Theorising rehabilitation: Actors and parameters shaping normality, liminality and depersonalisation in a UK hospital

Abstract

Sociological concern for rehabilitation remains limited. This paper aims to contribute to rehabilitation theory. It examines two units of a specialist rehabilitation hospital in the UK (amputee and neurological services) by focusing on the key actors involved – families, patients, staff – and the parameters shaping their relationships. The findings extend previous theoretical understandings of rehabilitation in three themes: normality, liminality and depersonalisation. We argue, first: normality is constantly negotiated amongst the different actors. This complicates existing works’ critique of rehabilitation as reproducing the ideology of normality. Second, discourses produced during acute care shape the inpatient rehabilitation experience. This calls attention to the pre‐rehabilitation phase and complicates existing works’ emphasis on the transition from inpatient stay to the time of discharge. Finally, inpatient rehabilitation is notable in rendering the adverse effects of depersonalisation apparent. It combines the bureaucracy of a regular hospital ward, with institutionalising aspects of long‐term care. These findings have a potential to enhance practice as well as knowledge. We call for a deeper sociological attention, combining theory‐building with empirical data for a better understanding of inpatient rehabilitation.

Focusing on “what matters”: the Occupation, Capability and Wellbeing Framework for Occupational Therapy

“…Nicholls (2022) has pointed out that the rehabilitation professions have derived enormous social privilege and economic gain from disabling practices that include compiling hierarchical categorisations (on the basis of physical ability and function), the use of humiliating assessments, and ongoing efforts to induce "normality". Thus, while individual clinicians may strive with individual patients to renegotiate the possible parameters of "normality" in the context of disability (Bermez et al, 2021), this represents a disruptive and unsanctioned form of practice; one that counters the principles ardently promoted by the profession itself.…”