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World War II Rehabilitation Franklin Roosevelt, who knew what rehabilitation could mean to someone with a disability, wrote the following to the Secretary of War in 1944:
"No overseas casualty [should] be discharged from the armed forces until he has received the maximum benefit of hospitalization and convalescent facilities, which must include physical and psychological rehabilitation, vocational guidance, prevocational training, and resocialization." The President, with the encouragement of Bernard Baruch, thus gave official standing to a branch of medicine that had long struggled for recognition among other medical specialties. Rehabilitation medicine had started to come into its own, albeit on a small scale, after the First World War, through the efforts of Drs. Albee and Kessler, and Frank Krusen, a specialist in physical medicine. By the 1940s, it had achieved some success with new surgical treatments and other therapies. In cases of disability, the focus of rehabilitative medicine was to treat the whole person, not simply the injured limb or organ. The goal of treatment was to return the patient to society functioning at the highest possible level. World War II, like previous wars, created a huge number of casualties who needed rehabilitation and made the field visible again. During the war, Dr. Howard Rusk applied that rehabilitation model in his first Army Air Force command with such success that it spread throughout the armed forces. Patients were urged to get out of bed as soon as possible and begin a "reconditioning" program to develop residual capabilities. Even severely disabled patients were kept busy in bed instead of being treated as sick and isolated individuals as they had been in the past. Motivation, psychology, and what we would now call "feedback" were as important as surgical reconstruction. As the war ended, Rusk and other rehabilitation specialists predicted a huge postwar need for their methods. Major rehabilitation centers were planned where psychiatrists, physical and occupational therapists, and medical social workers would work with medical doctors and surgeons in a unified approach to rehabilitation. Many wanted to harness the technical and scientific expertise of the war effort and put it to peacetime use. The thinking went that, if we could build an atomic bomb, surely we could solve any medical problem-- and disability was perceived primarily as a medical problem, even by rehabilitation specialists. Postwar rehabilitative medicine had its star doctors and success stories. Howard Rusk was a tireless promoter of his rehabilitation model and appeared in newsreels and picture magazines. But despite vastly increased federal funding for medicine and the new heroic status of doctors-- as seen in TV dramas and picture magazines-- advocates of rehabilitative medicine were never able to get their plans fully funded or the planned centers built. Rehabilitative medicine had come about because specialized acute care could not meet the needs of many people with disabilities. But most people, including many in the medical professions, continued to believe that the cutting edge of medical work was basic research-- the search for the cause of disease-- or surgery. Rehabilitation wasn't seen as glamorous or urgent. Rather it involved coming to terms with conditions that doctors believed were incurable-- and thus offered less dramatic opportunities. Still, the doctors who followed Rusk's lead made a great difference in the lives of individuals. People who in other times or under other medical regimes would have been allowed to languish in hospital wards or at home in bed, written off as "hopeless," were given new hope, and new faith in their own abilities. Despite these achievements, many of the people for whom the pioneers of rehabilitation medicine campaigned eventually began to resent and fight against the medical model of disability that most of those doctors held. Rehab doctors worked in a world that gave immense authority to doctors. As doctors, they determined not only what a person with a disability could achieve, but in many cases how he or she should achieve it. If doctors decided that it was possible for an individual patient to walk, the patient's use of a wheelchair could be interpreted as failure--on both the patient's and doctor's part. Doctors projected their prognosis onto their patients who internalized-- and were consequently constrained by-- the doctor's medical understanding of their abilities. The sociologist Talcott Parsons has pointed out that the tacit contract existing between patient and caretaker implies that if the caretaker agrees to give his all, the patient agrees to get better. The goal of rehabilitation in the postwar years was to make possible the integration of people with disabilities into society. But despite the commitment of rehab therapists to seeing the disabled person whole, the commitment ended at the hospital door. Once the doctors and therapists had done all they could, patients-- and their caretakers and families-- were on their own. The person with a disability still had to navigate and come to terms with society individually. |
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