Written by guest blogger Jenny Setchell PhD BSc(PT)
There is a notable absence of conversations about the politics of physiotherapy.
I have been a physiotherapist for over 20 years. I have mainly worked clinically, and more recently entered academia. My drive to shift professional gears was that I wanted to spend some time building my own capacity to engage in some deep questions I had always had about my profession. What was of interest to me was the ostensibly apolitical nature of physiotherapy. I was continually surprised how extremely rare it was that anyone discussed this healthcare profession in terms of power or politics. To me, these have always been an inherent part of just about everything that humans engage in – and, I believe, important to attend to so that we can work towards being ethical people in the world.
However, I have found trying to engage in a discussion about power or politics was very difficult in the context in my profession. These discussions were (to me) notably absent from physiotherapy conferences, lunchrooms or education. Beyond advocating for the profession’s rights to increase or maintain their scope of practice, little is said. Where were discussions about the implicit or explicit politics in the way the profession presents itself to the world? Whose interests does physiotherapy represent? What types of unspoken or overt messages do we perpetuate or create with the ways that our profession operates? What does physiotherapy have to say about bodies, society, culture, diversity?
Politics is about power. When considered in a macro-political sense it is possible to understand that power goes well beyond who is in power in government. In fact, as post-structuralist thinkers such as Foucault argue, governance is not centralised to institutions such as the government, the police or the judiciary. In fact, the most successful forms of governance (political power) occur through institutions that look as if they have nothing to do with it – but in fact do. If physiotherapy is one such institution (1), this surely should be something that is on the table for discussion?
On the other hand, in a micro-political sense, so many of the seemingly insignificant things we do in our lives have political implications. To give a physiotherapy example, measuring how far a person’s knee bends and comparing it to a normal joint range supports systems that advocate for adherence to a particular norm. It supports systems that believe in a particular type of science that holds up ‘objective’ measurement and comparison as helpful and valid (2). These small acts can be dismissed as inconsequential, or more critically, they can be seen as part of a broader system of power that works to define a particular type of normal and exclude those who do not fit (3).
This type of thinking was the underlying driver behind my PhD and my recently published guest editorial paper in Physiotherapy Canada “What has stigma got to do with physiotherapy?” (4). I applaud the journal for taking up questions like the one in the paper title – which prompt a critical (and potentially political) consideration of the healthcare. In the editorial, I discussed how some of the macro- and micro-politics of physiotherapy play out when the profession meets with difference. I used the example of the stigmatisation of people labelled as overweight or obese. Stigma was a way in for me. I looked at what happens when a person labelled overweight is in a physiotherapy context (5, 6) and it showed me that there is so much that is political about physiotherapy.
- Nicholls DA. Foucault and physiotherapy. Physiother Theory Pract. 2012;28(6):447-53.
- Setchell J, Nicholls DA, Gibson BE. Objecting: Multiplicity and the practice of physiotherapy. Health. 2017:1-20.
- Gibson BE. Rehabilitation: A post-critical approach. Boca Raton, United States: CRC Press; 2016.
- Setchell J. What has stigma got to do with physiotherapy? Physiotherapy Canada. 2017.
- Setchell J, Watson B, Gard M, Jones L. Physical therapists’ ways of talking about weight: Clinical implications. Physical Therapy Journal. 2016;96(6):865-75.
- Setchell J, Watson BM, Jones L, Gard M. Weight stigma in physiotherapy practice: Insights from patient perceptions of interactions with physiotherapists. Manual Therapy. 2015;20:835-41.
Dr Jenny Setchell holds conjoint post-doctoral positions in Canada (Bloorview Research Institute) and Australia (The University of Queensland). Her research interests include the socio-political aspects of healthcare delivery. Clinically, she is a physiotherapist who has mainly worked in the musculoskeletal sub-discipline.