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Procedia Social and Behavioral Sciences 5 (2010) 1804–1810

WCPCG-2010

The impact of disability on self and society: an agenda for research

on rehabilitation of disabled in Nigeria
Sabo Suleiman Kurawaa * F F

a
Department of Sociology, Bayero University, Kano-Nigeria

Received January 8, 2010; revised February 6, 2010; accepted March 13, 2010

Abstract

Disability requires a complete reorientation of roles by the individual. The disabled individual’s redefinition of roles takes place
through social interaction with his family, friends, co workers, other disabled persons and members of his community and the
medical staff as well as rehabilitation officers. The important difficulty for the disabled is that his disability affects his interaction
with others. He cannot rely on old patterns and role expectations. He must therefore reconstruct many of his social relationships
with others as he rebuilds his roles and modifies his self- identity. This paper is divided into five major sections. The first section
deals with the introduction. The second section is on the conceptual explanations for disability and rehabilitation. It also situates
the concepts within relevant theoretical frame of reference(s). The third section is to do with the description of the onset of
disability and its consequences. The fourth section explains the effects of disability on values and normative structures. The fifth,
which is the final section, is an analysis of rehabilitation as socialization or re-socialization process and its prospects and
challenges for the future which may necessitate setting up an agenda for further research in Nigeria.
© 2010 Elsevier Ltd. Open access under CC BY-NC-ND license.

Keywords: Disability, rehabilitation, nigeria, society.

1. Introduction

It is assumed that most people will be injured or even suffer from diseases at some point in their lives but few
individuals foresee that they will ever be disabled. It is common to expect pain and discomfort with injury and
disease, but the implications of chronic incapacitation are seldom anticipated, let alone be understood. The patients
and those around them are not socially and psychologically ready to cope with the conditions of the chronic disease.
The onset of disability is accompanied by a complex series of shocks to the individual and to everyone around him.
The disability is usually the result of some trauma or disease. The impact of disability may take many forms. The
first effects are often physical pain, limitation of mobility, disorientation, confusion, uncertainty and a disruption of
roles and patterns of social interaction.
Initial concern is frequently with the question of survival: Will I live or die? After this emotional shock was
subdued, the difficult process of re defining the situation continues. The disabled person, like any other individual, is
a product of his social interaction and his environment. Hence, the behaviors and expectations of others mold or

* Sabo Suleiman Kurawa.

E-mail address: sabokurawa@yahoo.co.uk.

1877-0428 © 2010 Published by Elsevier Ltd. Open access under CC BY-NC-ND license.
doi:10.1016/j.sbspro.2010.07.368
 Sabo Suleiman Kurawa / Procedia Social and Behavioral Sciences 5 (2010) 1804–1810 1805

influence the behavior and expectations of self. In the light of this, the disabled may ask further questions, such as:
Who am I now? What can I do? What will I be able to do? What do others expect of me now? Why did this happen
to me? etc. These are some of the questions that the disabled person confronts. Those around the disabled person
pass through a similar series of shocks and questions. Similarly, their initial concerns are with survival, but as time
passes they question and re examine the effects that his disability will have on their lives.
In response to their friends, relations and those around him, the disabled person rebuilds roles and self identity
with a view to adapting to his condition of disability. How does he adjust? Is he feeling of being stigmatized? Is he
set apart from the able-bodied persons? Is he pitied or rejected? Does he frequently feel shame and confuse as he
tries to manage his “changed or spoilt identity”? How does he redefine new roles of disabled?
In the past, the traditional values and normative structures in Nigeria mitigated the adverse effects of disability
through the social and psychological support which emanated from the mutual solidarity of kinship and extended
family system. Thus, the disabled persons were kept at home and treated with affection and love. The rehabilitation
programmes were “family or community based” in orientation. But, with the gradual erosion of the societal values,
the disabled persons are today seriously affected. Some disabled persons are kept at institutional or vocational
centers for rehabilitation, while many are left to fend for themselves, usually at the “mercy of nature”, roaming
around our streets or left at homes with little or no attention, at all. Such disabled persons are more often treated as
living dead. Such a condition requires for the setting up of an agenda to precisely understand the concepts of the
disability and rehabilitation with a view to evolving a more humane system.

