Christina Lee outlines the core tenets of Disability Critical Race Theory (DisCrit) and discusses its necessary application in the medical humanities field.
What is Discrit?
Disability Critical Race Theory – or DisCrit- is a critical theoretical framework developed by special educational needs scholars Subini Ancy Annamma, David Connor, and Beth Ferri. It explores the co-construction of race and ability and the ways in which racism and ableism are built into the processes and structures of educational institutions.
In their research, Annamma et al. observed that students of colour are overrepresented at special education schools and that disability is often mobilised to justify racial and class segregation (Annamma, Connor and Ferri 2013, 7). White middle-class students with learning disabilities are more likely to perform well academically because they are able to utilise diagnostic labels to negotiate access; while poorer black and ethnic minority (BAME) students with learning disabilities are more readily disciplined due to perceived behavioural and emotional problems.
Drawing on the work of disability studies scholars, black feminist scholars, and disabled artists and activists of colour, Annamma, Ferri, and Connor proposed seven tenets of DisCrit for understanding racism and ableism.[1]
Tenet one, DisCrit ‘focuses on ways that racism and ableism circulate interdependently’ to uphold notions of whiteness and ability as normal.
Tenet two, DisCrit ‘values multidimensional identities and troubles singular notions of identity’. It views race, dis/ability, class, gender, and sexuality as intersectional.
Tenet three, DisCrit ‘emphasises that race and ability are socially constructed’, but understands that being labelled as raced or dis/abled can have a material and psychological impact on the person.
Tenet four, DisCrit ‘privileges the voices of marginalised populations’ who are traditionally not represented within academic and social research.
Tenet five, DisCrit acknowledges that race and disability have historically been used to deny the legal rights of citizens.
Tenet six, DisCrit recognoises that ‘gains for people labelled with dis/abilities’ have largely been made because they benefit the middle-class.
Tenet seven, DisCrit ‘requires activism and supports all forms of resistance’ (Annamma, Connor, and Ferri 2013, 11).[2]
As expressed in these tenets, DisCrit understands racism and ableism as interconnected and deeply entrenched within social and institutional structures. Structural racism refers to the policies and practices embedded in healthcare, criminal justice, and educational systems that favour the dominant races and disadvantage ethnic minorities (ENAR 2022). Structural ableism refers to the ways systems and policies are designed to privilege non-disabled bodies and minds and exclude disabled ones (Dolmage 2017). Structural ableism includes buildings that are physically inaccessible to people with mobility difficulties, noisy environments affecting those with hearing difficulties, and attitudinal prejudice against neurodivergent folks.
Disabled students of colour experience the construction of their racial and disability identities as simultaneous processes. Historical beliefs about black bodies as unintelligent and violent underlie racial biases against people of colour in modern education, legal and criminal justice systems (Annamma et al, 2013). Poorer students of colour with disabilities, whose behaviour deviate from white middle-class norms of respectability, are labelled as aggressive and excluded from schools (Adams and Ervelles 2014). Young black people with identified or unidentified disabilities are more likely to be unemployed and incarcerated as a result of systemic failures to provide appropriate social and medical support.
Racism and ableism in medical education and healthcare
Although DisCrit has been applied to a range of disciplines including law, higher education, and theological education, its relevance to medical education and the medical humanities is largely unexamined (Fears 2021). Yet a DisCrit framework can help illuminate how structural racism and structural ableism affect disabled people of colour in medicine and healthcare.
In medical education, black applicants (many of whom come from low socioeconomic backgrounds) continue to have a significantly lower acceptance rate than other racial groups. Even when people of colour succeed academically they continue to experience racial injustice. People of colour who also have disabilities face additional challenges as ableist beliefs about disabled people’s ability to work can reinforce racial stereotypes that frame people of colour as lazy.
