15 The body-as-machine and physiotherapy’s reductionism

In many ways, physiotherapy is an archetypical functionalist profession because it works to rehabilitate those who are ill or injured, and it is happy to be one ‘arm’ of the complex Western healthcare system, and operates alongside other ‘organs’ of state-sponsored healthcare (medicine, nursing, occupational therapy, patients, healthcare assistants, managers and administrators, etc.). The body analogy here is particularly relevant, partly because of physiotherapy’s longstanding affinity with the body-as-machine ^[1], but also because functionalist thinkers have always drawn heavily on organic metaphors of bodies and parts, to explain how they thought society worked.

Reductionism is the practice of simplifying what would otherwise be a complex, holistic entity by dividing the whole into smaller parts, and is a fundamental principle of functionalism and Western healthcare. Reductionism became a necessary part of biomedicine as the complexity of the body in health and illness became clearer. Although forms of reductionism have operated in healthcare for centuries, it acquired real power in the 19th century, as medicine began to divide into specialties. By the early 20th century, healthcare services were being designed around these specialties, and every profession that aspired to imitate medicine’s ideal-type traits, was required to follow suit.

Reductionism in physiotherapy manifests in a number of ways: at the bodily level, with physiotherapists emphasising body systems (musculoskeletal, cardiorespiratory, neurological), and structures (anatomy, physiology, pathology, biomechanics, kinesiology). But also in their corresponding specialisations. Reductionism is one of the main reasons physiotherapy has musculoskeletal, neurological, and cardiorespiratory specialities. But reductionism also relates to the way physiotherapists moulded the profession to treat not just the body, but also society, ‘as-machine’.

It was not only physiotherapists that saw the body-as-machine, though. In fact, the profession adopted this approach, in part because it had been an important feature of Western thinking since the Industrial Revolution. The metaphor of the body-as-machine enabled nation states to govern their growing populations through the designation of different role identities for different people, including the creation of a class of professionals to act as one important cog in the harmoniously progressive machine of society. But reductionism also shaped modern methods of industrial production, and the capitalism to which physiotherapy has been so intimately tied.