Issues of Normalcy and Disability in Relation to Prosthetics

Man has had to deal with his climate, other members of his species, and people from other species in order to survive. This contact has been known to be dangerous in the past, with injuries arising from trauma or accidents. Prosthetics is the science of using artificial additions to replace missing body parts, especially limbs, in order to improve aesthetics, restore wholeness, and/or improve physical functionality. The term prosthetics comes from the Greek words for "to add to" (pros) a position (thetikos). A congenital anomaly (such as Amelia after maternal thalidomide ingestion), traumatic loss (war), and disease consequences (such as leprosy) are all common causes of the absence of a body part. The word prosthesis refers to the actual addition that is placed on the body.

The media hypothesis postulates look at prosthesis as an addition that is meant to be a continuation of oneself and help with the manipulation of the environment). This theory acknowledges the deficiency in the environment, which will not be changed without the manipulation from man. It also shows the deficiency of the man, who requires the prosthesis to interact with his environment. This hypothesis is in itself, a two-fold phenomenon referring to a virtual sense of addition (man with his typewriter) and a physical sense of addition (an amputee with his prosthetic leg or arm).In whichever form; a prosthesis is a medium of interaction with one's environment.

Prosthetics have been a part of man’s civilization from millennia. Prosthetics have evolved from mere physical replacements of lost limbs to today’s complex technologically advanced functional analogs of the lost limbs. The earliest signs of prosthetics are seen from the Egyptian civilization with the replacement of severed or lacking limbs with wooden stumps. The earliest sign of a functional prosthetic limb also came from the Egyptian civilization in the form of a metallic toe custom fit to the owner of the lost limb. The growth of prosthetic science slowed during the dark and medieval ages, only to recur in the 18th and 19th Century with the rise in war and casualties thereof. Suffice to say that the injuries from war especially from the 18th to 19th century were a big motivation in the development and evolution of prosthetics. Some survivors of war on return home were involved in the creation of artificial replacements of their severed body parts. This advancement necessitated prosthetics made from different materials that were not prone to infection e.g. from wood to iron to metallic alloys; focused on the comfort of the prosthetic.

Perhaps, the bigger question is why man is so enamored with the prospect of replacing and maintaining function. Other than the convenience of replacing a lost biological function, is there a deeper social construct that insists upon remaining within the norms of society and in this way frowns upon any atypical functionality not seen with the average members of the population?

Historically the term disability was akin to inability, there was a notion therefore that disability of any kind showed a complete lack of ability to sufficiently interact with one’s environment. These can be illustrated by some communities’ interaction with the disabled. A Kenyan tribe would tie up the mentally handicapped outside the home to live out their life. Children with Down syndrome were for a time thought to all of equally very low IQ. However, these ideas have evolved over time to mean a stable limitation.

The World Health Organization, however, hopes to give a wider and more inclusive definition. It includes the medical (an issue involving a body part and thus having a physical manifestation of limitation of function) and the social (an issue that takes away from the normal interaction of one with their environment either during execution or involvement).

There are some generally accepted models used to analyze disability. The medical models of disability analyze disability as a biological impairment. Therefore the medical models explain the disability experience and consequences as a result of the biological mental or physical impairment. The medical model by looking at the impairment as a biological phenomenon fail to accurately account for the social consequence of the impairment.

The rehabilitation model is an offshoot of the medical model. It postulates that with sufficient rehabilitation, a person can recover from disability. Disability is an intrinsic trait that is abnormal and that can be recovered from. Its lack of acceptance of lifelong disabilities is a major reason why this model is not accepted.

On the other hand, the social models of disability look at disability as the limitation between the individual and their social experience (Anastasia 117). That is, disability purely as a result of an impaired interaction of the individual with their environment (Liasidou 2014) or with other individuals. The social model, on the other hand, is faulted as not adequately recognizing that because disability actually affects well-being; it has an actual biophysical limitation as a component.

Each model has its own downfalls. The above models have been used to create governmental policies but not satisfactorily. The term disability, therefore, requires the analysis of both the medical meaning of the term and the social-environmental implications to the term. It is not sufficient to only use one model because each model has its strength. Disability analyzed holistically allows a greater understanding of the disability experience.

The Biophysical model, therefore, is the most popular of the previous models as it incorporates emotional, environmental and biological factors. This model resonates with the disabled people because it appreciates every sector that may be affected by the limitations arising from the disability and thus allows them to lead productive and conscientious lives the biophysical model goes far and beyond the individual construct, the environmental construct but looks at the whole disability condition in society as a whole.

Disability and disease have a contentious relationship with lines between the two spectrums easy to blur. Disability is widely viewed as a manifestation of Disease together with pain, suffering and/or death. However this description is met with some resistance as it is too linear, there is a need, therefore, to approach disability wholly and understand health and disease and its implication on disability.

The World health organization (WHO) offers a value-laden definition of health, offering that health is a state of well-being involving physically, socially and mentally. An alternative definition of health is a state of lack of disease of or freedom from disease. That is health is a state of typical species physiological function (Boorse).

