“Can one ever see a disabled body as it is, not as it was or as it should become?”
Eunjung Kim, Curative Violence
Existing philosophical conversations around ableism often prioritize questions of inferiority or access to legal, medical, educational, and cultural resources (Linton Reference Linton1998; Wolbring Reference Wolbring2008; Barnes Reference Barnes2016; Reynolds Reference Reynolds2017; Peña-Guzmán and Reynolds Reference Peña-Guzmán and Reynolds2019; Nario-Redmond Reference Nario-Redmond2020; Wieseler Reference Wieseler2020; Lewis Reference Lewis2022). Yet this focus on access or inferiority limits our ability to make sense of other shared experiences within and across disabled communities (Smilges 2023). Consider, for example, the following cases:
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1. After receiving her diagnosis of fibromyalgia, Liz Moore (Reference Moore and Wong2020: 76) describes her state of mind throughout the first few years as follows:
“I am desperate for a cure, to regain the life I used to have when I hiked and camped and could take a full course load of classes and when reading was easy. Back when I didn’t have to remember to take medications or, worse yet, refill the pillboxes.”
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2. In his memoir and collection of critical essays, Eli Clare (Reference Clare2017: 15) highlights the impossibility of a version of himself without cerebral palsy:
“[A]n original nondisabled state of being doesn’t exist…The vision of me without tremoring hands and slurred speech, with more balance and coordination, doesn’t originate from my visceral history. Rather, it arises from an imagination of what I should be like.”
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3. Elizabeth Engelman (Reference Engelman2017) recounts her deaf son’s reaction to his cochlear implant, which he received just before his third birthday:
“I said, ‘Hi Micah, can you hear mommy?’ His hazel eyes widened and he screamed in terror, his body trembling. Shock.”
Micah’s shock soon translated into full-throttle resistance that led to physical altercations between Elizabeth and her young child:
“At home, I wrapped my legs around my toddler and pinned him to the carpet in what looked like a wrestling hold as I tried to keep the processors for his implants on his head. He was crying, and I was crying, and I wondered if my actions could be considered abuse.
He refused to wear the $18,000 sound processors, and his defiance was feral: head butts to my face, kicks, bites. The back of his head smacked against my jaw, and for a moment everything went black. The [cochlear] implant surgery alone had cost $50,000. Auditory verbal therapy was out of pocket, the doctors were out of network. What choice did I have but to force him?”
Inaccessibility explains, to some degree, why Liz Moore can’t hike as easily as she once could. Yet it fails to capture the long-standing turmoil and grief that followed her change in circumstances. Inaccessibility (or rather, a distorted form of access) and assumptions of inferiority might partially explain why Elizabeth Engelman forced her young son to wear his cochlear implants even as he violently resisted.Footnote 1 But it doesn’t clearly explain the trauma that arises when deaf bodies are forced to conform to the hearing world under threats of violence, even (and perhaps especially) from loved ones. Finally, inaccessibility and inferiority can’t explain why friends and strangers continue to be fixated on the image of Eli Clare without cerebral palsy, even though he was born with cerebral palsy. Inaccessibility and inferiority are undoubtedly part of the story of ableism, but there is more to tell. This article,then, aims to complicate our understanding of ableism.
Using the novel modal device of counterfactual bodies, I argue that tracing the oppressive function of possibilities provides new insight into our understanding of ableism. My argument begins with a brief overview of counterfactual bodies, the curative origins of oppressive counterfactual bodies, and how they continue to proliferate at the institutional and interpersonal level. Distinguishing between oppressive counterfactual bodies (which I call pernicious counterfactual bodies) and their non-oppressive counterparts, I argue that some counterfactual bodies become manifestations of ableism under the imperative of cure. Under the imperative, striving to actualize counterfactual bodies becomes a morally-laden aim which occludes alternative possibilities for life in a disabled body. Disabled bodies are subsequently coerced into striving to actualize counterfactual bodies, thereby turning ordinary counterfactual imaginings into tools of oppression. Next, I outline the oppressive costs of counterfactual bodies, holding that the coercive impetus to actualize counterfactual bodies perpetuates systematic material, psychological and economic harms against disabled bodies. Finally, I consider the question of when counterfactual bodies become tools of oppression, ultimately arguing that this perniciousness is context-dependent.
A brief note about my terminology in this article—I use the term “disabled” to refer inclusively to disabled, Deaf, chronically ill, mad, crip, and neurodivergent individuals.Footnote 2 While philosophers have often distinguished between these categories, I use the term expansively because I think it is a mistake to fracture these groups in our philosophical arguments. But even if one disagrees with this approach, my argument will not rely on the assumption that each of these different groups is disabled. Instead, my argument hinges on the weaker claim that these groups experience ableism.
1. What is a Counterfactual Body?
One of the striking commonalities across the three opening testimonials is the way in which they foreground bodily possibilities. For Moore, the possibilities that are no longer afforded to her body serve as the source of her desperation post-diagnosis. For Clare, the imagined possibilities that were never afforded to his body are the source of much frustration. And for Elizabeth Engelman, the possible body she desires for her son Micah motivates her actions. Other testimonials from the disability community evince similar experiences of grief, pain, and desperation tethered to possibilities. While philosophers of disability have generally shied away from phenomenological accounts of ableism, I take this complicated relationship to bodily possibilities to be a fruitful starting point for further explorations of ableism. Taking these yearnings for a former life and body, or the constant wishing for an imaginary, non-disabled version of a body seriously, then, counterfactual bodies serve as the basis of my analysis of ableism. I define counterfactual bodies as the reimagining of disabled individuals without their disability. In some cases, like Moore, the counterfactual body is fully fleshed out and relies on the previous experiences and memories of inhabiting an abled body. In other cases, like Clare and Engelman, the counterfactual body relies on some combination of disrupted expectations guiding normative assumptions about bodies. And counterfactual bodies are more than a first-person phenomenon. Rather, such counterfactual bodies guide the actions and behaviours of both individuals (loved ones, strangers, and disabled people themselves) as well as societal institutions, in addition to shaping the self-perception of disabled people as deficient or incomplete.