2. Concepts of Disability and Rehabilitation

Disability refers to limitations in the kind and amount of individual’s physical and mental function. Increasing
attention has been given to the functional limitations resulting from the pathological conditions (Haber, 1971). But
the disabled does not live in a vacuum. He has to live and interact within an environmental and social context.
Hence a more plausible definition of disability is as follows: It is a limitation or incapacitation in individual’s
physical and/or mental function resulting from pathological conditions as viewed and reacted within the socio-
environmental context (Safilos- Rothschild, 1970).
Rehabilitation is a process of regaining lost physical and mental functions. It is referring to “a process of
regaining functionality from the physical and mental limitations or incapacitations of disability” (Fordyee, 2006:
77). By definition, the best rehabilitation programme is the one which most effectively helps the disabled to cope
with the problems of losing and regaining physical and social functions within a particular environmental context. It
involves a socialization or re socialization of the disabled.

3. Theoretical Framework

The two dominant theories for illness or disability are functionalist and interpretative approaches. The first
highlights the extent to which the onset of illness or disability can involve the adoption of an appropriate social-
role, the sick role (Parsons,1975). The second approach, by contrast, focuses on how the person who is ill or
disabled and those around him make sense of the illness or disability, and how these interpretations impact upon
action. In fact, the interpretative approach was formulated through critiques of the functionalist approach (Nettleton,
2001).
How people make sense of their disabilities is within the context of their personal biographies and in turn this
must invariably be influenced by, and meshed in with, the cultural values of the society in which they live
(Williams, 1984; Radley, 1993; Bozo, 2009). Hence, disability itself is a function of a society which fails to take
account of people who have physical impairments. Disability is a consequence of a society in which disabling
attitudes and disabling environment prevail. Thus, disability is not only a function of the physical incapacitation of
an individual but it is socially created. It is sometimes presumed that people who have functional impairments such
as deafness, blindness or restricted mobility have special needs. But these needs only become “special” within a
context which excludes, marginalizes or fails to take them into account in the first place. It is sometimes problematic
to talk of “the disabled” as a single a category when in actual sense they constitute a diverse group. However it can
be viewed more positively in that it draws attention to the minority status of people who have disabilities and as
such highlights the political nature of disability and contributes towards the creation of a sense of solidarity,
resistance, mobilization for a common goal and esprit de corps of the group.
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Therefore, it is evident that biophysical changes have significant social consequences. Disability reminds us that
the “normal” functioning of our minds and bodies is central to social action and interaction. Hence, disability throws
light on the nature of the interaction between the body, the individual and the society. If we cannot rely on our
bodies to function “normally”, then our interaction with the social world is restricted, our dependency on others may
be highly intensified and in turn our sense of self may be questioned or distorted.
For instance, the onset of blindness may limit movement of the disabled which means becoming dependent upon
others to perform tasks previously carried out by him, alone. He may therefore be asking or demanding so many
things which may turn him to be an object of ridicule. Disability can impact upon the disabled persons’ daily living,
their social relationships, their identity (the view that others hold of them) and their sense of self (their private view
of themselves). Thus, disability is at once both a public as well as a private phenomenon which requires appropriate
attention.

3.1.1. Onset of disability and its consequences

The onset of disability forces a redefinition of behavior. In a rather short time span, the disabled person discovers
that he is no longer able to conform to the values and norms of his society which he probably assimilated during his
continuing socialization. Thus, with his new set of information, he finds out that what was ‘normal’ for him
yesterday is not ‘normal’ now. He may no longer be healthy, independent, active, physically attractive to others,
capable of long work hours, and sexually potent. His income is drastically cut, he probably incurs huge medical
bills, and he has to learn entire new sets of adaptive behaviors. How does this individual now define himself? If he
cannot measure up to the values of the society, what worth does he have to himself and others? Now that his life
condition has changed, is he still normal or is he a freak or a deviant? The entire questions of self identity and
deviancy are faced within the context of re socialization process. Thus, the disabled person redefines deviancy and
values in terms of his resources, his own and others’ expectations, and his reference group.

