Touching on something important

In a fantastic comment on my latest blogpost in this mini-series looking at the innate and largely unspoken sensuality of physical therapy, Eric Kruger posted up a video from Youtube which shows Ken Cole and Rajesh Khemraj in a tutorial looking at the SI Joint at a 2014 NAIOMT Annual General Meeting (link to the original post and Youtube video here). In the comment, Eric concentrated on the question of the power asymmetry that exists in therapeutic practice.  I wanted to extend this discussion on a little here, so iIf you haven't read it already, I strongly advise looking at it before reading on. Lets take a moment to deconstruct the video Eric posted up a little.  Here we have three men 'manipulating' the body of the young female 'subject.'  They speak about her body not about her.  They teach from the basis that one SI joint is pretty much like all others (ergo, it could have been any body that they were manipulating, it did not have to be a young female model), and the assumption is that these measures effectively remove all semblance of sensuality from the encounter. This approach to the body is one of the defining features of physiotherapy practice.  It has been the basis of our approach to care for over a century, and it borrows heavily from a scientific and biomedical view of the body-as-machine.  By taking a technical approach to the manipulation of the woman's body, the therapist projects an image of enlightened detachment that, it is hoped, tacitly reassures the patient of their competence and their dispassionate disinterest in her as a living, breathing young woman.  She is reduced to an S-I joint - maybe the third one they have seen today - and she is interesting only in the way that the three 'cases' can be clinically differentiated. There are clearly a lot of merits to this approach, and I am not being facetious here.  Going to a therapist who is interested in one's body parts and does not look at you as a sensual object of sexual desire is an important way in which we engender trust in our clients/patients.  It is a mark of respect and no small amount of professionalism.  People come to see us for our therapeutic experience and knowledge, and do not want us to cross the line into a personal engagement with them as sensual beings. But as Simon Williams argues;

[A]s the history of western civilization shows, bodies are amenable to discipline and control – from the prison to the factory, the school to the asylum – but this nonetheless fails to detract from the fact that they are always threatening, through their libidinal flows and corporeal desires, their pleasures and their pains, their agonies and their ecstasies, to ‘overspill’ the culturally constituted boundaries which currently seek to ‘contain/constrain’ them. Indeed, it is from these ‘unruly’ desires that the need for corporeal ‘discipline’ arises...Bodies, in short, from their leaky fluids to their overflowing desires and voracious appetites, are first and foremost transgressive: demonstrating their continual resilience to rational control (Williams, 1998, p. 438).

This is a very dense but beautiful way of saying that try as we might, we cannot contain the sensuality of touch simply by appearing to be interested only in the body-as-machine. In some ways, the image of the three specialists working on the body of the young woman, using their status and expertise to handle her in ways that would be permissible only in the context of a therapeutic encounter, reminded me of the classic image of Charcot and his 19th century lectures on hysteria.

What is odd about this is not so much that the woman is the subject of the male objectifying gaze (such a common feature of modern media culture - with all its attendant harms to women's self-image), but that we have normalised it to the point that we are not surprised when it happens. It used to be custom and practice that physiotherapy students 'stripped off' early on in anatomy classes as a way to condition them to seeing the body dispassionately.  We learnt from anatomy textbooks that perpetuated the idea that one SI joint was pretty much like any other, and that there was no 'I' in anatomy.  We were disciplined to see the body-as-machine for lots of very powerful reasons, but one of the most important was as a mechanism to deal with the innate sensuality of our work. The problem is that we lose as much from this approach as we gain.  A point I want to return to shortly. Reference Williams, S. J. (1998). Health as moral performance: ritual, transgression and taboo. Health: An Interdisciplinary for the Social Study of Health, Illness and Medicine, 2(4), 435-457.