Constructive Functional Diversity

This article was downloaded by:[University of Otago] On: 9 October 2007 Access Details: [subscription number 778407368] Publisher: Informa Healthcare Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Disability & Rehabilitation

Publication details, including instructions for authors and subscription information: http://www.informaworld.com/smpp/title~content=t713723807

Constructive Functional Diversity: A new paradigm beyond disability and impairment Philip Patston a a Diversityworks Group and Trust, Auckland, New Zealand

Online Publication Date: 01 January 2007 To cite this Article: Patston, Philip (2007) 'Constructive Functional Diversity: A new paradigm beyond disability and impairment', Disability & Rehabilitation, 29:20, 1625 1633 To link to this article: DOI: 10.1080/09638280701618778 URL: http://dx.doi.org/10.1080/09638280701618778

PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article maybe used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.

Downloaded By: [University of Otago] At: 00:58 9 October 2007

Disability and Rehabilitation, October – November 2007; 29(20 – 21): 1625 – 1633

Constructive Functional Diversity: A new paradigm beyond disability and impairment

PHILIP PATSTON Diversityworks Group and Trust, Herne Bay, Auckland, New Zealand

Abstract Aims of the paper. This article presents a more dynamic and constructive paradigm than the current dominant ones (for example medical or social models), to describe and change the impact of impairment and disability. The reflections contained are inspired by personal and professional frustration with the existing polarized ideology of human function, which fails to adequately describe the diversity of physiological and psychosocial function amongst people. It aims to provoke and inspire dialogue about our current paradigm of human function in relation to value and capacity. Key findings and implications. Within this paper: I critique society’s biases regarding of functional deficit relative to the subconscious fear of losing function; I question the polarity of the negatively framed language of impairment and disability; I offer constructive, creative ‘solutions’ to describe the experience of atypical function. In so doing, an entirely new language of diverse human function and a concept of Constructive Functional Diversity (CFD) is proposed, which includes a complex yet logical array of modes and outcomes of function. Conclusions and recommendations. Finally I suggest the benefits of a more dynamic paradigm of functional change in enhancing rehabilitative outcomes, including client-directed practice.

Keywords: Conceptual framework, disability, language, models of disability

Introduction A more radical approach is needed: we must demolish the false dividing line between ‘normal’ and ‘disabled’ [meaning impaired] and attack the whole concept of physical normality. We have to recognise that disablement [impairment] is not merely the physical state of a small minority of people.

It is the normal condition of humanity. [1] Functional diversity is a relatively new way of thinking about impairment and disability, though the term itself is used in a variety of contexts: To describe ecological [2] and biological [3] processes; to explain the variation in team and workgroup performance [4]; and to describe a fundamental characteristic of ageing [5]. Roman˜ach and Lobato (2005) related it directly to disability and impairment when they proposed the term ‘women and men with

functional diversity’ to ‘[represent] the most forgotten and discriminated ten per cent of humanity throughout the history of almost all human societies’ [6, p. 1]. They argued that none of the common terms used currently to describe this group was positive or neutral and that even the World Health Organization’s new International Classification of Functioning, Disability and Health (ICF) [7], was no more than a ‘praiseworthy attempt to shift the ‘problem’ of functional diversity from the person to the environment . . . [while still using] the words impairment, limitation, restriction, barrier and disability’ (p. 3). But functional diversity is far more than simply a new term to describe the internal experience of disabled people. It is an innovative way of thinking that takes away the boxes of impaired (or disabled) and a comparative normal. It allows all people to share in the complex array of human function and

Correspondence: Mr P. Patston, Diversityworks Group and Trust, PO Box 46256, Herne Bay, Auckland 1147, Aotearoa New Zealand. E-mail: [email protected] ISSN 0963-8288 print/ISSN 1464-5165 online ª 2007 Informa UK Ltd. DOI: 10.1080/09638280701618778

