Wednesday, 31 March 2010

Cerebral palsies: a limited understanding

A very widespread one

Middle England sinks back into winter, so today I took refuge in the warmth of W. H. Smiths newsagents and sought out this week's issue of the British Journal of Nursing. I was looking for the full text of the review article on cerebral palsy mentioned here on Conductive World on Monday. This earlier mention had relied of the article's formal abstract and now I wanted to see the complete review. There was the BJN in paper form, bright an glossy, thick and perfect-bound, and at under a fiver less than half the cost of just buying the complete review article on line.

A tempting purchase but, while much of the rest of the issue is probably fascinating for nurses, it bore no direct interest for me. A fiver is a fiver, and the curiosity value of this review article was insufficient incentive for me to shell out (though, were I still teaching, it would have make a great now-not-to teaching aid).

So I took the third option, lined up unashamedly with the other old pykers, and skim-read it on the spot.

A fair abstract

And oh, ugh, the on-line abstract was certainly a fair one of the complete article: a quick line up of some physical aspects of cerebral palsy, a confused diversion into diagnosis (medical) and labelling (sociological), a mention of a couple of 'therapies' and – presszto! – time for an unjustified-by-the evidence leap into multi-disciplinary practice, unargued, undefined and undescribed). Oh, yes, and another non sequitur along the way, the the central role of the nurse in all this, again unargued undefined and undescribed.

But the essential psycho-social mechanisms linking all this together, the effects upon lives, both upon individual development and family life, the means to combat the effects – and the things not to do if one is not to make things worse – sorry, these were not there. Presumably the readership constitutes primarily fellow nurses. What might their roles be, in what circumstances, what understandings of development might they respond to and impart? Again, sorry...

Of small matter perhaps in the great scheme of things, but the great scheme is made up of many small matters, and so many of them at this level of professional discourse (and let no one think that I am singling out nurses over this) can so easily represent unthinking restatement, uncritical assembly of facts, without a theoretical position to link them together to old them up to the light..

Instead one may have, as here, implicit and unrecognised reinforcement of the understanding that a developmental disability such stems from as cerebral palsy is sufficiently and best accounted for in terms of its underlying 'physical' basis, making it (again implicitly) unlike any other developmental disorder, I can hardly imagine a article dealing with, say, children with hearing impairments, slipping through into the pages of BNJ, that could be analogous is any way in in its overall structure. There would be universal outrage!

Why do motor disorders have to put up with second best?

Persising hegemony – what a pity

This is not the fault of the editors or even the author of this particular article. Go to the bookshelves, look at the paediatric and habilitational literature (tellingly, there is no special-educational literature) on children with cerebral palsies). Look at what the voluntary (charitable) organisations say and write. Look at such official documents in which you can discern a gleam of concrete meaning beneath all the obfuscating verbiage.

Of course there are skilled, experienced and insightful people working in all disciplines, who fully understand and operate within understandings that are psycho-social, transactional, systemic, dynamic etc. When things are written down, however, for some reason these aspects tend to be pushed aside while the same old stuff is stated and restated, in the same old terms – i.e. in the current hegemonic professional discourse (apologies, that does sound dreadfully post-modern!). The present public discourse deserves a piori examination and challenging debate – not uncritical review

Perhaps I am being too harsh and review articles of the kind mentioned here would not be doing heir job were they not to reflect this dominant orientation within the public record. But in the meantime, pity the nurses and student-nurses whose attitudes and practices may be informed with knowledge that is partial and insufficient. Pity the families who, although they cannot know what is going on, most certainly 'know' that something is falling terribly short in how 'the professionals' (and, again, not just nursed professionals by a long chalk) understand and deal with them and their children. And pity the kids.

Don't take my word for it

If you are in the British Isles this Easter weekend you may be in for a chill old time, with snow, sleet, wind and rain. Duck into your local branch of W. H. Smiths, browse the magazine racks and seek out the current issue of the generally excellent British Journal of Nursing.

Find the article on cerebral palsy and judge for yourself. Am I right or am I wrong?

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Review article in question

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