How Disability Affects Well-being

What is the relationship between disability and well-being? (In this post, I’ll call this the Relationship Question.) The Relationship Question is both enormously complex and highly fraught—philosophically, socially, and politically.

Philosophers have starkly different views. One prominent view, held by Elizabeth Barnes, is that disability is a Mere Difference: having a disability does not, on its own, make one’s life go worse, although in our ableist society, disabled people are more likely to live worse lives because of barriers and stigmas. On the other hand, philosophers like Peter Singer have held that the lives of disabled people are typically worse than the lives of non-disabled people. According to Singer, disabilities can prevent individuals from pursuing some of life’s central pleasures and opportunities. Some of Singer’s writings have provoked the vitriol of many in the disabled community. I’ll say more about that below.

The Relationship Question is largely empirical. In a paper published in 2023 in the Journal of Philosophy of Disability, I argue that both sides have erred in not properly consulting the scientific literature. Sensing a need for a philosophically-informed literature review, I decided to undertake the task.

This post’s brief summary of my paper omits a lot of details and qualifications; for those with concerns about what I say here—I assume that will include many readers!—I ask that you consult the original paper before passing judgment.

The literature on the Relationship Question is enormous. There is a journal, published under the umbrella of the American Psychological Association since 1972, dedicated in large part to the topic. There are also many studies in other disciplines: public health, economics (including the subfields of behavioral, welfare, and labor), and in the medical sciences of particular disabilities.

I reviewed findings about both the general relationship between having a disability and well-being, as well as relationships between specific disabilities and well-being. Here is a quick summary of six key findings.

• On average, disabled people have a significantly lower level of well-being than non-disabled people.
• This decrement in level of well-being is to a not-insignificant extent attributable to ableism in society, but it cannot be attributed entirely to ableism.
• For those with acquired disabilities, well-being typically drops dramatically in the early years of the disability. While it increases to some extent afterwards, it does not, on average, return to previous baseline levels.
• Nonetheless, studies show that disabled people typically have a level of well-being that is good.
• There is considerable heterogeneity among disabled people. For instance, those with spinal cord injury have, on average, a substantially lower level of quality of life than those with schizophrenia.
• Adults with some congenital disabilities such as cerebral palsy and spina bifida have levels of well-being that are comparable to those without disabilities (although this is not the case for all congenital disabilities or for youth with those disabilities).

To say that the Relationship Question is empirical does not mean that there is no room for philosophical clarification and critique. In the paper, I discuss eight reasons why it is difficult to get a sense from the scientific literature of the precise impacts of disability on well-being. I’ll highlight three here.

First, given the heterogeneity between disabilities, it is unclear to me whether it is even worth asking how disability (as a whole) affects well-being, rather than asking, for each disability, about its effects. (In a more recent paper, I explore this concern in more detail.) The view taken to oppose the Mere Difference View has been called the bad difference view. But a better name is Negatively-Averaged Disability Variantism. Disability is clearly not always a bad difference.

Second, there are many measures in the vicinity of well-being that are studied, including subjective well-being, objective well-being, quality of life, and life satisfaction. In light of the fact that there is no philosophical consensus regarding the nature of human welfare, individual studies shouldn’t be taken to reveal information about some single quality of well-being writ large.

Third, different studies define disability differently, and the definitional differences play a role in studies having different results.

I should note that Barnes, in a more recent book, has also critically examined the empirical literature on the Relationship Question. I agree with a great deal of what Barnes says, though in the end I am more optimistic than is Barnes about the value of the empirical literature.

My own judgment is that despite some of the problematic aspects of the scientific literature, there is a great deal of convergence about the negatively-averaged effects of disability on well-being. This is especially evident when looking at meta-analyses of particular disabilities. For multiple sclerosis, spinal cord injury, and rheumatoid arthritis, chronic pain and poor sleep play a significant role, and it is hard to consider those problems to be caused entirely by ableism.

At the same time, several studies clearly indicate that some of the decrement in well-being is indeed attributable to ableism. And while disabled people have a lower level of well-being on average than non-disabled people, the literature shows that disabled people typically live good lives—perhaps quite a bit better than certain social stereotypes might indicate.

How do these findings connect to the contentious philosophical debates regarding disability? While I am critical of Barnes’s mere difference view in my paper, I also am critical of Singer’s writings. First and perhaps foremost, Singer himself does not adequately consult empirical evidence regarding the Relationship Question before making judgments about the well-being of disabled people. While Singer has, in recent years, softened his tone regarding disability, my own view is that he still has not adequately changed his views in light of the empirical research.

Furthermore, much of Singer’s (and other contemporary bioethicists’) discussion of disability concerns reproductive and parental choices regarding disabled children. But as noted above, while youth with certain congenital disabilities do, on average, have a lower level of well-being than non-disabled counterparts, adults with certain congenital disabilities do not. These facts may make a difference for some contemporary bioethical discussions of reproductive choices.

One thing that is clear is that we should not rely on unreflective negative social stereotypes of disabled people when making judgments about their well-being. It is reasonable to have an affirmative view of disability even if the mere-difference view is false.

All in all, the Relationship Question cannot be answered by armchair theorizing. I have done my best to summarize the literature, and I encourage other philosophers interested in the Relationship Question (and in related bioethical debates, especially those regarding congenital disabilities) to do more to engage with the empirical work, especially given the limitations of my own review. The fact that my findings show some support for both sides of this often polarized debate may help foster more constructive dialogue. Getting the Relationship Question right has enormous importance for bioethics, institutional policy, and social practice. Moreover, given the universality of disability, getting the Relationship Question right can significantly increase our understanding of human life more generally.