Worth thinking through here is the question of how such counterfactual bodies arise and, perhaps more importantly, how they proliferate. We might turn to the medicalization of disabled bodies (among others) as a possible candidate. Broadly, standards of “normalcy” for the human body gained significant traction through the work of Adolphe de Quetelet (1796-1874), a Belgian statistician and well-known eugenicist (Davis Reference Davis1995: 23-49). Applying his statistical training to physical, intellectual, and moral properties, Quetelet formulated the concept of l’homme moyen and turned common features into physical, intellectual, and moral exemplars. But the establishment of the mean entailed the corresponding construction of deviance. Within the larger context of Darwinism and its popular eugenicist application to human bodies, deviance was quickly codified as a threat to the progress of the species (Baynton Reference Baynton1996). The thought was that if average bodies contribute to humanity’s physical, intellectual, and moral progress, then deviant, disabled bodies become a threat, which must be corrected. From this, it might be inferred that morality requires the normalization and “correction” of deviant bodies, tragically leading to violence.Footnote 3
And the notion of correction—better known as cure—is intimately tied to the concept of counterfactual bodies. While not often thought of in modal terms, cures and curative practices rely heavily on the possibilities afforded to bodies. After all, the possibility of a cured body frequently underpins and guides curative procedures. One scholar who has developed the modal dimension of the concept of cure, albeit in slightly different terms, is Eunjung Kim in her book Curative Violence. Footnote 4 Understanding cure as a process of political, moral, emotional, and economic negotiations between disability and normality, Kim conceives of curative violence as force used to eradicate differences across bodies in the name of improvement (2017: 41). In the tradition of Judith Butler’s normative violence (Reference Butler1999: 18-19), curative violence is motivated by “the imperative of cure”—that is, the idea that the only permissible way to live and engage with a disabled bodies is by striving towards cure (Kim Reference Kim2017: 14-15). Under the curative impetus, violence can unfold in at least two ways:
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1. It can take the form of violently rejecting the possibilities of life with disability as different but equally valuable ways of life,
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2. Or the form of physical violence that is preemptively justified in attempts to cure disabilities.
Taken within the context of the imperative of cure, then, counterfactual bodies originate from our ordinary, innocuous imaginings. Guided by our socially determined standards of normality, comparisons arise between the actual body and the cured, imagined body—that is, the counterfactual body—bringing non-normative features of the disabled body sharply into view. Under the curative impetus, counterfactual bodies become a morally-laden aim, (falsely) presented as the only viable option for life in a disabled body, and engendering action (which can include curative violence), to actualize these imagined bodies. Counterfactual bodies, then, can become manifestations of ableism, oppressing in the name of (and through) the imperative of cure.
Readers familiar with the disability studies literature might wonder about the relationship between counterfactual bodies and Alison Kafer’s” imagined body,” as presented in Feminist, Queer, Crip (2013). Kafer’s concept of the “imagined body” is temporal, focusing on the body that a disabled person would develop. In contrast, my concept of “counterfactual bodies” is modal and concerns the body that disabled people should strive to actualize. What this means is that counterfactual bodies include impossible, imaginary bodies (as in the case of Eli Clare without cerebral palsy) as well as (future or past) possible bodies (as in the case of Liz Moore or Micah Engelman).
Others might suggest that the eugenicist origins of curative violence have long since dissipated, given the scientific, medical and political rejection of eugenics post-World War II. In reply, it is far from clear that such a rejection took place beyond surface-level renaming of practices and associations. Genetic screening, reproductive selections, and population control all suggest some historical and intellectual continuity with eugenicist projects (Peterson Reference Peterson2024: 254-259). Additionally, claiming that eugenics was rejected in this way does not entail that its underlying ideologies (i.e. the imperative of cure) cannot continue to inform medical, scientific, and political practices and institutions. As Eli Clare argues in Brilliant Imperfection: Grappling with Cure, the medical industrial system is a primary example of an institution that perpetuates the imperative of cure (2017: 15). We might think here of the tens of thousands of dollars poured into research dedicated to curing congenital deafness in children as one small but representative example of how the imperative of cure underpins the medical industrial system. This is not to say that this is all there is to medical research, nor is it to suggest that all cures are necessarily bad, but instead that the historical and intellectual relationship between eugenicist projects and the medical industrial complex has led to a curative impetus that often goes critically unchecked (Bashford Reference Bashford, Bashford and Levine2010: 540-553).
While the medical-industrial complex is a significant factor in creating and enforcing counterfactual bodies, it is far from the only institution that ensures their ubiquity. Consider, for example, the fact that most education systems take for granted that the primary modality of language instruction ought to be verbal (as opposed to signed). The standards established by these societal institutions often communicate important assumptions about which bodies will be valued, and perhaps more importantly, which bodies will be excluded. Another way in which institutions proliferate counterfactual bodies is through the wellness industry. Much of the wellness industry is centred on getting your healthiest and “best” body through quick (and overwhelmingly ineffective) fixes. The wellness industry encourages consumers to think about their counterfactual bodies by promising an easy and efficient means to achieving them. So, behind the choice to drink chlorophyll daily or stick strictly to a carnivore diet, we often find counterfactual bodies shaping such decisions and behaviours—sometimes dangerously so (Dryden Reference Dryden2023).