The WHO definition thus can allow one to be healthy yet disabled or to be unhealthy and not disabled. According to a value-neutral definition like that of Christopher Boorse, disability is inherently unhealthy but because of its value-free nature, it is atypical but not undesired.

In some, a disability may be as a result of disease(Amyotrophic Lateral Sclerosis and loss of limb function) or a disease may be classified as a disability due to its debilitating nature(leprosy).It is important to consider this as etiology and natural history of disability may determine the need and/or the type of corrective measure,

The atypical nature of the disability and the instrument nature of health under a value-free definition gives strength to the argument for corrective measures (Charlton 36).Instrumental health is a means to achieve a biological and survival end, corrective measures are therefore a means of recovering this biological function. These measures, however, do not only have to be medical but can also be social and environmental.

In this regard, prosthetics as a corrective measure can be viewed in a variety of ways. A prosthetic in that it replaces physiologic function (ability to walk) can be a medical corrective measure. However, it can also be seen as an environmental corrective measure, helping the person move from one place to another and as a social corrective measure (in that it can reduce the stigma of lack of a limb when interacting with other individuals).

The universality of corrective measures is questionable because not all scenarios require correction. Adaptation to an environment may be considered the use of one's traits to maximally exploit one's environment (Boorse, 511).For instance, a short statured stocky man due to malnourishment may be better suited for work as a coal miner than a tall robust man. Therefore, in some cases, the individual may use the nonconforming trait to the advantage of their environment. Therefore, in a situation where someone is disabled but healthy or where the disability is not because of a disease process and in a situation where the disability trait improves a person's interaction with their environment, corrective measures may be unnecessary.

Normalcy is a conformity of a variable or a trait based off of the average of that variable collected from a population. The need for belonging and identity is a common theme in man. Allowing one to survive as part of a clan or tribe of other individuals. Historically, to be chosen as part of a tribe or clan required that one had certain desirable traits that would build upon the strength of the tribe or clan such as physical strength and agility. Distinctly, there was also a need to conform physically and socially to members of the tribe. The very sick and the very old were left to the will of nature.

Two different societies thus can be seen to develop from this paradigm. The ideal society, in this society, desirable traits are collected from each individual to model an ideal human that is unattainable to reach and thus that no one can conform to. In contrast, the conformist society, that conforms to the average traits of the individuals in a population (Hartley 128).

The development of statistics in the European culture gained wide acceptance in the 19th century with the use of mathematics and statistics in a wide variety of political and public health issues. Statistics application to the human society also established itself into European culture. It is at this time that there was a need to conform to the specified average traits of the population as a whole, with outliers to those traits standing out in the population. Over time, this conformation to the average traits became the ideal (Hartley 125).

A political philosophy also began to dominate based off of this social conformity to normalcy. That is, a need to correct for the people who were perceivably no conforming to the social normalcy. These corrective methods were either financial or medical corrective methods. A powerful social construct of dependence was therefore created and perpetuated.

Christopher Boorse outlines that most medical definitions of normal health parameters (blood pressure, weight, pulse, basal metabolism rates) are collected from the average of population. Thus, statistical normality also rears itself in the medical definition of health as well. Consequently, this average collected from the population is seen to represent health. However, this thinking may be flawed in that the average parameters may be a representative of an unhealthy population or an atypical trait like red hair could be completely healthy(Boorse 507).Thus furthering the question whether statistical normality should be the guideline to describing disease.

Every species is designed with specific physiological functions that help it to survive in order to reproduce the next generation of species. For the species to be healthy it has to at least perform each of these physiological functions efficiently and in a concerted fashion. A failure of one of the physiological function can jeopardize the health of the individual in the species. However, disease itself is heterogeneous nature and abnormal functioning of the body can be compensated for and show no symptomatic signs of illness or disease for a long time. However, extreme case the otherwise typical body may decompensate and finally show disease. Therefore, health is seen as a state in which the individual’s system is functioning on a typical capacity, with typical efficiency in a typical environment (Boorse 504).

In the conformist and normalcy society, a new paradigm develops called Disablism. This is a phenomenon, that is social relational in nature. In it, those who conform to society, or are seen as normal by society impose a new social paradigm that restricts those seen as disabled in terms of their interactions with their environment, with their aspirations and during their execution of normal activities. In this way then, the disabled person becomes socially oppressed and restricted (Anastasia 121).

Discrimination of disabled persons then is just wholly based on the person’s limitation and this leads to a strained social relationship. This social phenomenon may be structural and institutional for instance with the lack of provision of ramps for wheelchairs, lack of toilet amenities for the disabled. These external albeit subtle or strong forms of restrictions by society may leave disabled people frustrated and unwilling to interact with the general to society. An internal crisis may as well occur from the labels that are associated with the disabled. These labels may occur in areas of education, at home or in the media. These labels may have a deep undesirable effect with the disabled especially as children or as adults.