Downloaded By: [University of Otago] At: 00:58 9 October 2007

1626

P. Patston

benefit from their strengths. Roman˜ich and Lobato allude to this by ‘[attempting] to go even further and avoid the social strategy of ‘‘deviationism’’, the one that produces the ‘‘them’’ and ‘‘us’’ groups, to put forward that functional diversity is something inherent to the human being’ (p. 6). But they contradict this by repeatedly defining functional diversity as ‘a reality in which a person functions in a different or diverse way from most of society’ (p. 4). In contrast, the approach presented here recognizes that all people function in diverse ways. The deficit mindset of impairment and disability The foundation of my concept of Constructive Functional Diversity (CFD) calls for the complete removal of any notion of difference or deviation from a predetermined norm. Otherwise, we simply change the boxes’ labels from disabled and non-disabled to diverse and non-diverse. The potential of functional diversity to truly change the social mindset is to create one box only, labelled functional diversity, in which all human beings sit, stand, lie or otherwise exist. Within this one box, however, I have defined a complex array of modes and outcomes of function. These parameters of function allow us to become aware of our functional similarities and differences. Each of us has a different capacity to function at different times and in different situations. Many activities involve functioning in several ways. For example, elite athletes need to function at a very high capacity physically and cognitively. Scientists may need only cognitive capacity to perform well. Artists’ aesthetic appreciation requires motor, sensory and creative capacity. We would forgive an athlete’s temporary lapse in concentration, or a scientist’s dubious aesthetic discernment. We would not judge an artist’s capacity because of a tendency to be reclusive or lack of social skills. In fact, society forgives people for these deficits because of their successes. Sometimes their successes are even attributed to their deficits. Currently, we categorize impairment and disability with a framework of comparative levels of ability. Likewise, Nordenfelt [8] observes a similar contrast in the medical model of health: ‘The perfectly healthy person . . . does not have any diseases or maladies’. He cites the belief of holist health philosophers that disabled people are in fact unhealthy: ‘A healthy person has the ability to do what he or she needs to do, and the unhealthy person is prevented from performing one or more of these actions’ (p. 1462). Despite his reference to the ICF’s distinction between ability/capacity, performance and opportunity, he makes, of course, the same assumption that has in turn inspired the social model

of disability. But even the social model, with its disabled/non-disabled comparison, perpetuates our dualistic view of society by virtue of function (see also Gzil et al. in this issue [9]). Whether from the medical or social model, we define people as impaired – and as a result disabled – in relation to their difference from a socially determined notion of what it is to be unimpaired or non-disabled. If you can walk, you’re non-disabled; if you can’t, you’re disabled. This method of classification is logically flawed, because it does not acknowledge the impact of context. Imagine competing at the Olympic Games – you would be physically impaired by comparison with the athletes. Just like someone with a limp on a busy street, you may slow the pace of the Olympic, but you wouldn’t be considered disabled. Nor do we label someone disabled if they can’t act, sing, cook, swim or practice law, just because some people can. Then why do we define some people by their (or our own) perceived functional deficit? Why do we describe a person as blind, rather than incredibly creative in their ability to navigate the world without sensory input? Why do we describe people with Down syndrome as intellectually disabled, rather than, as is so often the case, intuitive and honest? Why don’t we applaud the emotional repertoire of people whom we label as having bipolar disorder? Similarly, why do we continue to label people (even ourselves) using medical terminology (Cerebral palsy, Down syndrome, Multiple Sclerosis, Asperger’s syndrome)? We do not invent conditions for elite athletes, creative geniuses or beautiful people like Acute Physiological Superiority Syndrome, Ineptitude Imperfecta (Einstein’s Disease) or Aesthetic Arrogance Disorder. I would argue that the answer is fear – our own fear of losing function. Dysfunctionphobia – our own fear denied We are all influenced by the values, beliefs and attitudes that condition us from birth. Often these are subconscious and we have little awareness of them, but most often our response to impairment and disability is negative. The usual reactions to the encounter of impairment or disability include sadness, a focus on loss, pity, denial and even shock, horror and devastation [10]. When I introduce the idea of dysfunctionphobia and functional diversity at workshops, I ask participants to tell me how they would react waking up the next morning with a number of different changes: . . . .

You You You You

have different coloured hair; are rich and famous; are the other gender; have a different sexual preference;

Downloaded By: [University of Otago] At: 00:58 9 October 2007

Constructive Functional Diversity . .

You are another race; You have 50% of your physical, intellectual or emotional capacity.

I give them the following response options: ! ! ! ! !

I’d Hate it to happen; I’d Fear the unknown; I’m Not Sure; I’d be at Peace with the world; I’d Love it to happen.

