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The Making of Rehabilitation

The Making of Rehabilitation: A Political Economy of Medical Specialization, 1890-1980

Glenn Gritzer
Arnold Arluke
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  • Book Info
    The Making of Rehabilitation
    Book Description:

    Focusing on the history of one medical field—rehabilitation medicine—this book provides the first systematic analysis of the underlying forces that shape medical specialization, challenging traditional explanations of occupational specialization.

    eISBN: 978-0-520-90917-5
    Subjects: Anthropology

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. Foreword
    (pp. xi-xxii)
    Eliot Freidson

    The division of labor represents two of the most fundamental characteristics that mark human life off from that of other animals—the capacity to create tools that aid in the performance of specialized tasks, and the capacity to cooperate with others in the performance of complementary tasks that yield a joint product. It exists in some form in every human society, but wherever society is complex and reasonably large it is composed in large degree of formally defined, stable occupations in which workers specialize in various tasks that produce the goods and services on which human life depends. The division...

  4. Acknowledgments
    (pp. xxiii-xxiv)
  5. 1 Introduction
    (pp. 1-14)

    This century has witnessed an explosion of specialties in the health care field. When the United States entered World War I, one medical specialty was recognized by the American Medical Association (AMA). A handful of other specialties were organized by the 1930s but attracted only 17 percent of all physicians to full-time specialty practice. At present, fifty-two specialties are recognized by the AMA and approximately 80 percent of all physicians are specialists. Moreover, almost every medical specialty has one or more recognized subspecialties. Psychiatry, for example, has subspecialties in social psychiatry, forensic psychiatry, psychopharmacology, and family therapy. Some subspecialties have...

  6. 2 The Bases for Specialization, 1890–1917
    (pp. 15-37)

    Throughout most of the nineteenth century the regular medical profession was hard pressed by competition from medical sects and by internal competition resulting from an “oversupply” of practitioners. The medical sects were especially critical of the “heroic” medicine predominant in the first half of the century which often relied on large doses of drugs and methods such as bloodletting for routine treatment. By contrast, regular medicine’s competitors called for more benign therapies, such as fresh air, water, exercise, and diet, which for many centuries were used to treat the sick. In a medical profession oriented toward achieving dramatic results, little...

  7. 3 War and the Organization of Work, 1917–1920
    (pp. 38-60)

    Before World War I disability was not considered a medical or a social problem in America. The new “scientific” medical profession had extended its domain within the constraints provided by the fee-for-service market. Disabled people, who were generally unable to pay for lengthy professionalized care, were thus excluded from the services of the new medicine.

    A new creed of social responsibility was developing, however, in a period of increasing consciousness of social problems, especially those caused by industrialization. Social reformers in the progressive era recognized and confronted for the first time the growing number of people disabled in industrial accidents....

  8. 4 Foundations for a Division of Labor, 1920–1941
    (pp. 61-85)

    The nineteenth-century medical market had been competitive and sectarian. In the twentieth century, the regular medical profession’s gain of exclusive rights to certain tasks eliminated many medical sects and healers. Those nonphysician practitioners who remained had their services legally delimited, although osteopaths and chiropractors were still competitors. While the number of different groups providing medical care was declining, the internal complexity of the medical profession was increasing. By the early 1920s more than twenty segments existed in the profession. Interested groups contested control of these segments and how they should be differentiated. Licensing, training, and professional certification were all considered....

  9. 5 The Rediscovery of Rehabilitation, 1941–1950
    (pp. 86-122)

    Rehabilitation medicine’s first fifty years had two phases. In the first and generally ignored phase, marginal medical practitioners organized around the use of electrical devices to treat acute diseases. The second phase covered the institutionalization of physical therapy from the beginning of World War I to the start of World War II. It included recognition by the military during the First World War, organization of a professional association by physical therapy physicians, and creation of physical and occupational therapy. It concluded with the physicians gaining control over the allied occupations and moving toward medical specialty status in the late 1930s....

  10. 6 The Redivision of Labor, 1950–1980
    (pp. 123-158)

    Until the 1950s the allied occupations accepted their subordination to medicine because they perceived this relationship as beneficial and necessary. With the professionalization of groups such as chiropractors, and with the proliferation of new “therapy” workers such as corrective therapists, physical therapists wanted more protection of their territory than the medical profession provided. While physical therapists turned to state governments for protective licensing legislation, occupational therapists, for a variety of reasons, did not.

    Since the mid-1950s the allied groups have tried to increase their autonomy vis-à-vis physical medicine and the medical profession. The enlarged federal role in health care during...

  11. Epilogue
    (pp. 159-170)

    To accept the natural growth model, we would have to accept that the present structure and domain of rehabilitation medicine could not have been otherwise. But the rehabilitation field could have proceeded along different lines at certain historically critical points. For example, had there not been a war physicians specializing in electrotherapy might never have been accepted into the medical profession. Eventually they might have become direct competitors of physicians, as did osteopaths, chiropractors, and optometrists.

    Again, conflicts during World War I between the military and the civilian Federal Board for Vocational Education were crucial in separating the boundaries of...

    (pp. 173-173)
    (pp. 174-175)
    (pp. 176-176)
  15. Notes
    (pp. 177-206)
  16. Index
    (pp. 207-214)
  17. Back Matter
    (pp. 215-216)