3.1.2. Self-Reaction of the Disabled

There are three essential ways in which an individual may react to the public labelling of his disability (Clinard,
1974). He can deny its existence, he can accept it, or he can seek indirect benefits from the situation. Those
individuals who have always put a singularly high value on their appearances tend to view physical handicaps as
misfortunes or even personal disasters. The most likely reaction to an incurred disability in this case is denial of its
existence. Some people desperately attempt to deny the situation and to remain ‘normal’ and non disabled, a practice
common among the mentally retarded. Deaf persons may pretend to hear, and the stutterer often tries to “mask” his
speech behavior, while the blind may wear dark glasses. The masking of a disability does not hide the fact from the
person himself that he is disabled nor does it hide it from certain significant others.
Some persons may view their disability as acceptable although not ideal. They are able to accept their disabilities
without being plunged into hopelessness and despair. Such individuals feel that they are worth while persons who
can go on living a full life by capitalizing on their unchanged abilities and minimizing what they can no longer do.
This attitude is often not an immediate response to labeling but rather one that occurs after the individual has passed
through the denial or despairing period.
The last category of disabled persons consists of those who appear to adapt to the changes of disability all too
eagerly and painlessly and seek the benefits that accrue from it. Physical limitations and restrictions that could be
overcome are maximized: remaining capabilities are minimized. Though this disabled person has been legitimately
labeled, he tends to cultivate secondary and “illegitimate” gains from his status. In some cases, disabled persons may
even be motivated to resist medical treatment or rehabilitation therapy if they perceive that this care could bring
about a sufficient improvement in their conditions that they could be required to return to their undesirable pre
disability status. . It was however pointed out by Ludwig and Collette (1970) that the social isolation, economic and
personal dependency that frequently result from disability tend to influence the person’s mental health status. Thus,
the disruptive consequences of this dependency have far- reaching effects on self- esteem and one’s concept of self
or self- image.
3.1. .3. Effects of disability on values and normative structures
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The values and norms of a society shape and influence the socialization and /or re socialization processes as well as
disability and its rehabilitation processes. Hence, disability must be interpreted in the light of societal norms if
individual and group responses are to be understood. Values and norms do not determine behavior and produce the
“over socialization concept of man”, but they do exert powerful influences on human social interaction and shape
the entire socialization or re socialization processes. There are mutual influences between values, attitudes and overt
behaviour (Rokeach, 1968). They also have an overarching relationship and an interactive effect on disability and
rehabilitation.
The disabled person undertakes rehabilitation within the context of his own and his family’s values, attitudes and
behavior as well as those of the larger society. The dominant values in the Nigerian society are important
considerations in a study of adaptation to disability and rehabilitation of the disabled persons. During the 18th and
19th centuries, and even beyond, the disabled persons were treated in their communities through a collectivist system
(Forbidan, 1986; Kani, 2009). It was a system firmly established upon the extended family, kinship network and
communal relationship. The system was specifically used as a platform for extending support, sympathy, pity, and
solidarity to members, especially the disabled persons. During the adaptation stage, the disabled persons used to
have ‘care in community’ to ease the pain and discomfort of disability and facilitate rehabilitation. The hallmark of
social integrity and respect of the family and kinship of the disabled persons was to confine and rehabilitate them
within the community.
Today, there is a surprising development on what are the dominant norms and values in Nigerian culture and
society within the 21st century. Nigeria in attempts to be brought within the orbit of the capitalist system has to be
gradually transformed to imbibe the values and culture of America and a host of Western countries. One prominent
change was the adoption of individualism which superseded collectivism. Thus, achievement and success are
measured in- terms of wealth or income, occupation, prestige, power, and a generally improved condition of one’s
well being and/ or a relatively high standard of living for a very few individuals- the elite in the society. But there
seems to be a contradiction as majority of the Nigerians are suffering from poverty, poor health, living in untidy
environment most often infected with diseases and illnesses, pains, sufferings and , constrained with physical
limitations. This situation is further compounded by the capitalist ideology- the shift from ‘health’ as public health
related to social/environmental factors to “health” as private, with the individual responsible for his own well –
being.
It means that, under capitalism, medicine (and by extension rehabilitation) is commoditized. Thus, medicine
enters in to the market as a commodity, to be bought and sold as any other products. It becomes increasingly
profitable for two of the dominant interests within capitalism- the finance sector through insurance premium; and the
corporate sector; especially through drugs and medical instruments sales. Power to direct and exploit the medical
system is accrued to the subsidiaries of large corporations enjoying monopolistic control over market sectors, a
process which is characteristic of capitalism as a whole, where monopoly capital invades, directs and dominates
social life (Turner, 1987).
Nigeria’s National Health Insurance Scheme (NHIS) was established only in 1999. The scheme was aimed at
achieving health related Millennium Development Goals (MDGs). Currently it enrols only persons who are
employees in the formal employment sector. However, as the scheme is mandated to offer universal coverage to all
Nigerians by 2015, there are plans to extend health insurance schemes to the informal sector in the future. According
to Nigeria Demographic and Health Survey Report (2008) majority of men and women have no health insurance
coverage (97 and 98 percent, respectively). The most commonly used, among all categories of insurance, is the
employer- based insurance. But “only 2 percent of men and 1 percent of women are covered by this type of
insurance” (Nigerian Demographic and Health Survey Report, 2008:45).
Given this scenario, it is evident that the country has many constraints; which are in consequence of a society in
which disability attitudes and disabling environment prevail, which are socially created. The pertinent questions are:
How are the disabled persons rehabilitated? What are the challenges and prospects for rehabilitation of the disabled
persons, in Nigeria?