Over the last year, in response to a suggestion of 50% reduction in capacity, most of the people who participated reported that they would hate it and be fearful with few exceptions while the other changes provoke, at worst, uncertainty. Interestingly, most people laugh at the other possibilities but become very serious at the mention of functional change. When I ask participants why this occurs, people express feelings and fears regarding the ability to cope. But, as I point out, loss and grief is part of any change – presumably we would grieve the loss of black hair when we bleached it, or the loss of being male if we became female or vice versa. Similarly, a person’s religious upbringing may make waking up gay far harder to cope with than being disabled. The difference, I propose to these groups and also to you, is that the first five changes are highly unlikely to happen overnight, without a concerted effort of will and autonomous decision-making, but the last change is possible, even statistically likely in some cases, to happen unexpectedly and involuntarily. Additionally, we are conditioned to believe that impairment is ‘wrong’ and unnatural which understandably contributes to dysfunctionphobia. It is further exacerbated by the long history of social exclusion, devaluation, poverty and discrimination experienced by disabled people, which people witness with distress, but without the realization that they individually and collectively cause it. Oppression and discrimination against disabled people is often called abilism (or sometimes disablism). Abilism is the institutionalized belief that being non-disabled is better or more natural than being disabled (in the same way that racism is the belief that one race is better than another, and heterosexism is the belief in the superiority of heterosexuality). It is a belief that legitimizes society’s ignorance or lack of awareness, insensitivity or, at worst, cruelty. Dysfunctionphobia explains the collective, institutional phenomenon of abilism in individual terms. Similar to homophobia and xenophobia, I explain dysfunctionphobia as an internalized, often subconscious, fear or hatred of losing function, or becoming unable to function independently. This fear stems from an aversion to

1627

dependence, which we might associate with childhood, old age and vulnerability. Dysfunctionphobia seems more ubiquitous than homophobia and xenophobia. There seems to be decreasing acceptance of people who fear or despise people because of differences in race or sexual preference. But there seems to be more acceptance of people who fear and despise the potential for differences in function. In fact, when I have suggested that we should all embrace the possibility of functional change or impairment in each other, or ourselves, some people have responded with derision and even anger. The average person lives in denial that at any time they could have a car accident and become paralyzed or brain injured; they could have a stroke, develop an anxiety disorder or become depressed, lose hearing or sight. I believe this denial causes society to fail to provide support, remove barriers and challenge discriminatory attitudes: The things that dis-able people. This denial occurs in resistance to an effective societal response, which would require an admission that a non-disabling society potentially benefits all people, not just the 20% [11] perceived as needing the intervention. Importantly, I suggest that the root fear relates to the inability to cope, rather than the change or loss of function. We are infinitely adaptable; disabled people adapt when adequately supported and newly impaired people share this potential. Communicating this possibility at the beginning of a rehabilitation process could impact in terms of client-directed practice, giving a totally different potential focus – adaptation – as well as or instead of restoration. It is not just non-disabled people who exhibit dysfunctionphobia – many people who are impaired either fear or dislike their own functional deficit and/or the possibility of a further loss of function. Disabled people often apologize for their inability to do things, or for their need of support. Some may even discriminate against others with the same or different impairment (e.g., physically disabled people often do not want to associate, or be associated, with intellectually disabled people). Young adults with acquired impairment as a result of accident or illness may be desperate to return to their communities or workplaces, but are terrified about appearing in public as a ‘disabled person’. And why wouldn’t they? They have been raised in the same dysfunctionphobic society and subjected to the same negative attitudes and beliefs. As such, dysfunctionphobia becomes both internalized and institutionalized. I would go so far as to say that dysfunctionphobia is a hidden epidemic in society, caused by our binary ideologies of human function (impairment and disability), which needlessly fuels discrimination [12]. The challenge is to stop people thinking merely

