Academic journal article The Canadian Geographer

Thinking about Environment: Incorporating Geographies of Disability into Rehabilitation Science

Academic journal article The Canadian Geographer

Thinking about Environment: Incorporating Geographies of Disability into Rehabilitation Science

Article excerpt

One of the health sciences that attempts to strike a path for its professional practice outside the limitations of biomedical discourse is occupational therapy. The biomedical framework is found to be inadequate in dealing with many aspects of chronic illness and disability, which commonly are lived out and managed in the community without the benefits of resolution through the cures and processes of acute care management. With a long-term primary, if not sole, concern for disability, occupational therapy's theoretical base emphasises the importance of bringing a holistic approach and the client's perspective to processes of clinical reasoning. These include problem-solving around issues of social and physical function in everyday life, with an aim of enhancing self-care abilities and participation in leisure and productive (paid and unpaid work) activities. The individual client's needs are the central concern of the therapeutic process, but increasingly the environment is included as an important component of clinical reasoning. This signals the considerable influence of a social, rather than medical, model in thinking about 'disability', and a turn to other disciplines by occupational therapists in their search for tools to analyse the causal linkages between client behaviour and 'environment'.

Geographical concepts are particularly pertinent to this search for understanding environment-client behaviour connections, and this article describes the outcome of a graduate student project that used insights from social theory and geographical work in analysing the daily routines of a person with chronic illness. (1) We draw on a case study of changes in the everyday geographies of a man with HIV/AIDS as his illness progressed, which was constructed through informal interviews with him by the second author. In the first section of the article we discuss the social model of disability and geographical work that builds on this, and further work in health geography that has incorporated poststructuralist interests in the discursive inscription of 'deviant' bodies into analyses of disability or chronic illness experience. We then make some connections between these emerging perspectives in health geography and current concerns in occupational therapy theory and practice. This is followed by presentation of the case study; the analysis and 'mapping' employed to understand the daily routines of 'Scott' indicates the close and recursive interweaving of encoded spaces of life and bodily inscription of the self in place as this man under palliative care negotiated his body, his neighbourhood and his medical care. We conclude with reflections on the contribution geography can make to an applied discipline such as occupational therapy.

Conceptualising Disability

One important direction in contemporary geographic studies of disability has been informed by the social model of disability. Constructed initially by British sociologists, with Oliver (1990, 1996) as particularly influential, this model challenged biomedical interpretations of disability and introduced the notion that various types of oppression are important in understanding the day-to-day experience of disabled people. According to such a perspective, disabled people as a marginalised group excluded from full citizenship by an array of social attitudes and normative ideas that are written into the landscape to produce 'ableist environments', encounter countless physical and social barriers to their participation in society. Proponents of the social model of disability thus argued that disability was socially produced or constructed rather than the inevitable result of physical or mental bodily impairment.

More recently, in the interdisciplinary literature on disability, there has been growing emphasis on the heterogeneity of the experience of disability and the conundrum of whether chronic illness can be understood adequately through the same model. …

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