4. Discussion on Rehabilitation: Challenges and Prospects

The term ‘rehabilitation’ is frequently assumed to have very misleading connotations of patient passivity and
dependency. On the contrary, the participant in the rehabilitation process is in actual fact, actively engaged in
adjustment and adaptation process that permits him to become increasingly independent of those around him. Thus,
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the disabled person must re adjust to a new set of resources, old patterns of social interaction are changed, and the
cultural norms that guide the process must be modified to fit the new circumstances (Albrecht, 1976).
Various types of disability have different degrees of visibility. For instance, serious facial burns may be highly
visible and elicit dramatic responses from others and yet not be very disabling in terms of physical function. Oral
and orthodontic problems may be very disabling for eating and speaking and yet have little effect on social
interaction, self concept, engagement and marriage (Rutzen, 1973). Thus, there is a distinctive difference between
the visibilities of the disability and its social and psychological consequences as well as the rehabilitation of the
disabled persons. Both of these aspects of disability have a lasting impact on the rehabilitation process. For most
disabled individuals, independence and maximum physical function are the goals of the rehabilitation process. These
goals are determined by and interpreted in the light of the individual’s resources, his own and others’ expectations,
and his environment. The success of the rehabilitation is contingent upon the changing of values and goals, the
identification of specific problems, an accurate assessment of resources, and the modification of behavior.
In Nigeria, rehabilitation of the disabled persons is generally carried out by families, friends and in few cases by
governmental agencies (through institutional or custodial care). Most of the disabled persons who have received
rehabilitation programmes, in form of training, skills acquisitions and other services available, through the
governmental agencies have rejected continued application of what they learnt to make themselves economically
independent and be socially integrated with their communities (Saleh, 2009). They prefer to be, set out on their own
as, beggars. Begging is often lucrative, and many beggars are able to earn more than they would by working in a
workshop as disabled persons. It is essential to recognize that the causes of the adaptation to disability lie not only in
the psychological of marginal individuals but in general reactions to disability as well. If non -disabled persons do
not pity and sympathize with the disabled persons or cut them off from the mainstream society, or force them in to
positions of helplessness, or patronize them, begging could hardly exist and be resilient. There would be no
motivation to beg, and there would be no “market for the beggar’s product”. Thus, judgments about the seeming
immoral actions of beggars are incongruent with the responses to and treatment of disabled by the non disabled
persons.
It is important to recognize that begging, particularly in most Northern part of Nigeria, has both religious and
cultural implications. The disabled persons are to be treated with sympathy, love and care with a view to mitigating
the adversary effects of disability and integrating them within the fold of the larger society. There are however some
people who have misconstrued the position of Islam on disability and the religious teachings on how to handle
disabled persons with love and sympathy. Such individuals feel that they are therefore obliged to give alms to the
disabled persons, especially those who beg publicly. Giving alms signifies sympathy, love, care and concern in
recognition of the dependency role of the disabled persons. But Islam does not advocate dependency role, blindly;
instead, it encourages both the disabled and non disabled persons to work, in accordance with their capabilities,
earning a living and be economically independent.
Under the pretext of religio- cultural cover and support, disabled persons beg for alms to deliberately exploit their
dependency role in order to profit from playing such a role. The dependency role is further exploited and
compounded by few non disabled persons who beg for alms. They manipulate their bodies and body- movements to
act as crippled or disabled persons with a view to deceiving their patronisers- getting their sympathy and receiving
alms. They beg for alms; roam around the streets or station at strategic places, usually at traffic- lights. They are
held in great disdain by almost all ‘legitimate’ disabled persons because such ‘illegitimate’ disabled persons do great
harm to the cause of bettering the position of the disabled persons in the society because they cheat their patronisers
and exploit the dependency role, thereby re inforcing stereotypic ideas about disabled persons.

