Interview with Tobba Therkildsen Sudmann

As part of our ‘interview’ series with people in the Critical Physiotherapy Network, I asked Tobba Therkildsen Sudmann some questions about her approach to
physiotherapy, research and life in general.  Tobba is the Head of the Masters programme in Community Work at Bergen University College in Bergen, Norway.

Your thesis ‘(En)gendering body politics: Physiotherapy as a window on health and illness’ explored your interest in contemporary social theory and critical hermeneutics and talks about physiotherapy as a precarious social encounter (see link to thesis here).  Can you talk more about where your interest in these subjects comes from and how your background has influenced your research?

I believe my patients, students and children have been my best mentors in these questions. I was educated a physiotherapist in the mid 80s, and we trained to believed that our functional diagnosis and treatment suggestions where the only way to frame patients concerns and ailments, and that our preferred way of treatment and prioritizing where not open to negotiations. However, during my years as a hospital physiotherapist working in neurology, neurosurgery and orthopedics/traumatology, I learned the hard way that there is more to life than measuring the range of movement of pinkies or assessing for similar leg length. Visiting patients in their own homes before discharge also taught me to appreciate what matters in life: how to make the best of what you have, and how to mobilize personal and social resources to reach goals set by those concerned. Supervising physiotherapy students in clinical placements was also a great pleasure, and a great way of learning how other disciplines add value to physiotherapists practise.

Since I graduated I have kept on educating my self in law (jurisprudence), pedagogy, health and social administration, gender studies and medical sociology. Norwegian physiotherapy is a conspicuously gendered field when it comes to working divisions between primary care, hospitals, private or public services, and specializations, as I have detailed in my thesis. Gender perspectives are inherently critical, more often than not inspired by thinkers like Goffman and Foucault. From critical gender studies there is a short distance to critical disabilities studies, and discourse perspectives. Lastly, I have also learned a lot about how the differences between people matter in social interaction and in social stratification by raising three children born in Brazil and two born in Norway. Mothering 5 boys of different colours, abilities and temperaments is a practical education in critical social theory and anti-oppressive practice.

How has your research developed since your 2009 thesis?  

I was teaching and supervising a lot both before the thesis and afterwards.  I have always been fascinated by what people manage to do despite their impairments, ailments, scare resources or other constraints; how they are able to allocate and mobilize bodily, material, social or fiscal resources to reach their goals; and how people slip slide between different positions of being in need of protection and assistance (proxy), or are able to exercise agency and participate in whatever they like (with or without assistance).  My interest in community work grew out of these questions, and critical perspectives on health promotion and rehabilitation were major driving forces. Community work in Bergen is a bottom up initiative, acknowledging humans as always already social beings, and appropriating collective action to alter conditions and prerequisites for creating a sense of community and social participation.

Whose work has influenced you most in this area?  

I love to read, and I read a lot: fiction, prose, cartoons, and heavy scientific literature. My favourite authors are Erving Goffman, Hans-Georg Gadamer and Michel Foucault. Goffman, Foucault and Bourdieu worked together in Paris in their early days, and when one reads these authors with this in mind, they overlap a lot, and supplement each other. Hans-Herbert Kögler has done a marvelous job combining Foucault and Gadamer [1], and the re-reading the canons series has several volumes that have nurtured my interests in these fields [2, 3]. Gadamer’s later writings hold great potential for critical practice and research [4, 5].

In our program in Community work Goffman’s writings on stigma, presentation of self, gender and social interaction are key readings. Anti-oppressive practice is a core topic, and Paolo Freire’s classical series of “Pedagogy of Oppression” is on the reading list [6-8]. One of our key books was written by Tesorieiro from Australia [9], a book much appreciated by students from Norway, UK, and Tanzania.

Anti-oppressive practice seems to be a very important issue for you.  Can you talk about how this features in your research and practice, and whether you think this is important to physiotherapy? 

Making people competent and able to exercise agency is a key goal in my community work.  As a physiotherapist I bring the body to the fore, which is not much mentioned in community work. Neither are all the small but very significant bodily differences between us that are played upon in any social setting and always make an impact.  None of these things have an impact on physiotherapy at the moment.  Health promotion, physical activity, everyday living, talking and writing about people as competent social actors are all key ingredients in my work. Everybody is knowledgeable about something, even though it might be things illegal or socially disregarded.

What are some of the challenges and areas of growth that you’d like to see in physiotherapy today?

