Medical Rehabilitation for Life Changing Conditions [Editorial]

Abstract

…the experienced doctor thinks in larger units of time, not just backward to cases in the past but, more interestingly, forward, trying to see into the patient’s indeterminate future. (Sennett, 2008, p247) …the meanings of stories are found, and from them people draw both moral and practical guidance on how to carry on. (Ingold, 2011, p210) What makes a condition life changing? Lasting physical impairment is one answer. Another, perhaps less obvious, is the disruption of two vital functions that serve as life’s maps and compass. Respectively, imaginative functioning conjures what we could do, while our ethical functioning evaluates what we should (Jesudason, 2025). On this view, illness becomes life changing when it disables the prospective imagination with which we normally create our lives. Retrospection and interoception take over as we interrogate the past for causes and the body for threats (Horhota et al, 2012; Fani et al, 2024; Opdensteinen et al, 2025). Pre-occupied, we struggle to envision a future, losing trust in it. Ethical evaluations then curdle into recriminations, as we lose our sense of the right way to turn. Being creative and evaluative, these two functions shape what we make of our other capabilities, so their disruption by illness is of wide consequence, particularly when seeking to rebuild. Despite this importance, such imaginative and ethical dysfunction is commonly just medicated, labelled respectively as anxiety and low mood. Alongside talking therapies, these generic approaches can leave patients with troubling and particular medical concerns. This editorial argues, instead, for the specific rehabilitation of imaginative and ethical functioning, using expert medical counsel from specialists in Physical and Rehabilitation Medicine (PRM). While medical specialties often focus on minimising mortality and morbidity, PRM advocates a broader view of life, with emphasis on functioning as a key marker of health (Stucki and Bickenbach, 2017). Pursuing health rather than just the limitation of disease, the specialty uses the World Health Organisation’s International Classification of Functioning, Disability and Health (ICF) to work across the range of human capabilities, from biophysical to psychosocial (World Health Organization, 2001).