Prosthetics and Normalcy and Disability Issues

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Man has had to deal with his surroundings and other organisms to survive. This contact has proven to be dangerous in the past, with injuries arising from trauma or incidents resulting in the loss of body parts or even life. The science of replacing missing pieces, especially limbs, with artificial additions to improve aesthetics, restore wholeness, and improve physical functionality is known as prosthetics. The term prosthetics is derived from a Latinized Greek word that means “to add” (Coffey). The absence of a body part is usually caused by a congenital disability, such as Amelia’s after maternal thalidomide ingestion, traumatic loss, or disease symptoms, such as leprosy. The word prosthesis refers to the actual artificial addition that is placed on the body.

The media hypothesis looks at prosthesis as an addition that is meant to be a continuation of an individual 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 (McLuhan 11). 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 and a physical sense of addition. In whichever form; a prosthesis is a medium of interaction with one’s environment.

Prosthetics have been a part of man’s civilization for 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 (Norton). 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 of war and casualties thereof. Suffice to say that the injuries from war especially from the 18th to 19th century were a big motivation for the development and evolution of prosthetics (Boorse (a) 46). Some survivors of war on return home were involved in the creation of artificial replacements for 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; while equally focusing 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 (Boorse (a) 47). These can be illustrated by some communities’ interaction with the disabled. In early Greek and Roman times, those who were disabled were seen as a sign of rejection by the gods and were hence inferior to the rest of the human race. A West African tribe would assess the children who were born with disabilities and would leave them by the side of the river. This act of abandonment was done to return the children to the animal world where they were believed to belong (Munyi 32).

The World Health Organization definition, 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. In addition to the social, an issue that takes away from the normal interaction of one with their environment either during execution or involvement (World Health Organization (b)).

There are some generally accepted models used to analyze disability. First, there is the medical model of disability (Smeltzer 190). It explains the disability experience as a consequence of the biological, mental or physical impairment present in the individual. The medical model, by looking at the impairment as a biological phenomenon fails to accurately account for the social consequence of the impairment.

Second, the rehabilitation model is an offshoot of the medical model. It postulates that with sufficient rehabilitation, a person can recover from disability. In this model, the physical limitation is viewed as 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.

Thirdly, the social model of disability describes a limitation between the individual and their social experience. In this view, disability is pure because of an impaired interaction of the individual with their environment or with other individuals (Liasidou 123). Consequently, the removal of the barrier hindering the interaction between the individual and his environment will remove the disability. The social model, therefore, is faulted as not adequately recognizing that because disability affects well-being; it has an actual biophysical limitation as a component.

Each model has its downfalls. The above models have been used to create governmental policies but not satisfactorily. The term disability, therefore, requires an equal analysis of the medical and the social-environmental implications to disability. It is not sufficient to only use one model because each model has its strengths and weaknesses. 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 entire disability condition in society as a whole (Smeltzer 194).

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 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 offers a value-laden definition of health, offering that health is a state of well-being involving physically, socially and mentally (World Health Organization (a)). 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 (b) 547).

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 desired (Boorse (b) 548).

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

The atypical nature of the disability and the instrument nature of health under the value-free definition give 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 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 exploit one’s environment maximally (Boorse (b) 555). 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 conformity of a unique trait, based on the average from variables collected and measured from a population. Over time, human communities have developed from a small tight knit nomadic groups to large communities based on tribes and clans. These communities have consequently grown into formidable civilizations over millennia. The formation of communities was advantageous to early man as it gave protection and growth. Therefore, the need to belong to and identify with a community was ingrained in man (Stark et al. 56). 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. In these early communities, those who were a liability to the community such as the sick and the old were abandoned and left to the will of nature.

Two different societies thus can be seen to develop from this paradigm. The ideal society, in it 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 to, 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. Consequently, those who did not conform were viewed as a liability that the society had to compensate and cater for. Corrective methods were put in place to even out the gap; these were either financial or medical in nature. 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 the population. Thus, statistical normality also rears itself in the medical definition of health as well. (Boorse (b) 546). 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 (b) 547).

Every species is designed with specific physiological functions that help it to survive in order to reproduce the next generation. All physiological functions have to operate efficiently and concertedly. A failure of one of the physiological function can jeopardize the health of the individual in the species. However, the 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, in extreme cases, 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 (a) 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 (Liasidou 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 (Liasidou 121). These external, albeit subtle or strong forms of restrictions by society, may leave disabled people frustrated and unwilling to interact with the general society. An internal crisis may as well occur from the labels that are associated with the disabled. These labels may be present in areas of education, at home or in the media. Their end effect may be 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 advocates for disabled people rights have compared the oppression of the disabled with the stigmatization based on race, sexuality, and religion (Charlton 25).

