The Medical Model and the Social Model

When Warren Worthington II publicly announces that his lab has found a cure for the mutant gene, he argues that the mutants’ “affliction is nothing more than a disease, a corruption of healthy cellular activity,” a medical problem that the cure will fix. Listening to him, Storm angrily asks, “Since when have we become a disease?”

Worthington adheres to a physical model of disability, while Storm subscribes to a social model. In the social model, the problem is not physical. Rather, society creates disability by labeling, maintaining, and closing off options for certain people. Following this approach, the society in which the disabled/mutants live is to blame for the difficulties they encounter. (More will be said later about the social model of disability.) In the medical model, disability (or being a mutant) is seen as an undesirable and painful condition that needs to be fixed.¹ Medicine and science can provide cures and thus enable disabled people and mutants to enjoy all of the freedoms that “normal” people have.

Unlike the social model, which highlights the need for social change—legal protection, increased access, more social support, less prejudice—the medical model assumes that what is needed is more money and support for research into cures for disability. The medical model has been and still is the main way that doctors and scientists view disability. So it is no coincidence that the primary voice for the medical model in the movie is the head of Worthington Labs, a scientist. Consider Worthington’s speech:

These so-called mutants are people just like us. Their affliction is nothing more than a disease, a corruption of healthy cellular activity. But I stand here today to tell you that there’s hope. This site, once the world’s most famous prison, will now be the source of freedom for all mutants who choose it. Ladies and gentlemen . . . I proudly present the answer to mutation. Finally, we have a cure.

Worthington is not unique in his belief that the cure will offer freedom to mutants who choose it. Believing fervently in a medical model of disability, scientists have tried for a long time to find a cure for deaf people, and they have succeeded with cochlear implants, which are fairly effective if implanted in deaf children at an early age. The “cure” enables the deaf to hear and finally be “normal.” Who wouldn’t want this? Many deaf people, as it turns out. The reaction from some deaf people has been about as positive as the mutants’ reaction to the cure for the mutant gene.

Many disability activists argue that when scientists look for diagnoses and “cures” for disabilities, they send the message that people with disabilities are less worthwhile or, in fact, “defective.” Instead, disability activists suggest that disabled people should take pride in their bodies, just as some mutants have argued that pride is the appropriate attitude toward their unusual bodies.

Of course, disabled people form a diverse community, and not all of them have the same reaction. Some deaf and hard-of-hearing people, for example, have not been so quick to dismiss cochlear implants, and even some of those who have initially dismissed them have recently warmed up to them.

Jean, Rogue, and the Medical Model

It is tempting to think that all mutant powers are desirable traits that are radically dissimilar to any actual disability. But some mutant powers are, in certain ways, disabling. Wolverine’s power to heal allowed the painful and intrusive implantation of adamantium claws and the coating of his bones, but since Wolverine’s hands don’t have openings for his claws, he experiences intense pain when they cut through this flesh. Similarly, Cyclops must wear glasses to control the beams of energy coming out of his eyes; he can’t even remove them to make eye contact with his girlfriend. Furthermore, many mutants, such as Beast and Nightcrawler, look rather strange; their appearance prevents them from fitting into society.

But the strongest examples are Jean Grey/Phoenix and Rogue. Jean Grey is a class 5 mutant with extraordinarily powerful telepathic and telekinetic powers. Though her powers may seem enviable, The Last Stand suggests that she is in some ways disabled by her powers, which she cannot control. Even Xavier, who is so accepting of mutants that he has dedicated his life to leading a school for them, tries to control her “problem.” Is he buying into the medical model, as Magneto seems to suggest when he tells Xavier that he is similar to Jean’s parents in thinking of her as ill? Is Jean really sick, or is Xavier’s “treatment” causing her to be sick? The answer is not clear. What is clear is that Jean has strong recurring headaches, and once the negative side of her personality takes over, she does terrible things that she does not actually want to do, such as killing Scott, her lover, and Xavier, her mentor.

Not surprisingly, Rogue is one of the few X-Men who wants to be cured. She has one of the few disabilities that no amount of societal support can help: she cannot touch anyone without injuring that person. In the first ten minutes of the first X-Men film, we see Rogue seriously injure her boyfriend when she kisses him; later, we find out that he actually went into a coma. When Rogue first hears about the cure, she rushes into Xavier’s room. “Is it true? They can cure us?” she asks, her eyes sparking with excitement. She tells Logan, “I want to be able to touch people. A hug. A handshake. A kiss.” (One of the main people she wants to hug and kiss is, of course, her boyfriend, Bobby Drake.) Rogue’s eagerness to be cured reflects the fact that she views her power as a disability. She cannot touch anyone without absorbing the person’s life force, a trait that is useful in combat but not in interacting with loved ones.

