The Oxford Handbook of Philosophy and Disability gives us a cohesive portrayal of current Anglo-American thinking and debate about the central conceptions of disability within the burgeoning interdisciplinary field of Medical Humanities. Almost four-fifths of the contributors to the forty-three chapters of the Handbook hail from the United States and England, the vast majority of whom reference one another’s work. Within the limits of this short review, we shall firstly outline the general nature and scope of a volume well over 800 pages. Thereafter, we shall examine two contrastingly provocative assumptions upheld within this rich collection.

I

The editors’ succinct summary of the ten parts (as well as their constituent chapters) of the Handbook (xxvii ff.) quickly orients its readers. Part One, “Concepts, Models, and Perspectives of Disability,” pursues the different consequences of adopting medical and sociological views of disability which are then applied to the relationship between disability and well-being in Part Two, “Well-Being, Adaptation, and Causing Disability.” Part Three, “Justice, Equality, and Inclusion,” explores how concerns with the rights of the disabled challenge the theory of justice as fairness. This frequently modified theory derives from the seminal work of John Rawls, first articulated in the 24th October 1957 issue of The Journal of Philosophy. Part Four, “Knowledge and Embodiment,” draws from the two previous Parts’ reliance upon the testimony of the disabled as an epistemic basis for interpreting and understanding their lived experience. Part Five, “Respect, Appreciation, and Care,” explores the kinds of attitudes that ought to be had towards the disabled which Part Six, “Moral Status and Significant Mental Disabilities,” re-configures in terms of the moral standing that should be accorded to all humans, the mentally disabled included. Part Seven, “Intellectual and Psychiatric Disability,” deals with the sheer difficulty of diagnosing and classifying psychiatric disorders as exemplified by the autistic spectrum and depression amongst others. By contrast, Part Eight, “Technology and Enhancement,” investigates the complexities arising not so much from the prosthetic and pharmaceutical realms but from neuro-technological interventions and the role of the disabled in such treatment. Part Nine, “Health-care Allocation,” returns to the much-debated issue of the allocation of medical resources and the criteria of the priorities involved whereas Part Ten, “Reproduction and Parenting,” focuses upon the relatively new domain of decisions about bearing and parenting disabled children.

From the outset, the editors, Adam Cureton and David Wasserman, are particularly focused upon the purpose of the Handbook. They principally construe their task as twofold. The first task is to introduce philosophers and other intellectuals to current questions in disability in so far as it “raises fundamental issues about the significance of variations in physical and mental functioning” of the disabled personally and socially, ethically and institutionally (xxiii). The second, more ambitious task is to “set the terms of the philosophical agenda for disability” by advancing the discussion of key issues (xxiii); issues that have notably shaped and been shaped by communal attitudes towards and treatment of those regarded, in modern terms, as physically and mentally disabled.

The editorial introduction claims that contributors 

freely confront difficult boundary questions about what the philosophy of 

disability is fundamentally about: does ‘disability’ refer in the first instance to a family of traits or conditions possessed by individuals; a kind of interaction between an individual’s traits or conditions and [his or] her environment; a social group subject to exclusion and subordination; or a particular way of treating people for purposes of social control or political governance? (xxvi)

That said, Cureton and Wasserman explicitly state that “we regard disability as irreducibly ‘polysemic’ and so have tried to avoid organizing this volume around any particular definition, model, or theory of disability” (xxvi). At the same time, they concede a tendency amongst contributors to prefer one of two kinds of perspective or discourse. On the one hand, some consider disabilities to be contingent characteristics of individuals and therefore employ a “person first” approach. On the other hand, some regard disability either as “something imposed on people to control or exclude them” or as something “essential rather than contingent” and consequently adopt a “disability first” approach (xxvii). Arguments between the two perspectives have typically revolved around hypotheses and conclusions derived from “ignoring the complex person behind the disability” (xxvii), or from reifying disability without acknowledging its socio-political character, and conversely. Nonetheless, we might add, nuanced alternatives do exist when, for example, Suzy Killmister’s chapter on the severely cognitively disabled is content to use both approaches “interchangeably” (479, n. 2).

