influenced by moderators such as gender, the age of the victim, the type of disability, the type of sexual violence, the relationship with perpetrator, publication year, and country in which the study was carried out. Unfortunately, data were lacking to assess the effects of gender and relationship with the sexual offenders. Regarding gender, it would have been interesting to address the potential moderating role of sexual and gender diversity on sexual victimization, but it was not possible due to lack of information in primary studies.

The Moderating Effect of Age

Persons with disabilities were at significant higher risk than those without disabilities to be sexually victimized both when they were minors (age < 21; OR = 1.40) and adults (age ≥ 21; OR = 2.84), but the risk ratio was significantly higher in adults compared with the one in minors. This result suggests that although the risk of being sexually victimized diminishes after entering adulthood for persons without a disability, it remains relatively stable (if not higher) for persons with disabilities. In adulthood, individuals with disabilities still have the same limitations to consent and, in some cases, are still dependent on other people for care or personal assistance which may place them at higher risk of sexual violence than nondisabled people. These limitations are more similar between youth with and without disabilities. Moreover, adults with disabilities will likely have the same sexual needs as adults without disabilities, but the lack of adequate sexual education and social attitudes surrounding the sexual need and right of people with disabilities may place them at risk of sexual violence when trying to meet these sexual needs. Intimate partner sexual violence also represents a significant portion of sexual violence committed toward persons with disabilities, mostly involving adults ( Wade, 2002).

The Moderating Effect of Disability Type

Among persons with disabilities, the highest risk to be sexually victimized was associated with a sensory impairment with a rate nearly 4 times higher than that for other types of disability (intellectual/developmental, physical, or mixed; OR = 7.57). This finding contrasts with the results of Harrell (2017) which reported that hearing disabilities, a type of sensory impairment, had the lowest rate of violent victimization among the disability types examined. However, this meta-analysis specifically focused on sexual violence whereas Harrell included all violent victimization, such as robbery. Globally, these results support the importance of adapting prevention programs to the type of disability.

The Moderating Effect of Region

ORs for sexual victimization of persons with a disability were significantly higher in African countries ( OR = 20.01) than in all other countries, whereas it was lower in Western Europe countries ( OR = 1.60) than in the United States ( OR = 2.57). Although further studies in African (and Asian) countries are warranted, these results are more likely to reflect sociocultural differences than genuine risk difference. On the one hand, social movements such as #MeToo led to a significant increase in report of sexual violence to the police in North America (e.g., Moreau, 2019). On the other, official rates of sexual violence are known to be lower in countries with larger gender gap difference (e.g., Alyazzi del Frate, 2010), which might also affect (if not more) persons with a disability. Factors such as poor financial support, insufficient scientific taskforce, and lack of awareness or willingness to study the link between disabilities and odds to be sexually victimized should be addressed. Rates of sexual victimization for persons with a disability did not vary significantly across eras.

Summary of Critical Findings

The critical findings of this meta-analysis are summarized in Table 3.

Limitations

There are several potential limitations of this meta-analysis. First, even if one aim was to examine the moderator role of type of abuse (with or without physical contact) and relationship with the perpetrator, this information was not systematically reported in the studies reviewed. The type of housing (e.g., private house vs. institutional; independently vs. with daily support) might also represent a significant moderating factor in the link between disability and sexual victimization.

Second, since not all authors have the same definition of sexual violence, the prevalence rates may vary according to the position taken by the researchers. For instance, some will take a more conservative approach and decide to exclude all sexual violence without physical contact (e.g., exhibitionism, sexual harassment, indecent proposals), while others will prefer to use a more inclusive definition of sexual violence. When these prevalence rates are pooled, it is hard to interpret the estimated combined effect since the relative proportions involving sexual violence with and without physical contact can no longer be identified. Although this heterogeneity was reduced by the need to limit ourselves to just one form of sexual violence to avoid duplicating participants, the subcategory we used (rape) was not always present or identified using the same terminology (e.g., coercive sexual violence). Despite the conscious effort we made to select a form of abuse that referred substantially to the chosen concept or was as close to it as possible, some authors preferred to study the phenomenon of sexual victimization against individuals with disabilities from a broader perspective, that is, without using categories and sometimes without providing their definition of sexual violence in their study ( Giraldo-Rodríguez et al., 2015; Krnjacki et al., 2016; Platt et al., 2017).

The same situation was observed for the definition of disability, which could vary from one study to the next. Although some definitions appeared more often than others in the selected studies (such as one based on two questions, the first concerning the presence of limitations in activities of daily living and the second concerning the use of assistive devices), there was great variability in the measures used by researchers to establish whether or not a participant had some kind of disability. For example, some researchers recruited participants who self-reported as having a disability based on a few questions (e.g., Austin et al., 2016; Krnjacki et al., 2016; Martin et al., 2006; Mueller-Johnson et al., 2014), while others recruited participants who had received a diagnosis confirmed by a professional or with standardized measuring instruments (e.g., Brownlie et al., 2007; Haydon et al., 2011; Kvam, 2000; Mandell et al., 2005) or who had been admitted to a specialized treatment unit for people with disabilities (e.g., Ammerman et al., 1989). Thus, it would be reasonable to assume that the participants had differing degrees of disability and that, because of this heterogeneity in the degree of severity, we should be cautious when interpreting the risk rates obtained for each type of disability.

