I had a lovely conversation with some colleagues from Tromsø University’s School of Physiotherapy on Monday night after my keynote to the Norwegian Physiotherapists’ Congress. Having talked about ‘The End of Physiotherapy’, they asked me a question I seem to be getting asked a lot now. “So” they said, “what’s the answer … what’s the future for physiotherapy?”
Now it’s an absolutely foundational principle for me that it’s not my place to tell people ‘the answer’ (as if there could ever be an answer). And that’s partly because I subscribe to a Foucauldian approach to critical thinking that says you don’t replace one bad hegemony (or dominant way of viewing the world) with another. But as the week has gone on, and I’ve thought about this question more and more, I think I’ve come to the realisation that there’s something more to this response than simply a desire to be philosophically coherent.
I’m increasingly coming to believe that physiotherapists cannot make the change necessary to meet the challenges of the future of healthcare simply by doing the things they’ve always done better than they’ve done before. Reductive, objective, biomedical reasoning will not be enough.
This might be a challenging idea for some in the profession, but I don’t think it will be that shocking to members of the CPN. What may be a little more disconcerting though, is that I’m coming to believe that we won’t be able to ‘fix’ physiotherapy by flipping the coin and taking a qualitative, humanistic, or (inter)subjective position either.
The problem is that these two paradigms represent binary positions, and no-one ever wins in the contest between two powerful competing ideologies.
One only has to look at the news to see that oppositional politics has done nothing for climate change, world politics, religious conflict or social justice, largely because opposing views are deeply entrenched in people’s world view and endlessly contest that their moral right overwhelms the other’s.
Over the last couple of years, a number of us in the CPN have been exploring a series of philosophical approaches that challenge this binary way of thinking. Inspired by the work of people like Gilles Deleuze, Annemarie Mol, Manuel DeLanda, Karen Barad and Graham Harman, we’ve started talking about a philosophy of practice that doesn’t privilege the classic binaries that have beset medicine, healthcare and physiotherapy for years.
Next week I’ll be in Denmark with CPN member Jeanette Praestegaard, celebrating the centenary of physiotherapy in Denmark. And as part of the visit I’ll be spending the day with physiotherapy educators and practitioners at University College Absalon in Roskilde, and we’ll be talking about some of this.
They’ll be a mixed group of physiotherapists – some relatively new to practice, others with vast experience; some with strong leanings towards the sciences, others to the humanities.
I’ll be talking about the ways current ways of thinking in physiotherapy ‘capture’ them and lock them into reductive ways of thinking (quantitative and qualitative; biomedical and humanistic). It will be interesting to see if the idea of leaving these ways of thinking entirely – in order to find new ways to think and practice – resonates with them and provides more satisfying responses to the question, “What’s next?” than we’re now getting from the ‘old’ ways.