The School Form of the Hospital: How Does Social Class Affect Post-Stroke Patients in Rehabilitation Units?
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The School Form of the Hospital: How Does Social Class Affect Post-Stroke Patients in Rehabilitation Units? Muriel Darmon 1 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
This paper wishes to explain, using qualitative sociology, an epidemiological finding: that the extent of recovery following stroke is class-based and that patients from the working classes and lower socioeconomic groups are more vulnerable to functional impairments following stroke than those from higher socioeconomic groups. Based on a 15-month ethnographic study of neurology and rehabilitation units, the paper shows that hospital rehabilitation after stroke is shaped by a “school form,” and that it therefore proves far more efficient with patients who have scholastic dispositions, more frequently associated with people from the middle and upper classes with considerable cultural capital. “What is lost” during a stroke and “what is regained” after is not only a question of location in the brain and how serious the neurological incident was, but also correlates with classbased dispositions and attitudes towards practice, as well as language and learning situations. The notion of “school form” can be useful outside the school context per se when it comes to understanding social inequalities, since it can, in this case, explain the class-based processes through which health inequalities arise. Keywords Health . Stroke . Rehabilitation . Social class . Habitus . Social inequalities Stroke is today the most common cause of adult physical impairment. Following stroke, patients can lose the ability to walk, count, swallow, read, remember, seize an object, feel touch, or plan things. These abilities can, however, be partially or totally regained. Stroke therefore raises the question not only of adapting to disabilities but also of recovering lost skills. Medical advances today mean that survival after a stroke is increasingly likely. Rehabilitative therapy has therefore taken on major importance. It involves a vast range of therapists: physicians and nurses, but also physical therapists, occupational therapists, speech therapists,
* Muriel Darmon [email protected]
1
CNRS, EHESS, Université Paris 1 –Sorbonne, Paris, France
Qualitative Sociology
psychologists and neuropsychologists, adapted physical education teachers, and social workers. Patients, but also their relatives, are supposed to participate in the collective work of rehabilitation. My research aims to reach beyond the biological and neurological reasoning at play and decipher the social logics that may govern both the assessment of deficits and their potential recovery. Bringing sociology into the study of stroke itself—and not only its narratives or its representations (Faircloth et al. 2004; Pound et al. 1998)—is not such a big leap. More specifically here, the sociology of social class seems highly relevant to analyzing stroke since epidemiology currently shows the importance of social class in stroke recovery. It is usually said that one-third of
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