From this, an issue of contention also arises on classifying disabled groups as a minority needing specific rights and protections. This is because, in the face of Disablism, disabled persons may have their rights interfered with. In this case, disability moves from a whole health perspective to involve a social and civic rights one. Some of the advocated for disabled people rights have compared the oppression of the disabled with the stigmatization based on race, sexuality, and religion (Charlton 25).

Others, however, argue with these based on the fact that ideally disability in its itself a biological manifestation of universal human variability, thus disability should not be taken to be outside the norm but rather within the norm of variation. Nevertheless, due to the society factor, the disabled groups do face a considerable amount of stigma and discrimination as they are looked upon as inefficient or as dependent and thus may require the protection of a minority group to adequately cater for this difference (Charlton 26).

The drive to conform may be such a strong determinant of social success that an individual may be driven to discard their non-conforming trait even if there is no immediate medical need to conform. The earliest prosthetics, in the Egyptian civilization, were meant to replace the limb even in physical space alone; however, they did not replace function of the limb that was absent. The phantom limb phenomenon is now an accepted medical entity, where people who have lost their limbs through traumatic injury still have a sensation of limb and can even feel pain where the limb was previously located. The need whether conscious or subconscious to appear whole or to conform to social standards, albeit, perfectly or imperfectly.

In the 19th century, additionally, with the advancement of surgical procedures, there was a growth of clubfoot operations to try and straighten the foot, some of these, however, ended infected and resulted in amputations (Boorse 432). Despite the fact that some of the people who had the disability were well adapted to their environment but not to social conformity.

Social Conformity and the need for normalcy could, therefore, be a driving factor towards the creation of prosthetics. Body image is a sense of physical self-experience from childhood into adulthood. It is shaped by both external factors and internal factors. In childhood, this recreation in our mind of physical self is largely contributed to by our external environment because that is our primary teacher, as we have no prior experience to base life from.

The idea of body image is thus one of prime importance to health professionals dealing with people with a disability who may need a prosthesis. The body image bears and learns from the external environment thus the need to fit the norm may be a big contributor to why an individual may want a prosthesis.

This also has another connotation, of prosthesis embodiment. Each individual is different and their interaction with their environment will play a big role in their taking up of and acceptance of the prosthesis as part of them. The prosthesis for a child with a congenital anomaly of a limb may give an opportunity to finally interact normally with the environment. However, an individual who received a prosthesis later in adulthood after an accidental trauma at the workplace may view the prosthesis as a physical manifestation of his disability and thus a nonconformity to the norm.

The views of normalcy and disability, therefore, have a large bearing on individual’s perception and experience with prostheses. Disability in that it may limit the function of an individual, be it physical or social may encroach on someone’s identity. This is because one may end up being wholly identified by their disability

Prosthetics as a corrective measure may be used to change this situation. However, prosthetics may also disrupt one’s identity further because one may fell they are fully reliant on the prosthetic for their biological functioning. Further, for technologically advanced prosthetics that can interface with our neural network (Hill 87).

A question also arises as to whether the disabled individual who uses prostheses is still part and parcel of the tribe formed with other disabled individuals. Prosthetics may also be viewed as encroaching on one’s sense of independence. This is because they require maintenance, regular diagnostic and counseling services. Thus, it may be argued that the desired normalcy that is desired from prosthetic treatment is not fully achieved. Moreover, a part of the social construct of disability is that there is an ineffectiveness and a dependence on society. With prosthetics, this dependence on technology and medical treatment is still maintained

In conclusion, prosthetics as a branch of science continues to grow in leaps and bounds. Scientists have tried to integrate the best technology has to offer with a more realistic interaction between individuals and prosthetics. Integrated within prosthetics are sensory devices that allow for proper manipulation of the environment. The information age has also improved upon prosthetics. With neural interfaces and robotics being used to change the face of prosthetic science.

In this regard, scientists have started theorizing an alternate future where body augmentation and prosthetics will be integrated into society. The Cyborg theory (Garfield 18), for example, has brought to light on a new facet growing in science propagated by the internet technology. As a cyborg is a hybrid organism fully reliant on technology and enhanced with prostheses and implants, some authors foresee the world where cyborgs will be the desired even without being a conforming to the norm. Consequent to their dynamic and hybrid nature there is a feeling Cyborgs may cut across modernist thinkers by cutting across social constructs.

In addition, prosthetics may in the future be seen as desirable substitutes because of improving physical performance. Augmentation of the body, may then be a way to achieve ideal traits not available through the slow process of human evolution. Therefore, there may be a future where prosthetics are not only used as a fix to a disease process in response to disability but rather as a desirable and post-human extension. For now, a broader understanding of disability and its issues in relation to normalcy and health will only help build social understanding. Often time’s medical policy and social relations are hampered by a lack of understanding of the core issues facing the disabled, especially the social pressure to conform.





Works Cited

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