Rehabilitation Counseling Bulletin

http://rcb.sagepub.com/ Toward a Cultural Anthropology of Disability and Rehabilitation

David B. Hershenson Rehabil Couns Bull 2000 43: 150 DOI: 10.1177/003435520004300305 The online version of this article can be found at: http://rcb.sagepub.com/content/43/3/150

Published by:
Hammill Institute on Disabilities

and
http://www.sagepublications.com

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150

Toward

Cultural Anthropology of Disability and Rehabilitation

a

David B. Hershenson,

University of Maryland

The author reviewed both the anthropology literature and the literature of disability and rehabilitation, examining the extent to which the concepts, theories, and methods of cultural anthropology have been applied to the conceptualization and understanding of "disability and rehabilitation" as a cultural phenomenon. Future directions for investigation are suggested, with particular reference to its application in rehabilitation counseling practice and research.

he aim of this article is to survey the contributions that cultural anthropology has made to the study of JL disability (excluding psychiatric disability) and rehabilitation and to suggest some directions for further research that might guide rehabilitation counseling practice. Psychiatric disability has been omitted from this survey because it has received separate, extensive treatment in the anthropology literature and presents a unique set of issues (e.g., see Bock, 1999; Kleinman, 1980). This article contains the following:
1.
an

ology, political science, social policy) that use concepts taken from anthropology to examine questions in their own discipline concerning disability and rehabilitation and studies by anthropologists that examine concepts from other disciplines within the context of those disciplines (e.g., Franks [1988] test of &dquo;the theory of stigma developed by sociologist Erving Goffman&dquo; [p. 95]). HISTORICAL BACKGROUND
The behavioral and social science disciplines-psychology, sociology, and anthropology-emerged in the mid, 19the century. At that time, natural science, as the propelling force in the era of industrialization in Western society, was a highly valued intellectual enterprise. Therefore, early researchers legitimized the emerging behavioral and social disciplines by employing the same methods of empirical research used by natural scientists. The dominant philosophical paradigm underlying natural science is positivism, which states that a body of facts exists in reality and that these facts are accessible through rigorous hypothesis testing (Fuller, 1996). Sociology was first defined in positivist terms by Auguste Comte in approproximately

overview of the

disability anthropology;
2.
a

evolution of the study of and rehabilitation within cultural

review of works on disability and rehabilitation in the cultural anthropology literature ; a review of applications of anthropological concepts, theories, and methods in the dis-

3.

ability and rehabilitation literature; and

4.
some conclusions and suggestions for future research.

To keep this review focused and manageable in size, the author has omitted studies in other disciplines (e.g., soci-

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151

1830. Scientific psychology is usually dated from 1879, when Wilhelm Wundt established his laboratory at Leipzig. Somewhere between these two dates (arguably with Lewis Henry Morgans publication of League of the Iroquois in 1851, but certainly with Edward Burnett Tylors publication of Primitive Culture in 1871 ), cultural anthropology emerged as a distinct field. Anthropology consists of two principal branches: physical anthropology, which is related to the natural science of biology, and cultural anthropology, which is more closely tied to the behavioral sciences of psychology and sociology. Both these branches were heavily influenced by the theory of evolution (the former derived from Darwin, the latter from Spencer). Betweeen 1958 and 1968, the U.S. Social and Rehabilitation Service funded three successive national conferences to explore how the behavioral and social sciences could contribute the rehabilitation effort: first, psychology (Wright, 1959); then sociology (Sussman, 1965); and, finally, in 1968, anthropology (which, given the purposes of this conference, meant cultural anthropology; Chapple, 1970). It should be noted that anthropologists had participated in at least one project sponsored by the federal rehabilitation agency prior to this conference (Field, 1967). The order of the three conferences foreshadowed the order of subsequent contributions by these three disciplines to the field of rehabilitation. Not surprisingly, psychology, with its foci on individual behavior and therapeutic process, has contributed the most to the practice of rehabilitation. Sociology, particularly through the burgeoning area of medical sociology, has contributed significantly, because the viewpoint that disability is socially defined (i.e., labeling theory) and socially determined has
to

