The Ritualization of Rehabilitation

Abstract

There is widespread and increasing political interest in devising plans to support people who have or have had cancer to recover and recommence ‘normal’ lives. Educating cancer patients for this purpose is a central element in cancer rehabilitation in both Europe and the United States. One of the challenges in intervention research pertaining to rehabilitation is how to measure and explain the effects of a particular rehabilitation program. The social processes of particular programs are often a ‘closed box’ and not taken into consideration methodologically or analytically. In this article, we unpack and explicate the ‘closed box’ of a particular cancer rehabilitation program in Denmark by drawing on approaches from the study of ritual. By analyzing rehabilitation as a ritual and as ritualization, we identify and conceptualize some of the transformative activities involved in cancer rehabilitation. We highlight the significance of the ritual site, its aesthetics, its exaggerations, and the social and temporal organization of the program.

Keywords:

• cancer
• Denmark
• intervention research
• rehabilitation
• ritual

ACKNOWLEDGMENTS

The projects were supported financially by the Danish Cancer Society and were approved by the Danish Data Protection Agency. Prior to the fieldwork, participants were informed about the research orally and in writing. We would like to thank the participants at the rehabilitation programs and the health care professionals who let us carry out participant observation and who shared their experiences with us. We also thank the Danish Milieu for Humanistic Cancer Research for inspiring discussions.

Notes

Scholars report various physical and psychological side- and late-effects of the treatment, such as fatigue, pain, hot flushes, stomas, lymphedema, hair loss, radiation damage, fatigue, changes in weight, sexual problems, depression, and anxiety (e.g., Ross et al. 2005).

See, for example, the homepages: http://www.nci.nih.gov/cancertopics/wyntk/oral/ (U.S. National Cancer Institute); http://www.nature.com/nrc/journal/v6/n8/full/nrc1927.html (The French National Cancer plan), and http://www.dh.gov.uk/en/Healthcare/Cancer/index.htm (Cancer policy in England), accessed September 9, 2011.

The vicar comes once a week and addresses existential concerns in relation to cancer.

This period of fieldwork formed a minor, qualitative part of the FOCARE research project (see Høybye, Johansen and Tjørnhøj-Thomsen 2005; Høybye et al. 2008).

We use the term course (in Danish kursus) for a limited period of tuition and training (including lectures and lessons) about a particular subject.

For ethical reasons some participants were not invited because the first author considered that they had been too much affected by their illness to participate.

The caring attentiveness also had its costs. The staff felt themselves to be worn out sometimes. As one of the staff said, “Maybe we care too much.”.

Turner (1974:173) makes the same distinction between voluntariness and obligatoriness in his analysis of pilgrimage.

The statement ‘hit rock bottom’ is often used in the treatment of alcoholism or drug addiction. The rationale is that people have to go to the lowest point before they will accept treatment (e.g., Billinger 2005).

The action plan was an A4-sized paper called, “My action plan” with columns for “Topic,” “Goals,” and subsidiary goals: “What do I do?” “Do other people need to be involved?” What do I expect from them?” and “When?”.

There does not seem to be a general scientific consensus about the cancer-preventive effect of antioxidants. A Danish report about Antioxidants and Health concluded that “high intakes of fruit and vegetable are associated with reduced risk of several diseases, but there is no evidence that the preventive effect is due to the high antioxidant content” (Motions og ernæringsrådet, Publication no. 1, 2006).

According to Mattingly and Lawlor (2001), healing dramas are moments of recovery, that is, intense moments of experience that become significant turning points in the patient's process of recovery. Healing dramas are often set in motion by therapists or health professionals by means of acts, words, or stories.

Turner distinguishes between three types of communitas: (1) existential or spontaneous communitas, (2) normative communitas, and (3) ideological communitas (Turner 1974:169).

In the follow-up interviews, the majority of the participants recounted that they had made changes to their everyday lives after coming home from Dallund. Some had started cycling and walking more systematically, several reported making changes to their eating and exercise habits or in their working lives. Several participants spontaneously took out the action plan and commented on it at the interviews. Some considered it to be a kind of New Year's resolution that was bound to fail anyway, even though they did make some changes, whereas others used it as an important reminder, even though they were unable to keep strictly to the plan.

Several complained that it was difficult to keep up the motivational spirit after returning home, and suggested some form of follow-up.

Additional information

Notes on contributors

Tine Tjørnhøj-Thomsen

TINE TJØRNHØJ-THOMSEN is Professor at the National Institute of Public Health, University of Southern Denmark. Tjørnhøj-Thomsen has conducted anthropological fieldworks in India, Denmark, the United States, and Great Britain. Her main research fields are health promotion and prevention, cancer rehabilitation, intervention research, infertility, hearing loss, social relations and kinship, and medical and reproductive technologies.

Helle Ploug Hansen

HELLE PLOUG HANSEN is Professor in Humanistic Rehabilitation Research at the Institute of Public Health, University of Southern Denmark. She has conducted several fieldwork studies in Denmark within the field of psychosocial cancer care and rehabilitation. She is author of several books and articles. Her most recent anthropological research is about women, cancer, and rehabilitation.