"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 … [Read more...] about Physiotherapy fix-ation
This isn't the kind of material this blog usually deals with, but there's something fascinating in this recent report from Nathan Yau at flowingdata.com. The report looks at divorce statistics across different occupational groups and shows some interesting things about physical therapists in the United States. How much the findings can be extrapolated to other populations is debatable, but my sense is that there are some sociological principles at play here: perhaps about the linkage between one's profession, education and income and life fulfillment, that needs to be considered. The first set of data looks at divorce rates by occupation, and physical therapists come out with some of … [Read more...] about Divorce rates among physiotherapists
One of the biggest perks of my job - and there are many - is the opportunity to work with physiotherapists who are looking for new ways to think about their profession. These are some of the people who are offering insights into how physiotherapy might develop in the future, and one theme of some of this work that's emerged in recent years has been around the ethical care of others. What's most interesting for me about this work is how it's inverting the way we've traditionally thought about others, placing the ethics of care before our knowledge of them and their world. Ethics preceding ontology if you will. Here are three examples. Since the start of the year I've been … [Read more...] about Other ways of looking at others
The idea that people should take more personal responsibility for their health is nothing new. For more than 40 years now, we have been promoting the belief that self-care is obviously good and necessary, and that people should be less passive and less dependent. This view has been particularly prevalent in physiotherapy, where the shift away from so called 'passive' modalities has been accompanied by an equally powerful set of discourses pushing behaviour change and an activity-is-best agenda. We've written about some of the dangers of this approach elsewhere (Nicholls et al, 2018), but a recent paper published in the journal Sociology of Health and Illness adds weight to the belief … [Read more...] about A more complex view of patient self-management
I recently had a very enjoyable holiday with my brother who was visiting New Zealand for the first time. At a cafe filled with follies and other quirky craft pieces I asked by brother - who is an accomplished photographer and teacher - what the difference was between an artist and someone's who's good with crafts. His answer has stuck with me ever since. "Artists", he said "deal with problems." The example he used was of Grayson Perry, a ceramicist who makes replica Greek urns. Amongst the ceramics community, Perry's pots divide opinions. Some with a stronger interest in the technical craft of ceramics deride his work as sloppy and poorly constructed. But what makes Perry an … [Read more...] about What’s the difference between a technician and an artist?
David Armstrong described in his brilliant book A New History of Identity how exercise and specifically posture had been utilised as tools of social engineering in the late 19th century (Armstrong 2002). When we think of a person's attitude today, we often think of it as being about their response to authority, but it was originally a term used to describe a child's standing posture. Towards the end of the 1800s governments throughout Europe and North America grew increasingly concerned about the fitness and strength of its citizens and began to think about ways to discipline children before they became slovenly. Military-style drilling and massed social calisthenics were encouraged, … [Read more...] about Reading personality into people’s movements
For the last two years I've been the academic leader of a team of psychologists and psychotherapists. Part of my reason for taking the role was to move away from physiotherapy for a while, and one of the things I've learnt is how much of what the 'pay' disciplines do should be a standard part of the physiotherapy curriculum and scope of practice. How on earth physiotherapists managed to survive for 100 years without exploring transference and counter-transference is beyond me. But one of the things that characterises many of the psy approaches to health and wellbeing is that they will look to the psyche and the mind for the answers to people's despair, anger and confusion. Today I … [Read more...] about Desperate, angry, confused? Sociology can help