Reflections on the first CPN Course on Vulnerability

This is a cross-posting from Matt Low that has also featured on the Perspectives on Physiotherapy blog.

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Recently, I engaged with the CPN regarding the topic of vulnerability with the goal of using the concept to think differently about critical aspects of Physiotherapy.

What proceeds next are the notes that were used to establish the conversation, followed by initial observations from the topics that surfaced.

Why the topic of vulnerability?

We all are feeling it, in one way or another, the sense of impending challenge, susceptibility, and even threat.

From the cost of living crisis due to the current war in Ukraine to the planetary health crisis with global warming and climate change due to the human consumption of resources.

The economic destabilisation from an ever-changing political climate through forms of sociocultural self-preservation, capitalism and right-wing othering of those that are more misfortunate than others.

The technological advancement, which is growing at pace, driving toward forms of change that may cause unforeseen circumstances out of human control such as machine learning and AI.

From the habitats we exist in, the architecture of the buildings, the furnishings, the offices, and clinics we may work within all have the capacity to endure and subsist…but change is inevitable. All entities that exist are all, in some way, vulnerable.

From a healthcare perspective, we support, care and help those that may be vulnerable.

However, we are also alert to the way in which the term vulnerability may promote stigma and marginalisation of individuals, groups, and communities.

Healthcare structures themselves are under tremendous strain even before the global pandemic, with vulnerable systems being challenged from under funding and underhand political manoeuvres oriented toward privatisation.

The term vulnerable can also be used in a vague way such that there may be a misunderstanding of who is vulnerable, why they are vulnerable, and what they are vulnerable to. This in turn can have the effect of obscuring systemic and structural causes of inequity, including the role of power for political purposes, and therefore limit opportunities for transformational change.

As a healthcare professional myself, much of my work is surrounded by language and acts that are intertwined with the concept of vulnerability.

But is vulnerability always negative—not necessarily—many know of the work of Brené Brown who describes vulnerability as ‘uncertainty, risk and emotional exposure’ and something that ‘forces us to loosen our control’ and to embrace it. To do this is to have the ‘courage to show up where you cannot control the outcome’.

Much like me, those that were involved and spoke up in the session were exposed and becoming vulnerable…

Vulnerability: A Poem by David Whyte

“Vulnerability is not a weakness, a passing indisposition, or something we can arrange to do without, vulnerability is not a choice, vulnerability is the underlying, ever present and abiding undercurrent of our natural state. 

_To run from vulnerability is to run from the essence of our nature, the attempt to be invulnerable is the vain attempt to become something we are not and most especially, to close off our understanding of the grief of others. More seriously, in refusing our vulnerability we refuse the help needed at every turn of our existence and immobilise the essential, tidal and conversational foundations of our identity.

To have a temporary, isolated sense of power over all events and circumstances, is a lovely illusionary privilege and perhaps the prime and most beautifully constructed conceit of being human and especially of being youthfully human, but it is a privilege that must be surrendered with that same youth, with ill health, with accident, with the loss of loved ones who do not share our untouchable powers; powers eventually and most emphatically given up, as we approach our last breath. 

The only choice we have as we mature is how we inhabit our vulnerability, how we become larger and more courageous and more compassionate through our intimacy with disappearance, our choice is to inhabit vulnerability as generous citizens of loss, robustly and fully, or conversely, as misers and complainers, reluctant and fearful, always at the gates of existence, but never bravely and completely attempting to enter, never wanting to risk ourselves, never walking fully through the door.”

The popularity of the concept Vulnerability over time:

Vulnerability has been used significantly since the 1920s, with an extraordinary amount of interest growing from the 1980s.

Etymology:

Latin Latin Late Latin Modern use

Vulnus → Vulnerare → Vulnerabilis → Vulnerable

Wound → to wound, hurt/injure wounding early 17th C

What immediately becomes apparent from the Collins dictionary is that vulnerability is conceived from a human and living perspective with negative connotations.

From the Collins dictionary

Vulnerable

1. Someone who is vulnerable is weak and without protection, with the result that they are easily hurt physically or emotionally.

2. If a person, animal, or plant is vulnerable to a disease, they are more likely to get it than other people, animals, or plants.