individual-environment interactions. Indeed, much of the past century has been spent in disputing the definition of &dquo;culture&dquo; (Kroeber & Kluckhohn, 1963 ), and agreement remains elusive. Likewise, there is no consensus on the definitions of &dquo;disability&dquo; and &dquo;rehabilitation&dquo; (Greenwood, 1985). Nagi ( 1965 ) defined disability as &dquo;a pattern of behavior that evolves in situations of long-term or continued impairments [physical abnormalities] that are associated with functional limitations [inability to perform normal roles or activities]&dquo; (p. 103). In different cultural settings, however, the same impairment may not lead to a functional limitation. For example, in cultures that do not employ machinery, epilepsy may be seen as a divine enabling gift (&dquo;second sight&dquo;) rather than as a potentially hazardous disability. Furthermore, as Vega and Murphy (1990) is not at pointed out, &dquo;The purpose of rehabilitation all clear. Broadly speaking, rehabilitation refers to the process whereby the health of a person is restored. Yet, health is a nebulous state. Is health the absence of illness, or the condition of optimal well-being? And what considerations affect how these conditions are differentiated?&dquo; (p. 97). Despite these unresolved issues, sufficient literature on the topic has been generated to warrant the review undertaken here.
...

...

CULTURAL ANTHROPOLOGY LITERATURE

The area of cultural anthropology in which disability and rehabilitation fall is psychological anthropology. Potentially relevant branches of this area include medical anthropology, the anthropology of work and careers (because of the vocational focus of rehabilitation), and the anthropology of deviance. Looking first at the domain of

the rehabilitation field. gained widespread the fact that Tylor, the first acknowledged English Despite anthropologist, did his initial fieldwork among the deaf in England and Germany (the research from which was published in 1865 in Researches into the Early History of Mankind [Bohannan & Glazer, 1988] ), cultural anthropologys contributions to the study of disability and rehabilitation have been the least evident of the three disciplines. Solid contributions by cultural anthropologists, however, exist and, over the past few years, have been growing in number and in sophistication. Cultural anthropologys slow start in addressing disability and rehabilitation may reflect the difficulty in achieving agreement on the definition of three key terms-culture, disability, and rehabilitation. In 1903, Tylor first defined the concept of culture in English (taken from the German kultur), equating it with civilization (the highest stage of cultural evolution; Langness, 1987). Franz Boas, however, disputed this definition and spoke of cultures in the plural, taking a relativistic position (i.e., all cultures have equal merit as objects of scientific study). Boass student, A. L. Kroeber, instead saw culture as a superorganic entity, a product of history rather than of
currency in

psychological anthropology (e.g., Bock, 1999; Cole, 1996; LeVine, 1982; Spindler, 1978; Williams, 1975 ), it may be noted that from the inception of both psychology and cultural anthropology, there has been debate as to whether culture is essentially all psychological (i.e., the pattern of
behavior based
on

person-environment interaction),

completely independent of psychology (as proposed by

A. L. Kroeber and Leslie White), the force that shapes the

domain of psychology (i.e., all the questions asked and answers

provided by psychology

are

culture-bound),

or one

of two interactive, mutually dependent phenomena along with psychology (cf. Bock, 1999, Table 1-1, p. 114; after LeVine, 1982). It is of interest that Wundt ( 1916), the father of &dquo;scientific&dquo; psychology, studied Volkerpsychologie, which he defined as &dquo;the psychological explanation of the thought, belief, and action of primitive man on the basis of the facts supplied by ethnology&dquo; (p. 7). Furthermore, Durkheim (the leading French anthropologist of his day),

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152

(the leading American anthropologist of his day), and Malinowski (a founder of British functionalism) were all students of Wundt (Bock, 1999). As Kiefer (1977) noted, &dquo;Most ethnologists used to hope they could identify biological, ecological, and cultural laws that operatedor that could be studied-independently of the workings of the human mind. This hope has faded for most of us in the last decade or two&dquo; (p. 103). Consequently, the most tenable position (and the most productive one for the anthropological study of disability and rehabilitation) appears to be the interaction position (the last of the four alternatives listed previously), which is represented in the
Boas of psychocultural adaptation (e.g., Edgerton, and of neo-Freudianism (e.g., Erikson, 1963). This 1976) position views &dquo;personality as a system with its own internal properties, interacting with the sociocultural system in a relation of limited interdependence&dquo; (LeVine, 1982, p. 97). In this position &dquo;relations between the two systems are the major foci of empirical inquiry&dquo; (LeVine, 1982,

approaches

p. 97).
It is of interest that the periodic reviews of medical anthropology strand within this domain (e.g., Colson & Selby, 1974; Fabrega, 1972; Hahn & Kleinman, 1983; Scotch, 1963; Young, 1982) have yielded almost no refer-

disability. Moreover, most books on medical anthropology (e.g., Helman, 1994; Kleinman, 1980, 1988, 1995; Loustaunau & Sobo, 1977; Rush, 1996) mention disability only in passing, if at all. This void perhaps can be accounted for by Steins (1979) thesis that people with
ences to