The Social Model

Unlike Rogue, many mutants reject the cure and the attitude of those who think that they need to be cured. Disability activists have also been angry that others persist in seeing them as defective. Encouraged by the women’s movement and the civil rights movement, the disability rights movement gained momentum during the 1970s. Over time, disability activists and theorists began to challenge the medical model of disability and propose a new social model of disability. Adherents to this model argue that “people with impairments were disabled by a social system which erected barriers to their participation.”² The social model politicizes disability, stating that the problem lies not in the body but in the social restrictions, “ranging from individual prejudice to institutional discrimination, from inaccessible buildings to unusable transport systems, from segregated education to excluding work arrangements.”³

Just consider that all of us with poor eyesight would be labeled disabled in a society where eyeglasses and contact lenses were not available. We would not be able to see well, our opportunities for jobs would be limited, and our interactions with other people would be impaired. Similarly, in a society where people have to travel long distances to get firewood, water, and food, athletically challenged people like me (and most Americans) would have difficulty getting materials that are essential to survival, and we would be considered disabled. In the United States and many other countries, though, we rely on tap water, electricity and gas, cars and public transportation, and we do not need to have much physical strength or endurance. So we are not disabled.

Similarly, at schools for the deaf or communities designed for deaf people, being deaf is not a disability.⁴ Deaf and hard-of-hearing people can communicate just as well with sign language as others do with the spoken word, and they have rich and happy communities. They are able to thrive and flourish, just as mutants do at Xavier’s School for the Gifted. In fact, many Deaf people do not consider themselves disabled.⁵ Rather, they see themselves as a cultural group that uses a different language than the majority. Deaf culture is rich with distinct experiences and a complex language. Many deaf parents of deaf children have actually resisted cochlear implants for their children. Such parents want their children to share in the rich deaf culture, and they want to contradict the message that deaf people are defective. Deaf people are disabled in the hearing world only if accommodations are not made for them and if they are discriminated against (just as hearing people would be in a place that used only sign language and where people had negative prejudices against the hearing).

Thus, according to the social model, it is not the physical impairment that causes disability. Rather, “it is society which disables physically impaired people. Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and excluded from full participation in society.”⁶ If the problems that some deaf and hard-of-hearing people encounter are due to social and institutional causes, we need to change the society, not the people, just as we need to deal with racism and homophobia, not make all blacks white and all gays straight.⁷

Dilemmas

Very early in the film, we are introduced to Warren Worthington’s son, Angel, a boy with wings. While this might seem like an enviable mythical power, the boy clearly does not see it this way; the portrayal of him trying to cut off the growth on his back is one of the more gruesome and touching parts of the film. Later, we see Angel as a young man. Underneath his clothes are his large wings, making him look like a hunchback. We can imagine that as he grew up, he was probably picked on by his human peers and he was likely unable to undress in gym class. So Worthington was probably motivated by his son’s suffering to work on a cure for the mutant gene. The father seems to subscribe to a medical model: he sees his son’s unusual body as a disability, and he sets out to fix it by developing a cure. Although Worthington is, of course, very different from Xavier, there are similarities between the two: Xavier also thought of Jean—who is almost like an adopted daughter to him—as being sick and consequently attempted to use his power to control her.

After the mutant cure is developed, Angel is supposed to be the first to undergo the treatment. At the last minute, however, he changes his mind. Just as Angel frees himself from the medical chair, his father tries one last time to remind him that he wants the cure.

Father: It’s a better life. It’s what we all want.

Son: No. It’s what you want.

Being a caring, loving parent who wants his child to have the best life possible fits the very idea of a virtuous parent. Many parents who want their deaf children to get cochlear implants simply want the best for their children. If indeed Worthington developed the cure to help Angel, he might also be a virtuous parent. But the dialogue indicates Worthington is less interested in the cure because he wants the best for Angel and more because he wants to eliminate the feeling that he is an inadequate parent (for having an “abnormal” child). Or perhaps, like some hearing parents who have deaf children, he simply has overly negative ideas about what being different is like; he cannot imagine living in his son’s body and he thinks his son does not want to live in that body either—he thinks that his son wants to be “normal” because that is the only life the father knows.

