The Critical Physiotherapy Network is a diverse group of people, but if you was one thing that probably unites most of its members, it would be the critique of the biomedical model. In one way or another, we are united in our sense of frustrations with the limits of this model and the way it is applied to physiotherapy.
But we are not alone, and outside of the walls of the traditional medical library, there is a wealth of critical commentary on the model, much of it emanating from the social sciences.
Whether because of the rising cost of medically-led healthcare, the growing skepticism of its effectiveness, the knowing prescription of useless treatments, stories of medical misdemeanours and human rights abuses, the prevalence of iatrogenic disease and the creation of secondary health problems like antibiotic resistance and opioid dependency, or people’s greater choice in the healthcare marketplace, and the recognition of the need for a much greater ‘lay’ perspective in determining healthcare priorities, it is clear that biomedicine is no longer immune to critique.
Over the course of the next few posts, we’ll try to unpack the main criticisms of the biomedical model, and see how these apply to physiotherapy. The first issue spans many of the key features of biomedicine and goes to the heart of its core philosophy
The genius of Descartes’ idea that the body could be understood as separate from the mind lay in the fact that it gave permission for doctors, apothecaries and others to focus on the corporeal fleshy body, whilst the church held dominion over the mind. The mind was allowed to transcend the body, which was convenient because this allowed Descartes to keep God in the picture – a very important principle if he didn’t want to befall the same fate as Galileo, Spinoza and others. But while Descartes’ construction allowed for the creation of a medical profession with privileged access to the body, it also demanded that those who practiced on the body approached it within very strict parameters.
The body, for example, needed to be seen as existing ‘outside’ of its cultural, environmental, relational, social and spiritual perspectives; divorced from the world of thoughts, intentions, ideas, feelings and emotions. Illness could only be defined within the boundaries of bodily space, and so forms of madness, for example, would not be medicalised for another 300 years (prior to this point they were largely conceived of as acts of demonic possession, and ‘treated’, often barbarically, by the church).
And so Descartes’ dualism set up the conditions upon which medicine defined its identity and its practices. To this day, medicine privileges the idea of the body as distinct from the mind, from the social world the body moves within, and the relationships that sustain us. Illness, according to the biomedical model, is located firmly ‘within’ the body, be it in germs or genes, disease and sickness represent a distortion in the body’s physiology and, in this schema, all bodies are essentially the same; one hamstring muscle, bile duct and Circle of Willis, is the same for all.
While this approach simplifies the body, it also excludes so much, not least the extent to which illness is socially ‘patterned’. We know, for instance, that two people with exactly the same lung function can have entirely different clinical presentations: one will be hugely disabled, dependent on a cocktail of medications, and unable to work; the other will be the exact opposite. Medicine cannot easily account for these differences with it’s narrow view of the body and has sought in recent years to enhance the scope of its perspective and embrace other paradigms. And here we see perhaps a second critique of the biomedical model, which will follow in the next blogpost.