Prospectus

Between the Body and the World: Illuminating the Structures of Experience for Women with Spinal Cord Injury

David Owen, Ph.D. (Chair)

Lauren Freeman, Ph.D.

Brenda Brueggemann, Ph.D.

Darryl Kaelin, M.D.

Overview: Premise, Scope, and Rationale

In this project I will examine the intersections of disability studies and phenomenology in the context of the experience of women with spinal cord injury (SCI). More specifically, I will study the ways in which medical tradition and ablest cultural norms have created an epistemic injustice for this small population. This study will serve to illuminate the ways in which medical biases related to the “paralyzed” body as well as societal biases related to the bodies of women overall, serve to restrict and oppress female SCI patients.

My focus in this work will be on the barriers that exist between women with SCI and the understanding and actions of their health care providers, caregivers, family, partners and employers and the larger community. In order to examine the most specific commonalities of experience, I have excluded the SCI population as a whole, focusing instead on the “micro minority” that is women living with SCI. As these individuals make up only .08 percent of the SCI community, the treatment and research protocols have historically approached people with this injury as having a default male physiology and identity.

As emphasis on the patient experience grows in the health care and hospital industry in the United States, close examination of the barriers, traditions and assumptions that serve to found the epistemic injustice that women with SCI experience in their health care interactions and in their social lives should be at the forefront of that emphasis. In order to examine the experience of women with spinal cord injury, I will employ three major areas of study: disability studies, phenomenology and related and overlapping theories of the body in illness. I will use the first two in order to trace the historical and philosophical constructions of disability, the disabled body, paralysis and value and validity of a person with disability. I will also engage theories of the lived body to demonstrate the ways that a female identity and physiology further complicate treatment and thus the experience of women with spinal cord injury.

In five chapters addressing issues of disability, female social identity, structures of experience in health care and marginalization of non-normative bodies, I will argue that institutional biases regarding women with SCI can be broken down by developing tools that alter traditional interactions in health care. These tools must be structured in direct relationship to the structures that undergird the biases that are in place. Any effort to understand, facilitate, accommodate or alter the patient experience will require action related to the specific needs of the populations in question. Generic solutions and standardized surveys and approaches will not address the individual’s actual experience. I will work to develop a phenomenological instrument based on Havi Carel’s existing theory for facilitating the communication of the patient subject’s experience.

Rationale

The experience of a person with illness has been approached via medicine, medical humanities, disability studies, literature, philosophy and the social sciences. For all of the investigation into this topic from these disciplines, there is a relatively small body of literature. In order to examine the experience of a woman with SCI, a complex multidisciplinary approach is required. Much of the extant scholarship relates to medical management of or “cure” for conditions, the rights of patients or accessibility of care. Scholars have yet to delve into the impact on identity that treatment protocols, social attitudes, media representations and health care power differentials have for the woman living with paralysis from SCI.

One element that is missing from the literature is a tool that permits engagement by the patient, the physician, the health care team and the caregiver in a conversation about the experience of SCI from a woman’s perspective. Without such an instrument, it is difficult to prioritize the patient perspective. In order to move the patient’s goals, sensations and desires to the front of health care interactions, all parties must be able to refer to a common understanding of them. If female SCI patients were able to make their experience thoroughly understood through a consistent mechanism as part of the health care situation, physicians, therapists and nurses would be able to include the patient’s own priorities for their care and functional recovery more prominently in their treatment planning and encounters. Such a mechanism would facilitate sometimes difficult conversations between patients and caregivers, to better align their expectations of daily support, short-term and long-term goals. In this dissertation, I will seek to co-create a prototype of such a tool through efforts with women with SCI, their physicians, therapists, nurses and caregivers.