Neurorehabilitation: A Disciplined Disciplining Discipline
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Neurorehabilitation is an encompassing health service for individuals who experience impairments as a result of a neurological injury or disease. It aims to improve functioning, reduce disability and assist the individual to achieve a desired state. Contemporary perspectives of neurorehabilitation are underpinned by the belief that clients will actively engage in this process, collaborate with their rehabilitation practitioner and help themselves to achieve their desired goal. Client involvement is considered necessary for improved outcomes and as an ethical approach to service delivery. However, the extent and nature of this involvement appears equivocal. To explore how clients make sense of neurorehabilitation and position themselves as its subjects a poststructural discourse analysis informed by Michel Foucault’s theories of discourse and power was undertaken. Foucault’s concept of discourse and his approach to power draws attention to the power of discourse to construct its objects, the subject positions made available by the discourse and what these enable or constrain. This discourse analysis explored text where six neurorehabilitation clients discussed their relationship with their rehabilitation practitioners to find out how they constructed their own subjectivity. Neurorehabilitation was constructed as a discipline that selected a particular type of person to be its subjects and then acted on their behaviours. As a body of knowledge with techniques to shape behaviour, neurorehabilitation functioned as a technology of normalising power internalised by its subjects to address situations where function differed from what was considered normal. The participants were disciplined by, and disciplined themselves with the practices of the discipline to achieve their desired ends. Foucault’s concepts of governmentality and disciplinary power showed the productive way this normative power works to achieve particular ends. The participants became rehabilitation subjects in the hope they would achieve some kind of normality from the practices of the discipline. They were intertwined in strategic power relationships that involved obligations and responsibilities. Neurorehabilitation demanded their sacrifice and commitment in return for independence and wellbeing. This power relationship was productive and benevolent. The current trends in neurorehabilitation that advocate for devolving practitioner dominated services, incorporating client perspectives and adopting a biopsychosocial model capitalise on this strategic relationship. Viewing neurorehabilitation as a discipline revealed some of the strategies this technology used to achieve its ends. This can assist us to attend to the possibilities these strategies offer and be wary of the potential dangers.