• impairment
• disability
• handicap
• medical model
• social model

I read with interest the articles by Reindal and Harris since, although I accept that there is more to their papers than advocacy of models, they illustrate the dangers of the straitjacket approach to problems that using models represents.^1,2 One side implies that if you are an advocate of the medical model you can’t understand social impact, and the other that if you advocate the social model you must ignore physical impairment. I have recently retired from a professional life spent trying to provide services to disabled children, and in practice these mutually exclusive models do not work. Most of my patients did have physical impairments, which although rarely curable, did usually need treatment. These physical impairments often prevented them from carrying out actions, walking for example, with which their unimpaired peers had no problems. They were disabled. For many, society’s response to their impairment and disability, inadequate education, rejection by their family or community for example, caused further problems; they were handicapped. The effect of social pressure on the response to disability can influence very strongly the wellbeing of the disabled person. For example, a child with a major chromosomal anomaly was never acknowledged by the family. Her siblings were not allowed to play with her, and were not told that she was their sister. Her family belonged to a strict religious sect in which stigma attached to congenital abnormality such that it would have, for example, affected the marriageability of her siblings. At the age of four I lost contact with her and was told she had been placed in a long term residential institution. In effect, because of social pressure this family was denying, even within the immediate family that their own child was indeed a member of the …