Each day over the next week I’ll post up an abstract for a paper being presented by a member of the Critical Physiotherapy Network at the In Sickness and In Health conference in Mallorca in June 2015. (You can find more information on the conference here.)
Mobilizing Desire: A Deleuzian re-formation of movement
By Barbara Gibson & David Nicholls
In the field of rehabilitation medicine, enabling mobility is a primary focus of intervention. Mobilities establish one’s place in the world both in terms of material location and through the meanings assigned to different bodily movements and configurations. For example, wheelchairs and walkers allow access to the world but also mark the body as ‘other’. Our intent in this presentation is to surface the normative meanings of mobilities in the practice physical rehabilitation, and the possibilities for a reconfigured approach. To do so we draw on Deleuze’s notion of desire-as-movement. Desire in the Deleuzian sense radically differs from the notion of ‘wanting’ conceived as a compulsion to address a lack. Instead desire is a force of production, a fundamental flow of energy that moves towards something new, to connect and reconnect, to move and experiment. Movements are everywhere in rehabilitation and act on, with, and between body-subjects. Moving bodies are reconfigured from moment to moment through various temporary attachments that enact action. Some reconfigurations are socially valorized (‘enhancements’), others are stigmatized (‘dependencies’) but all are re-formations of self. Rehabilitation risks reproducing the normative body through promoting or discouraging different forms of mobility, but it could also be a key site for change. Drawing on three mobility examples – amputee mobilities, crawling mobilities, and wheelchair mobilities – we will suggest that rehabilitation practices oriented to helping disabled people look and move like others can limit creative innovation. We will explore the possibilities for freeing up ‘desire’ through a reimagined rehabilitation that asks: What can a body do? Such a move abandons the categories of disabled/nondisabled, normal/abnormal because they are no longer helpful in enabling human flourishing. Reimagining the ontology of the body-subject creates opportunities for new and contingent ways of doing-in-the-world that do not rely on preconceived ways of moving or uses of technologies. The project for rehabilitation becomes one of unleashing desire, that is, analyzing which movements and connections produce what effects, and sorting through how to maximize potentially fruitful attachments. Dispensing with the moral ordering of right and wrong ways to move opens up desire’s potential for pleasure, possibility and opportunity.
I’m loving the idea but what of those within the current rehabilitation process, those who have the dominant discourse, those for whom thinking differently is as abstract as some of the big words used in these posts? Here is an example of something I witnessed as a student working alongside a previous Remedial Gymnast who had then jumped through some hoops to become a physio. The patient had a gross right-sided deficit following a large SAH and had been in hospital for more than 5 months and was slowly recovering their voice (grunts, moans, vowel sounds) but not their movement. We set out a series of mats on the gym floor and then put various obstacles out, (wooden benches, rolled up mats etc) dotted about on top of the mats. The PT then stuck a pair of shorts over the patients head, and promptly tipped them out of their wheelchair onto the floor (How many have you have just said “WHAT”?) Object of the exercise, how to get yourself orientated and recover your position, in the dark and with no voice. The patient managed it and enjoyed the challenge. I was struck by the practicality of it (recovery after sliding out of a bed or a chair). I dare say though, had the departments ‘Neuro’ physio’s seen it they would have been apoplectic. The point is, the system teaches us to narrow our view in order to be in the system. The system then rewards those with a narrow view (more courses, seniority, reproduction of the ‘same’). Believe me I love the idea of thinking differently, thats why I am here, but until the system, from registration boards and their ‘scopes of practice’ to departments and their monitoring of the minutiae can address ‘freedom’ we will forever be under the control of those who dominate discourse.
Hi ‘rgh’ (can you add your name to your next post?)
Barbara is away on leave at the moment, so she may not be able to comment, but here are my thoughts on your post.
Firstly, you raise some excellent points. I totally agree that there are enormous constraints upon practice, and that it can be all too easy to make idle suggestions for how things might be done differently, but that these can mean little if the constraints on practice aren’t tackled too.
I wasn’t shocked by your example. I only hope the client/patient was informed properly and given the right to refuse this kind of ‘constraint-induced’ therapy if they wanted to. I’ve seen this kind of thing done before by physios, for pain management (School of Bravery-type things) and for people with chronic breathlessness. It can work if it’s managed well but it can border on ‘rendition’ in the hands of an inexperienced, over-zealous practitioner. We have to be careful it’s for the patient’s benefit, not our ego.
There are a couple of points you make that I’d like to challenge. Firstly, you argue that we use ‘big words in these posts.’ It’s true that some of the language is different to that which physios are used to, but changing the way people think often begins with changing the way they express their ideas. And you do use some pretty big words yourself; ‘right sided deficit following a large SAH.’ I presume you’d argue that your words were words that physios have been trained to understand. Would you not afford us the same privilege, and judge whether our words are big and abstract after a century of use, not when they are in their infancy?
And although, I agree, the ideas can sometimes appear abstract (remember we’re all traditionally-trained physios too), philosophy is nothing if it isn’t practical. It is very much about how people do things, how they express their ideas, what opportunities are there for them and which are denied. So I’m really glad this provoked you to write. Let’s hope it also provokes people to act.
Dave Nicholls, Auckland
Can we start then by adding philosophy and psychology to the undergrad curriculum?