Considering what the editors emphasize about their anthology, has the general nature of the Handbook in terms of its overarching content and methodology been neglected? Even a passing acquaintance with the philosophical study of disability over the past decade or two cannot deny its deep dependence upon ethical and socio-political contentions drawn from other disciplines. This has been demonstrated time and again by debates about attempts to reconcile John Rawls’ adaptations of social contract theories and the place of the severely disabled such as that between Martha Nussbaum and Henry Richardson in the December 2006 issue of The Journal of Ethics. Indeed, these debates expressly re-emerge within Part Three of the Handbook, as, for example, Christie Hartley in Chapter 11 (195-211), Christopher Riddle in Chapter 13 (229-244), and Adam Cureton and Alexander Kaufman in Chapter 15 (261-278) explore social and ethical repercussions of the lack of a capacity to co-operate within social systems and the various means of resolving disabled individuals’ apparent lack of engagement.

At the same time, disability studies are permeated by a method of analysis epitomised by Michel Foucault. This arguably remains the case even if Foucault is less frequently acknowledged within the Handbook than is Rawls—here by Shelley Tremain in Chapter 5 (82-89) and Melinda Hall in Chapter 36 (633-651) as they investigate how the gamut of institutionalized regulations and practices disempower the disabled amongst others regarded as abnormal. Nowhere is the method more pointedly expressed, according to his biographer Didier Eribon (1989, pp. 199ff.), than when Foucault, applying for admission to the Collège de France, states that his published works during the ‘sixties question “how madmen were recognised, set aside, excluded from society, interned, and treated.” This leads Foucault to conclude that knowledge of the mentally disabled “takes shape not only in the theoretical texts or experimental instruments, but in a whole system of practices and institutions” (trans. Betsy Wing).

II

In the space remaining, this review will conclude with two contrasting assumptions encountered in notably pivotal passages of this extensive collection of chapters. In order of their emergence within the Handbook, the assumptions centre around the polysemy or multiple meanings of disability and the nature of cognitive or intellectual disability.

The first of the assumptions is sounded when Jonas-Sébastien Beaudry immediately asks how the polysemy of the “highly contested concept” of disability should be handled (3). Yet what is left unsaid is that polysemy itself is equally contested. Granted, there is little dispute that “disability” possesses some explanatory power owing to its differential but “close” relationship with other polar concepts such as “normality, abnormality, capacity, and incapacity” (4). So, too, is polysemy, in its predominant form of single words associated with two or more senses or meanings, similarly possessed (e.g. “Paolina got [= became] panicky”; “Pasquale got [= procured] the evening meal”; “Paolina got [= understood] the point of Pasquale’s concerns”). It can often be distinguished from, say, homonymy where single words are associated with apparently unrelated meanings (e.g. “Paolina banked [= deposited] her weekly wage” versus “Pasquale’s turning car dangerously banked [= tilted laterally]” or again “Paolina took fright when thunderclouds suddenly banked [= amassed]” versus “Pasquale and Paolina have always banked [= relied] upon their mutual trust”).

