During the past two decades, debate about disability definitions, concepts, models and policies has been led primarily by Western white middle class disability activists and scholars. This paper contributes to the discussion by examining how disability is conceived and disability culture is developed in a poor, African-American community. The recognition of disability as a defining identity and disability culture as a cohesive force is unusual in the African-American community, and we ask what conditions are necessary for such an identity and culture to develop. To address this question, in 1998 we began a 5 year ethnographic research project concerning young African-American men in the spinal cord injury unit of an inner city rehabilitation hospital in Chicago USA. Based on this research, we argue that there are three necessary conditions for a disability culture to emerge in a group of African-Americans who acquired their disability violently. First, is the perception of social alienation from family and fellow gang members. Second, is immersion in a supportive physical and social environment where disability meanings are produced, reinforced and passed on across generations. Third, is the development of personal narratives and metaphors that give meaning to disability, anchor behavioral changes and help to reconcile value conflicts. Our analysis allows us to understand a change in identity among these young men and the emergence of a shared disability culture represented through signs, symbols, language, rules and ceremonies. This analytical framework also permits us to re-examine disability culture in white society and in specific disability cultures such as deaf culture and to suggest that while there are similarities across groups, disability culture is not monolithic.