The medical-industrial complex, our educational systems, and the wellness industry, then, are three key institutions that sustain counterfactual bodies, but counterfactual bodies are not solely proliferated by institutions. Inspiration porn, and its grip on the cultural imaginary, is another place in which we find counterfactual bodies being reinforced by the “success” of the cure, as in the case of audiences flocking to videos of deaf children with new cochlear implants hearing their mother’s voice for the first time.Footnote 5 And finally, interpersonal interactions might also sustain counterfactual bodies. In their most extreme form, they might look like Elizabeth Engelman pinning down her toddler to insert his implants, but ordinary conversations can do the trick equally well. A parent forcing their child to undergo another surgery, a spouse pressuring their partner to take anti-depressants, or any other moment in which a loved one seeks to uncritically force a “cure” onto a disabled body can enforce the counterfactual body. The point here is that our social world—institutions, interpersonal relationships, and social expressions that support the imperative of cure—sustains and reinforces counterfactual bodies.
To reiterate, then: thinking beyond ableism as inaccessibility or inferiority brings us to the question of possibilities and the concept of counterfactual bodies. Counterfactual bodies originate through a familiar comparison between bodies and “normalcy” standards, and they are sustained by the imperative of cure. The curative impetus, enforced by our institutions and other parts of our social world, reaffirms cure as the only viable possibility for life in a disabled body.
And yet, it seems intuitive to say many of these counterfactual imaginings are not manifestations of oppression—far from it. In other words, an account of counterfactual bodies needs to make space for the fact that we imagine alternate versions of ourselves all the time without concern. And not only do such imaginings seem to be non-oppressive, they also seem to be core elements of our agency. Consider the work of Catriona Mackenzie and other feminist philosophers who have long defended the importance of engaging in imaginative counterfactual speculation. As Mackenzie has argued, our ability to take on “different possibilities or postures of the self” is a central tenet of our agency (Reference Mackenzie and Atkins2005: 138). And under conditions of oppression, Mackenzie emphasizes, these imaginings seem even more important because they provide the recourse of a better, imagined life.
Mackenzie is right that imagining oneself otherwise is valuable. But it is not the mere fact of imagining otherwise that underpins the oppressiveness of counterfactual bodies. Rather, it is the imagining of possibilities which are distorted by the imperative of cure and subsequently lead to harm in order to eradicate embodied differences. While everyone imagines themselves otherwise, not everyone is subject to the imperative to instantiate these imaginings, nor are they subject to unjust systematic harms in the attempt to instantiate said imaginings. It is important, then, to recognize that certain bodies are subject to different aims on account of such possibilities. This is not to say that all imaginings of possibilities are necessarily oppressive to non-normative bodies, but rather that there is a set of possibilities that can be distorted by the imperative of cure and therefore become mechanisms of oppression. If we want to claim that counterfactual bodies can be oppressive, then we need to know how these counterfactual bodies wrong disabled people and at what point they become oppressive.
2. The Oppressive Costs of Pernicious Counterfactual Bodies
Not all counterfactual bodies are oppressive, but some counterfactual bodies become vehicles of oppression when they are distorted by the imperative of cure. For this modal device to be philosophically useful in elucidating ableism, we need a clearer understanding of how counterfactual bodies come to be distorted in this way. In other words, under what conditions do some counterfactual bodies become vehicles of oppression? And how do these distorted counterfactual bodies impact the lived reality of disabled people? The next two sections, then, explore preliminary answers to these questions. For the sake of clarity, I will reserve the term counterfactual bodies to refer generally to any sustained reimagining of disabled individuals without their disability, and the term pernicious counterfactual bodies to refer to those counterfactual bodies which come at the expense of actual disabled bodies under the curative impetus.
Taking seriously the concept of pernicious counterfactual bodies entails that possibilities play a non-negligible role in our structures of oppression. This idea should already be somewhat familiar to philosophers, given its kinship to Joel Feinberg’s claim that we can be wronged by being unduly robbed of some set of possibilities (Reference Feinberg, Aiken and LaFollette1980). But my claim here is different. Rather than being wronged in virtue of the denial of possibilities, one can be harmed by the sustained proximity of particular, distorted possibilities. It is not the possibility itself (that is, the counterfactual body) that harms disabled people, but rather the way in which such possibilities become a vehicle for oppressive ideologies like the curative impetus. The pernicious counterfactual body therefore acts as a spectre, haunting disabled bodies, loved ones, and even institutions with the illusion of a non-disabled version of a disabled body. The problem with pernicious counterfactual bodies, however, is not merely the poisonous imaginings, but the way in which the impetus to actualize them comes at a material, social, and morally non-negligible cost, therefore leading to oppression.