Implications of the cure for mutant parents are not explored in the movie, except for Angel and his father. We do know how some of the other parents feel, though. Mystique tells the prosecutor at one point, “My family tried to kill me, you pathetic meatsack.” Bobby’s parents are not so extreme but seem terrified and shocked to find out that he is a mutant. Jean’s father refers to her “illness.” If these parents knew about the cure, they would likely have made their children undergo treatment. But what would the world of the X-Men be without Bobby, Jean, Mystique, and Angel? And without all of the other mutants whose parents would have chosen to “cure” them of their abnormalities early on?

Although it is tempting to assume that being a mutant is better than being disabled, it’s not clear whether this is always the case. How is brutal Sabretooth (or even Bobby or Pyro) better than a child with Down syndrome? Some parents of children with Down syndrome describe them as “stars in an increasingly materialistic world,” “without exception magic children” and capable of “unconditional love”; it seems likely that some parents would rather have a child with Down syndrome than a child like Sabretooth, Pyro, or Rogue.⁸ In fact, it’s possible to think of children with Down syndrome as having special powers: one parent of a child with Down syndrome even said, “[We] often wish that all our children had this extraordinary syndrome, which deletes anger and malice, replacing them with humor, thoughtfulness and devotion to friends and family.”⁹

In the ethics of medicine and health-care, the principles of beneficence and nonmaleficence have extraordinary importance. Simply put, the principle of beneficence says that we should do good whenever possible, while the principle of nonmaleficence says that we should do no harm. But applying these principles can be tricky. Is the child being harmed by not getting a cochlear implant? Or is she harmed by getting it? Would Rogue be harmed if she was no longer a mutant? Would Bobby be harmed if he could not create ice? The answers to these questions are not clear. Parents are supposed to look out for the best interests of their children, and most of them do. The reason why they disagree so much is that it is not obvious what the best thing to do is. X-Men fans are attached to all of the quirky attributes of the X-Men, but if we had a child like Beast or Nightcrawler, would we seek treatment for him? What if the child was like Rogue?

The issue is even more complicated when we start considering not only the well-being of the child but also the well-being of society. The principle of utility says that we should act so as to promote the greatest overall good or happiness, taking into account both short- and long-term consequences. Is the cure maximizing the greatest overall good? If Sabretooth’s mutant gene is causing him to be brutal and sadistic, would his parents be justified in “curing” him? Assuming that we knew Jean would end up killing her boyfriend and Xavier, as well as a lot of other mutants and human beings, would we be obligated to seek treatment for her?

How we treat those with so-called disabilities shows what kind of values we have. What sort of virtues and principles do we value? How do we conceive of equality, justice, fairness, personhood, good parenting, autonomy, individualism, abnormality, dependence, happiness, freedom, community, duties of the state toward its citizens, or the likelihood of social change?

Curing Oneself of Persecution

When the cure is first introduced, Storm asks, her voice filled with dismay and anger, “Who would want this cure? I mean, what kind of coward would take it just to fit in?” Hank/Beast gives the answer that many parents of children with disabilities would give: “Is it cowardice to save oneself from persecution?” Later, Hank, who is covered in blue fur, points out to the beautiful Storm, “Not all of us can fit in so easily.”

Like many disabled people, the mutants are not well understood or well liked by their fellow human beings. In the first X-Men movie, Dr. Grey explains to Congress that the mutants have been met with fear, hostility, and even violence. Much like Rogue and those who line up to receive the treatment, some disabled people draw attention to the pain, the isolation, and the social difficulties they encounter. And unlike Rogue, who can live in Xavier’s school, many of them do not live in supportive communities, in places where they can thrive and flourish, surrounded by others like them.

Society is not structured to protect disabled people or enable them to participate in society. Rather, societal structures perpetuate or exacerbate their disempowerment. Our buses, cars, buildings, and household appliances have not been made for people with mobility or vision problems. People with disabilities of all kinds are still often denied the social support that they need, such as appropriate accommodations in the workplace, schools, and public spaces. Furthermore, disability is often accompanied by poverty, especially in the United States, where forty-eight million people are without health insurance. So for many parents, cochlear implants represent the opportunity to save themselves and their children from the persecution that accompanies being different.

The Cure as a Weapon

One way to fight against the discrimination is to work on legislative campaigns that change the social barriers encountered by those with disabilities. The Last Stand, however, does not have a sympathetic portrayal of this approach. At a large meeting held by a group of mutants after they hear about the cure, one mutant who seems to be the organizer of the event explains,

“This is about getting organized, voicing our complaints to the right people. We need to put together a committee and talk to the government.” Would this approach work? The film suggests it wouldn’t. The mutant seems naïve in his belief that the government will change. The dialogue that follows is instructive:

Arclight (interrupting him): They wanna exterminate us. Organizer: This cure is voluntary. Nobody is talking about extermination.

