New: Normals

Think about how much time you spent learning about the 'normal' body in physiotherapy school.

Think about how much time you spend in clinical practice assessing people to see what's 'abnormal.'

And all of those clinical trials that develop sensitive, reliable and valid measures of activity, bodily function, movement and pain; all based on some universal notion of normality.

Tests and measures have to assume that there is one universal normal for them to be universal.  So, in principal, a score of 13 on the Modified Borg Scale means the same thing in Afghanistan as it does in Alaska, and a BMI of 28 is obese no matter where you live.

Physiotherapists learn the principal of normality early on in their training and they never let it go.  The anatomy books that we studies show us pictures of a standard human body and tell us that the piriformis muscle originates from the anterior surface of the sacrum and inserts into the greater trochanter.  Gender, race, age, culture matter not.  All that matters is that this is a normal and stable base upon which all other norms of bodily function can be built.

Normalisation is far from common sense or obvious however.  Even the idea of defining norms has a history built around the attempts of the medical profession to assert its power and social standing (Porter, 2006).  The ability to be the people who define what we accept as normal has been hugely significant in the dominance of biomedicine in contemporary Western culture.

But these ideas are increasingly being challenged.

Normalisation is pernicious.  It creates 'abnormality' and in doing so opens a space for the marginalisation and stigmatisation of people who might not choose to be labelled as deviant.

Some authors have argued that our desire to normalise makes health professionals 'parasites,' because our social value is tied to the need to constantly invent new disorders that we can then claim special responsibility for (Swain, French and Cameron, 2003).

And in these (post)modern times, when bodies are being seen as increasingly 'plastic,' fluid, adaptive and malleable, it is hard to sustain the idea that there is only one universal norm that we all comply with.

Normalisation is dangerous because it promulgates the idea that one size fits all.

It will be hard for physiotherapists to claim that they are patient-centred, or be able to adapt to the diversity and complexity of individual human differences if they continue to promote the idea that there is one norm against which all can be measured.

References

Porter, R. (2006). The cambridge history of medicine. Cambridge: Cambridge University Press.

Swain, J., French, S., & Cameron, C. (2003). Practice: Are professionals parasites? In Controversial issues in a disabling society (pp. 131-140). Buckingham: Open University Press.