In many ways, the entire Western healthcare system is built around normalisation. The fact that it is the job of ‘the system’, and all those that work within it, to identify those people who are ill, sick, or suffering, and to offer them a cure, is so deeply entrenched in the way health services work that it would be hard to imagine it otherwise. But imagine it otherwise we must, or else the more problematic aspects of the approach remain hidden. Firstly, we should remember that normalisation is a social construct. What this means is that there is no object that you can point to to say “that is normalisation right there”. It is an idea; an invention, based on a set of principles that … [Read more...] about Critique of the biomedical model #4 – Standard Deviation
Physiotherapy, and biomedicine generally, owes a lot to René Descartes (for a refresher on an earlier post on the critical issue of Cartesian Dualism in PT, go here). But Descartes’ influence extends much further than just the body-as-machine, and has fundamentally shaped medicine and physiotherapy practice ethics for more than 100 years. 400 years ago, Descartes set out to discover what could be known beyond doubt. His method was to doubt everything, from the existence of physical objects around him, to dreams and ideas. What was left, he surmised, would be the basis upon which all knowledge could be built. The first thing Descartes believed he could trust was that he himself was … [Read more...] about Critique of the biomedical model #3 (or what it really means to be a person)
The second major critique of the biomedical model is less about the model itself, and more about the arrogance and hubris that it engenders in its followers. Since the 1950s, dozens of writers have taken biomedicine to task for its hegemonic power (meaning its ‘preponderant influence or authority over others’ ) and control over the way we think about health and illness. People like Elliot Freidson, Terry Johnson, Magali Sarfatti Larson, Anne Witz, Ivan Illich, Mike Saks, and Anthony Giddens have offered scathing critiques of the biomedical model. The biomedical model, they argue, attempts to penetrate too deeply into people’s lives, leaving little room for other ways of … [Read more...] about Critique of the biomedical model #2
Thus far, we’ve covered five of the main features of the biomedical model - the model that underpins so much of the theory behind the way physiotherapy functions. These have been: Specific aetiology, or the search for the specific cause of the patient’s signs and symptoms Germ theory and the belief that illness is caused by disease within the body Cartesian dualism and the mind-body split Objectivity and experimentation And reductionism, or the anti-holistic belief that the person can be understood as a collection of systems and structures In this penultimate post, we’ll look at normalisation. Normalisation is the belief that certain people, certain … [Read more...] about What is the biomedical model #6
So far in this short series on the biomedical model, I have looked at three of its founding principles: specific aetiology, germ theory, and Cartesian Dualism. In this post we’ll examine one of the facets of modern medicine that is perhaps the most familiar and tangible concept for modern-day physiotherapists – objectivity and experimentation. In the previous post on Cartesian Dualism, I explored how the French 16th century philosopher René Descartes argued that there was no way to prove the existence of anything, because our dreams were so real we could never prove that we were not dreaming right now. What Descartes showed was that we could not trust our senses and that seeing … [Read more...] about What is the biomedical model #4
Over the last few weeks, we’ve been running a series of blog posts on the biomedical model. Biomedicine is, without doubt, one of the most powerful discourse affecting the way physiotherapists think and practice, but it is also rarely explained or explored. So over the next few blog posts I’ll be unpacking its essential features. The first two posts in the series focused on specific aetiology and germ theory. In this post, we’re going to tackle Cartesian Dualism. Cartesian Dualism gets it’s name from the work of the French skeptical philosopher Rene Descartes (1596-1650) who, perhaps more than anyone, captured the zeitgeist of the Renaissance by defining a distinction between the mind … [Read more...] about What is the biomedical model #3
A lot is said about physiotherapy being biomedical and following 'the biomedical model', but what exactly is this, how and why does it underpin physiotherapy? Over the next few blog posts, I'll try to explain the idea of the biomedical model in a bit more detail and show why and how it has influenced physiotherapy. I'm going to tackle 7 key aspects of the model. There are more, of course, but these are considered by most people to be the main ones. Specific aetiology Germ theory Cartesian dualism Objectivity and experimentation Reductionism Normalisation Body-as-machine Understanding something about these will give you a stronger sense of why they're so … [Read more...] about What is the biomedical model #1?