However, once we start to interpret “disability” when used in different contexts, ranging from the “activist” and “biographical” to the “medical” and “legal” (4), it can refer to different phenomena and assume different meanings, if not values. Resolving the polysemous enlargement of “disability” is not achieved simply by a reductive stipulation (e.g. disability is “equate[d] … with impairment” (5)) or even a complex stipulation (e.g. disability is identical to the “interaction between individual traits and social environment” (6)). Polysemy is similarly affected by shifting contexts whether, for instance, linguistically grounded by etymology or metaphorically extended. For example, what were taken to be distinct homonyms above—say, “banked” as deposited and as relied—now seem to be polysemous variants of being or becoming secured, be it financially or affectively. Alternatively, bearing in mind the open-ended set of features or properties—not all of which must be instantiated for a concept to apply to, say, game, language, and number—Ludwig Wittgenstein’s popularized notion of “family resemblance” (1945, §65ff.) can influence our understanding of polysemy. The sheer proliferation of, say, the sense or meaning of “over” blurs both what is part of the meaning of the word and what results from contextual uses, for example, “Paolina and Pasquale live over the crest of our street” [= on the other side]; “No, Pasquale does not exert strange powers over Paolina” [= control]; “Paolina hung a painting over the water stain in the foyer” [= covering or concealing]; and “Pasquale always reads Paolina’s latest draft over the weekend” [= during]. Needless to say, specifying linguistic (or semantic) and interactional (or pragmatic) contexts does not automatically explain why the ubiquitous presence of polysemy in our languages continues to be extended or why it should exist at all.

Because context overrides stipulation, Beaudry suggests that we adopt the “more abstract” strategy of a “second-order,” “open-ended” account (6). Such accounts—whilst wrestling with the “dilemma of specificity,” with whether the concept of disability can or should “achieve consistency and stability”—  

still offer a unified account of disability … because they do not offer first-order rules to decide what counts as a disability, but instead second-order rules to decide what those first-order rules should be. (6)

Most readers of Metapsychology have heard of higher-order theories of consciousness that aim to account for the difference between conscious and non- or un-conscious states of mind in terms of the relationship between a conscious state and a representation of that state, be it an apprehension (or “feeling”) or a thought (or “cognitive processing”) of it. In other words, second-order theories aim to specify both the elements within a domain of discourse and the relations between its propositions including arguments based upon them. Some higher-order theories operate universally (“all elements within a domain of discourse or propositions have such-and-such a property”); some operate existentially (“there is at least one element within a domain of discourse or propositions with such-and-such a property”). Joshua Shepherd’s chapter investigates disability in, for instance, minimally conscious cases by their impact upon the enabling capacities of “control over one’s situation” (123). He explicitly grounds this first-order hypothesis by appealing to “the absence of many … higher psychological” elements including “attention, reasoning, imagination, memory” and to the “lack [of] access to the range of patterns of thought and streams of consciousness” (130).

However, Beaudry’s appeal to the second-order strategy does not prevent the radical riposte of Margrit Shildrick who concludes in her 2009 monograph Dangerous Discourses of Disability, Subjectivity and Sexuality:

a more critical approach takes the further step beyond the straight-jacket of binary differences to explore the fluidity of all forms of categorisation … [and] not an exercise in standpoint theory that would create new hierarchies… (p. 170)

Indeed, she concedes that what many would “find intolerable is that the question of what comes next is deliberately left open” (p. 171). By refusing “to flatten out the multiple layers of significance and meaning,” Shildrick upholds the need for disability studies “not to settle on a singular perspective,” but “to continue a process of intersectional exploration … even in the absence of an alternative way forward” (p. 172). If polysemy is as prone to this radical critique as is disability, readers might begin to wonder whether the Handbook has embarked upon a manageable enterprise.

III

The second of the assumptions regarding cognitive disability is most directly discussed by Licia Carlson. She begins by reminding us that various kinds of conditions and disabilities have long been regarded as “some form of cognitive or intellectual impairment, deficit,” or deviation, albeit with “shifting terminology” tied to philosophical enquiries ranging from the nature of mind and agency to morality and language (482). When focusing upon efforts to gain conceptual clarity and specificity, Carlson also reminds us that “Intellectual or cognitive disability denotes a broad category that is both internally and externally heterogeneous” (483). The internal factor, “identifiable biologically or genetically,” ultimately invites “precision” when postulating congenital or acquired causes, constraints upon learning, degrees of severity, and specific capabilities or perceptions (483). That, in turn, rationalizes her demand that philosophical analyses (including their hypothetical case-studies, stipulative definitions, and thought experiments) should explain not only “the underlying narrative assumptions that inform our concepts and cases,” but they should also deal with the historical and socio-political factors that “shape the concepts and categories” (484). Indeed, Carlson pointedly remarks, “the complex history of ‘intelligence'” illustrates how theories of cognitive or intellectual disability are riddled with “porous and contested” conceptions (484). Carlson’s measured section on conceptual clarity and specificity ends by enumerating the challenges presented by non-verbal individuals, developmental potentialities, and the tendency to divorce physical from cognitive disabilities as part of her overarching strategy of addressing the “multiple axes” (494) facing philosophical enquiry.

