Saturday, 10 April 2010

A mouldy oldie?

A lesson from history

I have just had my attention drawn to the fact that certain material from the British Medical Journal of 1989 is available on line:

Abstract. Conductive education, which was developed at the Petö Institute in Budapest, has been publicised incorrectly as a method of treatment for children with cerebral palsy. From the results of information given and our own observations during a week's visit to the institute we conclude that a minority of carefully selected children with cerebral palsy and spina bifida, who have a relatively good prognosis, are educated at the institute; the education is carried out with appropriate medical, surgical, and orthotic intervention; and the children probably function better as a result of the intensive programme than do similar children in Britain in areas where therapy is scarce. They seem to achieve, however, what we would expect similar children in Britain to do when facilities are adequate. Though our findings do not therefore justify using public funds to refer children to the institute, some (self selected) families benefit from a visit, particularly from the positive attitudes of the staff. The role of the conductor and the integration of programmes into a classroom setting have much to recommend them, and conductive education, if successfully transferred to Britain, might be beneficial to a wider range of children than in Hungary.


You can find the complete article at:
http://www.bmj.com/cgi/reprint/299/6708/1145

Due thanks to Gill Magure for helping me track this down. You can also see the interesting correspondence that followed


I  recall something of all this from the days when it came out. The article reported the impression s of a group of three people who attended the 'five-day course' that the Pető Institute put on to accommodate some of great glut of Western professionals of all sorts who wanted to see Conductive Education for themselves, in response to the showing of the TV film Standing up for Joe and the rush of (first) British parents to sample Conductive Education for themselves – in Budapest, which was the only place then where one could do so.

I remember too how cross I was at the cannily crafted formulation that this article arrives at, still coming over bright and clear after all these years. The difference now is that that I am no longer cross at it. This does not signify 'all passion spent', simply my recognition, deep, deep down, of what I already then knew intellectually, that professionalism means self preservation, 'a conspiracy against the laity', of the most extraordinary power – and possibly the best practitioners of this are the docs. Knowing that intellectually falls short of judging the colossal power of the established sysetm to resist change. Even the then great public enthusiasm for Conductive Education (and it must be hard now for those who have come on the scene later to appreciate just how great and vocal this was, could be turned into a plea for more resources. I  do not blame individuals for their roles in all this (not in most cases anyway, and not in this instance), instead I acknowledge an elemental social force!

What's Plan B?

It seems unlikely that Conductive Education will ever again, in any presently foreseeable future, be subject to such public attention and such professional analysis. But what happened in the late eighties replays now – with the considerable benefit of hindsight – as a warning not to tinker with 'social nature', without a very good Plan B. The more powerful the action created, then the more powerful the reaction that will be generated in return. Without any need for conspiracy theory, one can look back and see how the existing institutions have been able to absorb the shock of the alien paradigm represented by Conductive Education ('alien' here is meant to imply something quite outside existing comprehensions – though at the time the general perception was that it meant Hungarian!). Put it differently, CE was a bacillus injected into our society's existing ways of oing and peceiving. The built-in antibodies were very quickly deployed and to survive at all within its new host the invading organism has had to accommodate and adapt...

Over many year there have been many calls from within Conductive Education for 'a new Standing up for Joe'. I have always talked down this suggestion, on the basis that this film was not at root simply about cerebral palsy or even Conductive Eduction – whatever the excellent intentions of those who made it. It was a Cold War production and without the Cold War there would have been no story, and nothing like the popular response.

Reviewing this phenomenon now, from an even longer standpoint, I would add a second reason not to hold one's breath for the long-term success of such an exercise, even if one could achieve it in the first place. It is that 'the system', ensconced within the powerful social position that it occupies, may well 'always win' (rather like the hose or the bookies in gambling).. Here we are now in a new century, more that twenty years since the world was powerfully informed of a paradigm breakthrough in the care and welfare of those affected by  motor-disorders. Where are the big guns, in cerebral palsy, for example, what do they think about Conductive Education in 2010? What is the position of, for example:
  • United Cerebral Palsy (US)
  • Scope (UK)
  • European Academy of Cerebral Palsy
  • American Academy of Cerebral Palsy
  • Relevant 'professional' bodies around the world
  • 'research', or 'science' if you prefer the term
  • umpteen relevant government departments in nearly all countries

As far as they are concerned, and in so far as they may have heard of Conductive Education at all now, CE is something that irritating parents have let out of its distant Hungarian bag but (to mix metaphors even more!) has now been safely shunted into a tiny siding on the far fringes of the field, and is going nowhere.

Some breakthrough!

It had better be a very good Plan B.

Reference

Robinson, R. O., McCarthy, G. T., Little, T. M. (1989) Conductive education at the Petö Institute, Budapest, British Medical Journal, vol. 277, pp 1145-1149

2 comments:

  1. "the British Medical Journal of 1968" I didn't believe my eyes!!! Than I realized it should have been 1986...

    ReplyDelete