On the positive side, several anthropologists have viewed disability as a construct, most notably Estroff (1993), Groce (1985, 1987, 1992; Groce & Zola, 1993; Scheer & Groce, 1988), and Ingstad and Whyte (1995). Schneider (1955), a medical anthropologist, wrote an article on the social dynamics of physical disability in army basic training. Ablon (1984), also a medical anthropolo, gist, published a book on the social dimensions of dwarf ism in U.S. culture. Murphy, Scheer, Murphy, and Mack (1988) applied the concept of liminality (i.e., &dquo;caught and fixated in a passage through life that has left them socially ambivalent and ill-defined, condemned to a kind of seclusion no less real than that of the initiate in the puberty rites of many primitive societies&dquo; [p. 235]) in an ethnographic study of persons with paraplegia or quadriplegia living in the New York metropolitan community. Murphy (1990), a well-known anthropologist, also applied this concept in his landmark participant-observer report of his own experience with disability resulting from a spinal cord tumor. Cobb and Hamera (1986) applied Kleinmans (1980) concept of explanatory models to two individuals with amyotrophic lateral sclerosis, or Lou Gehrigs Disease. Frank (1986), also an anthropologist, applied the phenomenological concept of &dquo;embodiment&dquo; to the life history and views expressed by a 35-year-old woman bom with quadrilateral limb deficiencies. Over time, the func-

permanent disabilities and chronic illness represent a threat to the medical model of diagnosis and cure of pathology and hence have been a &dquo;demedicalized&dquo; (i.e., our approach doesnt work on them, so they must not be a medical problem and are therefore outside the scope of medical anthropology). Similarly, the ethnographies that focus on work behavior (e.g., Lee, 1979; Richards, 1939) did not discuss disability, which in our culture has primarily been defined in terms of work incapacities. Perhaps people with severe disabilities in the subsistence-level cultures that were the subjects of these two studies do not have high survival rates, so an operational concept of disability would be moot (although there are doubtlessly culturally consensual affective responses to persons who succumb to this status). The anthropology of careers literature (e.g., Goldschmidt, 1990; Hakken, 1993) has yielded no greater coverage of disability and rehabilitation. Likewise, and perhaps most surprisingly, the anthropology of deviance literature (e.g., Edgerton, 1976; Erchak, 1992; Freilich, Raybeck, & Savishinsky, 1991) has had little to say about disability. However, Edgerton (1976) noted, &dquo;The most relevant issue here is not what causes mental retardation-or blindness, or any other physical disability-but why some cultures regard it as seriously troublesome and others do not. About this subject, we remain almost wholly ignorant&dquo; (pp. 62-63).

tioning and self-image of this woman provided the basis for an examination of the demands placed on persons with severe physical disabilities in contemporary U.S. culture. Vaughan (1998) presented a comparative study of blindness in the United States, Africa, China, and Spain; Deshen (1992), an Israeli anthropologist, has written an ethnography of blindness in Israel. Edgerton, a wellknown U.S. anthropologist, has published extensively on the adaptations made by persons with both mild and severe mental retardation (e.g., Edgerton, 1979, 1984, 1993; Kernan, Begab, & Edgerton, 1983). One unpublished study is of sufficient significance to warrant inclusion in this review: Weiss (1985), using data in the Human Relations Area Files, compared cultural patterns for dealing with persons with disabilities in 47 non-Western societies around the world. Disability-related aspects of culture that she examined included &dquo;infanticide, invalidicide and senilicide, marriage, attention to the disabled-positive and negative-social institutions, statuses and roles&dquo; (p. 14).