In The Politics of Reality (Reference Frye1983), Marilyn Frye argues that oppressed groups are reduced, controlled, and trapped by a network of systematically related forces, and this oppression is only visible at the macroscopic level—that is, if one looks at the whole structure, and the plight of the collective group enmeshed in it. Just as a microscopic perspective might not reveal the network of interconnected wires that prevents a bird from flying free, Frye argues, viewing oppression from a microscopic view similarly disguises the network which constrains oppressed people. Building on this insight, pernicious counterfactual bodies provide another way for us to recognize the impact of the curative impetus on disabled people across a range of disabilities. Pernicious counterfactual bodies might therefore be understood as one wire constituting the birdcage of ableism. Seemingly innocent imaginings of another body, alongside widespread discrimination, epistemic injustice, and the continued exclusion of disabled bodies, do not exist in isolation from one another. Rather, they operate in tandem and, by doing so, trap, control, and oppress the disabled community by making their actual bodies functionally unliveable. Broadly inspired by Ann Cudd’s account of oppression, which emphasizes how direct and indirect material and psychological forces sustain and reinforce structural oppression, I outline three categories which demonstrate how the the imperative to actualize pernicious counterfactual bodies perpetuates systematic physical, material, and psychological harms against disabled people: disproportionate commitment of resources, suspended body grief, and pain, suffering, and death. (Cudd 2006). While these are not the only ways that pernicious counterfactual bodies can come at the expense of disabled people, they constitute some of the most egregious harms. Alongside the other, more familiar harms of ableism like discrimination and paternalism, pernicious counterfactual bodies contribute to the oppression of disabled bodies.Worth bearing in mind here is the fact that these categories might be more or less pertinent to different kinds of disabilities; they are meant to serve as a broad starting point rather than an exhaustive list.
2.1. Disproportionate Commitment of Resources
One way in which disabled bodies suffer under the imperative to actualize counterfactual bodies is through the disproportionate commitment of resources, both at the individual and societal level. By this, I mean the usage of material, psychological, economic, and temporal resources to transform one’s actual body into the counterfactual body, including but not limited to money, time, energy, and labour. At the individual level, consider the example of June Eric-Udorie, a young woman diagnosed at birth with Congenital Idiopathic Nystagmus. Discussing the impact of relentless visits to the doctor with her mother, Eric-Udorie (Reference Eric-Udorie and Wong2020: 54) notes,
For a huge part of my childhood, I felt like I was a piece of clockwork waiting to be fixed. The feelings started early, with the numerous appointments to eye specialists with my mother, trying to see if there was a way to cure my dancing eyes. ‘It is incurable,’ the doctor would say, and when we got home my mother would wail, even though the doctor, like many other doctors, simply confirmed what she was told when I was born on that rainy Thursday in 1998.
For Eric-Udorie’s mother, the possibility of a daughter without Congenital Idiopathic Nystagmus motivates countless visits to specialists and justifies long hours of medical testing and assessment. The resources (time, energy, and money) dedicated to the possibility of curing her daughter’s condition demonstrates the priority granted to Eric-Udorie’s counterfactual body over her actual body. But such prioritization comes at a very real cost. As disabled people often tell, the hours spent in the doctor’s office, the money wasted on homeopathic cures, or the energy drained by remedial speech therapy (Clare Reference Clare2017; Lakshmi Piepzna-Samarasinha Reference Piepzna-Samarasinha2018; Wong Reference Wong2020) come at the cost of money for accessible technologies, time spent enjoying the day, and energy for relationship-building grounded in love and acceptance.
At the societal level, we find the same pattern amplified. As Eli Clare aptly notes, the organizational priorities and agendas of non-profits, medical, and governmental institutions funnel disproportionate resources toward research and cures—in other words, counterfactual bodies (2017: 85-89). Consider the ways in which a cure-based approach to autism has been platformed by the current US Secretary of Health and Human Services, Robert F. Kennedy. Kennedy’s approach is overwhelmingly focused on eradicating autism, going so far as to publicly support unregulated and unapproved “cures” such as umbilical cord stem cell infusions—the likes of which cost approximately $15,000 per infusion (Pilkington 2026). Far from a recent turn, we see this same prioritization of cure over structural support needs in the 2006 Combating Autism Act, later renamed the Autism Collaboration, Accountability, Research, Education and Support Act (Ma Reference Ma2021). Significant amounts of the (nearly) 1 billion dollars appropriated by the bill prioritized curing autism because, as Michael E. O’Hanlon and Stuart Spielman note, “the Combating Autism Act focuses primarily on future generations” (Reference O’Hanlon and Spielman2006). What this means in practice is that consistent and robust access to health care, accommodations throughout one’s education, and liveable working conditions continue to be secondary to the goal of curing autism. Yet again, the counterfactual body comes first.
Finally, it is also important to acknowledge that disproportionate commitments of resources can have radically different impacts depending on one’s intersectional identities, especially socio-economic status.Footnote 6 For low-income and working-class communities, the imperative to instantiate one’s counterfactual body becomes an additional burden to navigate. So while the harm of disproportionate commitments of resources can be felt across the disabled community, some members are more vulnerable than others.
2.2. Suspended Body Grief
There is an ordinary grief that comes with life in a body. As our bodies change over time, we must all engage in the (non-linear) process of negotiating, learning, and accepting our bodies. But striving to actualize pernicious counterfactual bodies can interrupt this important process, thereby compromising one’s relationship with the reality of their body. A second way in which pernicious counterfactual bodies come at the expense of disabled bodies, then, is through the suspension of body grief.
As coined by disabled writer Jayne Mattingly (Reference Mattingly2025), body grief is the sense of loss and mourning which stems from confronting one’s ever-changing embodiment. Mattingly explains in her blogpost “Body Grief and Disability Pride Can Coexist” (Reference Mattingly2023),
[B]ody grief is a sense of loss — loss of freedom, loss of control, loss of safety, loss of hope. And as with any loss, we can only reach a place of acceptance once we have learned to grieve: a cyclical, and often lifelong process that requires awareness, sharing, storytelling, patience, deep feeling, and the choice to live with our grief.
