Thanks to everyone for their comments on connectivity. It’s clear that the concept has captured people’s imagination. I’ve had a few queries about the concept that I thought would be worth discussing here. Most revolve around whether connectivity is just stating the obvious – describing very common aspects of practice in high-minded language. So I thought I’d try to address this question here.
Is connectivity just stating the obvious?
Some people have commented that connectivity, at its basic level, sounds a lot like everyday practice. Connecting people with mediating technologies like other people, things, and new ideas, is something that physiotherapists, OT, doctors and nurses have done for generations. Massage, mobilisation, exercise, electrotherapy, hydrotherapy, etc., all involve some kind of connection with something, so isn’t this connectivity? In which case, what’s all the fuss about? Aren’t we just attempting to give a fancy name to something that is really quite normal?
For me, this isn’t a criticism, but a strength of the concept – at least as it applies to physiotherapy. If a new idea is going to gain any critical purchase with the profession, it must already resonate with people. Like the new record that sounds like it came out years ago, it must have a ring of familiarity to it. Connectivity makes some sense for the profession simply because it is something we’ve been doing for years. But, it wouldn’t also have its radical power if it didn’t also change something fundamental about how people think and practice.
If connectivity is only seen as the everyday links we make between people, objects and ideas, then yes, it’s no different to what we’ve done for years. But what if connectivity wasn’t just a description of an aspect of our practice, and instead became its purpose?
Connectivity, as it seems to be emerging in the literature, offers a new way to theorise health and illness. We’re familiar with the biomedical way that dominated health care for much of the 20th century (the search for specific aetiology, the body-as-machine, reductionism, quantification and experimental objectivity), and we’re familiar with the critical response from sociology that emerged after WWII (social construction, personal value and meaning, systems and structures, emancipation and voice). One looks for disease within the physical body, the other looks for illness in the experience of the individual or collective.
All of us have become used to situating ourselves along a line somewhere between a biomedical quantitative view of the world and the social qualitative end. If you’re a critical theorist you sit out at one end with the phenomenologists and ethnographers. If you’re a biologist and scientist, you sit at the other. And ne’er the twain shall meet.
The biologists have their methods; their experiments and clinical trials, and the sociologists have their interviews and observations. Neither particularly likes the other or understands their world view, and the rise of post-positivist research and mixed-methods designs has simply shown that if you stand in the middle of the road you get hit by traffic from both directions.
Connectivity is different, literally different. If this was a tug-of-war competition with the biological sciences at one end of a rope, and social sciences at the other, connectivity would be standing off to one side drinking cider with the choir. It stands apart, in a way that few philosophies of thought and practice have been able to before. It does this because it’s purpose is not to deduce the biological basis of a person’s disease, or understand the personal or social meaning of illness but, radically, the everyday practices; the doing of life.
What makes it so different, is that the focus is not on the physical body at the expense of the person’s lived experience or social context, or the lived experience of the person devoid of a body. Connectivity focuses on what is being done, the practical doing of the world. It’s not about whether a person has 93 or 96º of elbow flexion, but what they do with it. Equally, it’s not about what a person says they do, it’s about what they actually do.
Surprisingly, what people actually do in their lives has not been the focus of much research interest in the past. Quantitative research into people’s activity and function generally reduces their individual actions and strategies for living down to measurable variables and assesses against a validated normal. Qualitative research – particularly phenomenology – looks at what people say matters to them, not directly at what they do. Neither particularly looks at the strategies people use to manage and normalise disadvantage, illness, pain, loss of function. Which is ironic really, given that this is what physios and OTs spend most of their life assessing.
In the past we’ve resorted to quantitative and qualitative tools to assess our patients, and have used biological and social reference points to evaluate people’s activity. But what if we stopped doing this and, instead, evaluated our success on the basis of whether we helped the person connect with the mediating technologies that allowed them to feel movement, happiness, relief, comfort, strength, and maybe even the wind in their hair?
Connectivity argues that physiotherapists have focused too much on the objective measure of function (our biomedical impulse), but that the turn towards hearing the voice of the client/patient is also fraught with difficulty, because it pulls on the same rope as biomedicine in the game of philosophical tug-of-war (see the example of the medical and social models of disability in an earlier post).
Instead of focusing on returning the person to society’s idea of normal, our role becomes one of helping the person achieve things that are meaningful to them by connecting them with techniques, people, objects, practices, strategies, tools and ideas that make these things possible.
In the past we’ve connected people with these things in order that we might better meet a biological or social function. Connectivity suggests a different way, a third way, that makes the connection the very goal of the therapy, it’s ultimate point. You succeed as a therapist if you maximise the diversity and significance of the connections a person makes with things that help them live a meaningful life.
The fact that physios have been doing work like this for generations is just a bonus!
A note of caution
I’ve used connectivity as the first of possibly many ideas out there in the world of philosophy that I think physios might find interesting. Our primary goal as a network this year is to help introduce a bit more philosophy into physiotherapy practice, so this seemed like a good place to start. This doesn’t mean that we’re advocating for connectivity to be the new face of physiotherapy. I’m a postmodernist and critical theorist at heart so anyone that suggests they have the answer to anything will make me very suspicious. So we will soon move away from connectivity to explore some other equally interesting ideas, leaving you with the task of making your own connections with new ways of thinking and practising.