DISABILITY AND REHABILITATION LITERATURE

To highlight the contributions of anthropology, I have taken the relatively simplistic tack of dividing the literature into that written by anthropologists (previously discussed) and that written by others (primarily in the re-

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153

habilitation field). In reality, however, the literature forms a continuum of emphases rather than a dichotomy. For example, although not written by anthropologists, there recently has been an increasing number of books published that examine the place of disability in a culture. Garland (1995), a social historian, analyzed how deformity and disability were viewed in classical Greek and Roman cultures. Thomson (1997), a scholar of U.S. literature, presented a similar analysis of how deformity and disability have been viewed in U.S. culture over time, primarily from a feminist perspective. Another scholar of U.S. literature, Phillips (1990), found uniform patterns of social interaction and self image related to disability in the oral narratives of 33 persons with disabilities within U.S. culture. She concluded that her findings support the thesis that reactions to disability are a cultural construct. These works contribute to the emerging area of disability studies, which appears to be following in the tradition of such already established fields as womens studies and African American studies. Moving from studies of disability and culture per se, one finds a number of studies that examine disability and culture for its implications for rehabilitation. Using the same database as in her previously cited study, Phillips (1985) found that definitions of success for persons with disabilities in U.S. culture have been shifting from traditional, stereotypical ones (e.g., perseverance, normalization) to more individualized, context-specific definitions. Consequently, she concluded that rehabilitation practitioners must reassess their orientation and consider moving further away from the medical model and toward greater individualization of the rehabilitation process. Similarly, Kerr and Meyerson (1987) questioned the U.S. cultural assumption that independence is always the preferable state and, instead, suggested that for some persons with disabilities in some situations, dependence or interdependence may be better orientations. These authors therefore suggested that rehabilitation services should assist individuals in achieving the flexibility and skill needed to comfortably enter into relationships spanning a range of dependency, as needed for different func, tions. Fowler and Wadsworth (1991) noted that attitudes toward people with disabilities in U.S. culture posed barto the employment of these persons. Therefore, rehabilitation personnel must promote positive perceptions of persons with disabilities and advocate for the incorporation of these perceptions into the cultural values of individualism and equality of opportunity. Thorn, Hershenson, and Romney (1994) used the technique of cultural consensus analysis to determine commonly held cultural beliefs about the attributed causes of disabilities. They found that, among U.S. citizens, these attributed causes included fate or Gods will, natural or medical causes, societally imposed barriers, and careless or reckless behavior by the person who has a disability. Williams,

Hershenson, and Fabian (in press) found

that the first

riers

three of these attributed causes correlated with beliefs held by nonprofessionals as to what constituted an appro, priate rehabilitation approach. Studies on disability and culture with implications for rehabilitation have also been carried out in other cul, tural contexts. In a study of cultural beliefs about diabetesrelated visual impairments among Native Americans, Ponchillia (1993) concluded, &dquo;Although it is risky for non-Native Americans to generalize about the effects of traditional cultural beliefs and practices, particularly among different tribes or bands, it is unwise to ignore the importance of these beliefs and practices to the provision of effective services.... Sensitivity toward traditional beliefs and perceptions can increase the chances for the success of rehabilitation services&dquo; (p. 335). Finally, addressing this issue in yet another cultural context, Miles (1996) concluded that Western approaches to disability services planning (e.g., seeing the process in terms of human rights and community-based rehabilitation) are not applicable in South Asian cultures. Instead, he recommended using an informational approach based on Asian cultural values and local conceptions of disability. Moving from studies of disability and culture that have implications for rehabilitation to studies of culture and rehabilitation, Jaques and Hershenson (1970) proposed that the concepts of work and deviance within a culture affect the practice of rehabilitation counseling in that culture. Percic (1986) noted that the roles, values, attitudes, and norms of a culture affect client expectations, interactions, and outcomes of the rehabilitation process. Criswell (1968) stated that cultures determine the handicapping effects of certain disabilities and the values placed on different rehabilitation goals and processes. Banja (1996) noted that rehabilitation process and outcome are affected by cultural effects on illness behavior, attribution of etiology, and treatment expectations. He proposed, however, that the ethics of rehabilitation (e.g., acceptance of diversity, environmental engagement, social justice) could provide a cross-culturally acceptable basis for treatment. Szymanski and Trueba (1994) proposed that the anthropological construct of castification ( i.e., the process of differential marginalization) could be usefully applied to the conceptualization of disability and of the rehabilitation process (e.g., power differentials between professionals and clients). There is a relatively extensive literature on rehabilitation programs and practices in different specific

cultures, including Afghanistan (Miles, 1990), Japan (Marshall, Wilson, & Leung, 1983; Myers, 1983), and Tanzania (Kisanji, 1995), as well as among Latinos (Zea, Garcia, Belgrave, & Quezeda, 1997; Zea, Quezada, & Belgrave, 1994), Mexican-Americans (Kunce & Vales, 1984; Smart & Smart, 1991, 1993), Navajo (Lowrey, 1983), and Pacific Islanders (Fitzgerald & Anderson, 1992) in the