Given that disabilities are frequently accompanied by distinct psychosocial needs, physical pain, or a mode of engaging with the world in tension with the social, normative, or built environment, body grief is a common companion to life with a disability. Whether one is born with a disability or becomes disabled later in life, living with a disability involves constantly learning and re-learning how to navigate the world with one’s distinctive needs and changing body. There is little reprise when it comes to body grief, given that a new experience or an unexpectedly recurring situation might provoke new waves of grief. But through these ruptures and moments of forced learning, disabled people must care for their bodies. They encounter the reality of their bodies, exercising agency by trying out new (or restarting old) hobbies, finding a more accessible job, or taking classes part-time. As one learns to navigate the world in ever-changing, disabled bodies, one is reminded that our body may not always meet our expectations or desires, but they are, as Mattingly rightly reminds us, “always on our side” (2025: xvi).
Yet pernicious counterfactual bodies can artificially suspend the process of body grief. As Eunjung Kim (Reference Kim2017: 9) notes, “[F]or disabled people normality exists always one moment away, urging us to suspend our life in the present and not to attempt social changes.” If disabled bodies are inundated with the pretense of a cure on the horizon, and there is no possibility of a flourishing life without a cure, then facing the reality of one’s body becomes unnecessary. Why mourn the limits of one’s actual body when a nearly-there cure will fix it? Body grief is thus disrupted by the pernicious counterfactual body, free of disability and grief and betrayal, and full of possibilities. By providing an idealized alternative, counterfactual bodies provide an unsustainable escape from the difficult process of engaging with body grief.
Of course, body grief can impact different disabilities in radically different ways. In the case of cognitive and neurodevelopmental disabilities, for example, we should distinguish between disabled bodies with low and medium support needs and those with high support needs. In lower or medium support neurodevelopmental disabilities like Dyslexia or Attention-Deficit/Hyperactivity Disorder, the usual refrains of “try harder” and “just focus” offer one example of how body grief is effectively suspended by the false attribution of control. These refrains stem from a common misunderstanding of dyslexia, for example, as a condition that can be overcome through hard work. But continued exposure to such misleading ideals leave neurodivergent bodies in a vicious cycle of striving (and failing) to actualize a neurotypical counterfactual body, often compounded by frustration and shame (Gohring Reference Gohring2024). In these cycles, we find suspended body grief, where the focus on actualizing one’s counterfactual body takes precedence over one’s actual body.
And turning to cases of high support needs (more commonly known as profound cognitive or neurodevelopmental disabilities), suspended body grief might look quite different. Moreover, this line of thought provokes an important, related question— namely, can one experience body grief for a body not one’s own? Here we might differentiate the moral question from the empirical question, that is, differentiating whether it is morally appropriate for loved ones to experience body grief for a body not their own from whether this occurs as a matter of fact. It seems clear that families do experience a kind of body grief around their loved one’s disabled body, as evinced by the examples of Elizabeth Engelman and June Eric-Udorie. Such examples also suggest that it is prima facie wrong for family members to experience body grief around a disabled body that is not their own, but this line of questioning requires robust analysis beyond the purview of this paper.
2.3. Pain and Suffering
One final way that the imperative to actualize pernicious counterfactual bodies comes at the expense of disabled bodies is through the pain and suffering inflicted onto disabled people. Curing a disability, if at all possible, is rarely a painless or easy process. Similarly, experimental procedures are rarely painless or easy. If the curative impetus preemptively justifies pain and suffering in the name of cure, then any pain and suffering inflicted to actualize a counterfactual body can become justified—and these are tricky waters to tread.
This preemptively justified pain can arise as one is undergoing or recovering from a curative treatment. Take, for example, the common use of tobramycin, amikacin, or gentamicin to treat life-threatening respiratory infections in people living with Cystic Fibrosis. Otherwise known as aminoglycosides, these antibiotics have documented negative side effects including nephrotoxicity, neuromuscular blockade, and ototoxicity, better known as induced hearing loss (Tarshish et al. Reference Tarshish, Huang and Jackson2016: 6-12). Ototoxicity is especially common, with 2 to 45% of adults with Cystic Fibrosis reporting permanent, aminoglycoside-induced hearing loss (Guthrie Reference Guthrie2008: 92). As a life-saving treatment, the importance of aminoglycosides cannot be discounted. But it is equally important to highlight the assumptions about what kind of pain or suffering is deemed preemptively tolerable to disabled bodies, assumptions that often go unaddressed in these contexts. Cures will never be pain-free nor will they be free of side effects or long-term consequences, which entails that individual tolerance for pain and other adverse side effects cannot simply be assumed.Footnote 7
Moreover, even if a cure is minimally painful, post-treatment pain and suffering might also deter individuals from procedures which could instantiate counterfactual bodies. Vision restoration procedures, for example, are often touted as miraculous, and accounts of such procedures emphasize the joy and wonder experienced by their previously blind patients. Yet alongside that very real joy and wonder are accounts of widespread fear and depression. And there is little to no mention of the tragic cases in which vision restoration surgeries have led to suicide (Beauchamp-Pryor Reference Beauchamp-Pryor2011: 10-11).
