Physiotherapy is part of the debt we pay when things go wrong

English law once included a principal that the thing that had caused accidental death or injury – the carving knife that had accidentally chopped off the finger, or the carriage that trampled the person’s leg – should be surrendered to God in recognition of its part in causing harm or suffering.  This ‘thing’ was called a deodand and it existed in law from around 1200AD until it was abolished in 1846.

The object would be surrendered to the crown and used or sold to compensate for the harm done.  William Pietz said that ‘any culture must establish some procedure of compensation, expiation, or punishment to settle the debt created by unintended human deaths whose direct cause is not a morally accountable person, but a nonhuman material object’ (Pietz, 1997).  This was the law of the deodand.

One of the things that came to replace the idea of the deodand was a belief that the State should take responsibility for the harms done to its subjects.  In the first half of the 20th century this took a very specific form, and arguably helped make physiotherapy what it is today.

Think of World War I; the polio epidemics of the 1930s, 40s and 50s; and the development of public health services to manage communicable diseases like TB and  influenza, and you have a nation state doing its utmost to compensate for things it believes it is responsible for.  The welfare state was born as a way to better care for the poor, the pensioner, the unemployed, and the family, and it put in place services that it thought ‘settled the debt’ caused by poor housing, poor sanitation, and other causes of unintended human suffering.

It is no coincidence that physiotherapy prospered under these conditions.  In fact, physiotherapy ‘benefitted’ – not in any callous way, just as a statement of fact – from each of these causes of human suffering.

Until, that is, the beginnings of neoliberal economic reforms in the 1970s.  Since then, successive nation states have slowly withdrawn from their national responsibility, and moved, instead, to promote the idea that each of us should be individually responsible when things go wrong.  Not surprisingly, physiotherapy now functions less as a form of national compensation and increasingly operates at an individual level.

In thinking about the profession’s past, present and future, we often think that our destiny is in our own hands; that it will be sufficient to prove that our assessment and treatment techniques are evidence-based.  We should probably consider how unimportant this has been before, and how our development as a profession owes more to obscure ideas like deodands than we have perhaps hitherto realised.

Reference

Pietz, William (1997).  Death of the Deodand: Accursed object and the money value of human life.  In Francesco Pellizzi.  The abject.  Res, 31: 97-108.