Such “axes” see Carlson’s chapter end on a transformative note which “can involve generating new metaphors and opening new spaces within which new forms of knowledge and discourse might emerge” (494). Admittedly, some contributors to the Handbook have bluntly discarded metaphysical presuppositions, for example, Jerome Bickenbach construing them as “conceptually incoherent and empirically meaningless” when applied to “bodily functioning” (54) and Suzy Killmister finding the “metaphysical game” cannot solely justify who is or is not human (476)). However, Carlson elaborates her conclusion as follows:

Literary texts, including novels and memoir, can serve as a basis for expanding the moral imagination, presenting alternate portraits of [intellectual disability], and facilitating critical reflection on our philosophical presuppositions… (494)

Now consider Carlson with reference to Roberto Calasso’s 1988 mythopoetic essay Le nozze di Cadmo e Armonia in an excerpt from its fourth chapter appearing in the 22nd April 1993 issue of The New York Review of Books. The excerpt meditates upon how Homeric heroes knew

Whenever their lives were set aflame … a god was at work … [B]ut what actually happened as a result was a surprise most of all for themselves. Thus dispossessed of their emotion, their shame, and their glory too, they were more cautious than anybody when it came to attributing to themselves the origin of their actions ….

No psychology since has ever gone beyond this; all we have done is invent, for those powers that act upon us, … names, which are … less closely aligned to the pattern of our experience …. The Homeric heroes knew nothing of … responsibility … For them, it was as if every crime were committed in a state of mental infirmity. But such infirmity meant that a god was present and at work. What we consider infirmity they saw as ‘divine infatuation’ (átœ) … [which] would gradually come to mean ‘ruin.’ But they also knew, and it was Sophocles who said it, that ‘mortal life can never have anything great about it except through átœ.’

Leaving aside Calasso’s allusion here to the central choric Ate ode in Antigone (ll. 582ff.), he then shifts from the psychological to the moral relevance of the ancient mythopoetic world:

Thus a people obsessed with the idea of hubris were also a people who dismissed … an agent’s claim actually to do anything …. For the Homeric heroes there was no guilty party, only guilt, immense guilt. That was the miasma that impregnated blood, dust, and tears … [These] heroes did not distinguish between the evil of the mind and the evil of the deed, murder and death. Guilt for them is … palpable, it looms. Perhaps the guilty party is as much a sufferer as the victim …. And, when considering the guilty party, there will always be an element of uncertainty. We can never establish just how far he really is guilty, because [he] is part and parcel of the guilt and obeys its mechanics. Until eventually he is crushed by it perhaps, perhaps abandoned, perhaps freed, while the guilt rolls on to threaten others, to create new stories, new victims. (trans. Tim Parks)

Whilst Calasso captures a tragic vision of life, a vision arguably attuned to the murderous world into which his generation was born, what is its relevance to Carlson’s approach?  That the literary cannot be summarily dismissed from comprehending the need for critically reflective, alternative ways of portraying the disabling reaches of “mental infirmity.” 

R.A. Goodrich is affiliated with the A.R.C. Centre for the History of Emotions (University of Melbourne) and the A.D.I. Philosophy & History of Ideas Research Group (Deakin University), co-edited the online refereed arts journal Double Dialogues since 2002, and co-ordinates with Maryrose Hall a longitudinal project investigating linguistic, cognitive, and behavioural development of higher-functioning children within the autistic spectrum and related disorders.