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.)
Re-inventing artisans for 21st century health care
By David Nicholls
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.
Hi Dave
would very much like more on this subject matter. Similar discussions have been occurring on the CSP (iCSP) board although largely rooted around the more prosaic concept of apprenticeship.
Is there any possibility of an expansion on the subject or if not some direction for further reading (yet more reading in this information rich(?) world)
ANdy
Hi Dave, I really like this idea of taking things back to the nub. Over the past few years we have witnessed a rise in the number of artisan producers at our local farmers market. With their jams, pickles, oils, breads etc. The market is always packed come rain or shine and yet the very same types of products are available just down the road at the local supermarket. Or are they? Is jam, jam? There’s the supermarket jam, packed full of all sorts of ingredients, including many that remain ‘anonymous’ to those that consume it. And then there’s the farmers market jam, with who knows what in it, other than fruit and sugar, minimally regulated and interferred with, but still recognized as jam. To get the jam on the supermarket shelf the producer, on a large scale, has to satisfy various rules and regulations and then needs to market their product. To get the jam on the wooden table at the farmers market requires a desire and dedication to want to make a difference, otherwise why bother? So, Cartesian Dualism has produced and delivered a homogenized version of healthcare, one that’s easy to regulate, deliver and market. Whereas, to me, the artisan seeks to find the nub, work with it, mold it, and produce a quality end result for all. Good luck with presenting this idea. Regards RGH or Rich H (Auckland).
Thanks Andy
Well…as it happens there is a bit more coming. I’ve written a chapter for a new book, edited by Franziska Trede (a CPN member) and Celina McEwan titled ‘Parrhēsia, artisans and the possibilities for deliberate practice’. The book is titled ‘Educating the deliberate professional: Preparing practitioners for emergent futures’ and will be coming out later in the year. I can’t share the full text of the chapter, but happy for you to see the abstract.
In this chapter, I have used the historical figure of the artisan to develop a critique of the limits of present health care practice. Drawing on Michel Foucault’s later works on truth-telling (parrhēsia) and Hannah Arendt’s writings on action, making, behaviour and fabrication, I offer the possibility that a revised notion of the artisan practitioner may offer insights into how our practice may become more deliberate in the future. Artisan practitioners fell into decline as industrialisation, capitalism privileged fabrication over ‘hand-made’ craft – a point not lost on Arendt who argued that our culture had become tainted by ‘making’ and ‘behaviourism’ at the expense of ‘action’, which had an important self-constituting function. Foucault echoed this critique, arguing that the care of the self relied on one’s ability to speak the truth to another, and that this exercise carried significant personal risks. State authorities had learnt to use truth-telling as a confessional technology to encourage docility, but Foucault argued for an aesthetics of existence that confronted and challenged the limits of this governmental and juridical response. The (post)modern artisan represents an exemplar of a practitioner that, I believe, would find favour with both Arendt and Foucault. Self-aware, critical, and comfortable with the complexity and ambiguity of health care today, the artisan is examined as a parrhēsiast and as a practitioner committed to action: the very model of the deliberate professional.
Hi Rich
Couldn’t agree more. The jam analogy is really relevant I think. The profession is coming to a real crossroads where it has to decide if it’s going to serve the whole population, or just those that can afford it. As the welfare state recedes, more people are being given the freedom to choose their health provider (if they have the money that is!) Do we want to be the supermarket jam or the artisan provider? But then this traditional dichotomy is a problem too because who in their right mind is going to want physiotherapy to become like supermarket jam? Where’s the kudos in that? So what we see happening is the slow and unquestioned drift towards specialisation (consultancy positions, master/doctoral entry programs, extended scopes, etc.). But where does that leave the population that won’t be able to afford these elite services in the future? And this is a problem because it’s with the poorer 80% of the population that the majority of the population’s health problems reside.
So in the chapter I mention in my reply to Andrew below, I try to re-imagine an artisan different to the pre-industrialised version that we saw up until the 18th century, and speculate if this might not be a third alternative to the supermarket/specialist dichotomy.