Physiotherapy fix-ation

“There’s a great, probably apocryphal story about the noted psychotherapist Wilfred Bion (pron. bee-on), who when confronted by a patient who wanted simple answers to her problems, said: “I don’t know why you’re getting so angry, I wasn’t trying to help you”.

Such stories seem at odds to the way you should behave as a healthcare worker, perhaps because we are conditioned to think that our response to patient’s problems should always be to look for a solution; to fix or cure them; to return them to (their) normal; to rehabilitate or restore them.  Our whole approach to physiotherapy is especially teleological, with a defined goal or end in mind.*  And we define our success by outcome measures and pre-determined discharge criteria.

But other professionals and practitioners have no such hang-ups.

Many psychotherapists, like Bion, reject the whole idea of recovery and rehabilitation, and prefer, instead, for their clients to gain insight.  Many areas of psychotherapy have nothing to do with fixing people’s feelings and behaviours but are concerned instead with subverting our taken-for-granted assumptions and gaining greater insights into our psyche.

Similarly, artists have no interest in fixing things or returning things to normal.  On the contrary, their work is often subversive and anarchic.  The modus operandi of architects, musicians and sculptors are often to respond to the environment.  They leave it up to the plumbers to fix the drains.

And philosophers are rarely ever motivated to provide answers to questions like “what constitutes a good life”?  Rather, they see their role as prompting us to think more deeply about these things and understand more of the inherent complexities of seemingly everyday events.  As Michel Foucault put it, “My job is making windows where there were once walls.”

It’s not difficult to see why physiotherapists have had a historical fix-ation with cure since our employment has often depended on it.  We have been responsible for fixing some of the physical sequelae of war, poverty and pestilence, and we have been very good at it.  So good, in fact, that we don’t really see a need to change.

But perhaps other kinds of physiotherapy lie beyond the narrow confines of our obsession with outcomes, and while these approaches might rely on us being freer to decide on our profession’s underlying philosophy than we are at present, the benefits might significantly outweigh the costs.

 

*This was one reason for calling the book The end of physiotherapy.