The Minority Body

The Minority Body is an important and provocative book. It moves disability further into the center of philosophical debates about well-being, harm, and group identity with bold, original arguments; clear, engaging writing; and vivid, concrete examples. Although much of the book is drawn from previously published articles, their integration suggests a unified philosophical project. Those articles have already begun a philosophical conversation continued in the book and its early reviews. After a brief summary, I will join that conversation, focusing on the earlier, more foundational parts of the book and occasionally referring to previous critiques.Barnes challenges the superficial consensus that has emerged in response to a generation of disability scholarship: that disability should be seen as an interaction between a biological impairment and the physical and social environment; that disability is not (usually) a tragedy, just a misfortune compounded by stigma and injustice; that individuals with even very serious disabilities can and do flourish, although they would (of course) be better off without them. Barnes rejects this now-conventional wisdom, arguing that disability should not be defined in terms of impairment; that it need not be, and often is not, a misfortune at all; and that there are no grounds for assuming that the lives of many or most people with disabilities would go better without them.In chapter 1, Barnes searches for a unifying or explanatory definition of disability that includes paradigm conditions, doesn't beg normative questions about the (dis)value of disability, and avoids circularity. She rejects definitions based on absent or deficient biological functions, instead defining “disability” as a socially constructed set of bodily conditions:A person, S, is physically disabled in a context, C, if and only if(i) S is in some bodily state x(ii) The rules for making judgements about solidarity employed by the disability rights movement [DRM] classify x in context C as among the physical conditions that they are seeking to promote justice for. (46)She suspects that these rules employ “cluster-concept reasoning,” selecting conditions with a sufficient number of features such as being stigmatized, complicating routine tasks, requiring assistive technology, and causing chronic pain, access barriers, or shame.Barnes claims that this definition avoids circularity because the DRM can be identified without relying on a definition of disability, for example, by the kind of reforms it advocates. Identifying the DRM in this way does not rest on how its members describe their movement, but on those reforms, for example, ramps and braille, not free speech or animal rights. Even this basis for identification may rest on an intuitive sense of “disability.” But the movement thus identified has revised any such intuitive understanding of disability, developing rules that go well beyond the intuition, rather than circling back to it.Chapter 2 introduces and defends that idea that disability, so defined, is, in itself, a mere, rather than a bad (or good), difference, that is, akin to race, sex, or sexual orientation. Barnes explains the variety and complexity of mere difference views and provides several examples. She then attempts to weaken the resistance to her preferred version by questioning the self-evidence of the judgment that disability, as such, is a bad difference.In chapter 3, Barnes defends a value-neutral model of disability that grounds mere-difference views. (Since there are a variety of such views, it's not possible to specify a precise relationship between value-neutrality and mere difference.) For Barnes, disability can be “neutral simpliciter” even if some specific disabilities are not, and even if every disability is bad overall for some of the people who experience it. To make the case for neutrality as she defines it, she adduces the testimony of people who find their lives no worse because of their disabilities.Chapter 4 challenges the widespread tendency to dismiss such testimony by discounting “adaptive preferences.” Barnes finds no basis for greater skepticism about the firsthand reports of people with disabilities than any other presumptively competent people. She argues that such skepticism is a form of epistemic injustice; an unfair, unwarranted denigration of the testimonial capacity of those belonging to disfavored social groups.Chapter 5 tries to blunt the force of what many regard as the strongest objection to a mere-difference view—that it deems it permissible to cause disability in previously nondisabled individuals. Barnes responds that (1) the strongest objections to causing disability do not presuppose that disability is a bad difference; they apply equally to unconsented interventions altering any significant trait or condition, good, bad, or neutral; and (2) where there is no issue of consent and no transition costs, causing a nondisabled person—for example, a newborn—to be disabled is objectionable, if at all, only on a noninterference principle that would also condemn changing a disabled to a nondisabled person.Chapter 6 offers a spirited philosophical defense of disability pride. A culture of pride enables disabled people to interpret their experiences of disability positively, against the powerful, recalcitrant “common sense” view of disabilities as great burdens and of disabled people as significantly worse off because of those burdens.Overall, The Minority Body offers a bracing challenge not only to mainstream philosophy but also to much recent work in philosophy and disability. The alternative account Barnes offers, however, raises several issues, of which I will focus on two. First, its definition of “disability” puts the concept largely beyond the reach of philosophical engagement. In the face of questionable exclusions and difficult questions of inclusion, Barnes's definition encourages a problematic buck passing. Second, the concept of “neutrality simpliciter” that grounds mere-difference views is both underdefined and extremely weak.1Relying on the DRM's tacit rules to determine what counts as a disability has significant costs. It leaves critics with little basis for objecting to a biased or arbitrary rule—a concern Barnes has acknowledged (NPDR Forum 2016). While a critic could treat an intuitively mistaken exclusion of a candidate condition as a mistaken application of a rule, it's not clear how to distinguish a misapplication from a mistaken rule. Thus, Barnes sees the initial exclusion of HIV as a misapplication, since the kinds of accommodation demanded by the DRM clearly benefit people with that condition (NPDR Forum 2016). This suggests a rule like “Promote justice for people with bodily states who would benefit from the reforms we seek.” But why wouldn't this rule extend to people with MS, a condition Barnes appears to regard as excluded by a biased, not misapplied, rule? She plausibly attributes its exclusion to the DRM's effort to distinguish disabled people from sick people. But that effort would be threatened by including people with HIV, generally regarded