Therefore, the amount of people suffering from debilitating illness and injury that is debilitating, is actually rising. This leaves millions of people disabled, even though they may not appear to have any visible restrictions at all.

Who is Disabled?

So what does "disabled" mean? Let us be honest. The label, "disabled" is quite confusing! We see special interest stories all of the time on television about a disabled person who just finished a marathon or is on a ski team. They are labeled as disabled, because they are no longer able to run on their own legs. Yet, they do not like to be called DIS-abled, because they are still ABLE, active and vital to do many things. They feel that even though they may have a limitation or obstacle, they are certainly not unable or DIS-abled.

Work Disabled:

The Social Security Administration defines being disabled in regards to being unable to work for at least one year, thus qualifying for disability benefits:

Disability under Social Security is based on your inability to work. We consider you disabled under Social Security rules if you cannot do work that you did before and we decide that you cannot adjust to other work because of your medical condition(s) (Social Security, Disability Benefits, 2000 ).

Because Social Security makes payments to those who are work-disabled, their definition falls under the guidelines of no longer being able to work. Thus, they do not decide if someone has a disability, instead, if they are disabled or unable to work.

Having a Disability (in the workplace):

The Supreme Court recently redefined the definition of having a disability in its relationship to limitations in the workplace for the American Disabilities Act and the Equal Employment Opportunity Commission:

This year, the Supreme Court held... that the determination of whether a person has an ADA "disability" must take into consideration whether the person is substantially limited in a major life activity when using a mitigating measure, such as medication, a prosthesis, or a hearing aid. A person who experiences no substantial limitation in any major life activity when using a mitigating measure does not meet the ADA's first definition of "disability" (a physical or mental impairment that substantially limits a major life activity) (EEOC, Instructions..., 1999).

One example might be of a person who is legally blind without glasses, but not with glasses. They would not be considered as having a disability under these regulations, because the eyesight is no longer limiting with glasses. But, if even with glasses, their eyesight substantially limits them, then they would be considered to have a disability.

Having a Disability (in life, daily living and work):

What constitutes having a disability or a severe disability under the regulations of SIPP, according to the Census Bureau:

A person is considered to have a disability if he or she has difficulty performing certain functions (seeing, hearing, talking, walking, climbing stairs and lifting and carrying), or has difficulty performing activities of daily living, or has difficulty with certain social roles (doing school work for children, working at a job and around the house for adults) (U.S. Department of Commerce, Disabilities Affect One-Fifth of All Americans, 1997).

Adults aged 15 and over were classified as having a severe disability if they used a wheelchair or had used another special aid for...were unable to perform one or more functional activities or needed assistance with an ADL [Activities of Daily Living] or IADL [Instrumental ADL], were prevented from working at a job or doing housework, or had a selected condition including autism, cerebral palsy, Alzheimer's disease, senility or dementia, or mental retardation (U.S. Department of Commerce, Americans With Disabilities, 1994).

Generally, if a person has a physical limitation that limits major life activities they have a disability (or impairment). Now, that disability may not keep them from being able to work or participate in various activities with equipment to help them, some limitations or accommodations.

In fact, according to the U.S. Department of Commerce, "In the prime employable years of 21 to 64, for example, 82 percent of people without a disability had a job or business compared with 77% of those with a non-severe disability..." (U.S. Department of Commerce, Disabilities Affect One-Fifth of All Americans, 1997). In other words, almost the same percentages of people with mild to moderate disabilities are working as people without disabilities. 

On the other hand, only “26% of those with a severe disability” (U.S. Department of Commerce, Disabilities Affect One-Fifth of All Americans, 1997) are able to work, because their disability impairs them to the point of not being able to work, even with helpful devices. In all, a person can have a disability or difficulty performing certain functions; but when their disability becomes so limiting that they are unable to perform daily activities and/or work, then they are considered to be “disabled.” 

When most people think of a disability, they picture in their minds a person with a visible, obvious limitation. However, as there are many levels of disabilities, there are also many types of disabilities. What most people do not realize is that a person can have a hindrance that comes from the inside and may not even be visible from the outside.

This person could have debilitating pain, fatigue, weakness and/or cognitive impairments from a diseased spine, organs, nervous system and/or cells that keep them from being able to function at a normal level. They may have an injury to their back, head, legs or spine that limits their ability to work or even complete daily tasks. Nonetheless, their bodies will not cooperate with their desires whether or not others can see the damage on the outside.

Visible Disabilities: People with outward limitations like missing limbs, paralysis or blindness often face the challenge of overcoming society's assumptions about their disabilities. They are put into a category of being disabled, but many times they are still able to work, raise children and even participate in sports with a little assistance. Many become frustrated when others assume they are helpless and cannot be productive. And, they are hurt when they are treated like they are not just as valuable to others. Mostly, they do not want to be defined by their DIS-abilities, but respected for their dis-ABILITIES.

