From disablement to enablement: Conceptual models of disability in the 20th century

Purpose. The aim of this work is to provide a general view of the conceptual elaborations on disablement in the 20th century and to discuss the role of these different contributions in developing the current concepts of disablement. Method. A review of the literature on conceptual models of disablement in the past century has been performed. Results. The 20th century has witnessed important theoretical considerations on health, diseases and their consequences. These considerations have generated various conceptual models, some of which share the same focus and point of arrival, the so-called 'Disablement Process'. Among the models that were developed, two stand out, which were drafted and disseminated under the aegis of the World Health Organization, namely the International Classification of Impairments, Disabilities and Handicaps (ICIDH) and the International Classification of Functioning, Disability and Health (ICF), but these are just one part of the conceptual elaboration in the field. Further conceptualization was produced in health and social settings by specialists, self-advocacy associations and activist groups. Conclusions. The current ICF model of the World Health Organization has been translated and recognized in 191 countries; it also incorporates the contribution of self-advocacy associations and it is now recognized by most of them. This model has enjoyed higher visibility than other conceptual models, though its level of development was not higher or more original. To our opinion the ICF is not very clear on the essential choice of the model, i.e., to see disablement as a dynamic process that happens when personal limits collide with socio-environmental needs, rather than as a personal feature. This choice is instead clearer in other models, like Nagi's 1991, the Institute of Medicine (IOM) model by Brandt and Pope, where the identification of three dimensions (the individual, the environment and the individual-environment interaction) clarifies the role played by all three dimensions within the process of disablement and introduces major hints for further considerations on how to create virtuous processes of enablement.