A friend of mine works with young people who are first- or second-generation migrants to New Zealand. Her job is to equip them with the skills they’ll need to run campaigns, advocate for their communities, and improve the lives of the people around them. They’re ‘therapists’ of a sort.
She has a simple way of knowing whether someone is doing the right thing or not. She asks “Are you kicking up, or kicking down?”
By ‘kicking up’, she means agitating against those people with power, the ones in positions in authority.
All too often people find it easier to kick down: taking aim at the people who are easy targets, because they’re vulnerable, less powerful, less fortunate. It’s the psychology of the bully.
Kicking up is an important strategy for critical thinking. First, you need to think about who, in your world, carries authority. In physiotherapy it could be managers, department heads, regulatory boards and professional authorities, national and international leaders. They’re not bullies, but there is an asymmetrical power relationship between you and them that works in their favour.
That means that all of the organisations that promote and regulate particular ideas about physiotherapy are sites of critical inquiry: WCPT, The CSP, APA, APTA, and the Critical Physiotherapy Network. And you need to be constantly vigilant for those times when one of those organisations – my own included – look like we’re kicking down.
“Kicking” of course, is a strong term, but we have all seen in recent times how quickly some people take to figuratively and literally kicking people less fortunate than themselves: the ‘foreigner’, the disabled worker, the transgender woman, the black youth, the fat kid, and so on.
Sometimes healthcare does its kicking insidiously through sanctions and restrictions, rules and rights of access. We can do it ourselves through norms and customs that seem, on the surface, to be neutral, but hide powerful mechanisms of ‘othering’.
Perhaps the best example of this is the system of biomedicine itself, which is soaked in white, male, Western values. There are some stunning examples of kicking up starting to emerge from physiotherapy, and these are changing the way we’re starting to see the profession.
Just beginning to ask questions about whether your actions are kicking up or kicking down could be the first step to a more critical future for the profession.
Some great kicking up reading in physiotherapy
Carden-Coyne, A. (2008). Painful bodies and brutal women: Remedial massage, gender relations and cultural agency in military hospitals, 1914-18 . Journal of War and Cultural Studies, 1(2), 139-158. doi:10.1386/jwcs.1.2.139/1
Dahl-Michelsen, T. (2015). Gender in physiotherapy education: A study of gender performance among physiotherapy students and changes in the significance of gender. PhD.
Eisenberg, N. R. (2012). Post-structural conceptualizations of power relationships in physiotherapy. Physiotherapy Theory and Practice, 28(6), 439-46. doi:10.3109/09593985.2012.692585
Gibson, B. E., & Teachman, G. (2012). Critical approaches in physical therapy research: Investigating the symbolic value of walking. Physiotherapy Theory and Practice, 28(6), 474-84. doi:10.3109/09593985.2012.676936
Hammond, J. A. (2013). Doing gender in physiotherapy education: A critical pedagogic approach to understanding how students construct gender identities in an undergraduate physiotherapy programme in the united kingdom. Doctor of Education.
Kell, C. (2013). Placement education pedagogy as social participation: What are students really learning? Physiotherapy Research International : The Journal for Researchers and Clinicians in Physical Therapy, 19(1), 44-54.
Linker, B. (2005). Strength and science: Gender, physiotherapy, and medicine in the united states, 1918-35. Journal of Women’s History, 17(3), 106-132. doi:10.1353/jowh.2005.0034
Praestegaard, J., Gard, G., & Glasdam, S. (2014). Physiotherapy as a disciplinary institution in modern society: A Foucauldian perspective on physiotherapy in danish private practice. Physiotherapy Theory and Practice, 31(1), 17-28.
Ottosson, A. (2015). One history or many herstories? Gender politics and the history of physiotherapy’s origins in the nineteenth and early twentieth century. Women’s History Review. doi:10.1080/09612025.2015.1071581
Setchell, J., Watson, B. M., Gard, M., & Jones, L. (2016). Physical therapists’ ways of talking about overweight and obesity: Clinical implications. Physical Therapy, 96(6), 865-75. doi:10.2522/ptj.20150286doi:10.3109/09593985.2014.933917
Sudmann, T. T. T. (2009). (En) gendering body politics. Physiotherapy as a window on health and illness. PhD Thesis.