Review of Barbara Gibson’s book ‘Rehabilitation: a post-critical approach’

There are a lot of physiotherapy books in print, but not many of them engage in the kinds of (post)critical thinking celebrated by the CPN.

One exception is Barbara Gibson’s superb Rehabilitation: a post-critical approach, published last year by Taylor and Francis.

Earlier this week a new review of the book came out in the eminent journal Disability & Society.  The review highlights the many radical and important features of the book, and celebrates Barbara’s ability to ‘extend[s] these discussions and bring[s] a critical eye to bear on concepts that remain under-theorised within the field’.

There is a link to the review in the title of the journal above, but if you’d prefer, here it is in full.

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This new book in the ‘Rehabilitation Science in Practice’ series from CRC Press makes a significant and valuable contribution to the social studies of rehabilitation, by bringing concepts and approaches from disability studies (especially critical disability studies) to bear on the subject. Reading this book as an academic in disability studies, who is undertaking social research on the lived experience of rehabilitation, I regard Gibson’s book as an important and noteworthy addition to the literature. Gibson introduces ‘criticality’ to current mainstream thought on rehabilitation. What I mean by this – and what I think Gibson means by this – is an approach which dares to ask questions like ‘what is rehabilitation for?’, ‘who is rehabilitation for?’ and ‘what kinds of assumptions does rehabilitation make about bodies?’. In Gibson’s words:

[r]ehabilitation professionals are committed to helping to enhance people’s lives, but may struggle with how to do so in light of some of the bigger questions regarding their roles in, for example, working to maintain hope for recovery, ‘normalize’ impaired bodies, and/or promote greater acceptance of diverse abilities. (4)

The book, which includes a Foreword by Thomas Abrams and one chapter which is co-authored with Gail Teachman and Yani Hamdani, examines a series of key themes relating to rehabilitation theory and practice. These include, among others, ‘normality’, ‘quality of life’, ‘development’ and ‘in/dependence’. In each case, some of the certainties associated with the medical conceptualisation of the theme are challenged. This is often achieved by exploring the history of the concept, or by looking at it from another angle – for example, an angle supplied by the work of a particular thinker or group of thinkers, such as Foucault or Deleuze and Guattari. The author also draws on a wide range of works from disability studies to develop her arguments. The ‘post-critical’ in the title is, Gibson notes, borrowed from Agger (1991), and used as a ‘shorthand to capture the commonalities among the traditions that inform [Gibson’s] approach’, which include both ‘“post-modern” and “critical” approaches’ (4).

As someone with a background in the medical humanities, who has recently joined a medical school, Gibson’s discussion of the concept of ‘quality of life’ fascinated and intrigued me. The concept is an important tool in the health sciences for measuring the effectiveness of a given intervention, or for the economic evaluation of treatments, where the notion of the ‘quality-adjusted life year’ or ‘QALY’ is often invoked. Yet Gibson questions some of the received wisdoms that have grown up around ‘quality of life’. Tracing the rise of the concept as a key outcome measure in medical research and clinical psychology, the author locates its emergence as a formal category in the rise of the ‘interview society’ of the USA in the 1960s. The first patient-reported questionnaires were used in psychiatry during World War II and the post-war years, Gibson explains. More recently, the World Health Organization has developed ‘holistic measures of quality of life’ (53) such as WHOQOL 1998. Yet the uncritical dominance of quality of life as an assessment category has not been unproblematic – Gibson documents a ‘confusion surrounding health, function and QOL’ (55), which can lead to an ‘assumed causal link between functional abilities and quality of life’ (55). In this way, Gibson argues that the quality of life tool can be one of the measures through which the disabled body is ‘materialized through practices’ (63; original emphasis). The author observes that ‘disability, impairment, and quality of life do not precede their measurement but rather are constructed in part by tools that reflect notions of “dysfunctional” lives and persons as necessarily flawed’ (63; original emphases). Thus we can ask: how far is the concept of quality of life, as it is currently deployed in health contexts, defined through a lens that privileges able embodiment?

Gibson’s stance is radical within the rehabilitation science literature, where approaches which question the automatic valuing of, for example, the use of the statistical norm, or an increase in function, are few and far between. Within disability studies, some of the ideas Gibson discusses – such as ‘normality’ – have been circulating for a number of years, but Gibson extends these discussions and brings a critical eye to bear on concepts that remain under-theorised within the field. Indeed, rehabilitation itself has long been viewed with suspicion by proponents of the social model of disability; it is seen as an edifice of a medical ideology that is intent on ‘correcting’ non-normative bodies (Abberley 1995 ; Oliver 1990; Oliver, M. 1993). This has meant that disabled people’s lived experiences of rehabilitation are rarely researched using a disability rights framework – something my own research seeks to address. Gibson’s book introduces more questioning and criticality into conventional approaches to rehabilitation, and for this reason it is to be hoped that it reaches a wide audience of medical and allied health professionals. Rehabilitation: A Post-critical Approach also has the potential to challenge the received wisdom within disability studies that rehabilitation is always an oppressive practice and thus not of interest to researchers or theorists. Gibson reveals that there is plenty of scope for a critical engagement with this field for the disability researcher.

Harriet Cooper
Norwich Medical School, University of East Anglia, Norwich, UK
h.cooper@uea.ac.uk
© 2017 Harriet Cooper
https://doi.org/10.1080/09687599.2017.1309140

References

Abberley, P. 1995. “Disabling Ideology in Health and Welfare – The Case of Occupational Therapy.” Disability and Society 10 (2): 221–232.10.1080/09687599550023660.

Agger, B. 1991. “Critical Theory, Poststructuralism, Postmodernism: Their Sociological Relevance.” Annual Review of Sociology 17: 105–131.10.1146/annurev.so.17.080191.000541.

Gibson, B. (2016). Rehabilitation: A post-critical approach. New York: Taylor and Francis.

Oliver, M. 1990. The Politics of Disablement. Basingstoke: Macmillan.10.1007/978-1-349-20895-1.

Oliver, M. 1993. What’s So Wonderful about Walking? Inaugural Professorial Lecture, University of Greenwich, February. http://disability-studies.leeds.ac.uk/files/library/Oliver-PROFLEC.pdf.