The medical reshaping of disabled bodies as a response to stigma and a route to normality

The everydayness of falling: consequences and management for adults with cerebral palsy across the life course

PURPOSE

To explore the cause, influences and consequences of falling for adults with cerebral palsy (CP) across their life course, and how this is managed.

MATERIALS AND METHODS

We used interview data from a multimethod UK study exploring the effects of ageing with CP and healthcare across the life course. Twenty-six participants were recruited and interviewed using various digital platforms to maximise inclusive participation in the UK. Follow-up email semi-structured interviews were conducted to further explore experiences of falls. Transcribed interviews were analysed thematically.

RESULTS

Falling and fear of falling (FoF) is problematic for over half of the participants in the sample. They perceived falls and FoF as limiting their participation, autonomy and independence in employment, social and cultural activities. Participants used their own management strategies, due to limited specialist interventions or practitioner knowledge to manage or prevent falls. Practices, such as the use of a wheelchair or avoiding activities prompted changes to relationships and identity.

CONCLUSIONS

Falling for adults with CP happens earlier in life compared to the general population. Adults with CP may benefit from specialist falls prevention services to help maintain muscle strength and balance. Research is needed to evaluate effective interventions for people with CP.

A legacy of silence: the intersections of medical sociology and disability studies

Disability remains on the margins of the social sciences. Even where disability is foregrounded as a category of analysis, accounts regularly emerge in silos, with little interdisciplinary dialogue acknowledging the potential intersections and points of convergence. This discord is particularly acute within medical sociology and disability studies, yet there is mostly a legacy of silence about the relationship between the two disciplines. Drawing upon data from a qualitative study with parents of disabled children in the UK, I show the value of meshing ideas and tropes from medical sociology and disability studies to make sense of parents' lived experiences. They described the challenges of living with 'impairment' and a need to readjust expectations. At the same time, parents were keen to not align with a deficit framing of their lives. They talked in affirmative terms about their children as sources of joy and vitality, perceived themselves as 'normal', and described convivial, even unremarkable, interactions in public spaces. Yet, parents encountered difficulties when navigating institutional settings and bureaucratic arrangements, or what was commonly referred to as 'the system'. Their troubles were not located in their children's bodies, but in-as per a disability studies sensibility-cultural and structural systems preventing their capacity to live well I argue that both disability studies and medical sociology offer something to the analysis, thereby recognising the gains of not simply buying into the tradition of one worldview. I conclude by imploring for more concrete conversations between both disciplines.

A Longitudinal Analysis of Disability-Related Interpersonal Violence and Some Implications for Violence Prevention Work

This article explores the extent to which disabled individuals experience interpersonal violence due to victimization. Data on people injured by violence were collated directly from the accident and emergency units in hospitals. High frequency daily data were obtained from computerized records of 26 major accident and emergency departments in London for each day throughout the year of 2016. The final sample consisted of 408,000 observations. A fundamental distinction of our research lies in applying the Generalized Method of Moments system panel estimator to our sample. This makes our empirical estimates robust to endogeneity and joint determination unlike previous empirical research in this area. Data analysis provides strong evidence confirming the victimization of people with disabilities and the necessity to focus on disability equality in violence prevention work.

Vulnerability as practice in diagnosing multiple conditions

The paper contributes to contemporary understandings of vulnerability by expanding their scope with an understanding of vulnerability as generated through institutionalised practices. The argument draws on experiential accounts of navigating the practices of diagnosis by people living with multiple conditions of ill-health and disability. Vulnerability as a concept is used widely across different domains and conveys a multitude of meanings. Contemporary biomedicine, and its associated health systems and services, understands vulnerability mostly as inherent to particular physical and mental bodily conditions that put people at risk of ill-health or emotionally fragility. This may combine with a more epidemiological understanding of vulnerability as the experience of certain population groups subject to entrenched structural inequalities. Philosophers and feminists have argued that vulnerability is a universal experience of being human while political commentators have explored its potential as a resource for resistance and action. Diagnosis within medicine and psychiatry has been the subject of extensive social analysis, critique and activism. The paper draws on first-hand experiential accounts collected through face-to-face interviews with people living with multiple conditions about their experiences of diagnosis, mostly at the primary care level. We identify five aspects to diagnostic practice that are harmful and exacerbate the experience of vulnerability: temporal sequencing; diagnostic authority; medical specialisation; strategic symptom selection; medical isolation. However, these diagnostic practices are not best understood only in terms of the power asymmetries inherent to the medical consultation, but are embedded into the very institution of diagnosis. The paper thus proposes a combined approach to vulnerability that recognises it as a universal condition of humanity but one that becomes animated or amplified for some bodies, through their own inherent incapacities or the external structures of inequality, and through the practices of medicine as situated in particular times and places.

Uneasy encounters: Youth, social (dis)comfort and the autistic self

Notions of deficit and 'faultiness' shape depictions of the association between autism and uneasy social relationships. That framing has been the focus of critique by autistic activists and scholars who, exploring autistic people's sociality, reframe issues of social difficulty in terms of inequality and discomfort. Located within this set of debates, the article analyses data from a UK based study of mental health narratives derived from semi-structured interviews with 19 autistic young adults aged 23 to 24. The NIHR funded the study, and a UK National Health Service Research Ethics Committee gave ethical approval. Sociality and social difficulties, feelings of discomfort, and perceptions of the autistic self as 'faulty' were themes of the study. Exploring the nexus of inequality, non-autistic social power, fears about social performance and (dis)comfort that underpinned the accounts, the article explores the conclusions the young adults reached about social difficulty. Critically examining notions of improvability, the article contributes to debates about sociality, social difficulty and comfort by questioning the assumption that social dysfunction is due to autistic 'fault'. The article concludes with a discussion of inequality in autistic and non-autistic encounters, and of the social dynamics that deny autistic people social comfort.