Trump, Brexit and physiotherapy

Like most people, I'm still feeling the shock of Donald Trump's US presidential election win last week.  Once all the dust has settled, and people have started to face up to what has been called the 'post-truth' era in politics (see this or this), there will have to be some real soul searching about what this all means for the future of our societies.  Big issues like environmental degradation, personal security, tolerance for others, and health, will play out alongside more 'local' issues like paying the weekly bills, dealing with family problems, and managing our busy lives.

Amidst all this 'noise' its worth reflecting on something subtle but highly significant about this recent election and the Brexit vote that took place in Britain in late June, and that is the decline of truth, as we have come to know it in the 'developed' countries of the West, as a meaningful discourse in 21st century life.

Donald Trump's running mate and Vice President elect Mike Pence recently wrote that it was 'Time for a quick reality check. Despite the hysteria from the political class and the media, smoking doesn’t kill. In fact two out of every three smokers does [sic] not die from smoking-related illness and nine out of ten smokers do not contract lung cancer' (link).

There's ample that Pence is wrong about this (see this link, for example), and that his views on environmental and human rights (link) are divisive, discriminatory and bigoted.  But that hasn't stopped him rising to the top of one of the world's most powerful political offices or influencing millions of people with his beliefs.

Indeed, so tenuous were some of the statements made by both sides in the recent US election campaign that the Pulitzer Prize winning website Politifact developed its own Truth-O-Meter™ (link) to show how egregious some of the statements made by the candidates were.

Truth, as we once knew it, has clearly been in short supply these last few months.  But what's not clear is whether we have actually arrived at a 'post' truth era, or whether we are all just more comfortable with a plurality of truths: truths that depend on one's perspective and orientation, values and beliefs.

There was once a time when most people placed enormous faith in powerful institutions like the church, doctors and lawyers, teachers and the police, to tell them what was right and wrong, good and bad.  But can we say the same is true today?  With frequent abuse scandals, and evidence of malpractice, ethical breaches and the misuse of power by people in authority, do we really still believe that the doctor/priest/judge knows best?

Added to this, since the end of WWII there have been growing calls from women; people of colour; gay, lesbian and transgender people; disabled people; indigenous people and those born into social disadvantage, to have their voice heard and to throw off the false truths that positioned them as 'other' in society.

These calls have been amplified by the distributive perspectivism of social media and what Silverman and others have called an ‘interview society’ (Silverman 1997; Gubrium & Holstein 2002, p.9).

But why does this relate to physiotherapy?

Well, perhaps one of the most salient effects of all of this change is the way truth is now being conceived.  Physiotherapists are wedded to a model of truth that is intimately linked to reason, logic, and a fair degree of detached objectivity.  Our belief is that if we can demonstrate through empirically-supported evidence that our interventions 'work', then this will be enough for government and third-party funders to support us, and for the public to choose us over the competition.

It may be reasonable to argue that people will default to this belief system when it comes to health, because it either matters more to them than climate change, terrorism and poverty, or because it matters less (and so they are happy to hold on to outdated beliefs in 'facts' simply handed to them by health professions).  My personal belief, though, is that people do not make these kinds of distinctions, and are reasonably consistent in the way they manage and filter the information they receive and decide to act upon.  And there is no doubt that we're all far more cynical in the face of authority than we used to be.

Given this, the US election and the Brexit vote suggest that we may have finally crossed a Rubicon when it comes to the way we think about truth, and the old security of authoritative, didactic, expert-derived professional knowledge that has so long provided security in the face of doubt may be damaged beyond repair.

If that's the case, physiotherapists and others are on to a losing battle if we think that empirical evidence for the efficacy of respiratory training in patients with multiple sclerosis and lateral amyotrophic sclerosis will be enough to influence people's opinion (link), or that science-based arguments that education, exercise, and weight loss are considered core treatments in the management of OA (link) will be sufficient in the post-truth world.

And if we aren't doing this work to influence people's opinion, what are we doing it for?

Without a hint of irony, Mike Pence explained why he thought Americans were flocking in numbers to see the movie Titanic: "We love this movie because we still love truth" he said.

So it seems.  But in a post-truth world, this simple fact may be the only thing we share with Pence, and we're all the better for it.

Reference

Gubrium, J. F., & Holstein, J. A., 2002, From the individual interview to the interview society. In J. F. Gubrium & J. A. Holstein (Eds.), Handbook of qualitative research (pp. 3-32). Sage, London.

Silverman, D., 1997, Qualitative research: Theory, methods and practice. Sage, London.