Magneto: No one ever talks about it. They just do it. And you’ll go on with your lives ignoring the signs all around you. And then one day . . . they come for you. Then you realize, while you’re talking about organizing and committees, the extermination has already begun. Make no mistake, my brothers. They will draw first blood. They will force their cure upon us.

In a movie made in the United States, a country whose history includes colonialism and racism, is it a coincidence that Magneto’s army—suspicious of the government’s intention—is predominantly Hispanic, Asian, and black? And that Xavier’s group—much less suspicious of the government, much more willing to work within the system—is mostly white? (Except for Storm, but she is also the one who is most outraged about the cure.) It is surely not a coincidence that Magneto himself is a Holocaust survivor (and he reminds us of this by showing his tattoo soon after he expresses his thoughts about an extermination), and he seems determined to never let anyone persecute him or his kind ever again. It is well known that during the Holocaust, the Nazis euthanized and sterilized those they deemed to be “defective.” It is less well known that in the United States, the eugenics movement was also widespread in the early twentieth century. For example, in 1931, almost thirty states had sterilization laws aimed at the feebleminded, and twenty thousand people were forcibly sterilized at that time.¹⁰

Mindful of this history, some people argue that fetal screening for disabilities and the selective abortion that often follows has the effect of decimating people with disabilities. Many parents, for example, are horrified to find out that their children have Down syndrome; indeed, about 90 percent of women choose to terminate their pregnancies after prenatal diagnoses show that they are carrying children with Down syndrome.¹¹ Similarly, because implanting deaf children with cochlear implants allows them to perceive sound and learn spoken language, cochlear implants have the effect of eliminating new generations of deaf people. Thus, while some, like Worthington, see technological advances as “cures” and “sources of freedom,” others are suspicious, seeing weapons and genocide.

Indeed, although the mutant cure was initially available as an option for those who wanted it, it quickly became a weapon in the hands of the government. First, they use it against Mystique; then, at the end of the movie, against all mutants. But the government is not the only one using it; some mutants also use it against other mutants. Wolverine and Beast stab Magneto with it in attempt to take away his mutant powers.

Stereotypes and prejudices against disabled people abound. People imagine that a disability is a defect, something to be fixed, and they assume that disabled people will be delighted to hear about scientific discoveries that are aimed to cure them. Some of them are. But other disabled people might relate more with Storm, who, on hearing about the cure, argues with pathos that there is nothing to be cured. With extraordinary power, The Last Stand calls into question the intuition that the first stance is the only justified one: that mutants, or the “disabled” require a cure to lead meaningful lives. As Storm insists, there’s nothing to “cure.”

NOTES

1 When I refer to “disability issues,” I refer to a wide range of disabilities, of many different kinds: visible or invisible; mental, physical, or emotional/social; inherited or acquired; common or uncommon; minor or severe; and so on.

2 William Hughes and Kevin Patterson, “The Social Model of Disability and the Disappearing Body: Towards a Sociology of Impairment,” Disability and Society 12, no. 3 (1997): 328.

3 Michael Oliver, Understanding Disability: From Theory to Practice (Basingstoke, UK: Macmillan, 1996), p. 33.

4 See, for example, Neil Levy’s “Reconsidering Cochlear Implants: The Lessons of Martha’s Vineyard,” Bioethics 16, no. 2 (2002): 134-153.

5 Deaf people capitalize the word Deaf to refer to their culture, in a similar way to our capitalization of the words American or French, while deaf with a small “d” refers simply to being deaf.

6 Oliver, Understanding Disability: From Theory to Practice, p. 22.

7 For more information on the social model of disability, see Susan Wendell’s influential book The Rejected Body: Feminist Philosophical Reflections on Disability (New York: Routledge, 1996).

8 Quoted in Peter Singer’s “Shopping at the Genetic Supermarket,” in Asian Bioethics in the 21st Century, edited by S. Y. Song, Y. M. Koo, and D. R. J. Macer (Tsukuba, Japan: Tsukuba University Press, 2003), pp. 143-156.

9 Quoted in Ann Bradley’s “Why Shouldn’t Women Abort Disabled Fetuses?” Living Marxism 82 (September 1995); See www.informinc.co.uk/LM/LM82/LM82_Taboos.html.

10 Ruth Hubbard and Mary Sue Henifin, “Genetic Screening of Prospective Parents and of Workers: Some Scientific and Social Issues,” in Biomedical Ethics Reviews, edited by James Humber and Robert Almeder (Clifton, NJ: Humana Press, 1984), p. 77.

11 Cited in Rayna Rapp’s Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America (London: Routledge, 1999), p. 223.