In a 1977 Science article, psychiatrist George Engel critiqued the “biomedical model” approach to disease. Engel argued that this biomedical model, which accounted for disease based on somatic and molecular traits, lacked an examination of equally important psychological and social aspects. Engel proposed an alternative “biopsychosocial model” for understanding the challenges of disease. Many science and health professionals joined Engel in his critique of the biomedical model as an overly reductive worldview. Molecular approaches to understanding chronic disease and disability were becoming increasingly prominent in the 1970s, but offered limited perspectives on causes, classification, and management. In this paper, I argue that critiques of the “biomedical model” were an important vehicle by which alternative narratives of disability entered the classification systems of biomedical professionals.
Historians have described biomedical classification as a fraught arena where social, moral, and biological assumptions intersect. I draw on archives, published literature, and interviews to examine evolving conceptions of disability in multiple editions of the World Health Organization’s International Classification of Impairments, Disabilities, and Handicaps (ICIDH). The first edition of ICIDH, in 1980, was an early response to biomedical model critiques. ICIDH added a focus on the social consequences of disease, but was widely criticized for maintaining a biomedical perspective on the somatic origins of disability. In response, the second edition in 2001 adopted Engel’s “biopsychosocial model”. Nonetheless, disability advocates continued to critique the WHO disability classification, as part of their ongoing efforts to encourage the uptake of alterative social and minority group models of disability.