Christopher Boorse, however, argues that disability is itself a biological manifestation of universal human variability. The argument means then that the disability is 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 the function of the limb that was absent (Norton). 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.

In the 19th century with the advancement of surgical procedures, there was a growth of clubfoot operations to try to straighten the foot. Some of these feet, however, ended up being infected and resulted in amputations (Boorse (a) 432). Despite that fact, some people were well adapted to their environment, with social conformation being the only problem.

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 (Mitcham 1529). In childhood; external factors play a huge role in influencing body image. A child who has little or no personal life experience will primarily learn about the image from his parents, teachers, media or other children.

The idea of body image is thus one of prime importance to health professionals dealing with people with a disability who may need the 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 the 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 (Mitcham 1530). However, an individual who received the prosthesis later in adulthood after an accidental trauma at the workplace may view the prosthesis as a physical manifestation of his disability and thus the nonconformity to the norm. Individual’s perception and experience with prosthesis have an impact on the person’s view of normalcy and disability. The physical or social limitation resulting from disability can encroach on someone’s identity.

Prosthetics as a corrective measure may be used to change this situation. However, prosthetics may also disrupt one’s identity further because one may feel 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 arises as to whether a person with a certain disability who uses prostheses is still part of the group formed by 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 from prosthetic treatment is not fully achieved (Mitcham 1533). The social construct in place links disability with ineffectiveness and dependence. These perceptions are perpetuated to the society at large as well as to the people in the disabled community. 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 of prosthetics has also undergone improvement, as is the face of prosthetic science with the use of neural interfaces and robotics.

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. A cyborg is an organism enhanced with prostheses and implants. It is a hybrid organism that is fully reliant on technology. Consequently, the organism will be high performing and effective. The dynamic and hybrid nature of Cyborgs will cut across social constructs like gender, age, and race. Therefore, some authors foresee the world where cyborgs will be the desired even without conforming to the norm of the general population. Arguably, the strength of the cyborgs, therefore, may lie in their non-conformity (Munyi 33).

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 future where prosthetics are not only used as a fix to a disease process or in response to disability, 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. Medical policy and social relations are usually hampered by a lack of understanding of the core issues facing the disabled, especially the social pressure to conform.

Works Cited

Boorse, Christopher (a). “Disability and Medical Theory.” Philosophical Reflections on Disability Philosophy and Medicine, 2009

Boorse, Christopher (b). “Health as a Theoretical Concept.” Philosophy of Science, 44(4), 1977, pp. 542–573.

Charlton, James I. “The Dimensions of Disability Oppression An Overview.” Nothing About Us Without Us Disability Oppression and Empowerment, 2004, pp. 21–36.

Coffey, Sarah. Prosthesis. Lucian.uchicago.edu. 2017 https://lucian.uchicago.edu/blogs/mediatheory/keywords/prosthesis/ Accessed 16 Feb. 2017.

Garfield, Benjamin. “The Cyborg Subject: An Introduction.” The Cyborg Subject, 2016, pp. 1–33.

Hartley, Christie. “Disability and Justice.” Philosophy Compass, vol. 6, no. 2, 2011, pp. 120–132.

Hill, Sophie. “Threshold Concepts in Prosthetics.” Prosthetics and Orthotics International, 2016.

Liasidou, Anastasia. “Critical Disability Studies and Socially Just Change in Higher Education.” British Journal of Special Education, vol. 41, no. 2, 2014, pp. 120–135.

McLuhan, Marshall. Understanding Media: The Extensions Of Man. 1st ed. Cambridge: MIT Press, 1994. Print, pp 10-30.

Mitcham, Carl. Encyclopedia of Science, Technology, and Ethics. Detroit, MI : Macmillan Reference USA, 2005.

Munyi, Chomba Wa. “Past and Present Perceptions Towards Disability: A Historical Perspective.” Disability Studies Quarterly 32.2 (2012), pp 30-33

Norton, Kim. A Brief History of Prosthetics. Amputee-coalition.org. N.p., 2017. http://www.amputee-coalition.org/resources/a-brief-history-of-prosthetics/ Accessed 16 Feb. 2017.

Smeltzer, S.C. “Improving the Health and Wellness of People with Disabilities: A Call to Action to Important for Nursing to Ignore.” Nursing Outlook 55 (2007), pp. 189-195.

Stark, Rebecca, Karen Birchak, and Nelsy Fontalvo. Anthropology. 1st ed. Hawthorne, N.J.: Educational Impressions, 2002.pp 55-70

World Health Organization (a). Constitution of WHO: Principles. http://www.who.int/about/mission/en/ Accessed 16 Feb. 2017.

World Health Organization (b). World Report on Disability. (pp. 1-350) http://www.who.int/disabilities/world_report/2011/report.pdf Accessed 16 Feb. 2017.

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