3. Vulnerable something can be easily harmed or affected by something bad.

And From Google:

1. Exposed to the possibility of being attacked or harmed, either physically or emotionally.

Initial Observations Following the Discussion on Vulnerability

The first session of the CPN course on vulnerability was a very affirming and positive experience.

The concept of vulnerability was openly discussed, and a many key points arose, some of which are below:

Conceptual vagueness: It was apparent that the concept of vulnerability was vague. This included whether it be used as a universal concept that centred on the demise, fragility, susceptibility of entities that exist or whether it was focused on humans, environments, ecosystems, objects, and relations.

Location: Associated with conceptual vagueness, the location of vulnerability appeared to be an important topic of discussion. Should the focus of vulnerability be centred on humans and potentially be reduced to physical, emotional or cognitive properties? Certainly, viewing vulnerability from a human perspective, a human centring, tended to focus on individuals rather than communities and societies. Furthermore, these dimensions of vulnerability appear to coincide with the domains of human abilities as introduced in developmental psychology, namely physical, social and intellectual abilities. One cannot but feel that focusing on humans and, individuals, does not express the concept of vulnerability in quite the way in which humans rely on their environments and other nonhuman entities that shape existence.

What are the alternatives? If we were to conceptualise vulnerability as an arrangement of complex entities that coexist and cohabitate, then we would need to draw a larger location. The boundaries of which appear permeable, multi-variant and multivalent. The qualities of vulnerability may vary in intensity, in time and in space.

Temporality: The concept of time entered the discussion. Whether this should centre on human experience, from the notion that our current experiences are existentially located from an individual’s previous experiences and events, entangled with the concerns and expectations of the future. Or whether the concept of time should be considered differently. For example, geological stratifications and tectonic plates move slowly, compress and manifest landscapes across vast time-periods in comparison to human lifecycles. From what temporal scale should the concept of vulnerability be seen?

Manifestation: How the concept of vulnerability is conceived was also discussed. Vulnerability could be seen as a concept from its etymological roots as a ‘wound’ing and as such carries negative connotations. This negative aspect of vulnerability could include fragility, frailty, weakness, susceptibility, but there was also discussion around positive aspect of vulnerability. The American Professor, researcher and author Brené Brown was brought into the discussion in how she describes vulnerability as an asset, as something that if one could draw courage could use vulnerability as are strength and a positive power. It also seems perhaps evident that for change to occur, an entity would need a capacity to be affected, thereby the need of vulnerability would need to exist for transformation to occur. Vulnerability, however, exists regardless if change manifests or not. Invulnerability appears not to exist. From early superheroes such as Superman and his fragility to kryptonite and the war hero Achilles had his weakness at the back of his heel.

Scepticism: There was much discussion around the normative state around the concept of vulnerability and that vulnerability is used as an ‘other side’, a way in which something becomes normalised akin to homeostasis. It was felt that vulnerability was a ‘feel good’ concept that skirts around the fact of the fleetness of existence toward death and decay. Conversations included aspects of Nietzschean ideas of existential non-meaning, that life itself has no meaning, but vulnerability was used to give a sense of hope or something for people to grasp hold of. The concept of vulnerability could be seen like casting a comfort blanket on a nature of reality. The term ‘fugaciousness’ came to light, referring to an entities lack of enduring qualities, of transience, transiency, impermanence, and evanescence.

Humanistic conception: There were criticisms placed on the concept of vulnerability in that it was often reduced towards a human understanding, perspective and orientation. It, therefore, suffered with value laden qualities which could be used in unequal power dynamics and distribution. For example, who was vulnerable, what groups or individuals and for what purpose were they assigned that label? The very identity of being vulnerable and of vulnerability could be used to subjugate human and non-human entities for others gain.

Process orientation: The quality of vulnerability itself as a process was discussed in reference toward a feeling of fluctuant and a dynamic nature of vulnerability. This process orientated perspective cast a shadow on the vulnerability, being a static concept bereft of the unfolding viewpoint of existence.

Next steps: It was felt that a helpful next step was to examine an ontological basis of vulnerability, and to do so require approaching this from a certain philosophical perspective. That philosophical perspective will be from the work of Gilles Deleuze and Felix Guittari who will be introduced next time.