As a neurological physiotherapist by background my engagement with futures has been long held – literally through the holding of limbs, facilitation of muscle activation and of movement, working through and around impairment, to enable function. Physiotherapy seeks to push boundaries of possibility to restore and regain function following injury. This aim of ‘return-to’, while backwards sounding is forward facing – in both theory and practice in many areas of physiotherapy, but not all. In the field of severe neurological injury and illness absolute restoration is often impossible. In such situations ‘return-to’ has to be replaced with adapt and learn anew.
My academic engagement with futures was born from the realisation that ‘the social’ moulds the futures of the patients I care for as much as my hands and their bodies can. Subsequently, how the futures of people with severe brain injury are shaped through the process of rehabilitation formed the focus of my doctoral research. Futures now serve as both topic and lens in my work illuminating the clinical, social, ethical issues and experiences surrounding the care and rehabilitation of people with neurological conditions – and those who care for them.
Rehabilitation-as-restoration is alluring but in neurology, the rehabilitative dream is often an illusionary. Although some do recover well, very well, the futures of these men and women remain hampered and constrained. Their horizons are not open and broad, but closed and short. Despite rehabilitative success their futures are poorly imagined as anything but a point of discharge from the rehabilitation setting to another place, the meeting of their day-day care needs and possibly, at best, some vocation.
Such a stilted future is the imaginings of health care professionals for those patients who rehabilitate well; the futures for those who are unable to display progress in multiple rehabilitative domains is compressed further still, to an extended present, or worse still – go unimagined.
In theory, brain injury rehabilitation is future facing, in practice however the futures of those with severe injuries extends little beyond now, this afternoon and the rest of today. Ever living in the present breeds frustration and conflict for families and patients themselves who do project beyond today.
Futures are critical is highlighting restraint, successes and failures of well-known and conceptualised processes such as rehabilitation. Challenging the temporal orientation illuminates the disjuncture between what rehabilitation is proffered to be and do and what it actually achieves, and for whom. The impact of futures work then, is it’s role in critically examining and exposing the intricacies of complex patient, staff, family interactions, health care experiences, and health care organisational processes, practices and systems.
I have been a member of the futures matters collective since 2012. My futures work dovetails with my core research focus – the study of severe brain injury health care practice and family-AHP relations.
The exploration of brain injury rehabilitation and the temporal role in caring relations has inspired a series of collaborations with members of Future Matters Collective and outside. A series of collaborative projects have developed between myself, a physio and social scientist, Professor of Communications Research, Jenny Kitzinger, Artist Seth Oliver and Educationalist, Senior Lecturer Geraldine Latchem-Hastings. Each collaboration now boasts it’s own futures focus and influence.
Bibliography and suggested temporal reading for healthcare professionals
Adam, B. (1995). Timewatch. Cambridge: Polity Press.
Adam, B. and Groves, C. (2007). Future matters. Action, knowledge, ethics. Leiden: Brill.
Bowlby, S., McKie, L., Gregory, S. and MacPherson, I. (2010). Interdependency and Care over the Lifecourse. London: Routledge.
Chernus, L. (2011). Aging and the experience of ‘remembered’ time: A biopsychological exploration. Time and Society, 20(3), pp. 325-345.
Davies K (1994) The tensions between process time and clock time in care-work: The example of day nurseries. Time and Society 3(3), pp. 277–303.
Elchardus, M. and Smits, W. (2006). The Persistence of the Standardized Life Cycle. Time & Society 15(2/3), pp. 303–326.
Ely, R. and Mercurio, A. (2010). Time perspective and autobiographical memory: Individual gender differences in experiencing time and remembering the past. Time and Society 20(3) pp. 375-400.
Ferrie, J. and Wiseman, P. (2016). Running out of time’: Exploring the concept of waiting for people with Motor Neurone Disease. Time & Society doi:10.1177/0961463X16656854) (Early Online Publication).
Folbre, N. and Bittman, M. (2004). Family Time: The social organization of care. London: Routledge.
Gebhardt, M., McGehee, L. and Grindel, C. (2011). Caregiver and nurse hopes for recovery of patients with acquired brain injury. Rehabilitation Nursing 36(1), pp. 3-12.
Harris, D. (2015). Lived-through past, experienced present, anticipated future: Understanding “existential loss” in the context of life-limiting illness. Palliative and Supportive Care 13, pp. 1579-1594
Jain, S. and Kaufman, S. (2011). Introduction to special issue. After progress: time and improbable futures in clinic spaces. Medical Anthropology Quarterly, pp. 25(2), pp. 183-8.
Kaufman, S. (2006). And a time to die: How American hospitals shape the end of life. Chicago: University of Chicago Press.
Lawton, J. (2002). Colonising the future: temporal perceptions and health-relevant behaviours across the adult lifecourse. Sociology of Health and Illness, 24(6), pp714-733.
MacBride-Stewart, S. 2013. The effort to control time in the ‘new’ general practice. Sociology of Health and Illness 35(4), pp. 560-574.
Mazur, S. and Ellis, D. (2014). Right people, right time: Prehospital and Retrieval Medicine. Emergency Medicine Australasia, 26(5), pp.423-425.
Pritchard, P. (1992). ‘Doctors, Patients and Time’ in Frankenberg, R. (eds) Time, Health and Medicine. London: Sage, pp. 74-93.
Shirani, F. and Henwood, K. (2011). Taking one day at a time: Temporal experiences in the context of unexpected life course transitions. Time and Society 20(1), pp. 49-68.