What is the book going to be about?

An occasional series on writing a new critical physio book

Photo by Shane on Unsplash

This is the fourth post in an occasional series walking through my process in writing a new book.

The idea of these blog posts is to share the journey and talk about share some of the things I’ve learned writing The End of Physiotherapy and Physiotherapy Otherwise.

So far I’ve touched on:

1. An introduction to the new book

2. What needs to be in place if you’re going to do something like this

3. Some of the ideas informing the book

But I haven’t yet talked about what the book is actually about.

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For the longest time, I’ve wanted to study the cultural history of the physical therapies.

To that end, I wrote The End of Physiotherapy as a way to think about the historical conditions that made physiotherapy possible. This was followed by Physiotherapy Otherwise, which looked at the profession sociologically.

But neither of these really tackled the philosophies behind some of the most basic aspects of practice. What is the body, really, to physiotherapy? What is touch, or movement? Are they just bio-physical processes? If so, what of people’s experiences or the social forces that shape what and how we practice? How do we understand what is ‘real’ in all of this?

Take something as commonplace to physiotherapists as touch, for instance.

When you think about touch in its broadest sense you would have to conclude that physiotherapy takes a very particular and specific view of it.

Touch is absolutely everywhere, across the entire universe, involving every single kind of entity, in every moment of its existence, and has occurred throughout time.

So physiotherapy’s decision to focus on specific forms of bio-physical touch designed to diagnose and treat a narrow range of physical problems in humans seems quite specific! And something like a deliberate, well-thought-out approach, designed to address some aspects of this universal phenomenon, and disregard others.

But if this were the case, you would surely expect to find screeds of literature discussing the merits and limitations of this approach, and a clear statement of why physiotherapists should concentrate on this and not something else. But this just isn’t so.

And given how central touch is to physiotherapy practice, it’s quite remarkable how little it has been theorised. We know more about Economic Models for Cost Effectiveness of Physiotherapy Interventions Following Total Knee and Hip Replacement than we do about something as important as touch.

I’ve come to believe that physiotherapy has fallen into using touch the way it does because of the social and political necessity to practice in certain ways to establish a professional enclosure. And it was so successful in securing its privilege that it never needed to really establish the philosophical basis of its beliefs.

But simply relying on custom and practice or past performance is a dangerous way for a profession to think about the future. And there’s no doubt that there are a lot of conversations about the role of touch in physiotherapy right now. Be it discussions about the merits of so-called ‘passive therapies’, people’s touch deprivation with COVID, or the rise of haptic technologies, touch is very much in vogue.

So, at its most basic level, what I’d like to do in this new book to tackle is the question of what the physical therapies actually are, and what they might become for the profession in the future.

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Perhaps an illustration might help here.

Staying with the concept of touch and physiotherapy, consider these questions:

1. What actually is touch? We know that at an atomic level the gap between atoms is so vast that most things that touch are basically gaps filled with electromagnetic charge and ‘dark’ matter. So does anything actually touch anything anyway, or is it all just air?

2. If touch is so ephemeral, should abandon the illusion of our bio-physical approach to touch because it misses too much? Despite the problems of locating where and when touch actually happens, what can it tell us about the longed-for touch of people who have lost a loved one, or the touch of a surging crowd at a rave? Perhaps phenomenological, sociological, cultural, or ecological explanations of touch would be more useful?

3. When we talk about therapeutic touch, what is it exactly that constitutes something as therapeutic? For instance, am I only being ‘therapeutic’ when I put my hand on your painful shoulder in a clinic, as opposed to when I make the gesture to hold you up as we stagger back from the pub? Do you have to be ‘qualified’ in something and ‘intend’ it to be helpful to make it therapeutic? If so, where does ‘therapy’ actually reside? Is it in the sensory nerve endings of my hand, in the relational space between us, or somewhere else entirely? If we’re going to understand it and claim it as our own, it would surely be good to know where it really ‘is’.

Photo by Tadeusz Lakota on Unsplash

4. Does a human have to be involved for it to be therapeutic touch? Given that deliberate acts of human touch make up roughly 0.000000000000001% of the touch events happening throughout the cosmos at any one time, how do we account for all of the other touch stuff going on? Are the air molecules passing under an airplane being therapeutic by helping the plane stay in the air? Are the leaves of a tree being therapeutic when they fall to the ground, rot, and provide food for the soil? If these aren’t going to be considered therapeutic forms of touch, we should probably be clear about why. And should we really be so restricted in our thoughts about the kinds of touch that are therapeutic? If not, what should we be including, and why?

5. And what rights do we assume for ourselves when we wantonly walk on the earth or step on the kitchen floor? Did we ask the soil’s permission in the same way we would ask a person before we touch them? Did we ask the kitchen tiles? If not, why not? Should we just assume the kinds of human exceptionalism that have been linked to so much exploitation in the past? Or could touch be a vector to some radically new ways of thinking about the physical therapies beyond just massage and passive movements?

Some of these questions sound obscure and flippant, but the truth is that they’re riven with complexity and can’t really be answered without a deep dive into philosophical ideas about what things are and our relationship to them.

Physiotherapists work with all manner of entities: people, exercise bikes, concepts and ideas, muscles, treatment couches, latex gloves, hopes and dreams, births and deaths… but we’ve never really established our ontological position for these things. We’ve just fallen into a biomedical way to see them and taken that as read.

I mentioned in the 2nd post in the series that I’m interested in a new set of philosophies called Object-Oriented Ontology (OOO) or speculative realism. These take a much more inclusive and interesting view of entities that are embroiled in the enormous world of the physical therapies. My suspicion is that they might just offer us some really interesting new ways to think about massage, exercise, movement, function, and rehabilitation, into the future.

Only time will tell though.

So there are two lines coming together here. On carries the research on the cultural history of the physical therapies. The other carries the philosophy.

My hope is that the two lines converge at some point in the near future in a way that I only have the vaguest sense of right now.

If you have any suggestions or thoughts for ways to go forward, books you think I should read, or pointers of any sort, it’s always lovely hearing from you. Just leave a comment below. And thanks, as always, for being open to touching the void.