Downloaded By: [University of Otago] At: 00:58 9 October 2007

1628

P. Patston

in terms of impairment and disability and facilitating a change in their understanding and value of function. The new language of Constructive Functional Diversity Crucial to the power of the current mindset is the language we use. If we express a new mindset – one of diversity rather than comparative deficit – we need new words and terms. Edward de Bono emphasizes the importance of precision in the use of words to become more expressive [13]. The common trait of existing language in impairment and disability is negative and comparative; the focus of the new language is constructive and solution focused. Something is constructive when it is ‘carefully considered and meant to be helpful.’ [14] The language of impairment and disability is seldom either. De Bono also asserts that positive thinking keeps us in undesirable situations if it immobilizes us from action by perpetuating thinking good things about bad circumstances. It is constructive thinking that moves us towards the desirable outcome [15]. I have already proposed that CFD removes the comparative ideology of impairment and disability. However, there will, for some time, be a need to identify verbally the distinction between people labelled disabled and non-disabled. At this point in time, I believe it is more important to change how we do that than whether we do it. The risk of not coining new terms is that only disabled people will become known as functionally diverse, which is incorrect, because all people (all beings, in fact) are functionally diverse. The new language, therefore, coins the phrases ‘people with unique function’ and ‘people with common function’. The word unique is, in keeping with de Bono’s recommendation, a powerful reframe to our understanding of people who do not have common function, meaning ‘different from others in a way that is worthy of note.’ Below (Table I) is a beta version1 of a complete CFD vocabulary, preceded by its impairment/disability incumbent (including WHO ICF terms). Further explanation of terms in included in the following section, which explains the concept of CFD in more detail. Constructive Functional Diversity – accepting our natural variance In this section I will begin to outline in more detail the concept of CFD that I am proposing. There are four core elements: (i) Modes – how we function; (ii) Outcomes – why we function;

(iii)

Value (or desired state) – the level of importance placed on function; (iv) Capacity (or actual state) – the level of ability to function.

Modes of function As human beings we function in a variety of different ways – we taste, we move, we communicate, we think, we feel, we express. In analysing these and other means of function I have built a list of nine modes of function, into which we can place any manner of function. I suggest also that these are the aspects of function that we value most. CFD modes begin with a focus on ‘doing’ and move to a focus on ‘being’ (Figure 1). . Biological function: Includes basic biological functions such as chemical reactions in the brain, circulation, organ function etc. . Aesthetic function: Includes function in terms of appearance, beauty, and attraction. One only has to observe such industries as modelling and cosmetics, or the social obsession with dieting, to recognize the importance placed on our ability to be appreciated aesthetically. . Motor function (or physical function): Includes all aspects of our ability to coordinate movement and perform activities. . Sensory function: Sight and hearing, but includes taste, smell, kinaesthetic sensation, etc. . Cognitive function: Our ability to think, reason, perform intellectual activities; includes intellectual intelligence. . Social function: Includes capacity for expressing and interpreting communication (over and above motor functions of talking and writing); engaging in relationships; understanding social mores etc . Emotional function: Our ability to experience, interpret and understand emotional feelings; includes emotional intelligence. . Creative function: Our ability to imagine solutions, innovate, design and inspire unique outcomes. . Spiritual function: Our attention to being rather than doing; higher beliefs about life and self, including how we observe or express these – through religion, ritual etc. Sexual and cultural function may seem obviously missing from this list. I have deliberately not included them as it seems to me that they involve all of the listed modes function. Or they may be better classified as outcomes. Or they might become

Downloaded By: [University of Otago] At: 00:58 9 October 2007

Constructive Functional Diversity

1629

Table I. Constructive Functional Diversity (CFD) language. Impairment/disability perspective

CFD perspective

Explanation of term

Impairment, including functional impairment (ICF) – ‘significant deviation from statistical norm’ Diagnosis

Unique function

The distinctive capacity and value of function held by an individual or group

Origin of unique function

The cause of or reason for an individual’s unique function The favouring of a certain capacity to function over another People who hold a distinctive capacity and value around function The majority of people who exhibit regular modes of functioning

Disability; disablement (social model definition) People with disability(ies); people with impairment; disabled people People without disability(ies); people without impairment; non-disabled people To disable someone

Functional bias

To be disabled

To experience the impact of functional bias Functional enhancement (system or device)

Disability support (service or equipment)

People with unique function People with common function

To exhibit functional bias

Independence/autonomy Acquired impairment Rehabilitation

Functional synergy Functional realignment Functional reconfiguration

Adjustment to impairment

Functional reconciliation

Limitation to activity (ICF) – ‘difficulty in performance of activity’

Internal functional opportunity/gap

Restriction to participation (ICF) – ‘problems in involvement’