While 38% of doctors and medical students felt that they were comfortable disclosing their disability to their organisation, only 20% of BAME respondents said the same. Stigma and fear of work discrimination discourages BAME medical students and health workers from disclosing their health conditions. By contrast, white doctors and medical students were more likely to secure reasonable adjustments for their health needs and feel more supported by colleagues than BAME doctors (BMA 2020, 3).
Despite the UK being an ethnically diverse population, there is a lack of representation of dark skin and diverse body types in medicine, as the white (young, male, slim) body continues to be used as the standard patient in clinical trials and medical assessments (Powelle et al. 2022). This racial bias has a detrimental impact on black and Asian patients who tend to experience more diagnostic errors than white patients.
Almost two thirds of black respondents to a survey commissioned by the Black Equity Organisation reported experiences of racial discrimination from doctors and staff in healthcare settings (Black Equity Organisation 2022). Ethnic minority patients who do not speak English as their first language or have culturally specific lifestyles are labelled as non-compliant and difficult when they do not understand and are unable to follow care instructions.
According to the Commission on COVID-19, Disablism and Racism established by the Voluntary Organisations Disability Group, 92% of respondents who identified as disabled people of colour felt that they were treated unfairly during the pandemic because of their disability and race. Many experienced attitudinal, language, and cultural barriers when accessing medical care and public health information (VODG 2022, 23). These “everyday acts of interpersonal discrimination, implicit biases, cultural and structural racism” discourage ethnic minorities from seeking medical care (Razai et al. 2021, 1).
Towards a DisCritical medical humanities
As the medical humanities becomes more critical of power in medicine, it must also be reflective of its own complicity in enabling discriminatory processes that marginalise non-white non-normative bodies and minds (Viney et al. 2015). Although there are now many scholars from India, Africa, and Asia working in the medical humanities, the field remains dominated by white non-disabled Anglophone researchers in the Global North.
Medical humanities programmes often rely on materials that are expressive of western culture and European notions of health (Hooker and Noonan 2011). The foundational canon of medical humanities literature on illness is principally populated by white authors who do not discuss health disparities in relation to racial and social justice (Banner 2016).
Medical humanities has a unique relationship with medical education. The field has the power to catalyse new forms of knowledge production and facilitate positive ‘actionable change’ in medicine (Kaundinya and Schroth 2022, 2). A DisCritical medical humanities has the potential to destabilise “the certainties of medical culture” and challenge the positioning of Eurocentric biomedicine as “neutral, acultural and apolitical” (McNaughton 2023, 5; Wong et al. 2021). This involves by incorporating perspectives from non-European health cultures and actively questioning the ableist and racist assumptions underlying medicine and our own teaching practices.
DisCrit both privileges the voices of marginalised people and requires activism. As well as diversifying the curriculum to represent different skin colours and types of bodies and minds, medical humanities must validate and centre the lived experiences of marginalised peoples through minority-led collaborative research. Health justice cannot be achieved without social justice, racial justice, and disability justice. A medical humanities that troubles knowledge and social hierarchies can help transform oppressive structures and lead the way towards genuine and inclusive collective liberation.
[1] Annamma, Ferri, and Connor credit intellectual influence from critical race theorists James Baldwin, Anna Julia Cooper, Mary Church Terrell, W. E. B. Du Bois, Yuri Kochiyama, Bayard Rustin and Kimberlé Crenshaw, as well as disability activists like Patti Berne, Anita Cameron, Mia Mingus, Leroy Moore, and Alice Wong.
[2] They use the term dis/ability to highlight how disability tends to be culturally defined as the inability to perform certain tasks. The slash disrupts this understanding and signals the social construction of disability.
About the Author
Christina Lee (she/her) recently completed her PhD in English and Medical Humanities at King’s College London. Her thesis was titled ‘The Care of the Dis-ease Self: A Foucauldian Critique of Buddhist Meditation Memoirs as Narratives of Healing’. Her research looks at experiences of illness and disability, embodiment, and intersectionality.
References
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