I’ve decided to submit two abstracts for the ISIH conference next year.
The first follows some work I’ve been doing for a chapter I’m writing for an upcoming book by Franziska Trede and Celina McEwen titled ‘Educating the deliberate professional: Preparing practitioners for emergent futures’, and looks at the historical role played by artisans and whether professions like physiotherapy might find some meaningful and interesting ways to reinvent this role in 21st century health care. This is the first abstract:
Re-inventing artisans for 21st century health care
Calls for health professionals to be more than ‘technical rationalists’ have been prominent in professionalization literature for more than half a century. Professions with a strong history of skills-based competence have struggled more than most to respond to these calls. Those that have been heavily influenced by biomedical discourses – professions like dentistry, osteopathy, physiotherapy and podiatry – appear to be doubly disadvantaged because of biomedicine’s strong affinity for Cartesian Dualism and its reductive tendencies. Foucault reminds us, however, that no power can ever be total, and that power always carries with it the possibility for resistance. Consequently, we have seen in recent years a number of counter-narratives emerge within the professions allied to medicine that call for new forms of ‘deliberate’ practice. Using physiotherapy as a paradigm case, I explore the history of the present of physiotherapy’s long affinity with biomechanical discourses drawing on Hannah Arendt’s work in The Human Condition. Arendt’s conceptualisation of action, making, behaviour and fabrication are deployed to re-examine the concept of the artisan; a once predominant mode of labour relation that fell into decline with the Industrial Revolution and the emergence of mass-market economies. In recent years, the artisan has returned as a form of resistance to consumer culture, and it appears that people people in advanced economies are looking to more bespoke, embodied experiences – even in their everyday purchasing decisions. To this end, I examine whether the artisan might create the necessary conditions where traditionally skills-based professions may finally break free from the constraints of biomedical rationalism and engage in more ‘deliberate’ modes of practise.The second abstract references work I’ve been doing for a number of years now, looking at the history of physiotherapy before it became a legitimate and orthodox health profession. I’m particularly interested in the way the women who founded the profession used a very ‘masculine’ model of practice and exerted this over other women of similar age and social standing to get a foot hold as a new profession. Here’s the second abstract:
Suffrage suspended? Counter-narratives of womens’ quest for professional legitimacy
A great deal has been written about the role the suffrage movement played in the development of nursing and midwifery during the late nineteenth and early twentieth centuries. Much of this research points to roles played by middle- and upper-class women in professionalizing socially validated notions of caring, and the importance of this in demarcating practice territories that complemented the work of (male) physicians. Little attention has been paid, however, to the development of new professional identities for women at the margins of nursing and midwifery. In 1895, the Society of Trained Masseuses (STM) was formed by a small group of nurses and midwives in an attempt to legitimize massage and establish it as a worthy career for educated women. Many of the Society’s founders were firmly committed to female suffrage, yet evidence suggests that they knowingly adopted overtly androcentric ideologies to establish their profession’s subordinate relationship to medicine. Critically, members of the STM took advantage of neurasthenia – one of the most prevalent disorders of the late nineteenth century – to establish their credibility. The preferred treatment for neurasthenia was known as the Rest Cure, an approach that has been heavily criticised for the paternalistic, infantilizing attitudes of it’s male proponents. The Rest Cure involved strict isolation, force feeding, and a range of passive therapies that would become the basis of the STM’s scope of practice. In this paper I argue that the women who founded the STM used neurasthenic women to establish their legitimacy and create a new professional identity that manifests today as physiotherapy. I argue that physiotherapy may be the first female-dominated profession to make a virtue of overtly androcentric ideologies in order to establish and legitimize new professional roles for women.If you haven’t made your submission yet and are keen to attend, the process is very easy. Go to the conference website and follow the links through to the abstract submission site. The deadline for submission is 15 November 2014.
