I am the lowliest of us all... an MS0 (for a few more weeks, at least).
I have a significant physical disability and am, by anyone's standards, fairly high-achieving--i.e. not usually held back or incapacitated by my disability. However, I have to say that I think that while the idea that people are "as disabled as they think they are" captures something important about the experience of disability, it leaves a whole lot out. Phsically disabled people who believe in their own value, see significant positive possibilities for their lives, have passions & goals, have good creative problem-solving skills, know their strengths & limitations, are resilient, have strong interpersonal skills, do not have comorbid mental illnesses, etc, are of course more likely to lead high-quality (and high impact) lives. (Also it helps A LOT to have money, status, luck, and/or strong social support.) If you're bogged down by feelings of defeat, inadequacy, etc., overwhelmed by the needs of your body and/or the demands of organizing your care, or just feel like crap all the time, it is tougher. I completely agree that there is a huge psych componant to pm&r, and beyond comorbidities, this is it. I wish I knew how to bottle the drug that could impart these positive attitudes and skills--imagine the good that could be done with it! (I also recognize that, without making excuses for anyone, "bad" attitudes often come about in situations where personal, social, and/or material resources are seriously lacking.)
However, even with a super-adaptive, positive attitude I don't believe we can really "think away" or "believe away" our disabilities. Even high-achieving people with disabilities must deal with the realities of being disabled. Disability makes life harder, for real. Among the regular issues physically disabled people must deal with are physical inaccessibility, policies inadequate for dealing with our needs, insensitive and/or inaccessible medical care, employment discrimination, inadequate "special" education, social stigma, and many more practical/logistical issues to be managed compared to people without disabilities. Attitude and life skills are all-important in negotiating these difficulties, but don't do away with them. (It's also worthwhile to note that, while someone with, for example, amputation may *look* dramatically disabled, someone with extreme pain or fatigue (e.g. with fibromyalgia or M.S.) may have a much more substantial impairment in practical terms. As one with an obvious disability, I can report that I get a lot more strokes--people are more immediately impressed with me--than some of my colleagues with less visible or easily understandable but equally "impactful" impairments.) I think that handicap* is an interaction of the physical/biological impairment (i.e. disability), the person's attitude, and his or her environment. You can't really attribute it to just one thing.
Disabled atheletes get a lot of press, and deservedly so, since their accomplishments are impressive. However, at elite levels their lives are like mine the way NBA players' are like yours... Well, not exactly, since there aren't millions of dollars or fans in disabled sports, but close enough. They get a lot of help in the form of coaches, organizers, sponsors, etc. helping manage those accessibility issues and logistics, plus the rewards of doing something high-status and with built-in goals. They also tend to have "sexy" disabilities: paraplegia not quadriplegia, amputation not CP, etc... few speech impairments, little fatigue issues, little trouble with contractures or uncontrolled spasticity, little mental illness, and so on. This is not to minimize their achievements at all--they are super impressive! and often in the face of significant obstacles--just to say that there are sometimes some different issues faced by many disabled people who lead more "regular" lives.
I also welcome this conversation. I have thought a lot about these issues, and I'm excited to have other people thinking about them too.
P.S. Although it's not usually in the realm of PM&R, I see no contradiction in calling someone incapacitated by PTSD "disabled". I like the definition of disability laid out in the ADA, which handily covers psych and cognitive impairments as well as physical and sensory.
P.P.S. I think this conversation partly hangs on semantics: what is "disability"? "handicap"? "impairment"? "incapacity"? etc. the following is maybe a start, but i'm sure there's more to be said!
* Some disability theorists use words this way: disability=a physical or mental impairment, residing in the individual; handicap=a situational interaction of person + social & physical environment that results in abnormal limitations for an individual... in other words, if you can't walk you have a disability, but if you encounter a set of stairs while using your wheelchair you are handicapped in that situation