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154

United States. Strauss (1985) compared two multicultural societies-those of Israel and Nigeria-and their cultures regarding attitudes toward birth defects, rehabilitation, and community participation. He concluded that culture is an important variable in cleft lip and palate research. Several studies have compared the attitudes of rehabilitation practitioners across different cultures. Jordan and Friesen (1968) compared the attitudes toward people with disabilities and the interpersonal values of rehabilitation personnel (primarily occupational and physical therapists) in the United States, Colombia, and Peru (characterized by the authors as modem, transitional, and traditional cultures, respectively). The U.S. personnel scored most positively on the Attitudes Toward Disabled
& Campbell, 1960) scale, predictions concerning interpersonal values were not confirmed, although the groups differed significantly from each other. Although the authors relate the U.S. samples positive score on the ATDP to the United States being the most modem culture, it must be noted that the U.S. sample was older and had more education than the other two samples-factors that also could
as

Persons

(ATDP; Yuker, Block,

but

predicted,

(1988) recommended incorporating knowledge of Chicano culture into rehabilitation counselor education programs. Hershenson ( 1989 ) compared rehabilitation counselor education in Australia and the United States. Finally, several studies have used ethnographic research methods to explore rehabilitation process issues. Spencer, Young, Rintala, and Bates ( 1995 ) conducted an ethnographic study of a patients socialization to the culture of a rehabilitation hospital. The patient was a 30-year-old man with spinal cord injury who was interviewed daily throughout his 116 days of hospitalization. Likewise, Hill ( 1978) used participant observation and intensive interviewing to examine the different perceptions of clients and staff on two different units (physical rehabilitation and nephrology) conceming the rehabilitacan tion process. She concluded that, &dquo;Anthropology make a contribution, both conceptually and practically, as rehabilitation moves away from fragmentation and compartmentalization and toward a more comprehensive approach to social intervention and client care&dquo; (p. 62).
...

have accounted for the differences. Westbrook, Nordholm, and McGee (1984) compared Swedish and Australian female occupational and physical therapists and nurses on their reactions to case histories of six individuals with accompanying interview transcripts. Australians were more likely to see the individuals as dependent, depressed, and poorly adjusted; to respond verbally to their feelings; and to recommend counseling. Swedes were more likely to react with specific treatments and technical aids and to see dependent individuals as having poorer prognoses. Conversely, Cope, Kunce, and Buchanan (1973) examined counselors views of clients from two different U.S. subcultures. Taking a &dquo;culture of poverty&dquo; approach, the authors asked 183 rehabilitation counselors to rate 36 behavioral statements as to whether they were more characteristic of individuals from poverty backgrounds or from middle class backgrounds, or were equally characteristic of both. Of the items, 14 were seen as more characteristic of persons from the culture of poverty (e.g., &dquo;Lacks persistence in following through on goals&dquo; [p. 164]), and 16 were seen as more descriptive of persons from middle class culture (e.g., &dquo;Has good sense of self-direction&dquo; [p. 165]). The respondents indicated that they believed that differences between the two cultural groups existed in the areas of health, language styles, work skills, and psychological characteristics. Such pervasive perceived differences may affect the respondents delivery of rehabilitation services to the two groups. Several studies have also addressed the place of cul-

