Paternalism and Professionalism: Tensions between Social Work and the Disability Rights Movement

Background and Purpose:  People with disabilities have been objects of social work practice since the emergence of the profession.  When the disability rights movement became a national force in the 1970s and 80s, outside observers might have expected strong collaboration with social workers, rooted both in historical ties and in a shared commitment to social justice and empowerment.

Instead, relations between the disability rights movement and social work institutions were often adversarial.  Independent living centers and other new, movement-based organizational forms that grew out of disability activism were primarily alternatives to, rather than partners with, established social work agencies.  Even in more recent decades, despite determined bridge-building efforts by committed scholars and practitioners, social work and disability services/advocacy exist as largely separate fields.

This paper explores the historical forces that shaped the present situation.  Identifying the tensions that emerged between the two fields provides insights that may help to develop socially just practice that fosters disability rights.

Methods: This paper is rooted in historical analysis of archival materials from the disability rights movement, before and shortly after the passage of the Americans with Disabilities Act.  I use grassroots publications like Mouth and The Disability Rag, as well as founding documents of key movement organizations like the first Center for Independent Living, to examine disability activists’ attitudes toward social work and other helping professions.  I analyze these sentiments in larger historical context, not only in terms of ongoing social work with people with disabilities, but also in light of social work’s concern with its status as a profession.

Findings: The disability rights movement rejected a model of service provision that clients experienced as paternalistic and medicalized.  Some activists derisively described social workers and members of other helping professions as “do-gooders” who believed that they knew what was best for people with disabilities.  They found social workers’ recommendations to assume an individual model of disability, urging clients to accommodate to larger social systems, rather than a social model that would seek to change the injustice of those systems.  In contrast, independent living centers structured themselves around control by clients in a clear rejection of the authority of non-disabled doctors, social workers, and other specialists.

Conclusion and Implications: Such sentiments obviously challenge social workers to challenge personal and institutional biases. But this client-driven approach also conflicts with key aspects of how social work has defined itself as a profession.  A belief that professionalism entails autonomy and authority, rooted in specialized training, dates back to Ernest Greenwood in 1957, and even to Abraham Flexner in 1915.  A service philosophy that centers the expertise of disabled clients may seem to threaten the professional status of trained social workers.

While this is a tension, it is far from irreconcilable.  There are other ways of conceiving of professionalism and expertise, and some prominent disability rights leaders are themselves social workers.  But to address this tension, we must face the questions it raises about what it means to be a social work professional.