But what about those for whom there exists no cure who are nevertheless forced to conform, reshape, or mask behaviours and embodied differences in the hopes of passing? We might think here of Applied Behaviour Analysis, a form of therapy that uses systems of rewards and punishments to encourage “appropriate” behaviour and discourage “inappropriate” behaviour in autistic children. Such compliance-based therapies have been rightly criticized for incentivizing children to learn how to identify their autistic traits, mask them, and present as neurotypical, even though long-term masking has been recognized by some to lead to autistic burnout (McCarthy and Wilkenfeld Reference McCarthy and Wilkenfeld2020: 31-69). As Dora Raymaker and their research team have argued, autistic burnout often includes chronic exhaustion, increased sensitivity to stimuli and overstimulation, and a reduction of executive function skills, all of which compromise the quality of life of autistic adults (Reference Raymaker, Teo and Steckler2020: 136-143). Moreover, prolonged autistic burnout can lead to physical and mental health deterioration, difficulties fulfilling daily tasks necessary for independent living, difficulty maintaining jobs or sustaining important relationships, and self-injury, suicidal ideations, and suicide attempts. So even behaviour-based curative treatments like Applied Behaviour Analysis can lead to distressing consequences for autistic bodies coerced into masking their neurodivergence.
This also leads us to the most dire consequence of the impetus to actualize counterfactual bodies—the death of disabled bodies. If a cured body is accepted as the only way to live a flourishing life, then what happens when one confronts the impossibility of a cure? For a disabled person, this reckoning can lead to the decision that death is better than a life with an incurable disability. Tragically, there isn’t much in the way of research on suicide in disability communities. And what research does exist tells a story not focused on how disabilities don’t make life worth living, but instead on how discrimination and societal assumptions about disabilities have a deleterious impact on mental health (Woodard Reference Woodard2010; Disabled World 2021). Contrast this lack of research, as disability activists and researchers emphasize, with the abundance of research and widespread public conversation around medical assistance in dying for people with disabilities. Within these two conversations, we can see how counterfactual bodies might play some role in reaffirming assumptions around “the life worth living” (Reynolds Reference Reynolds2022). If the curative impetus tells us that disabilities must be cured and occludes possibilities for a flourishing life with a disability, then it is easy to see how one might attribute high suicide rates among disabled people to their disabilities. And so, instead of conversations dedicated to improving the social and material conditions which might ameliorate depression and suicide rates within the disabled community, we end up with conversations around medical assistance in dying, and who ought to determine when a disabled person’s life is no longer worth living (Gill Reference Carol2004: 185-189). This is not to flatten the complexity around the intersection of suicide and disability, nor is it to assume that there is a singular “disabled” position on the question. Rather, I aim to highlight how conversations around death and disability overwhelmingly rely on assumptions that a flourishing life is rendered impossible by some disabilities, and that this is not unrelated to the curative imperative. Trapped in their own bodies, according to this logic, disabled bodies must be cured at all costs.
3. When Does a Counterfactual Body Become Oppressive?
Having made salient the costs of striving to actualize a pernicious counterfactual body, we turn next to the question of when a counterfactual body becomes pernicious. That is, under what conditions can a counterfactual body be distorted into a tool of oppression?
Counterfactual bodies are not necessarily oppressive, and it seems clear that the broader category of counterfactual bodies includes those of the kind described by Catriona Mackenzie as central to one’s agency.Footnote 8 Take, for example, disabled bodies living with cancer, chronic migraines, and IBD.Footnote 9 In these cases, it isn’t clear that the counterfactual body functions perniciously. Unlike our opening examples, these counterfactual bodies seem to bring possibilities into view and motivate one to care for their actual body in the present moment. Moreover, counterfactual bodies seem to be especially important in cases of life-threatening diseases, given the way they might provide hope and improve the statistical likelihood of success for treatments. Bearing in mind these non-oppressive counterfactual bodies, then, we move from the question of how a counterfactual body can become a tool of ableism to when it becomes so.
As I suggested earlier, pernicious counterfactual bodies are a distortion of our ordinary imaginative capacities, transformed into a tool of ableism by the curative impetus. The difference between pernicious counterfactual bodies and ordinary counterfactual bodies, then, does not seem to be a difference in kind. Rather, the imperative of cure can distort our imaginative capacities, thereby turning some counterfactual bodies into tools of oppression. Recall that the curative impetus sees cure as both an unreservedly valuable and necessary aim for disabled bodies (Kafer Reference Kafer2013; Kim Reference Kim2017). Perpetrated by both individuals and institutions, the curative impetus deems the eradication of embodied differences to be an unconditioned good, where such eradication includes but is not limited to physical changes, behavioural changes, and other changes pertaining to (and enacted through) one’s body. We might therefore say that counterfactual bodies become vehicles of oppression under the curative impetus insofar as their actualization is deemed an assumed good even if (or when) such instantiation comes at the material, psychological, and physical cost of the disabled body. Framed in this way, the oppressiveness of pernicious counterfactual bodies arises from the curative impetus imbuing the actualization of a counterfactual body with normative urgency and moral import.
But if counterfactual bodies become tools of oppression through the imperative of cure, then there are some questions that need to be addressed. For one, we might wonder whether it is morally salient if there actually exists a cure or curative practices for the disabled body. If so, we might assume that counterfactual bodies can only be oppressive when a cure does not exist. That is, the curative imperative is only oppressive when it violates the principle of ought implies can. We also might assume that if some cure is necessary for a disabled person’s survival, then the counterfactual body cannot be oppressive. In the remaining half of this section, I’ll call into question both of these claims by assessing both ideal and non-ideal curative conditionsFootnote 10
If it is the case that the counterfactual body cannot be safely realized without disproportionate consequences for the disabled body, then the counterfactual bodies seem to be oppressive. Reconsidering the examples of Eli Clare, Liz Moore and Micah Engelman, we know that counterfactual bodies are simply not attainable for cerebral palsy, fibromyalgia, and deafness—creating conditions ripe for suspended body grief and physical suffering as resources are poured into the search for a cure. Under such conditions, then, we find a clear violation of the principle of ought implies can, and such counterfactual bodies become oppressive.