CONCLUSIONS
Chapple ( 1970) summarized the conclusions of the 1968 federally sponsored conference, mentioned previously, regarding what anthropologists could contribute to rehabilitation. Potentially useful anthropological approaches to the study of disability generated by the conferees included the suggestion that traditional ethnographic observations
of time spent on an activity, sequencing of activities, spatial layout and movement patterns, interactions with others, technology used, and communication patterns could be applied to persons with disabilities to establish their cultural context. Among issues that could be addressed from an anthropological approach are how culture defines disability and how culture promotes the acceptance of disabled status (e.g., by fostering dependency, segregating those with disabilities, promoting differential life cycle pattems, restricting participation in productive activity). The conferees further suggested that the culture of rehabilitation programs could also be profitably studied using anthropological methods. Topics that could be viewed ethnographically included the sequencing of the rehabilitation process, cultural disparities between client and rehabilitation professional, values held by rehabilitation professionals, the use of paraprofessionals to meet staffing needs, institutional barriers to effective rehabilitation, and communication pattems within rehabilitation agencies. Finally, the conferees proposed that insights from anthropology could be applied in effecting and evaluating cultural and institutional innovations in the rehabilitation community and in its broader cultural context. Clearly, 30 years later, not all of these topics have been adequately addressed.

rehabilitation counselor education. Rubin, Pusch, Fogarty, and McGinn (1995) identified needs and educational priorities for enhancing the cultural sensitivity of rehabilitation counselors. Medina, Marshall, and Fried
ture

in

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155

Furthermore, as may be seen from review of the literature, much of the work on disability and rehabilitation done by anthropologists has been fragmented and has produced a number of conclusions that are based on inadequate data, are based on a lack of understanding of current best practices in rehabilitation, or are restatements of ex~

feel) toward persons who

are

categorized as

rehabilitation. These thus are of relatively little use to practitioners. Other studies, however, have provided valuable insights to guide rehabilitation counseling practice. What is needed to ensure an increase in the latter type of studies is the identification within cultural anthropology of a specific branch of study that addresses the topic of disability and rehabilitation. This

isting knowledge

in

disabled? What structures (e.g., ideas, behaviors, material objects) are there in the culture to promote or facilitate the culturally approved ways of acting toward those with disabilities? What structures are there in the culture that facilitate the functioning of persons with disabilities ? Does the concept of disability, if present in the culture, lead to a concept of rehabilita-

recognition will promote the development of

matic research

program~

and will stimulate the production of more and, on average, better work on this topic. It is important that rehabilitation counselors contribute to structuring this new branch. In that way, results useful in improving professional practice will more likely be generated. On the basis of the literature covered in this review, one may also conclude that disability is conceptually discrete from deformity, deviance, and illness. For example, deviance may include exceptionally superior, as well as exceptionally inferior, ability. One may be ill or deformed without being disabled (cf. Ablons [1984] study of dwarfism in the United States). Disability implies incapacity or disqualification, which are not synonymous, as one may be culturally disqualified even if physically and mentally able to perform a role (e.g., a cosmetics salesperson with severe facial scarring). This conclusion casts serious doubt on Jaques and Hershensons ( 1970) proposition that deviance is a necessary construct for analyzing the way a culture handles the phenomena of disability and rehabilitation. This conclusion also implies that the anthropology of disability and rehabilitation cannot be encompassed within medical anthropology-that branch of study is concerned with illness and curing. Disability, however, is not synonymous with illness (although it is sometimes the consequence of illness), and rehabilitation does not seek to cure. In public health terms, medicine aims at secondary prevention, whereas rehabilitation aims at tertiary prevention. Therefore, the cultural anthropology of disability and rehabilitation must stand as a discrete area in its own right and cannot find its place as a subarea of either medical anthropology or the anthropology of deviance. Questions that should be raised in constructing an ethnography of disability and rehabilitation include the

(e.g., in Nazi Germany, disability was recognized as a status, but it led to extermination rather than to rehabilitation)? How is work viewed within the culture (e.g., essential for physical survival, for spiritual salvation, or not a moral necessity), and how
tion

does this affect how rehabilitation is conceptualized ?