Great Dave – I have put this abstract in with 2 other non-physio authors Drs Michael Gard (Education/Exercise Science and Irmgard Tischner (Psychology):
Recognising the body as a colonised space brings up the question of who has the right to speak about the body. Who determines how it should look, what will make it healthy? Using the fat body within a health care context as an example, I discuss the dominant voice of health professionals in negotiating and defining body weight as simple and under individual control. Despite convincing evidence that the determinants of body weight are more complex than this, this perspective continues to be reinforced and validated by health care professionals (spanning many professions) and mainstream medical research into weight. Relatively silenced perspectives which trouble this simplistic view come from a number of areas including non-dominant cultural perspectives, people who are fat themselves, and the emerging area of fat-studies. Similarly, I show that clients of health professionals are likely to present much more complex or ambivalent perspectives on fatness. How can healthcare practice be changed to give greater consideration to these silenced perspectives? To examine this, I reflect on my own profession of physiotherapy, a large and growing health profession, which is under-researched in the area of self-reflection. I establish weight stigma in this profession and consider how weight is constructed within physiotherapy. I examine and contrast client and health professional perspectives on weight and propose that a model for change can be developed in health care practice based on this process. I reflect on my privileged position as member of dominant communities (that of health care, thinness, whiteness), which gives me opportunities as a ‘gatekeeper’ to challenge dominant practices by listening to and giving voice to ‘silenced’ perspectives. The limitations and complexities of conducting and applying research as a member of these dominant communities is also discussed.
I will submit this abstract, co-authored with professor in medical anthropology Anne-Lise Middethon, University of Oslo.
Embodied ways of knowing in physiotherapy – unexplored competencies?
The glocal phenomenon under scrutiny in this presentation is the marginalization and uncertain status granted to certain ways of knowing in physiotherapy.
The empirical material was generated through a study of Norwegian students of physiotherapy. Different ethnographic methods were used including repeated dialogic interviews/conversations with students of physiotherapy and participant observation at the out-patient department at Oslo University College. In addition I also draw on my own experience from teaching and tutoring students of physiotherapy. I have chosen a pragmatic approach in the sense of investigating what phenomena do. The paper is informed by works and theories of William James, Vinciane Despret, Maxine Sheets-Johnstone and Bruno Latour.
My description and analysis on how students of physiotherapy think and act when they work close to and hands-on with other persons’ bodies, brought to the fore that physiotherapy programs not only educate physiotherapists – they also educate bodies that are competent in certain ways. In order to recognize this as a central way of knowing, the physiotherapy profession needs to develop a suitable vernacular – bearing in mind that it might not be possible to verbally express the bodily ways of knowing in a precise and exhausted way. Through my research I develop the term ‘the competent body of the physiotherapist’. In my presentation I will elaborate some of its characteristics and how it comes into being through some examples on how the physiotherapist’s body enacts certain attitudes or ways of being, of acting and of reflecting in intercorporeal encounters. The competent body of the physiotherapist acts in dialogical, dynamic and flexible manners. It is tuned in to affect and to be affected, to touch and to be touched, and to move and to be moved. The competent body of the physiotherapist holds as one of its abilities a particular sensitivity towards another individual’s bodily signs and cues.
This calls for a professional way of qualifying incorporated knowledge. In an environment where the claim for evidence based practice is dominant, this kind of knowledge could be granted an uneasy status. In clinical practices however, this kind of knowledge often qualifies itself in the relations where it occurs.
I have taken the plunge – taken a while but have submitted the following:
The Experience of Practice-Based Educators: Supporting Disabled Physiotherapy Students
In the UK we have a substantial history of disabled people entering the physiotherapy profession. The most well-known group is probably those who have visual impairments. Over the last 20 years, however, the picture has changed with more students and graduate physiotherapists who are, for example, users of mental health services, have dyslexia or are Deaf or hard of hearing. Even though the presence of disabled physiotherapists is relatively well established in the UK health care services, students and graduates still report substantial barriers to full participation. The physiotherapists who supervise disabled students when they are on clinical placement are key players in the educational process and have a significant role in the students’ eventual success or failure.
This work explores the lived experiences of practice-based physiotherapy educators regarding their support of disabled physiotherapy students. The aim is to generate an understanding of the enablers and barriers that affect students’ ability to participate fully and to perform well whilst on clinical placements.
Drawing on critical perspectives of disability, the findings provide insights into the perceptions of UK health care professionals, about disabled students. An underlying feature of the ableist medical viewpoint, particularly in relation to patients, is a belief that impairment is inherently negative and should, if possible, be ameliorated, cured or eliminated. The findings show a tendency towards viewing disabled students through a similar lens resulting in stereotypical and sometimes prejudicial attitudes with regard to their ability to perform to the ‘required standards’. It is intended that exploration and development of an understanding of these viewpoints will facilitate dialogue among professionals, encouraging a more informed and critical debate about physiotherapy identity. This could in turn enable us to challenge the existing ‘order of things’ in the educational and health care settings and influence practice in relation to supporting disabled students.
Fabulous news Karen! The abstract looks fantastic, and I’m sure you’ll enjoy the conference. Are you keen to stay over for an extra day to have a CPN meeting?