External functional opportunity/gap

Barrier (ICF) – ‘environmental factors that condition functioning’

Functional challenge (obstacle)

Disability (ICF) – ‘negative interaction between person and environment’

Functional dissonance

The active demonstration of favouring a particular functional capacity or value The result of being a passive recipient of functional bias A system or device that enhances function by reducing functional gap or increasing opportunity A match in functional value and capacity A significant change in functional capacity The process to re-evaluate and change the relationship of functional capacity and value The outcome of functional reconfiguration The potential/latent value or capacity created a mismatch between functional value and capacity due to unique function The potential/latent value or capacity created by a mismatch in value and capacity due to functional bias The potential value or capacity created by removing an obstacle which creates an external functional opportunity/gap The discord caused by the presence of a functional challenge

components of new category. I’m not sure at this point – look out for them in CFDv2.0! Outcomes of function All function is motivated by a desire to achieve (or value placed on) a particular outcome. Like the modes, CFD outcomes move from a focus on ‘doing’ to a focus on ‘being’ (Figure 2).

Figure 1. Modes of function in CFD.

. Task – work or assignment, which may be simple, useful, important or difficult; . Job – paid trade or profession, something needing to be done or dealt with; . Occupation – an activity on which time is spent, paid or unpaid; . Role – the usual or expected function of someone, the part played in a given social context; . Meaning – what something means, what someone intends to express;

Downloaded By: [University of Otago] At: 00:58 9 October 2007

1630 . .

P. Patston Utility – the quality or state of being useful or beneficial; Purpose – the reason something or someone exists.

Value (or desired state) and capacity (or actual state) Value and capacity (also known as actual and desired states) are the dynamic, changing elements of CFD. Value changes all the time for individuals, groups, cultures and societies, for both modes and outcomes, regardless of whether they have unique or common function. The match or mismatch in value and capacity would therefore determine the level of functional synergy. The proposition therefore is that people with common function are more likely have higher levels of functional synergy than people with unique function because the capacity of common function matches the value of common function (for example, the ability to walk (CFD motor mode) matches the high value of walking). Value (desired state) could be measured internally and externally (in relation to a person’s internal or external experience). For example, I can measure society’s value of being able to sing well or understand meaning, and my own value in relation to my ability to sing well or understand meaning. When value and capacity do match CFD suggests we would experience functional synergy; when they don’t match, we would experience a functional gap or opportunity. Capacity could also be measured internally (ability without support or enhancement) and externally (assistance to function provided by people or equipment). CFD questions the legitimacy of the value of function and its outcomes, including roles, typically

Figure 2. CFD outcomes.

held by individuals and society. While capacity may be impossible, difficult or unreasonable to change, value is relatively abstract and variable and can be changed (and does change) quite fluidly in individuals and groups. Hence, one can change functional synergy by individually or collectively deciding to value a mode or outcome of function differently. This is fundamentally different to the ideology of Social Role Valorisation (SRV), formulated in 1983 by Wolf Wolfensberger: ‘SRV suggests that . . . it is most useful to seek positive valued roles for the devalued people and groups. SRV suggests that such role re-valorisation may be considerably more effective than other means of assisting people in devalued states. Consequently SRV suggests that enhancing competency and image (of the person and their surroundings) will result in positive roles being made a possibility for devalued people.’ [16]

Here is a series of hypothetical pictorial representations of the interaction between value and capacity (functional synergy) in CFD modes (represented separately) and outcomes (combined), where high value exists. Figure 3 shows low functional synergy and therefore high opportunity (indicative of someone with inadequate enhancement systems or devices or a recent realignment). Figure 4 shows unbalanced functional synergy (indicative a high achiever lacking work-life balance). Figure 5 shows high functional synergy (indicative of someone with unique function with adequate enhancements and alignment; or someone with common function with good work-life balance).

Figure 3. Low functional synergy.