4.1.1. Agenda setting for Disability Research

There is the need to define the most appropriate unit of analysis in studies on the disabled persons. Should the
studies be on the individual(s) as the unit of analysis or does it really need to go beyond that limit? Disability can be
conceived of as an attribute of the entire family or of the society because it dramatically affects the interaction
patterns of the family and its entire system of generation and allocation of resources. Hence there is the need for
more disability research which uses the family and larger society as well as the individuals as units of analysis.
There is the need to create effective dialogue between social scientists and practitioners in the rehabilitation field.
While the resources of the medical profession are in the area of acute care, practiced on a one- to- one basis in
 Sabo Suleiman Kurawa / Procedia Social and Behavioral Sciences 5 (2010) 1804–1810 1809

hospitals, the needs are in the areas of chronic illness and disease, rehabilitation, prevention, and community
medicine practiced outside of the hospital setting in the community, work setting, and home environment.
The challenges facing medicine today, in Nigeria such as prevention of hypertension, periodic cancer screening,
genetic counselling, dental care, pollution control, elimination of smoking, eradication of veneral disease, and
utilization of health care facilities are more social in nature and are not going to be fully solved by research results
from the laboratory. Effective solutions of these challenges or problems require the utilization of behavioral science
knowledge.
Much of the practice of rehabilitation medicine is subjectively based on clinical observations by medical
professionals accumulated within the walls of a hospital (Goffman, 1963). But the disabled person is hopefully
being prepared to function in a non institutional setting. Therefore it would seem that the training of specialists and
the practice of rehabilitation medicine should take place outside of the institutional walls. If many of the problems of
the disabled persons are social, then the solutions must take this into account. Conversely, the behavioral scientist
researcher will not be able to communicate well with medical professionals or disabled persons unless he enters into
their worlds, to be on the same wavelength.
Rehabilitation problems are social learning and cultural problems, but they are also based on a complex set of
medical complications and physical and/ or mental deficits. The ultimate test of theory is the explanation and
prediction of behavior. The behavioral scientist must observe the actual behavior of the disabled person under
varying conditions and for long periods of time before he can make predictions and explanations. Research based on
official records, explains what was reported, but it may not be an accurate indication of the actual behavior. The
problems of the disabled persons cut across many disciplines. Therefore, the solutions will require the cooperation
and knowledge of a broad range of professionals and practitioners.
There are many fruitful areas for research in rehabilitation which include problems of measurement and problems
of definition. What is disability and how is it related to illness and disease? There is no clear understanding about
the prevalence and incidence of disability. The manner in which the disabled person defines his situation through
social interaction with those in his environment should require concerted research and rehabilitation knowledge. In
certain societies disabled persons are hidden and avoided from interacting with the public. But in Nigeria, the
reverse is the case, why? Is there any relation between poverty and the failure or rejection of rehabilitation
programmes, in Nigeria? The impact of insurance companies will be an issue for future research, in Nigeria. It is
worth investigating to know whether or not the goals of insurance industry are the same as the goals of the disabled
person. The entire process of identity change and re definition of deviant behavior for the disabled person is also an
area open for investigation. The relationship between disability and act of self- destruction are yet to be explored.
The financial impact of disability on the family is assumed, but little is known about the social and psychological
cost to the family and community. Much could be learnt about the effects of values and normative structures on
behavior by an examination of the influence that the onset of disability has on norms transformation. Careful study
of religion and culture will provide a platform for assessing their effects and influences on rehabilitation for the
disabled persons and the way forward, in Nigeria.

5. Conclusion

It has been explained in this paper that the onset of disability does disrupt and destroy social relationships hence; the
disabled person and those around him have to be involved in a monumental reconstruction job. Thus, disability
brings in an entirely different set of problems that is new to most persons. Values and goals have to be changed and
new behaviors learnt due to the problems introduced by disability which are to be solved through rehabilitation. The
success of the rehabilitation process is contingent upon the changing of values and goals, the redefinition of specific
problems, an accurate assessment of resources and the modification of behavior. It has been observed that disability
occurs within a social context. While an individual may experience a physical disability, he must function within
both a social and physical environment. Poverty, cultural deprivation, lack of education, and a depressed job market
do influence the impact of disability on the disabled person, those who are close to him, and the society, at large.
The problems of the disabled persons and their rehabilitation cut across many disciplines, hence it necessitates the
setting up of agenda(s) for collaborative research, in Nigeria.
1810 Sabo Suleiman Kurawa / Procedia Social and Behavioral Sciences 5 (2010) 1804–1810

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