Changing Understandings among Physicians of Developmental Disabilities, 1950-1980

FAIN: FT-254241-17

Andrew Joseph Hogan
Creighton University (Omaha, NE 68178-0133)

Research and writing of a book on medical understandings of developmental disabilities in the second half of the 20th century. 

After 1950, the understanding and management of developmental disabilities were impacted by two countervailing trends. As public support for the unique needs and experiences of affected individuals increased, physicians began to link developmental disabilities to genetic causes. Genetic associations led to new identities and resources, but also reified disability as a pathological target for medical intervention. Scholars have extensively explored increasing postwar social support for disability. Less has been done to examine how evolving societal views of disability influenced the medical community. This project draws on archives, published literature, and interviews to examine evolving clinical narratives of developmental disabilities. The PI examines how and why new narratives of developmental disabilities entered the medical community, how clinicians responded to alternative viewpoints, positively and negatively, and the role of some professionals in promoting broader adoption.

Associated Products

The ‘Two Cultures’ in Clinical Psychology: Constructing disciplinary divides in the management of mental retardation (Article)
Title: The ‘Two Cultures’ in Clinical Psychology: Constructing disciplinary divides in the management of mental retardation
Author: Andrew J. Hogan
Abstract: During the late twentieth century, drawing on C. P. Snow’s well-known concept of a “two cultures” divide between scientists and humanists, many psychologists identified polarizing divergences in their discipline. This essay traces how purported professional divides affected the understanding and management of mental retardation in clinical psychology. Previous work in the history of science has compared the differing cultures of disciplines, demonstrating that there is no one, unified science. Through an examination of multiple “two cultures” divides within the discipline of psychology, the essay demonstrates that perceived divergences in the field were animated by considerations of professional identity, ambitions, and goals. It argues that differing views among clinical psychologists about mental retardation, and crucially the localization of its causes—in individual bodies, minds, and genomes or within social institutions—reflected their position among the multiple “cultures” of psychology. References to Snow’s two cultures spanned the late twentieth-century scientific and clinical literature and were often used to encourage a conversation about the nature and goals of research in a field. In considering these purported “two cultures” divides, the essay proposes that historians of science must take care to look beyond constructed polarities, to instead analyze the resulting discussions about professional training and purpose.
Year: 2018
Primary URL: https://www.journals.uchicago.edu/doi/abs/10.1086/701062
Format: Journal
Publisher: Isis

Moving away from the" medical model": The development and revision of the World Health Organization's Classification of Disability (Article)
Title: Moving away from the" medical model": The development and revision of the World Health Organization's Classification of Disability
Author: Andrew J. Hogan
Abstract: Recently, there has been a prominent call in the history of medicine for greater engagement with disability perspectives. In this article, I suggest that critiques of the so-called medical model have been an important vehicle by which alternative narratives of disability entered the clinical arena. Historians of medicine have rarely engaged with the medical model beyond descriptive accounts of it. I argue that to more adequately address disability perspectives, historians of medicine must better historicize the medical model concept and critique, which has been drawn upon by physicians, activists, and others to advance particular perspectives on disability. My present contribution describes two distinct formulations of critique that originated in differing interest groups and characterized the medical model alternatively as insufficient and oppressive. I examine the World Health Organization’s efforts to incorporate these distinctive medical model critiques during the development and revision of its International Classification of Impairments, Disabilities, and Handicaps.
Year: 2019
Primary URL: https://muse.jhu.edu/article/729239/summary
Format: Journal
Publisher: Bulletin of the History of Medicine

Social and medical models of disability and mental health: evolution and renewal (Article)
Title: Social and medical models of disability and mental health: evolution and renewal
Author: Andrew J. Hogan
Abstract: Over the last 6 decades, many published commentaries, from both within and outside the medical community, have criticized medicine’s characterization and management of mental illness and disability. These critiques have often referenced the “medical model,” a term that has multiple meanings but has almost always been used pejoratively. Prominent critics have included disability scholars and self-advocates, who attacked the so-called “medical model” and espoused an alternative “social model,” which characterizes disability as the product of an unaccommodating and oppressive society, rather than an individual and medical problem. The terms “social model” and “medical model” have frequently been used to highlight opposing views of disability, but there has been little historical examination of their origins and evolving meanings. 1 As a result, clinicians have had limited access to information about what these concepts mean to patients, making it difficult to respond adequately to the concerns they raise. For physicians, fully embracing social-model views would require political engagement and a greater focus on societal, rather than individual, problems. Even if most physicians do not adopt these roles, increased awareness of disability perspectives and familiarity with critiques of the medical model may help them to identify new ways of improving care for their patients, while also enhancing opportunities and support for clinical trainees and colleagues with disabilities.
Year: 2019
Primary URL: https://www.cmaj.ca/content/191/1/E16.short
Format: Journal
Publisher: Canadian Medical Association Journal

Disability Dialogues: Advocacy, Science, and Prestige in Postwar Clinical Professions (Book)
Title: Disability Dialogues: Advocacy, Science, and Prestige in Postwar Clinical Professions
Author: Andrew J Hogan
Abstract: Disability activism fundamentally changed American society for the better—and along with it the views and practices of many clinical professionals. After 1945, disability self- and family-advocates pushed for the inclusion of more positive, inclusive, and sociopolitical perspectives on disability in clinical research, training, and practice. Few books highlight disability advocates’ powerful efforts to reshape clinicians’ conceptions of disability. Too often, disabled individuals are presented as patients, victims, or dependents. In Disability Dialogues, Andrew J. Hogan highlights the contributions of disabled people—along with their family members and other allies—as professionals and activists who were influential in changing clinical understandings and approaches to disability. Scholars and advocates frequently point to clinical professionals’ presumed adherence to the “medical model” in accounting for their overly narrow and negative understandings of life with disabilities. Hogan instead reveals the value of examining clinical professionals’ concerns about role, identity, and prestige in motivating their rejection of more optimistic and accepting perspectives. Clinicians often viewed disability advocates’ efforts to reframe the experiences and oppression of disabled people in terms of sociopolitical and environmental factors as challenges to their professional status, jurisdiction, and preferred scientific theories and ways of knowing. Likewise, more positive views of disability were seen as threatening to clinical “objectivity.” Disability Dialogues contributes to historical, sociological, and bioethical accounts of disability and clinical professionalization. Hogan makes the case for why present-day clinical professional fields need to better recruit, welcome, and support disabled practitioners. Disabled clinicians are uniquely positioned to combine biomedical expertise with their lived experiences of disability as a sociopolitical issue and identity.
Year: 2022
Publisher: Johns Hopkins University Press
Type: Single author monograph
Copy sent to NEH?: No

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