But what about cases in which a cure does exist, but they result in disproportionate consequences or reduced well-being? Or cures that cannot always be safely realized? Take, for example, chemotherapy. If the counterfactual body is a body that is cancer-free and there exists a treatment to render the body cancer-free, then it seems as though these counterfactual bodies can be realized. Does this mean that these bodies are necessarily non-oppressive? Our instinct here might be to say so. And that might very well be the case for many, if not most, disabled bodies under these circumstances—such counterfactual bodies might motivate strength and determination instead of pernicious entrapment and oppression. But it doesn’t exclude the possibility that for some disabled bodies, a counterfactual body can be oppressive even when it is necessary for survival.
This might strike readers as unintuitive, but consider the case of cancer patients who reject chemotherapy. The decision to reject such treatments is a complicated one that remains understudied (Kim et al. Reference Kim, Jang, Andersen and Standish2021). But first-hand accounts from physicians whose patients reject chemotherapy tell of a story that coheres with a curative impetus, pernicious counterfactual bodies, and curative violence in the form of preemptively justified suffering. Researchers estimate that up to 19% of cancer patients have either wholly or partially refused chemotherapy, citing reasons that notably include “fear of adverse side effects of cancer treatment (particularly chemotherapy)” among others (Frenkel Reference Frenkel2013: 634-636). After all, chemotherapies often do more than treat cancer, frequently turning otherwise able-bodied cancer patients into disabled cancer survivors (Nekhlyudov et al. Reference Nekhlyudov, Campbell and Schmitz2022: 222-229). And that might be a worthwhile trade-off for some (or even most) people, but it will not be the case for everyone. While such refusal has sometimes been attributed to a lack of education (Chang et al. Reference Chang, Chang, Huang and Chen2021: 618), internationally recognized expert in integrative oncology, Moshe Frenkel (Reference Frenkel2013: 634), emphasizes otherwise:
Patients are often aware of the serious side effects and complications that are likely to accompany conventional therapies, and some have witnessed the ultimate futility of such interventions. They weigh the evidence and often make choices that reflect their underlying values and beliefs rather than rely on medical evidence or advice as the determining factor.
It is here, then, that we find divergence between the oppressiveness of a counterfactual body and the necessity of cure. For some, the physical and emotional cost of chemotherapy is not preemptively justified. As Suzanna, one of Frenkel’s patients, explained it:
Look, chemotherapy would add only 6% to my survival rate. But I would lose my hair, which is so precious to me, it would affect my social interactions, and I would suffer nausea and vomiting. In fact, the oncologist gave me a list of side effects two pages long! I’ve decided that I am willing to risk losing the theoretical 6% advantage chemotherapy would give me. Chemo would destroy my quality of life. I am not doing it.
For these patients, the curative treatment is simply not worth the physical and emotional costs. But such rejection comes at a steep price. Patients who refuse medical advice and recommended treatments are deemed “difficult,” and the quality of their medical care subsequently suffers as physicians struggle to navigate their professional responsibilities in the face of such “noncompliance” (Frenkel Reference Frenkel2013: 634-636; Asija Reference Asija2012: 3-6). Whether due to disagreement with the patient’s decision or a lack of guidance on what such care might look like, Frenkel highlights that health care workers “often feel uncomfortable, troubled, and even distressed” when dealing with patients who refuse treatment, which leads to communicative breakdown that can impact the quality of future care. Framed in terms of the curative impetus, such difficulties might be attributed to a rejection of a realizable counterfactual body. Under the curative imperative, disabled bodies must struggle to enforce limits on the pain, violence, and suffering they are willing to undergo for the sake of a cure. But if we cannot explore concerns around cure (or reject some curative treatment without compromising the quality of one’s medical care), then such counterfactual bodies become pernicious vehicles of oppression.
While the example of cancer patients might strike some as orthogonal to our ordinary intuitions about disability, recall that my argument does not strictly apply to those who identify as disabled. Rather, it extends broadly to those who experience ableism. Moreover, we see similar patterns in other, non-cancer cases, such as the case of the discontinuation of mood stabilizers by people living with bipolar disorder, with such discontinuation linked to increased risks of hospitalization, suicides, and higher mortality rates (Lintunen et al. Reference Lintunen, Lähteenvuo, Tanskanen, Tiihonen and Taipale2023: 403). The point here is that these cases are not as rare as they may seem, and we ought not assume that the necessity of treatment for survival insulates bodies from the oppressiveness of the curative impetus.
Having said that, one might reject these conclusions on the grounds that they rely on particular empirical conditions. That is, I have misdiagnosed the problem, and it is the side effects and impacts of curative treatments that generate oppressive conditions, and these can be improved. Just because there is no safely realizable cure now, the counterargument runs, does not entail that there will never be a safely realizable cure, and under safely realizable cures, counterfactual bodies will not be oppressive. And yet, even under ideal conditions of actualizing one’s counterfactual body, like an imaginary pill which cures disabilities without pain, suffering, or side effects, counterfactual bodies can still be oppressive.
