In the mid-1980s I was working on differentials and trends in mortality and health, with emphasis on gender differences. I wanted to aim toward a new arena. Disability seemed a fine one, especially because it concerns diverse consequences of health problems during life, and is very amenable to survey research. I turned to the disability literature for education and discovered it to be messy and dull. The writings had little scholarship, in my view, and terminology was confusing. Plenty of cacophonous heat and little light. In gerontology, the literature was often aimed at clinical assessment. The literature for children/youths with disability tended to be politicized and sometimes quite strident. All in all, I found little good thinking about disability to buttress and energize scientific research. Just one article was truly thoughtful (Nagi, 1965), and it was—and remains—highly useful. The topic of disability was gaining high momentum in science, and there was great need for thought and theory that could undergird research. I thought, "We can pull ourselves out of this." I wanted to write something that would give freshness and inspiration to the field of disability research, that would provide architecture for researchers, policymakers, and disability advocates. Certainly, a personal motivation was to think things through in a way to help my own research, but maybe the "thinking through" would be worthy of stating to others. I did not want the paper to be prescriptive, but instead inspire people to think deeply and answer certain issues for themselves before launching their next research project. How did I team up with Al Jette for the paper? We had known and respected each other for some time; I was in Ann Arbor, he was in Boston. We decided to apply for a large contract from NIH together. We started talking about the project design and discovered that we weren’t on the same wavelength about disability terminology, concepts, and perspectives. This was no surprise. Neither was anyone else. In the context of pursuing the contract, we needed to find common ground. And we agreed that the field's cacophony needed remedy. I said that I'd been planning a paper; we decided to prepare it together. The goals? To clarify. To excite. I wrote the drafts; Al critiqued, discussed, and suggested changes.

It went slowly; hard things do! I have found my notes of our first conversation, dated December 1989. The first draft was done a year after that. The first submission was in June 1991.

The paper was published in early 1994. That suggests there were some interesting slowdowns between first submission and publication. In truth, considering what happened, I now see this as a short interval! The paper was rejected by four prestigious journals. In two cases, it was reviewed and rejected. In the other two, it was rejected by the editor without review. Some of the comments were amazing to me; for example, that the paper's terminology was confusing, or that there was nothing new. I knew the paper was fine and did its job. For a fifth try, I sent it to Social Science and Medicine. It went through the review process, and received a revise-and-resubmit decision. We revised and resubmitted. The editor then received a damning review, indicating the paper was redundant with the literature, poorly organized, and muddled. He said he had to hold up the review process to get one more review. I "went through the roof," a mixture of anger and despair. I sent a courteous letter to the editor about the paper's innovation and rationale, simply to relieve the pressure. The additional review was entirely positive. And so, at last, "The Disablement Process" was published. All in all, by the skin of its teeth.

There was plenty of momentum in the late 1980s and early 1990s on disability, in both research and public policy. At the time, the Institute of Medicine (IOM) had a committee specifically devoted to disability. The committee published a book, Disability in America, which helped fill the niche of widespread need. Our work was independent of theirs, and timing was such that our review trouble was occurring at the IOM book's publication point (dated 1991). I regretted that we didn’t come out at essentially the same time. "The Disablement Process" did not draw on the committee's work for its ideas or perspectives, although the publication year of 1994 might suggest this to some. But none of these timing aspects mattered in the end. As people found and read "The Disablement Process", it apparently began to do exactly what I dreamed, namely, to make each person think through overarching issues and make their own decisions about how to proceed with research or discourse. When people talk to me about their experience reading it, they say the paper compels active rather than passive reading. They can hear the authors thinking, and they are drawn into fresh thinking themselves. It has been one of the great gifts of my career to hear people say this.

Mostly, but not completely! Al and I are quite different people. He came originally from a physical therapy background, and he maintains a strong pragmatic approach in his work. I came from a demography background, and hope my work could influence public health policy but have no direct skills for doing so. In writing and revising the paper, most of the initial differences in viewpoints disappeared. Several points remained on which we did not agree, despite whittling them down over time. Initially, I felt we had to find consensus on every single point, else we'd contribute to, rather than relieve, confusion for readers. But over time, I changed and realized that the differences in viewpoint could be drawn into the text, not stated as disagreements of the two authors, but as matters for readers to address and answer for themselves. Al and I probably still don't agree on some points, but that fits the spirit of "The Disablement Process"—to state the issues, suggest parsimonious approaches, but not prescribe them.

An author never knows what impact a paper will have. A theoretical paper's future is especially uncertain. And the journal's visibility can matter; Social Science and Medicine had a large international readership, but was not routinely read by American researchers at that time (it now is). Yet the outcome was not a total surprise. I knew that "The Disablement Process" untangled the field, that it had the potential to change and influence. The biggest surprise was how swiftly the paper made its way into research design and public discourse. Word of that started coming within two years or so. People I met said it was the foundation for their research project, or that they could read and reread it with freshness each time. I am happy that the paper has made a welcome difference to so many people. Until contacted by ISI, I had no clue it was so highly cited in the social sciences.

  How has the disability research field changed in the nine years since the article appeared?

The quality and volume of research on disability have increased hugely, and funding opportunities have grown in tandem. The topic has "taken off", and it likely to remain a central one in medical sociology and health demography for decades, due to population aging and public policy. Besides research momentum, the Americans With Disability Act (ADA) has made the topic of disability widely enter public parlance and decision-making.

  If you came to the field today with the same mindset you brought to it in the mid-1980s, what would you read as inspiration?

I would read three things: "The Disablement Process", Disability in America (the IOM book), and Nagi's 1965 article. I say that without any hubris. Those are, I think, the three best foundations for starting out or continuing in disability research.

It’s been 12 years since "The Disablement Process" was brewing in my mind. I didn't stop thinking theoretically when it was published! When I encounter knotty issues, I put notes about them in several file folders. One folder is called "Disability Troublespots". I'm stumped about how to clarify those issues, especially in ways that facilitate scientific research. Another is called "Disability Jewels". It contains notes with ideas I like (clear, elegant, broad), found in the literature or occasionally my own head. There are several theoretical issues I'm eager to spend time on. I need to figure out these issues for myself first—for example, "what is the most succinct statement of the problem?"; "why is it messy or absent in disability thinking?"; "if clarified, how can the topic be embedded in empirical research?" If the answers seem sound, they may be worth stating in a paper for others' consideration. I am applying for a fellowship that gives me the time to think. Proposing theory rather than an empirical project to a funding group is dicey, but I hope someone will agree to it. I'd like to spend a year doing theory and pumping iron. At the end, maybe there will be a paper that breaks the ice, and a stronger me.

One concerns time use and disability; another is how "environment" can be measured and brought directly into disability research; and there are more. I'll comment on the first, to give some flavor to the issue. When older people start having trouble doing activities because of health problems, they make adaptations. For example, how they comb their hair or put on shoes; how often they go to the grocery store; how long they walk outdoors for recreation. Many such adaptations are, in fact, changes in time use. Sociology has a large literature on the topic of time use, but disability has not been a theme. I'd like to join disability and time use, drawing on the literature and perspectives of both fields.