DISABILITY STUDIES

DISABILITY STUDIES

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Critical Analysis of the Relationship between Professionals and People with Intellectual Disabilities

 

Introduction

Romme (2016) explain that a professional is someone who has undergone extensive training to acquire a certain skill or skills. In these training, they have to obtain sufficient level of knowledge to enable them to execute their duties. These professionals work in three models: Trait Model, power as a key determinant, and finally social disability model. Among the features of a professional is the capability to execute duties and services as required, adherence to the professional code of conduct, trustworthiness and a focus on service provision. A good example of a professional would be a psychologist, a psychiatrist, and a doctor.

On the other hand, individuals with intellectual disability are those who harbor significant limitations in adaptive behavior and intellectual functioning. Intellectual functioning relates to the general mental wellbeing and capacity including reasoning, learning, practical and social skills. These imbalances or limitations are usually manifested among an individual before he or she attains the age of 18 (American Association on Intellectual and Developmental Disabilities, 2013).

There has been a discussion from various quarters about the existence of power imbalances between healthcare providers and patients of the intellectual disabilities. Subsequently, this has created an environment where the patient’s rights are abused. In addition, the power vested by the professionals is outrightly abused. For instance, Hanson and Mandeville (2000, p.15) notes that the relationship between persons with intellectual disabilities and professionals has been jeopardized by power imbalances. The authors goes on to point out that this imbalance is widely manifested in professional practice, agency culture, program policy and personal dynamics in healthcare delivery involving patients with intellectual disability. The purpose of this paper is to present a critical analysis on the effect of power on the relationship between professionals and people with disabilities.

How Professionals Work

To comprehend the expected relationship between persons of ID status and professionals, we first ought to know the way in which these professionals work. Accordingly, they work in three ways:

  1. Trait Model
  2. Social Disability Model  and
  3. Power, as a key factor determining the relationship of the disabled and professionals (Watson et al, 2014).

The trait model which was coined by Meerabeau and Abbott explains a professional as someone who has undergone the required training and acquired the needed skills and expertise in conducting their various works. This professional is supposed to employ the philosophy of service orientation, adhere to the laid down professional codes, and be honest and trustworthy.  

The second model which is power is as a key factor in determining whether the relationship between the disabled and professionals will be positive. For instance, if the professional exhibit excessive power and authority, then the disabled individual will not exercise his or her rights as desired and many not be involved in decision-making processes regarding her health status and or treatments. Power is usually relayed through professional knowledge and information and which can lead to the development of hierarchy within the same profession or extended within different professions (Brandon, 2014, p17-22). The final model is that identified as the social disability model whose focus is to counteract the oppression that disabled individuals undergo. In accordance to Heaslip and Ryden (2013), this kind of oppression is manifested through the medical model. This is whereby; professionals resort to maintaining the situation by personalizing problems of the disabled person. As per this model, all the problems affecting the disabled individual are as a result of his or her actions, and that the environment has no role in this. This deviates with the social models which require professionals to regulate the physical and emotional behaviors of the disabled individual and work to encourage them at conforming to specific norms.

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Professional’s Power and the Wellbeing of the Disabled Person

The relationship between professionals and disabled individuals has always been a smooth one. Further, this relationship can be better understood using historical developments, social perspectives, discourses and ideologies underpinning professionalism and the relationship between the patients and the professions, structural elements and the relationship between the state and the professionals (Watson et al. 2014).

Some studies and authors have presented detailed analysis regarding the way the disabled are abused, including the interaction between the disabled and carers Bennett et al., 1997, Biggs et al., 1995 and Slater, 2000). Similarly, Ticoll (1994) presents ways in which disabled people have been mistreated and their rights violated by those who are supposed to protect them and their rights. For instance, some of these disabled persons are reliant on their carers for issues such as economic, psychological and physical support or other essential needs. As such, they have no control over the actions of their perpetrators whether negative or positive towards their lives. Furthermore, they do not harbor the voice or credibility to complain about their supposed mistreatment. Chenoweth and Robinson, (2011) observed that the actions of the staff and or leaders, their behaviors, decisions and perceptions had a significant effect on the attitude and general well-being of the disabled person. Other factors that contributed to this abuse include service design, isolation of the disabled individual, and quality of the care environment, placement commissioning and planning, as well as the attitudes of disabled persons were critical factors determining the existence of abuse towards the disabled.

According to Marsland et al., (2007, p. 12) power is an essential construct determining the issue of abuse. Whenever power imbalance occurs at any level of the care hierarchy, then this creates a potential for its inappropriate utilization, thus reinforcing the risk of it being abused. The author continues to point out that power misuse leads to corruption of care and which subsequently results into designing and providing services which are not of the desired quality. Other issues that may be overlooked include moral concerns, lack of accountability in healthcare resources, and facilities. Consequently, this will lead to poor attitude, a feeling of isolation among the disabled populace.

