Critical conferences and decolonising physiotherapy

A couple of months ago I was lucky enough to attend a critical health conference in South Africa. The group that runs the conference is the called International Society of Critical Health Psychology (ISCHP). Similar to our organisation, ISCHP “provides a forum for scrutinising, challenging and questioning what is said and done in the purported pursuit of promoting and improving ‘health’ by health psychologists and others”. ISCHP has a membership of around 800 people and its main activity as a society is to organise bi-annual conferences (the first was in 1999) and to moderate an active email list. The email list provides members with information about relevant employment, publishing, conference or collaboration opportunities. You can check out their website (which they admit is in much need of an upgrade!) here. ISCHP is similar to the CPN in that members engage with a variety of philosophical, theoretical and methodological viewpoints and share:

“an interest in various critical ideas (e.g. social constructionism, post-modernism, feminism, Marxism, etc.) and various qualitative and participatory methods of research (e.g. discourse analysis, grounded theory, action research, ethnography, etc.) and their relevance to understanding health and illness. Further, they share an awareness of the social, political and cultural dimensions of health and illness (e.g. poverty, racism, sexism, political oppression, etc.)”

While the focus is certainly on psychology, the critical approach taken by ISCHP members draw from (and contribute to) other disciplines including sociology and philosophy. As a result the conference “draws a wide audience including health service providers, users, activists, students and scholars in a diversity of disciplines that take a critical orientation to health, illness and healthcare”.

Presentations at the conference were often broadly relevant to a range of health professionals including physiotherapists, and would be likely to be of interest to many CPN members, as they were to me. Amongst others I saw presentations on: big pharma, anti-depressant use and EBP (particularly salient to those of us working with pain), the (lack of) relevance of public health messages in prisons, HIV, chemsex, critical perspectives on beauty/fat, and a fascinating panel discussion on the interaction between politics, science and praxis. But that really is just a small sample of what was there. You can check out full details of the program here.

There were three keynotes at the conference and I thoroughly enjoyed all of them. Here is a brief overview of one keynote that I found particularly interesting. This will give you an idea of the depth and critical focus of topics raised at the conference. As you will see, the topic of the keynote is violence. I discuss what the exploration of this topic might open up for physiotherapy at the end of this post.

Prof Garth Stevens, a South African scholar, and clinical psychologist, presented a keynote drawing on his extensive background in the areas of race theory, violence and masculinity. He discussed violence: the sanitisation of violence, violence as spectacle, violence as representative of a global crisis, structural and personal violence (citing Žižek) and the conceptualisation of violence as a ‘problem’ rather than a ‘phenomenon’. Stevens contextualised violence within colonialism and decoloniality – including within this intersections with queer, feminist and Marxist theory (all mainstays of critical work). He spoke in depth about the position of health towards violence, critiquing the dominant aim of ‘violence reduction’. Stevens posited that health predominantly establishes violence within a disease framework that sees violence as individually preventable. He argued that violence is much more complex, and that forms of violence are embedded in different contexts, noting that health’s main perspectives on violence are apolitical, ahistorical, asocial and do not account for the embodied experience of violence. Health establishes violence as abhorrent, deviant, and as such promotes reason for moral panic that can be used to regulate the ‘perpetrator’ of violence – and this can easily be translated into regulation of marginalised groups. Stevens suggested that health’s main way of conceptualizing violence has ontological limitations that limit possibilities for response. He argued that the focus on violence by marginalised groups ignores the violence central to the birthing of colonialism (and indeed, the entire modernist project), that the sheer scale of the modernist project, including colonialism, took previous violence to a whole new level. Bringing a scale of massacre and racism, as well as a global system of inequality not seen before colonial expansion. Colonialism created fragmentation – a torn apart world that enables the violence carried out by those who were colonised.

Stevens discussed how a health focus on ‘doing’ and intervening into violence can be counterproductive. He argued against interventionism as an epistemological framing of violence, and against assumptions that violence is always a social issue that requires regulation of the individual body. He suggested other ways of considering violence – Can violence be a language of citizenship? What possibilities focus away from individual violence to political and social possibilities? He suggested a stepping back from interventionism (thinking what next to do about violence) and rather to take a moment to consider where to go from the modernist project that played/plays a large hand in establishing an environment where so much violence is possible.

I imagine some physiotherapists might immediately see the relevance of this keynote to their work, as there are some places where violence is rendered more visible. For me, having worked mainly in inner cities of wealthy countries the relevance to my work is not necessarily as easily seen. However, I thought the keynote made visible a myriad of ways this understanding of violence has relevance to physiotherapists who work in environments like mine, including in individual interpersonal interactions of a clinician and wider issues such as who has access to care. There is, of course ongoing implications of colonialism in the country I live in, Australia. For example, there have recently been strategies put in place with the stated aim of reducing violence in Indigenous Australian communities. These strategies mirror the interventionist health approach to violence discussed in the keynote. In order to carry out what was termed ‘The Intervention’ (a reaction to a report on child abuse in Aboriginal communities) the Australian government suspended the operation of the Racial Discrimination Act so that a range of special disciplinary measures could be put in place in certain communities. This intervention was widely critiqued, including by international organisations. While this is one example of acting on violence there are many, from many sources, not only from government policy and not always in such obvious ways. For example, the disciplining of Indigenous people in The Intervention is mirrored in some interpersonal interactions in health care settings. The fragmentation resulting from the era of vast colonialism and its myriad of repercussions is evident today in a ‘post-colonial’ world – including within the countries that did the colonising. Stevens certainly provided food for otherwise thought in physiotherapy.

If you are interested in reading more about (de)colonisation, check out our recent blog post about education here.

Links:

ISCHP Conference 2015 Website: http://www.ischp2015.co.za/

ISCHP Website: http://www.ischp.net/

Amnesty on ‘The Intervention’: http://www.amnesty.org.au/indigenous-rights/comments/26430/