There’s a great thesis to be written on the politics of physiotherapy.
It would include something about how the profession fought hard to become an ally to governments looking to return men to the Western Front during World War I.
It would look at the ways physiotherapists transferred this experience into rehabilitation and ensured people returned to work as soon as possible so that they would be productive members of society, rather than a ‘drain’ on the State or their communities.
It might even look at how largely silent physiotherapy has been about social inequality and injustice, and how we have managed to convince ourselves that for more than 100 years that physiotherapy was defined by knowledge of anatomy and physiology, biomechanics and kinesiology, T-tests and evidence of efficacy, and not the personal or social lives of the people that we called patients.
In recent years there’s been an outpouring of critical thinking directed at physiotherapy, but to date there’s been little written about physiotherapy’s role in the political economy that keeps the wheels of industry turning.
Karl Marx might say this was all evidence of physiotherapists helping to perpetuate the kinds of false consciousness that keep the downtrodden downtrodden. Hannah Arendt – another great writer on injustice – might say that physiotherapy functions by ‘fabrication’* (Nicholls, 2016).
A recent piece on the influence of Pierre Bourdieu can also be read as a critique of physiotherapy (even though the article is nothing to do with it). In the article, Jen Webb from the University of Canberra talks about Bourdieu’s distinction between art for art’s sake, and art that is produced for the market. Unfortunately, we can’t apply the same question to physiotherapy, because there is no physiotherapy done just for its own sake. Such an idea would be ludicrous.
Physiotherapy always has to be purposeful, teleological, deontological – to use the jargon – it always has to be goal-directed, outcome-based, and done for a reason: the person is sick/ill/injured/disabled, and so obviously needs to be mended, rehabilitated or, in some way restored to ‘normal’.
There is much to be said for this logic. Certainly the clear purpose shown in returning people to the machinery of production has earned the profession respect and a significant measure of social capital, but what has it also lost in the process? What shape have these principles given to physiotherapy such that it has become tied to an economic system that is seemingly in turmoil? Is it possible physiotherapy inadvertently contributes to injustice and inequality through practices that it has long been agnostic to?
Had Karl Marx been alive, I’m sure he would have had a field-day answering these questions. Perhaps its time that we had a go?
Nicholls, D. A. (2016). Parrhēsia, artisans and the possibilities for deliberate practice. In F. Trede & C. McEwan (Eds.), Educating the deliberate practitioner (pp. 91-106). Amsterdam: Springer.
*Fabrication is a word Arendt used to describe the kinds of work involved in predictable, repetitive, outcome-orientated activities seen in things like mass production, standardised care plans and objective rules-based practice. It is the opposite of spontaneous creative expression, art and subjectivity, and was, for Arendt, an indication of the misery now prevalent in post-industrial societies. There is a link to a pre-production copy of a book chapter I wrote looking at this in the context of physiotherapy here. The book would be an excellent read for anyone looking at the future of healthcare education.