It would also appear that different approaches are required for different aspects of the ethnography of disability and rehabilitation. For example, impairment appears to call for thin (Geertz, 1973), etic (i.e., objective mean-

by independent observers using operations) description. Disability, however, appears to require thick (Geertz, 1973), emic (i.e., subjective meanings perceived by the persons being studied) description; rehabilitation appears to require a mixtureetic for procedural case management issues and emic for interpersonal and coping issues. The range of issues involved in an ethnography of disability and rehabilitation is broad enough to require the use of a wide range of anthropological methods, such as participant observation, intensive interviewing, cultural consensus analysis, and cross-cultural comparison. Clearly, the core parties to the rehabilitation process (i.e., clients and counselors) offer a rich source of data from which to construct an ethnography of a culture of disability and rehabilitation. (For a discussion of ethnographic writing, see, e.g., Emerson, Fretz, & Shaw, 1995). Moreover, once the productive paramecan

ings that
similar

be verified

ble

following:
. Is there a concept of disability in the culture? if so, what constitutes being disabled? . If disability exists as a concept within a culture, how does the culture indicate that those in the culture should act ( including react and

of that topic have been established, it would be possicarry out cultural comparisons across disabilities, agencies, and national or regional cultural contexts that include discrepant views of disability and how it should be dealt with. Furthermore, as Marcus and Fischer (1986) suggested, &dquo;The critique of institutions and the culture of professionals is another promising area of ethnographic research.... Analysis could be done for professions that construct, according to their interests, secondary cultural models of clients that often conflict with the commonsense notions that the clients themselves have of what a person is, in different contexts of activity&dquo; (pp. 154-155). This proposal is immediately applicable to
ters to
...

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156

anthropology of disability (client) and rehabilitation (profession). If the topic of disability and rehabilitation gains recognition as a distinct area of cultural anthropology, and if it generates the types of research suggested here, the beneficial effects on rehabilitation counseling practice and research should be significant.
the
ABOUT THE AUTHOR

anthropology of medicine and everyday life (pp. 247-286). Berkeley: University of California Press. Fabrega, H., Jr. (1972). Medical anthropology. Biennial Review of Anthropology-1971, 167-229.
power, and practice: The

Field, A. J. (1967). Urbanization and work

in modernizing societies: A working paper. Detroit, MI: Glengary. Fitzgerald, M. H., & Anderson, D. D. (1992). Providing vocational rehabilitation services in Pacific Island communities: Myth and real-

David B. Hershenson, PhD, is a professor and director of the Counselor Education Doctoral Program in the Department of Counseling and Personnel Services, College of Education, University of Maryland. Address: David B. Hershenson, Department of Counseling and Personnel Services, Collage of

ity. American Rehabilitation, 18, 7-10, 47-48. Fowler, C. A., & Wadsworth, J. S. (1991). Individualism and equality: Critical values in North American culture and the impact on disability. Journal of Applied Rehabilitation Counseling, 22, 19-23. Frank, G. (1986). On embodiment: A case study of congenital limb deficiency in American culture. Culture, Medicine and Psychiatry, 10,
189-219.

Education, University of Maryland, College Park,

20742; e-mail: dh2l~umail.umd.edu

MD

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AUTHORS NOTES 1.

Funding was provided as part of the National Institute on Disability and Rehabilitation Research-funded Rehabilitation Research and Training Center study en, titled &dquo;Enhancing the Quality of Life of Stroke Sur-

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299-305.

Crewe, N. M., Athelstan, G. T., & Meadows, G. K. (1975). Vocational

vivors&dquo; (No. H133B980021). 2. The authors thank the vocational services staff at the Rehabilitation Institute of Chicago and the vocational

diagnosis through assessment of functional limitations. Archives of Physical Medicine and Rehabilitation, 56, 513-516. Crewe, N. M., & Dijkers, M. (1995). Functional assessment. In L. A. Cushman & M. J. Scherer (Eds.), Psychological assessment in medical rehabilitation (pp. 101-144). Washington, DC: American Psychological Association.

clients for their assistance in this study, William Sweetland for his editorial assistance, Dr. Rita Bode for her comments on the rating scale analysis,
services

and Johnnie

Berry for her review of the manuscript.

3. An earlier version of this study was presented at the 1998 annual meeting of the American Congress of Re-

habilitation Medicine in Seattle,

Washington.

Glanz, M., Klawansky, S., Staston, W., Berkey, C., Shah, N., Phan, H., & Chalmers, T. (1995). Biofeedback therapy in post-stroke rehabilitation: A meta-analysis of the randomized controlled trials. Archives of Physical Medicine and Rehabilitation, 76, 508-515 Linacre, J. M., & Wright, B. D. (1998). WINSTEPS: A Rasch program for rating scale analysis. Chicago: MESA Press. Mysiw, W. J., Corrigan, J. D., Hunt, M., Cavin, D. & Fish, T. (1989).
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