Firstly, physiotherapists don’t seem to be too interested in older people, and particularly not those with dementia, whether community-dwellers or residents in long term care facilities.  During the last couple of years I have been giving lectures around in Norway on physical activity for people with dementia, starting off with a discourse perspective on dementia. I’ve argued that people with dementia are constructed and perceived as a homogenous mass of non-learners, non-participants, unsocial and non-movers, and so end up losing physical, social and cognitive functions very quickly.  If carers or professionals perpetuate this stereotypical view they will never challenge older people physically, socially or cognitively and actually facilitates their loss of function by ignorance or neglect. See Bartlett for more [10, 11].

Secondly, there are not many physios – in Norway at least – interested in people with longstanding addiction and mental health problems. I am involved in two different projects with equine assisted activities and therapies (EAAT) for people with addiction/mental health problems. Equine assisted therapies are complex interventions with horses, people, places and activities, which challenge biomedical perspectives and approaches. Equine assisted therapies are social events, where the resources in the group, at the farm/stable, the nature and other animals, professionals and volunteers, are appropriated to facilitate changes – bodily or socially or in relation to drug use.

Thirdly, I am currently involved in a research project on development of radar based fall detection technology. The research group has two teams; a technology team and a social science/health care team (medical anthropology, occupational and physical therapy, nursing). Critical perspectives are needed to uncover the implicitly inscribed faller, ideas on ‘normal’ movement, ‘normal’ everyday living, experiences of dis/ability and embodiment, and the appropriation of ambient assistive technology. Successful ageing, ageing at home and leading an active life are the new health imperatives, and participation the new governance regimen.

These projects differ in scope, subject matter and population, but not when it comes to a need for critical perspectives.

Whose philosophical work do you draw on most in your critical hermeneutics, and what would you recommend people read if they want to understand this field better?  

Personally I am very fond of Gadamer, particularly his later writings, and I have learned a lot from Kögler’s merging of Foucault and Gadamer, and from the volumes on feminist re-reading of Gadamer and Foucault (and many more). Goffman also has a lot to offer, if one takes the time to read his complete work. His prose is simpler than Foucault and Gadamer, but the depth is the same. However, to many scientists, an author writing in everyday prose is dismissed.

A more generic answer would draw the attention to something quite different. When it comes to reading, my primary concern is that people read too little, and spend too little time grappling with long texts. Our students avoid books if there is an article available, but they read articles in the same manner as they scroll Internet pages. My suggestion to my students might also be relevant for physiotherapists, and that is a simple invitation to just read, everything and anything, and to reflect upon how a particular phenomenon or person or problem was framed in this particular text. A litmus test is also to check your gut feeling about how you would have judged this text if it was about yourselves, your beloved ones, or a person of different colour, age or gender. Changing gender, age and race in text completely transforms it, and shows us how social stratification, oppression and marginalization are written into everyday prose. For students, the challenge is to take these common experiences into professional practice, and to discover that physiotherapy is but another social practice, nothing above or beside other forms of social life.

Recommended texts

1. Kögler, H.H., The power of dialogue. Critical hermeneutics after Gadamer and Foucault. 1999, Cambridge: MIT Press.
2. Code, L., Feminist interpretations of Hans-Georg Gadamer. Re-reading the Canon, ed. N. Tuana. 2003, University Park, Pa.: Pennsylvania State University Press.
3. Hekman, S.J., Feminist interpretations of Michel Foucault. Re-reading the canon. 1996, University Park, Pa: Pennsylvania State University Press.
4. Gadamer, H.G., The enigma of health: the art of healing in a scientific age, ed. G. translated by Jason and W. Nicholas. 1996, Stanford California: Stanford University Press.
5. Gadamer, H.G., The Gadamer Reader. A bouquet of the later writings. Trans Robert E Palmer. 2007, Chicago: University of Chigaco Press.
6. Freire, P., Pedagogy of hope. Reliving Pedagogy of the oppressed. 1995, New York: Continuum.
7. Freire, P., Pedagogy of indignation. 2004.
8. Freire, P., Pedagogy of the oppressed. 1972, London: Penguin.
9. Tesoriero, F., Community development : community-based alternatives in an age of globalisation. 4. utg. ed. 2010, Frenchs Forest: Pearson Education Australia. XV, 344 s.
10. Bartlett, R. and D. O’Connor, Broadening the dementia debate: Towards social citizenship. 2010: The Policy Press.
11. Bartlett, R., Citizenship in action: the lived experiences of citizens with dementia who campaign for social change. Disability & Society, 2014(ahead-of-print): p. 1-14.