In addition, for certain subtypes of disability, such as developmental, neurological, language, learning disorder, and autism, there has not been enough research done to be able to interpret their respective risk rates. In fact, the small number of studies that include participants with these types of disabilities could be indicative of the real difficulty they have in being able to express the trauma they have suffered relative to others and not that they face less danger of being the victim of sexual violence. Yet the lack of results for these five categories of disability should not be confused with the absence of risk of sexual victimization.

Implications for Practice, Policy, and Research

These results have several implications for practice and policy. First, they show that school health and general health care professionals should be aware of and better equipped to (e.g., receiving specialized training, having access to validated instruments) assess sexual victimization of persons with disabilities. Second, public policy, the criminal justice system, and clinical settings should adopt systematic and standardized assessing and recording of possible sexual violence of persons with disabilities. Third, access to information and knowledge about available services for persons with disabilities should be readily accessible. Nationwide publicity should be provided and targeted to persons with disabilities and related professionals (through specialized websites, for instance). Fourth, physical and adapted access (e.g., for motor, sensory, and/or communication impairments) to authorities and support services should be assured (e.g., arranging transportation; providing sign-language interpretation or Braille written questionnaires). Fifth, reluctance to disclose sexual violence by persons with disabilities due to a lack of awareness of rights, fear of losing a home or social, and financial/disability-related support should be recognized and addressed. Sixth, sexual education should be provided to adolescents and adults with disabilities to enhance their knowledge about their rights, the notion of consenting, and the definitions of intimate partner violence and illegal sexual acts in general. Overall, health care screening of individuals with disabilities for sexual victimization (including intimate partner violence) is warranted, not only for prevention but also for intervention and treatment.

These results also have several implications for research. First, it is clear that the link between sexual violence and certain types of disabilities (especially autism and language impairment) is understudied and deserves further attention. Second, sexual victimization of persons with disabilities is also understudied in certain countries, especially in the Global South. Better awareness of the phenomenon and higher financial support for research about it are critically needed, all the more so in these countries. Finally, several types of possible moderating factors such as gender, type of perpetrator (e.g., school staff, caretaker, family member), type of disability (e.g., cognitive vs. motor vs. sensorial), and living arrangement (e.g., private home, supervised home, institutional) deserve further investigation.

Supplemental Material

Supplemental Material, sj-pdf-1-tva-10.1177_1524838021995975 for Sexual Violence Against Persons With Disabilities: A Meta-Analysis by Amylee Mailhot Amborski, Eve-Line Bussières, Marie-Pier Vaillancourt-Morel and Christian C. Joyal in Trauma, Violence, & Abuse

Author Biographies

Amylee Mailhot Amborski is a graduate student in psychology at the Université du Québec à Trois-Rivières. She conducted this meta-analysis as a partial fulfillment of her doctoral essay.

Eve-Line Bussières is an associate professor in psychology at the Université du Québec at Trois-Rivières and supervises Amylee Mailhot Amborski. She works in the field of autism with an expertise in meta-analyses.

Marie-Pier Vaillancourt-Morel is an assistant professor in psychology at the Université du Québec à Trois-Rivières. Her research focuses on the effects of sexual violence on adults' sexual and relational functioning as well as on the emergence of sexual difficulties in couple relationships.

Christian C. Joyal is a full professor in psychology at the Université of Québec à Trois-Rivières. He works in forensic neuropsychology, neuroimaging, and sexology.

Footnotes

References

References marked with an asterisk indicate studies included in the meta-analysis

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Supplementary Materials

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# data[].attributes.attachment_link.title
Sexual Violence Against Persons With Disabilities: A Meta-Analysis

# data[].attributes.attachment_link.description
A growing number of large-scale studies suggest that people with disabilities are at greater risk of sexual victimization than nondisabled individuals. However, certain results are inconsistent and whether potential moderators explain this ...

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Feminist disability studies emerged as a field of inquiry in the late 1980s, merging insights from the feminist movement and disability rights activism, with a focus on critiquing how disabled women were often excluded from both movements, highlighting the unique experiences of women with disabilities and the intersectional nature of oppression they faced; the term "feminist disability studies" was coined by scholar Rosemarie Garland-Thomson in the early 1990s, solidifying the field as a distinct area of study that analyzes the social construction of disability through a feminist lens.

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Disability Studies from Theory to Practice:  Finding Bioethics in the Frankenstein Ballet