Without wanting to sound like a pollyanna, I sometimes wonder if I’m not the luckiest man alive. I live in a beautiful country where human and natural disasters can often seem a long way away; I’m well paid for a job I love; I have ready access to fresh food and water; I’m healthy, and can fall back on public services that have reliably educated my children, emptied my rubbish bins, and generally kept the lights on. I live in a democracy where I can vote to bring about a change, I enjoy a free press, long hot summers, and TV channels that show regular baseball. There are billions of people around the world, who would give their right arm to be blessed with only half of these things.
Bill Bryson has talked about how we’re all blessed in some ways. Over the long stretch of the history of the universe, we are at the height of our technical and social sophistication. Poverty and pestilence are behind us and the the worst effects of climate change are a problem for tomorrow. Given all of this, I think I could be forgiven for taking a long summer holiday basking in the glow of my own personal achievements, and looking forward to another year of socially validated magnificence. The only person who could gloat more than me is the Queen of England who, by some freakish act of birth, is enjoying even more sumptuous prosperity than I am. (A fact for which I am justifiably jealous).
Being a white, European male certainly has its advantages, not least the ability to take these privileges for granted. Glenn Colquohoun – a New Zealand GP and poet – put it beautifully when he said that ‘The most difficult thing about majorities is not that they cannot see minorities but that they cannot see themselves.’ (Glenn Colquhoun, 2004, Jumping Ship, Four Winds Press). Colquohoun was talking about the dominant European culture in New Zealand and its relationship with New Zealand’s indigenous ‘people of the land’ or tangata whenua, but the same could be said for almost every dominant culture.
One of the characteristic features of dominant groups in society is that they think that ‘culture’ is something other people have. Culture becomes synonymous with ethnicity, so culture is something that brown- or black-skinned people have not ‘us’ whites. It largely ignores the full richness of culture that, of course, frames everyone’s existence. White European males are as immersed in their own cultural heritage as everyone else, we just don’t often seem to feel the need to acknowledge it, because we’re the ones at the top of the social heap, and difference is something you don’t have to worry about if you’re getting all the plaudits.
Profession’s can have cultural identities as well as people. But ask a physiotherapist about the culture of their profession and they will be hard pressed to tell you (a sure sign that physiotherapy is a profession enjoying some cultural privileges by virtue of its white European history.) The truth is we pay almost no attention to the profession’s cultural identity (or the plural ‘identities’ would probably be more accurate here.) We don’t articulate our professional culture to our students, preferring instead for them to imbibe it through a curriculum which emphasises objectivity, biomedicine and orthodoxy. We don’t write about our culture in the literature. And we don’t define it in our scopes of practice or professional definitions. Interestingly, over the last few years we have begun to have some of these discussions, and these discussions have coincided with the profession moving to university-based education and losing some of its prior authority. As physiotherapy is increasingly forced to account for itself, it is increasingly asking what it is and where is it going.
Our Critical Physiotherapy Network has a vital part to play here. We can critique some of the taken-for-granted assumptions that underpin the profession. We can be much more vocal about checking our own privilege and recognising that good quality health care begins with a desire to work alongside others who have as much right as we do to enjoy the pleasures of good health, a full stomach and a comfortable home. We can privilege our stories, build communities and networks. We can talk about our history, our present tensions and future dilemmas. We can show solidarity with our colleagues and advocate for those who have been systematically marginalised throughout decades of scientifically-dominated health care.
So here are six suggestions for positive steps you can take today to open physiotherapy up to more cultural diversity:
- Recognise your own cultural identities – make your cultural difference a part of your practice, talk about it and share it with people
- Create learning and therapeutic spaces where everyone can feel safe to be themselves. The profession is made up of myriad people from so-called ‘minority’ cultures. We owe it to our students and colleagues to embrace the full diversity of our cultures
- Talk about the cultural histories of the profession and explore what cultural influences affect physiotherapy today
- Set up networks or groups of people who share something of your cultural identities. We need LGBT lobby groups, women’s issues groups, physios of colour, disabled physiotherapy collectives, and a host of other diverse groups to open up the profession
- Take a critical stance to challenge, critique and actively resist attitudes that overtly ignore cultural difference
- Search out those hidden attitudes that perpetuate casual sexism, homophobia, racism and other forms of bigotry and make them visible
These are just some ideas. Of course, there is something very wrong about a white, male, European physiotherapist claiming any kind of mandate to advocate for these things. At best it can sound earnest and well intentioned, at worst horribly patronising. But these things need to be said, and if it comes from someone in a position of relative privilege then all the better.
There will be lots of people in the profession who vehemently disagree with this post and I understand that. It would be a terrible thing to replace our current myopic view of our own cultural histories with a new, equally autocratic hegemony. So we need to keep in mind that our role is about opening space for difference, inclusiveness, respect and dignity for all rather than dogmatic imposition of our own cultural biases. If we can do this, we will be taking important steps in resisting more than a century of cultural agnosia.