Granted, many disabled people would likely take the pill. The ability to fit in among neurotypicals, easing recurrent physical pain, wanting to return to one’s previous life—all of these reasons will reasonably motivate people to accept the cure pill and realize their counterfactual bodies. Some disabled people will choose a cure in every possible world (curative impetus or not), and there is nothing wrong with accepting a cure to live in one’s body with peace. But there are other disabled people whose decision to accept a cure might depend on whether they can live a flourishing life with their disability. What would it mean for disabled bodies to truly live a flourishing life with a disability? For starters, it would require proper institutional support around healthcare, education, employment, and other resources dedicated to basic needs. It would require recognizing that non-disabled bodies are not necessarily morally, physically, intellectually, and aesthetically superior to disabled bodies. It would require recognizing that disabilities are more than just deviant bodies. It would require recognizing Deaf Gain and the idea that deafness brings unique perspective and distinctive perceptual skills that contribute to human diversity (Bauman and Murray Reference Bauman and Murray2014). It would require recognizing the beauty that disabled artists have produced, like wheelchair dancing or De'VIA (Deaf View/Image Art).. It would require recognizing that these accomplishments arose because of disabilities, not despite them, and they could not have arisen without some resistance to the oppressive constraints of a pernicious counterfactual body. It would require recognizing that even if disabled bodies offer nothing unique or exceptional to the world, they still deserve the opportunity to live contentedly in their bodies. And it would require understanding that some bodies will continue to choose a cure. That is what would be required to imagine a world in which disabled bodies can live flourishing lives as they navigate their complicated, contradictory and ever-unfolding relationships with their bodies. A world in which disabled bodies can simply live in their bodies.
Taken together, then, counterfactual bodies can become pernicious under the imperative of cure. Whether a counterfactual body becomes oppressive depends on a number of contextual factors, including intersecting identities and material resources, so the imperative of cure is not sufficient for oppression. But minimally, we can conclude that the imperative of cure plays an integral role in the oppressiveness of counterfactual bodies. It does so by enacting curative violence in the form of preemptively justified pain and suffering as well as the occlusion of alternative possibilities for life with a disability.
4. Concluding Thoughts
At this point, one might be wondering how counterfactual bodies fit into contemporary debates around possible worlds. If pernicious counterfactual bodies are oppressive, shouldn’t I have more to say about the nature of these possible worlds? Or how we are afforded epistemic access to them? Additionally, this account also seems to assume that individuals are consistent across different possible worlds—otherwise known as transworld identity—yet this is (put mildly) a contested assumption. Some philosophers have accepted the possibility of transworld identity by defending the existence of individual “essences” or essential properties. Others have declared it incoherent or have jettisoned the idea in favour of counterpart theory—a theory proposed by David Lewis (Reference Lewis1968) which argues for counterparts across possible worlds rather than identical bodies.
In reply, this account does not demand particular conceptions of the nature of possible worlds, nor does it take a strong position on the question of transworld identity. Different positions on the nature of (and our epistemic access to) possible worlds cohere with this framework because possibilities operate as a tool of oppression—it exists as the birdcage, to return to Frye’s metaphor (1983). We can disagree about the nature of the wires running along the cage while accepting that birds are indeed trapped by the cage. Similarly, we can disagree on the nature of possible worlds while agreeing that disabled people can be trapped by the curative impetus and the counterfactual bodies of these possible worlds. In other words, what is relevant here is the logical function that these possible worlds play, not their metaphysical constitution. If one is a realist about possible worlds, then disabled bodies are trapped by alternative worlds that they will never be able to actualize. And if one is a non-realist about possible worlds, then disabled bodies are trapped by impossible, abstract thoughts. Either way, disabled people are trapped.
Relatedly, if one accepts transworld identity, then disabled bodies are oppressed by the possibility of who they could have been. If one accepts counterpart theory, then disabled bodies might be trapped by different versions of themselves. And if one rejects identity or counterparts across possible worlds, then the tragedy of counterfactual bodies becomes all the more bitter. Rejecting the logical coherence of possible worlds doesn’t evaporate the social existence of counterfactual bodies—rather, it entails that ableist values and structures have trapped disabled bodies in incoherent imaginings, and disabled people are all the more wronged on account of it.
Additionally, we might consider how counterfactual bodies impact other groups beyond disabilities. For example, it seems obvious that the curative impetus also extends towards fat and trans bodies. Far from being a drawback of this account, this is a benefit insofar as it offers clarity to the murky shared experiences between disabled bodies, fat bodies, trans bodies. Writers, activists, and theorists are increasingly bringing together these embodied experiences with the implicit understanding that there is some shared experience or common variable, but with little to say on what exactly is shared among them (Kirkland Reference Kirkland2006; Kafer Reference Kafer2013; Clare Reference Clare2017; Lakshmi Piepzna-Samarasinha Reference Piepzna-Samarasinha2018; Lakshmi Piepzna-Samarasinha Reference Piepzna-Samarasinha2022; ). Counterfactual bodies might offer one way of understanding such commonalities without reducing relevant differences or complexities.
By tracing the way in which possibilities can become tools of oppression, then, we can better understand ableism by taking seriously the complex, conceptual relationship between possibilities and the imperative of cure. But a modal analysis of ableism also encourages us to think more deeply about the familiar notion that possibilities can become tools of justice that guide us in building a better world (Spencer Reference Spencer2020; Zurn Reference Zurn2021). Consider again young Micah, who underwent cochlear implant surgery before his third birthday. His deafness was devalued and deemed a threat to his well-being, with cochlear implant surgery framed as its cure. But if we embrace alternative possibilities that come with life in a deaf body, then being deaf is merely another way to be in the world—neither better nor worse. Elizabeth eventually arrived at this conclusion and gave up on Micah’s counterfactual body. She embraced her child as he was, enrolling him in American Sign Language classes and supported his decision to cease wearing his cochlear implant. As Elizabeth (Reference Engelman2017) explains,
Micah’s first sign was ‘flower.’ To sign ‘flower,’ the right hand grasps an imaginary stem and holds it first against the right nostril and then against the left, and like a flower, Micah blossomed one new sign at a time and took his implants off his head for good.Footnote 11
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