Invisible Disabilities: Limitations that are not so obvious from the outside. These invisible limitations can stem from back, brain and spinal injuries. They can also be the result of diseases, disorders, chronic infections and birth defects. These injuries and illnesses manifest themselves with pain, fatigue, dizziness, cognitive impairments, weakness and nausea ranging from mild to severe to unbearable. People often assume that because someone with invisible disabilities may look fine on the outside, that they must just be over exaggerating, making excuses or lying about their situation. Sadly, this leaves millions of people feeling isolated and alone in their suffering, as their loved ones question the validity of their limitations.

Visible & Invisible Disabilities: Some people fall under both categories; they have both obvious, visible limitations that are mild to severe and invisible damage inside that causes such debilitating symptoms. They may need to use an assistive device, but it is not the chair, walker or cane keeping them from being as active as they would like to be, it is the disabling symptoms. In essence, for some it is the visible disabilities that hinder them, for others it is the invisible ones and for some it is both. 

Below, is a chart of some *general similarities and dis-similarities between having a disability that is visible on the outside, versus one that is not visible from the outside. The purpose is to create a better understanding of the frustrations, concerns and desires of people living with a disability that is visible and/or invisible.

*This chart is a "generalization" and not meant to be

a description of all cases and situations!

The irony is that it is not the visible impairments that are usually the culprit in someone being disabled or unable to work. Yet, when our visible limitations do not seem that bad, people cannot understand why we are impeded; but, it is the invisible symptoms they cannot see that are keeping us from being able to function. Therefore, throughout this book, when I refer to those with "invisible disabilities," I am speaking of people who have debilitating symptoms, whether or not they also have "visible" ones."

When a person has a visible limitation, we can see that they have impairments on the outside thus, we believe them when they tell us they cannot perform a task. For example, if a friend is in a cast, we do not question them when they tell us they cannot go water-skiing. But, when a person is debilitated by symptoms that are not visible, their integrity and intentions are often questioned when they declare they cannot participate. 

People with invisible disabilities are thankful and grateful for the invisibility of their impairment; yet, it can also be a great burden to bear, with its unique set of challenges. Because people cannot see the limitations for themselves, they often show their disbelief with a hurtful statement. This causes the person with the illness or injury to feel as if their character and honesty is being judged. Sadly, this cuts deeply, straight to the heart, when our virtue is being torn to shreds.  

Debbie, a woman with APS pointed out:

The greatest barrier I run into every day is people who think I am trying to rob the system or faking or whatever. I feel guilty when I have a rare good day and get to go out and act like a normal person, cuz then I know folds are going, ‘See!! I told ya! She is fine!!’ I am seriously ill, but to look at me, you would think I was young, healthy with everything going for me. I have often told my husband, at least if I had something visible…folks would not seem to treat me with such scorn and doubt (IDA E-Mail, 2001).

Lisa Copen, the founder of Rest Ministries, reasoned:   

He or she may be young, and no one really believes that there are young ill people in our country...The invisibility of most chronic conditions makes it even more difficult to convince others that you really are in pain (Copen, Why Don't Churches Understand Chronic Illness? pg 8).

In all, please do not make the mistake of making a visual judgment of what a person can and cannot do and do. We should not judge one another by outward appearance. Instead we should value each person individually. Simply talk with them and find out what their talents and needs are! Refusing to believe what you cannot see will only make others feel isolated in their struggles and as if you think they are not honorable, respectable and valuable to you. 

All too often, a person with a visible impairment is presumed to be unable to complete a task or participate in an activity; this is quite aggravating and hurtful to that person, when they are perfectly able to contribute and partake in the deed. And, it is just as insidious when a person explains their debilitating illness, yet people refuse to believe them, because they look fine on the outside; the disease may have eaten away at the brain, bones, spine, muscles, nerves, cells and joints, but because others cannot see the damage for themselves, they reject the validity of their limitations.

So, do not assume that someone using a wheelchair cannot do something or that someone not using a wheelchair can. Most of the time, it is not the wheelchair that keeps people from working and enjoying activities; it is the pain, extreme fatigue, neurological symptoms and cognitive impairment. 

Donna Herrell, a patient’s advocate with Lyme Disease explained: 

What most people do not understand is that most appearances are deceiving and do not reflect the disability caused by symptoms or disease. If someone is overly thin and looks under the weather, people may jump to the conclusion of AIDS. The person could be naturally thin with a recent case of flu. Conversely, you can look good and have cancer. We teach our kids not to judge people by their looks, but as adults, we do so every day (Herrell, Don't Judge a Disability by Its Cover, pg 1). 

In general, neither type of disabilities is worse than the other, because each person's degree of limitations is varied, despite their outer appearance. Some have visible disabilities, some have invisible ones and others fall under both categories. For some it is the visible disabilities that hinder them, for others it is the invisible ones and for others it is mutual.

Some people's symptoms/limitations are mild, some are moderate and others are severe. Some are able to work full-time, some part-time, some not at all and for others it is all they can do to make it to doctors’ appointments, shower and/or come to church once a week. The key is to listen, do not assume and take them at their word, despite what you see on the outside. 

Be mindful to value each person individually, because they are of great value to God. Whether we have a visible or an invisible disability, we are all striving for respect, understanding, accessibility and most of all... belief. We do not want others to prejudge us and be unwilling to hear the truth; we want people to listen and treat us like valuable, contributing people with integrity, courage and strength.   

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