Traditionally, professionals have misused the power accorded to them in various ways, of course to the disadvantage of their supposed clients. These include

  1. Terrorizing-whereby; the professional coerces a person into accepting certain behaviors, medications or beliefs, intimidating, refusal to attend a person as required and appropriately, utilizing equipment, and tools that are more intrusive, forcing compliance through punitive measures (Goddard and Tucci, 2003).
  2. Exploitation- In this case, a person is socialized into accepting actions or ideas that are contrasting to established legal standards. The professional may also resort to training an individual or individuals for his or her interests, or using the person’s situation for their advantage in one way or another (O’Hagan, 1995).
  3. Isolating – Where a person is unnecessarily restricted from accessing their relative, friends, colleagues and even neighbors. Individuals may also be restrained from accessing TVs, phones, work opportunities because of among other issues the schedule of the caregiver, and or contact with the administrator or manager (Glaser, 2002).
  4. Degrading-  This is another form of abuse towards the disabled and which include ridiculing a person, his or her religion, tastes and preferences, ignoring requests, harassment, or forcing the person to accept programs or beliefs which he or she does not ascribe to (Kovener, 2000).
  5. Neglect- This is also a common form of abuse which involves ignorance to provide care to a particular person or individuals, failure to offer stimulation, psychological support or nurturance as required (Champagne, 1999).

 

How Professional Power can be used to enhance the Relationship between the Disabled and the Caregiver

In accordance to Brandon, the kind of power exhibited by professionals determines the kind of relationships that will develop between them and the persons they are serving. He goes on to articulate that professional power is expressed through the exchange of knowledge and expertise. Therefore, that what they execute as their professional knowledge must be resilient, reliable, and of the high quality as possible.

The professionals are also supposed to embrace the social model of care which requires them to regulate the behaviors and emotions while encouraging them to confirm to specific norms. However, this should be on a positive perspective (UK Department of Health, 2011). According to Cameron (2013), this model is purposed to improve the wellbeing the clients including the disabled since it requires providers to offer personalized, but systematic support, and which should be tailored to individuals and groups thriving in the social care systems. Furthermore, the use of this approach will make it easy for the professional to interact with the client in a positive way and hence; create a positive relationship. It as well enables the practitioner to extend this interaction into other stakeholders including the management, the patient’s relatives, friends, colleagues and all those involved in care delivery. Subsequently, this will enable patients, (the disabled in this case) to have a positive attitude towards the staff and other professionals handling them at a social care system.

 

Three levels of power

 

  1. Structural Level

 

Magee and Galinsky (2008) explain that at the structural level, power occurs in social hierarchies, social structures or organizations. Marx introduced a philosophy of cultural hegemony which stipulates that in a society which is diverse, there is a tendency for the ruling class (or those in higher hierarchy) to manipulate the culture of the particular society. These include beliefs, values, and attitudes. Consequently, this will make the subjects to accept the cultural perspectives being advocated or implemented by the other in authority or with power. This implies that cultural hegemony tries to make the legitimize and give consent to professionals to influence the culture and values in individuals with intelligent disability

(Duncombe, 2012).

As indicated by Thompson (2010), people with ID find themselves embracing the ideas espoused by the professionals and which also become naturalized in them on a gradual basis. Consequently, they go on to generate stereptyped assumptions such as the disabled individuals have no values or a black disabled person will have to face many limitations as compared to the white counterpart. The social hierarchy therefore determines the relationship between individuals with disability and professionals at a structural level. In this respect, the social hierarchy structures divergent aspects of social identity including socioeconomic status, class, gender, ethnicity, age, alongside the various categories of disabilities. These aspects are essential particularly since they play a huge role in structuring a person’s life experiences.

  1. Cultural

 

Veneklasen and miller(2006) presents different types of cultural practices and values and how they relate between individuals with ID and professionals. The diverse cultural aspects include religion, ethnicity and organization cultures.  Different authors have opined that in most cases, disabled individuals are negatively perceived by majority of individuals.  For instance, for the majority of religions, cultural societies, and or ethnic groups, disabled individuals and disability in general are not viewed in good terms or in other words in positive terms. However, studies have showcased that disabled individuals and disability in general is defined by a society within a particular country and its meaning is determine by the inherent culture (Munyi, 2012).  In historical sense and among some societies such as in India, disability is considered as a bad omen and punishment for past evils. Subsequently, disabled individuals become rejects or outcasts in their own country.  These makes disabled people including those with intellectual disability to be powerless (Siperstein et al., 2004).  As earlier noted, the power vested by professionals is owed to their knowledge.

Additionally, a number of professionals are regarded as harboring the capability to deal with individuals who are having ID more specifically when these professionals hails from the upper echelons of the society.  For instance, in India, professionals are considered as a gift from god (Narayan, 2004). Therefore, individuals with ID are required to oblige and conform to the professional’s guideline which they are required to consider as pure truth. Consequently, this accord the professionals power in a cultural context while rendering ID people powerless.

 

Conclusion

This analysis makes it clear that the professional’s power has not always been used appropriately in traditional perspective. Consequently, this has resulted in abuse of disabled persons in various ways; economically, socially, psychologically, physically and even health wise. We have also seen that power abuse may be inform of isolation, degrading, exploitation and even terrorizing. This misuse of power can be regarded as a breach of the professional conduct which requires professionals to be people of integrity, oriented to the philosophy of quality service delivery, putting the interest of clients first and adherence to established care standards. This requires the said professionals to embrace the right care models including the social care model and most importantly, executing their power appropriately.

 

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