Downloaded By: [University of Otago] At: 00:58 9 October 2007

Constructive Functional Diversity

(2)

Figure 4. Unbalanced functional synergy.

the realignment, but also to join the group of stigmatized people that they have feared (dysfunctionphobia). CFD creates the opportunity for a person with functional realignment to perceive their situation from a position of value rather than stigma. Understanding motivation to recover With the caveat that motivation is extraordinarily complex [17], it is clear that some people demonstrate higher motivation than others to reconfigure function (rehabilitate) after a traumatic incident. CFD may be able to offer an explanation. If someone has lost capacity to function in a mode or outcome area that they highly valued, the impact will be greater than if they placed low value on that functional area. If the person realizes it will be impossible to regain that capacity internally, and isn’t satisfied with the use of functional enhancements, this will affect motivation. The options for successful reconciliation, therefore, are: (a) (b)

(3)

1631

To change the internal value placed on the affected area of function; and/or To raise the internal value in another area of function where capacity has been unaffected

Client-directed practice CFD fosters practice where clients can direct the reconfiguration process by exploring a dynamic landscape of functional modes, outcomes, value and capacity (internal and external). There can be a choice whether measurement or interpretation are determined subjectively (by the client) or objectively (by the professional).

Further research options/opportunities Figure 5. High functional synergy.

Benefits of CFD in enhancing rehabilitative outcomes CFD has the potential to have several benefits in functional reconfiguration (rehabilitation) settings for both clients and professionals. These are discussed below. (1)

Psychological benefit A CFD paradigm can create a shift in thinking for people who experience functional realignment (acquire impairment). The current binary paradigm requires people not only to survive the trauma of the incident that creates

This article provides a conceptual introduction to CFD based on my theoretical hypothesis and in so doing, raises several research questions. Does the CFD approach improve outcomes for people participating in rehabilitation services? If so – which people benefit most (e.g., people with spinal injuries, people with stroke, people with depression)? Which services are best for this approach (e.g., acute/postacute inpatient rehabilitation or community-based rehabilitation)? And very importantly, what outcomes are achieved? If a quantitative study were pursued, how would the outcome be measured? It may be useful to study the consequence of applying the CFD approach to rehabilitation services for people with functional realignment (e.g., spinal injury or traumatic brain injury) participating in

Downloaded By: [University of Otago] At: 00:58 9 October 2007

1632

P. Patston

their first inpatient rehabilitation. Maybe CFD will positively influence work-status or community integration two years down the track. Or maybe people exposed to it will just feel more positive about themselves and have higher life satisfaction, in which case the measures of ‘attitudes toward self’ or ‘life satisfaction’ would be more useful. Alternatively, a more open-ended research question may be applied, e.g., What influence does the CFD approach have on the experience of rehabilitation? In this case, a qualitative research design might be more appropriate, such as narrative analysis, participation action research, grounded theory, interpretative phenomenological analysis (IPA) or a focus group methodology. A qualitative approach would possibly be more useful than a quantitative approach as this idea is new and there is very little else to base research on, but it will not demonstrate causality between intervention and outcome, which can limit credibility. Another area of study could be the impact of CFD on the parents of children with unique function and what influence it would have on the decisions they make about the lives of their children. It would also be interesting to see if it influenced the behaviour of clinicians towards the people they work with/for. On a more abstract level it would be interesting to examine situations where high levels of function are not necessarily valued – emotional intelligence, for example. Emotional function is often lowly valued and matched by low capacity – watch any soap opera for evidence of this! What is the impact of an individual having high emotional capacity – a functional ‘surplus’ – where this is not valued? Another more complex exploration would be the impact of emotional or cognitive response to functional gaps in other areas. If emotional capacity is high, will someone respond more positively to a functional gap in motor function? If this response is positive is there, in fact, a gap at all, or does this indicate a reduction in internal value and, therefore, the creation of functional synergy?

constructive. I have suggested CFD provides the opportunity for benefits in rehabilitation settings, in relation to client perception of changed function, motivation to recover and client-directed practice. I have also proposed areas of research around its use. Acknowledgements A huge thank you to Kath McPherson for providing me the challenge to write this paper, for assisting with preliminary research and for many provoking discussions. Profound thanks also to Kate Diesfeld for such insightful comments and challenges; and for several sessions of intensive discussion and editing. Warm appreciation to William Levack for the phone calls and e-mails, especially about research opportunities. I am also grateful to Kyle Jack-Midgley, Claire Ryan, Carol Waterman and Martin Sullivan for enduring hours of conversations about functional diversity, for their reflection and comment on its principles and application. Thanks to Sharon Daly from the US who read an early blog on functional diversity and took the time to e-mail and tell me of a time where using the concept changed an outcome for the better, proving perhaps that it really works! Finally, to the other authors of this edition, especially Prof Alain Leplege, who peer-reviewed the first of many drafts: Thank you for your collegial support and may this be the first of many published articles debating the nature of how we perceive and express our understanding of function. Dedicated to the memory of Prof Alan Clarke, who shared my belief that impairment is more complexly about diversity than deficit. Note 1. A ‘beta version’ is the first version of computer software released outside the organization or community that develops it so that it can be tested in the real world. This is the first release of the CFD terminology and, like beta software testers, readers are invited to test the vocabulary and provide feedback.

