By now, the laboratory tradition, crafting transportable knowledge that allows for comparison, has been amply studied. However, other knowledge traditions, notably that of the clinic, deserve further articulation. The authors contribute to this by unraveling some specificities of rehabilitation practice. How do laboratory and clinical traditions in rehabilitation relate to independence? The first seeks to quantify people's independence; the latter attends to qualitatively different ways of being independent. While measuring independence is a matter of aggregating scores on a priori established (...) dimensions, clinical rehabilitation concerns coordinating different ways of being independent. While independence scales map a linear development in time, rehabilitation participants juggle with time, including uncertain futures in their present. In clinical practice, then, independence is neither a single, coherent, fact nor a clear-cut, stable goal. Instead, professionals as well as patients work by creatively doctoring with the large variety of elements that are relevant to daily life with long-term disabilities. (shrink)

Public debate about who or what is to blame for the rising rates of obesity and overweight shifts between two extreme opinions. The first posits overweight as the result of a lack of individual will, the second as the outcome of bodily drives, potentially triggered by the environment. Even though apparently clashing, these positions are in fact two faces of the same liberal coin. When combined, drives figure as a complication on the road to health, while a strong will should (...) be able to counter obesity. Either way, the body’s propensity to eat is to be put under control. Drawing on fieldwork in several obesity clinics and prevention sites in the Netherlands, this paper first traces how this ‘logic of control’ presents itself in clinical practices targeted at overweight people, and then goes on to explore how these practices move beyond that logic. Using the concepts of ‘will’ and ‘drives’ as analytical tools, I sketch several modes of ordering reality in which bodies, subjects, food and the environment are configured in different ways. In this way it appears that in clinical practices the terms found in public discourse take on different meanings and may even lose all relevance. The analysis reveals a richness of practiced ideals. The paper argues, finally, that making visible these alternative modes of ordering opens up a space for normative engagements with obesity care that move beyond the logic of control and its critiques. (shrink)

In vocational rehabilitation, empowerment is understood as the notion that people should make an active, autonomous choice to find their way back to the labour process. Following this line of reasoning, the concept of empowerment implicitly points to a specific kind of activation strategy, namely labour participation. This activation approach has received criticism for being paternalistic, disciplining and having a one-sided orientation on labour participation. Although we share this theoretical criticism, we want to go beyond it by paying attention to (...) the practical consequences of understanding empowerment as an activation strategy. Inspired by the field of Science and Technology Studies, we will explore the meaning of empowerment and activation in concrete practices of vocational rehabilitation in the Netherlands. Our analysis is based on the narratives of people with a work disability about their lives and the vocational rehabilitation programmes they participated in. We present five illustrative cases that how empowerment is ‘done’ in the practice of vocational rehabilitation and its unintended effects. Our analysis demonstrates that activation strategies seem to be caught in a paradox: instead of including people in society, they have excluding consequences. Vocational rehabilitation professionals can go beyond this paradox by learning from the ways in which empowerment is ‘done’ by clients in vocational rehabilitation programmes. (shrink)