“Disability is a political and cultural identity, not simply a medical condition.” 

 

– Friedman, 2019

This is part of our #AmIQualified editorial series, in which we discuss diversity, bias, and privilege, and the steps SLPs can take to ensure equitable, inclusive, and ethical services. See our other #AmIQualified editorials on privilege in SLP, cultural competence, bilingualism and white supremacy, and racism.

This post serves as an introduction to the concept of ableism, presenting points of consideration for SLPs who are beginning to learn about it. If you’re already familiar with ableism, the information presented here will not be new to you (but you might appreciate some of the links and resources). We have a more advanced discussion on the way for those who are ready to peel back the next layer.
 

Diversity, Equity, and Inclusion. What does that mean? 

In a nutshell, DEI initiatives are a step toward ensuring systemic support and a level playing field for people of all cultures, races, and genders. We want to topple the kyriarchies (these are systems that perpetuate oppression by elevating one group over another; e.g., racism, ethnicism, xenophobia, homophobia, transphobia, classism, sexism, ageism) to make life, liberty, and the pursuit of happiness a reality for everyone. 
 

If you view disability through the social model lens, then you likely see disability as a form of diversity. But society today, including how the field of speech-language sciences has been operating, pretty much runs on the medical model of disability, which translates readily to the view of disabled people as “less.” And you may have heard a word for that: ableism. 
 

We already know that -isms are beliefs that one group or type of person is inferior to the rest. Ableism is perceiving disabled people as inferior to abled people, and it manifests in many different ways at both systemic and personal levels. Throughout history, ableist acts have ranged from deliberate and absolutely horrific* to unintentional but still harmful. 
 

*Content warning: These links contain information on eugenics, the Holocaust (online museum exhibit, video presentation), and unethical medical experiments. 

“Enlightened ableism describes how non-disabled people employ a rhetoric of inclusion and equality related to people with disability, but continue with practices that marginalize and discriminate.” 

 

– Sharma & Hamilton, 2019

Am I causing harm?

Definitely. We all are, because it’s so woven into modern society.
 

For first steps, it’s common for folks to want a “Do” vs “Don’t” list. For example, don’t use words like “crazy” or “spaz,” or “that movie was so lame,” to express that you didn’t enjoy the movie as it uses mental, cognitive, and physical disability as the expense for comparison
 

But anti-ableist practice (and life) requires a much, much deeper look than an action list can provide. And if you haven’t looked closely yet, some forms of ableism might surprise you. Inspiration porn, like those viral “feel-good” videos and posts you see on social media, is a prime example. A non-disabled person being praised for being friends with a disabled person, or when a disabled person goes about their daily activities (grocery shopping, working out), and non-disabled people gush about their bravery and strength. This is like taking ableist microaggressions and broadcasting them for the benefit of non-disabled people. 
 

Wait… have I provided ableist services?

Yup. All of us have probably done or said something ableist in a professional capacity. Here’s where it gets tricky, because most of us probably don’t do these things on purpose. We think we’re doing the right thing, we think we’re helping people. But because education and healthcare run on deficit models (fix the deficit so the person is “normal”), ableism is kind of ingrained until we realize what it is and start noticing it in ourselves and others. It’s very easy for our praise patterns, or our therapy goals, to inadvertently teach kids that their worth is determined by their ability to perform academically, socially, or vocationally. 
 

Ableism in the speech therapy world might look like passing judgment on other professionals based on their vocal, feeding, or speech characteristics (see more examples here). It might look like dismissing a multiply-disabled individual from speech services altogether because our data (*our data*) show they haven’t made progress—instead of reimagining services for self-advocacy or communication breakdown repair through AAC. Or, keeping them in services for too long because we’re trying to meet some ableist standard of perfection!
 

So what do we do?

Recognize your biases. This may come with a level of discomfort. It’s not easy to process the thought that we come from a place of privilege, but it’s an important step. Start by increasing awareness of how our environment and society are structured in a way that is not accessible to everyone. And how the message to disabled people is that their job is to constantly try to appear and act non-disabled.

Seek perspectives from the populations you serve and learn the barriers they face. Question “the way it’s always been done.” Is there a better, more equitable way that doesn’t center non-disability as the goal? There are tools available to help engage individuals in the decision-making process no matter their age or ability. These are their goals and plans of care, after all. For more perspectives, check out these TED Talks on ableism from both disabled and non-disabled presenters. And consider incorporating resources created by the populations you serve to ensure representation in your therapy materials (e.g., this website, run by disabled Black, Indigenous, people of color, includes a small library of stock images you could use). 
 

Use inclusive language. Not sure what counts? Explore ableist words and expressions (and non-ableist alternatives) in this blog post by Lydia X. Z. Brown, and a perspective on why it matters here.
 

Take action. Remind your DEI committees that disability is a form of diversity, too. Tools like Universal Design for Learning are worth exploring. UDL is an evidence-based framework for adjusting the environment so that it is accessible to all learners, no matter their ability. Develop accommodations for your disabled students, and advocate for their use. This is how we meet disability through a social lens, by socially supporting disability throughout our community environments.
 

Search our site for more #AmIQualified posts. We have more on ableism and other -ism topics coming soon! And please don’t hesitate to reach out to us if you have expertise or lived experiences related to this topic as well. Thanks for thinking and growing with us!