Summary Although the term functional diversity has been used in a variety of contexts, it is a relatively new way of thinking about impairment and disability. The concept of Constructive Functional Diversity that I raise here promotes and operationalizes a strengthsbased approach by removing the notion of a comparative state of ‘normalness’. It requires a dynamic analysis of function in terms of the way we function (modes); why we function (outcomes); the internal and external value of function; and internal and external capacity to function. It offers a new language that is non-medicalized and

References 1. Sutherland A. Disabled we stand. London: Souvenir Press; 1981. p 18 (italics in original). 2. Temperate Forest Foundation 2000 – 2006. Accessed 31 May 2007 from the website: http://www.forestinfo.org/Discover/ diversity.htm 3. Kannan N, Taylor S, Zhai Y, Venter JC, Manning G. Structural and Functional Diversity of the Microbial date Kinome. Accessed 31 May 2007 from the website: http:// biology.plosjournals .org /perlserv / ? request ¼get-document& doi¼10.1371/journal.pbio.0050017 4. Fraser K. Functional diversity in work groups: A review and some practical suggestions. 2003. Accessed 31 May 2007 from the website: http://www.cs.nott.ac.uk/*kcf/ob_essay.pdf

Downloaded By: [University of Otago] At: 00:58 9 October 2007

Constructive Functional Diversity 5. Smith J. Functional diversity – a fundamental characteristic of ageing: Implications for social policy. Berlin: Max Planck Institute for Human Development; 2006. 6. Roman˜ach J, Lobato M. Functional diversity, a new term in the struggle for dignity in the diversity of the human being. 2005. Accessed 31 May 2007 from the website: http://www. leeds.ac.uk/disabilitystudies/archiveuk/zavier/Functional%20 Diversity%20%20%20%20%20%20%20%20%20%20_fv% 20Roma%F1ach.pdf 7. World Health Organization (WHO). International Classification of Functioning, Disability and Health: ICF. Geneva: WHO; 2001. 8. Nordenfelt L. On health, ability and activity: Comments on some basic notions in the ICF. Disabil Rehabil 2006; 28(23):1461 – 1465. 9. Gzil F, Lefeve C, Cammelli M, Pachoud B, Ravaud JF, Leplege A. Why is rehabilitation not yet fully person-centred and should it be more person-centred? Disabil Rehabil 2007;29(20 – 21):1616 – 1624. 10. Patston P. Making it Easy to Do the Right Thing. Wellington, New Zealand: Health and Disability Commissioner; 2007.

1633

11. Statistics New Zealand. Disability Counts. Wellington, New Zealand: Statistics New Zealand Te Tari Tatau; 1998. 12. Markovic´ L. Beyond binary opposition: de-gendering and redefining gender Facta universitatis Series: Linguistics and Literature Vol. 2, No. 10, 2003, pp 403 – 414. Accessed 7 June 2007 from the website: http://facta.junis.ni.ac.yu/facta/ lal/lal2003/lal2003-05.pdf 13. De Bono E. Word power. New York: The Penguin Press; 1990. 14. Microsoft Corporation. Encarta Dictionary (Microsoft Word) 1999 Bloomsbury Publishing Plc Accessed 31/5/2007. 15. De Bono E. New Thinking for the New Millenium. New Millennium Entertainment (CA); 1st ed. April 1, 2000. 16. Wikipedia 2007. Accessed 31 May 2007 from the website: http://en.wikipedia.org/wiki/Social_role_valorization 17. Siegert R, McPherson K, Dean S. Theory development and a science of rehabilitation. Disabil Rehabil 2005;27(24):1493 – 1501.