整合殘障概念模式之初探

A Proposed Integrated Conceptual Model of Disability

儘管殘障研究已經進行了數十年之久，但在殘障醫學、社會、心理與社會心理模式中所使用的殘障相關名詞，仍然未能取得一致的定義。由於缺乏共識，在使用時，矛盾與誤解便容易產生。因此，對於整個殘障研究而言，探求如何將不同殘障模式的相關用語加以整合，是相當必要的。有鑑於此，筆者於1998年提出殘障整合模式(integrated model of disability)，試圖整合不同領域中的殘障相關用語與概念。為了能夠完整呈現各殘障相關用語的特定意義與各殘障模式之主張，在1998年的殘障整合模式中，採用聯合國衛生組織(the World Health Organization， WHO)在1980年所使用的三個用語—傷殘(impairment)、殘障(disability)、與障礙(handicap)來說明模式中的主要概念，但捨棄三個名詞定義間受到殘障社會模式(social model of disability)批評的因果關聯與常態概念。在這個模式中，筆者除了企圖整合不同殘障模式外，還將個人處在傷殘、殘障、或障礙狀態間的動力關係，與身心障礙者在各狀態下所呈現出來的心理反應及可採用之介入策略，也一併呈現。此外，在此模式中，假設個人可以藉由社會心理策略(psychological-social approach)接納傷殘(acceptance of impairment)的介入，來幫助身心障礙者接納他們的傷殘，進而達到一個良好調適的狀態。近年來，筆者在應用該模式於身心障礙者輔導與服務工作後，發現該模式有若干處需要加以修正，有鑒於2001年WHO提出「國際功能、殘障、與健康分類」(International Classification of Functioning， Disability and Health， ICF/ICIDH-2)後，重新為殘障相關用語及定義提供了正向角度來解讀，引發筆者修正原有殘障整合模式之動機，特此提出修正後的整合殘障概念模式(integrated conceptual model of disability)，期望藉由此修改後的修正模式之提出，能夠對於日後國內殘障理論之相關研究，提供論證假設之基礎。

Although disability studies have been researched for several decades， there is still no consensus regarding the definitions of disability-related terms among medical， social， psychological and psychosocial models of disability. Due to the lack of consensus， confusion may arise when people in different areas use the same term but imply different meanings. Therefore， finding a way to integrate the different meanings of the terms into one model is essential to the whole disability studies. An integrated model of disability has been proposed accordingly by the writer in 1998. To fully represent the specific meanings and tenets in this model of disability， the World Health Organization's three-term definitions (i.e.， impairment， disability and handicap) in 1980 have been adopted but the causal link and normalcy notions， which are the parts attacked most by the social model， have been taken out from the definitions. The proposed integrated model of disability intended to present the dynamic relationships among different models， psychological reactions and interventions and to integrate the definition of impairment， disability and handicap in one model of disability. Moreover， the model presented a psychological-social approach (acceptance of impairment) in suggesting a means of intervention for people with impairments to help them accept their impairments and achieve a well adjusted status. After several year passed by， one of the three terms (i.e. handicap) has been replaced by another term and some positive notions have been addressed in the WHO's 2001 International Classification of Functioning， Disability and Health (ICF/ ICIDH-2). In order to compare with the ICF and to adjust some hypotheses and critiques in the model， a new proposed integrated conceptual model of disability has been brought up. The integrated conceptual model of disability may provide the groundwork of disability theory for further researches and discussions.