as sick, not as disabled. Moreover, the accommodations sought by the DRM, from ramps to flexible hours, would benefit people with MS at least as much as people with HIV.Critics of an exclusion will be tempted to treat it as a misapplication, since they have limited grounds for criticizing the rule itself without forbidden recourse to an independent definition of disability. In some cases, a critic could argue that the DRM's history and values favor a more inclusive rule. But they might not have; the DRM might have been unapologetically elitist, excluding all bodily states associated with intellectual, communicative, or psychiatric impairments, so that there could be no appeal to its history or values. Clearly, the category constructed by such rules would lack the interest that disability in fact holds. Disability, however, would have no less philosophical importance had the DRM's rules obscured its scope. Its definition cannot depend exclusively on those rules, even the more inclusive ones the DRM actually employs.Barnes's deference to the DRM also complicates her chapter-2 distinction between a disability's essential and inessential features. She readily acknowledges that all or most disabilities have inessential features that can be bad differences, rough counterparts to female menstrual cramps or higher male mortality. But what makes a feature inessential? Do the DRM's rules decide this, as well as determining which bodily states count as physical disabilities? Or is this a question philosophers can best address? By what criteria? For example, pain surely appears to be essential to chronic pain syndrome, which (now) counts as a disability. But not all essential features will be matters of definition. Nor does intuition offer much guidance. Which aspects of a progressive, life-shortening condition like Duchenne Muscular Dystrophy (DMD) are essential to it?A related problem arises in chapter 3, where Barnes defines value neutrality in terms of the core notion of “neutral simpliciter.” A feature is neutral if it is neither bad nor good simpliciter; a feature is bad or good simpliciter if and only if life goes worse or better for (almost) everyone who has that condition or feature, in virtue of having it. Barnes, though, never explains what it means for life to go worse or better in virtue of a condition. In chapter 2, she characterizes “in virtue of” as “hyperintensional” (64), which suggests that it must be the feature itself, not anything associated with it, however closely, that affects well-being. In chapter 3, she states that something is good or bad simpliciter if it “always, or almost always,” has a net positive or negative effect, respectively, on well-being (84).Paraphrases follow, but no further explanation: “if something is bad simplicter, your life goes worse in virtue of it specifically, even if its overall causal effects on your well-being ultimately make you better off” (87, italics in text). Barnes places a premium on isolating the direct impact of the “something” in question. Yet its reference is unclear. The chapter-1 definition of disability refers to the bodily states in the DRM portfolio. In chapter 3, though, Barnes denies that disabilities can be reduced to collections of physical characteristics, maintaining that a disability is a complex of physical, social, and experiential features.2 If neutrality claims concerned such collections, however, they would be very difficult to assess, since specific collections, if not unique, would rarely recur.Barnes's illustrative contrast of disability and cancer highlights these definitional questions. She suggests that cancer, unlike disability, may be bad simpliciter. This is a puzzling contrast, for two reasons. First, cancer is classified as a disability by many discrimination laws and disability rights groups. Second, it is difficult to see what features of cancer would work against that classification, given that Barnes regards diseases like DMD as disabilities. Some of those diseases, much like some cancers, involve pain, loss of function, and reduced lifespan. Perhaps cancers typically afford less opportunity for creative adaptation, or tend to be viewed as “hostile takeovers” in a way that these other diseases are not. But we are left to speculate on the relevant differences.Even with these definitional uncertainties, many conditions conventionally seen as bad or undesirable will qualify as neutral simpliciter. Barnes adopts a two-pronged strategy for defending the neutrality of disabilities with essential features that look like bad differences. She questions whether some ostensibly bad differences, like chronic pain, really are bad simpliciter. All that she needs to deny this is evidence that some lives go better in virtue of chronic pain. But she also recognizes that some disabilities may be bad differences. This recognition, however, does not threaten neutrality. Disability qualifies as neutral so long as a small minority of those with any of the bodily states qualifying as disabilities under the chapter-1 definition are not worse off in virtue (specifically) of possessing that feature. If this is a fair paraphrase of the neutrality claim, only the most unregenerate ableist would reject it.3The weakness of disability-neutrality poses a challenge to the claimed moral parity of causing and removing disability in the absence of consent issues or transition costs. In chapter 4, Barnes argues that if the former seems impermissible, and the latter permissible or even required, it is because disability is assumed to be a bad difference. But no such assumption is needed: one could see disability as neutral simpliciter and as a mere difference but still maintain that it was worse to cause than remove it. One would merely have to believe that the odds of being worse off overall in virtue of having a disability, or the specific disability in question, were significantly greater than the odds of being worse off overall without it. This belief is fully consistent with the view that some people's lives are not worse in virtue of having a disability, and that disability is thus a mere difference, in at least one of Barnes's senses.The challenges I've highlighted with Barnes' definition of disability and her notion of “neutral simpliciter” do not diminish the importance of The Minority Body. They are, rather, challenges commensurate with the philosophical depth and ambition of this provocative, highly original book. It has already become a seminal work on the definition and prudential significance of disability.I have benefitted greatly from conversations with, or reviews of this book by, Sean Aas, Stephen Campbell, Adam Cureton, Jennifer Hawkins, Dana Howard, and Joseph Stramondo. The views in this review are the author's own. They do not represent those of National Institutes of Health, US Health and Human Services, or the federal government

Analytic philosophy · Contemporary philosophy · Epistemology · Ethics in medical practice · Feminist Epistemology and Gender Studies · Patient Dignity and Privacy · Philosophy · Psychology

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