Being critical

In yesterday’s post I mentioned the Hybrid Pedagogy site and the work they had done to define what it means to be critical in education.  As a critical physiotherapy network, it’s probably important that we do the same thing and articulate how we think we are critical, because there are so many different meanings for the word, it could easily be misleading.

Critical can mean:

• Intensive care and the physiotherapy that is given to people in life-threatening situations
• Critically and systematically analysing the quality and content of research articles

These are almost certainly the approaches to criticality most familiar to physiotherapists today.  The first is a very specialised field of practice.  The second is driven by the requirement for our practice to be research- and evidence-based and is something that every physiotherapy student has to be familiar with if they are to become registered professionals.  But there are other meanings to the word critical that unite people in the Critical Physiotherapy Network and these are more relevant to our work and so need to be unpacked.

While some members of the Network operate in intensive care units and most will critically analyse research articles, what unites members of this Network is the sense that:

1. There is a time-critical project to reform the physiotherapy profession so that it can better serve the needs of the population in the 21st century;
2. A necessary part of this project is the critical analysis of the profession’s cultures, histories and philosophies (note the plurality here.  Getting away from the idea of the profession as a singular entity is just one of the ways this approach to criticality can be applied to future practice);
3. There are power asymmetries implicit in health care that the profession perpetuates that need to be understood and challenged.  Our beliefs about what is normal (movement, function, ability, etc.); the privilege we give to our knowledge compared with the knowledge of our service-users; and our profession’s limited acknowledgements of diversity of gender, ethnicity, culture, sexual orientation and language, for example, are powerful sources of social oppression that demand critique;
4. There are well established methodologies, philosophies and theories that extend beyond the confines of quantitative research and positivism that the profession knows little about but could bring important insights into our past, present and future thinking and practice, and that these warrant greater examination;
5. A constant critical attitude towards those things that appear to be most taken-for-granted and obvious in the profession is good and necessary if we are going to open the door to thinking otherwise and better prepare the profession for the future.

In the social sciences, the concept of Critical Theory is well established (see Agger, 1991; Cheek & Rudge, 1994; Crossley, 2005; Kincheloe & McLaren, 2000, for example), and derives from the work of The Frankfurt School – an influential and independent group of researchers and theorists who were influenced by anti-capitalist ideas about society in the years between the two World Wars.*  Some famous social theorists were associated with The Frankfurt School including Max Horkheimer, Theodor Adorno, Erich Fromm, Herbert Marcuse, and the school influenced continental philosophy for much of the twentieth century.  Many of the approaches to qualitative research that people use today (including ethnography, grounded theory, social surveys and observational studies), derive from approaches to the analysis of the social world pioneered by The Frankfurt School.

But today, critical theory is a major strand of research in health care generally and has moved well beyond the early work of The Frankfurt School, and there is a large body of work in nursing, psychology, medical sociology and education to refer to.  Here, gender studies, disability theories and post-colonial research offers a powerful critique of our long-standing affinity with Euro- and andro-centric, science-based practice.  These are all things we as a group are eager to pursue and promote in our attempt to move beyond seeing the word critical as only the province of people who work in ICU or students who do systematic reviews of the literature.

References

Agger, B. (1991). Critical theory, poststructuralism, postmodernism: Their sociological relevance. Annual Review of Sociology, 17, 105-131. doi:10.2307/2083337

Cheek, J., & Rudge, T. (1994). Been there, done that? Consciousness raising, critical theory and nurses. Contemporary Nurse, 3(2), 58-63.

Crossley, N. (2005). Key concepts in critical social theory. London: Sage.

Kincheloe, J. L., & McLaren, P. (2000). Rethinking critical theory and qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 281-285). London: Sage.

*With growing concern for the rise of National Socialist in Germany, Horkheimer moved The Frankfurt School to Geneva in 1931 before relocating it to Columbia University in New York in 1934.