33 Key principles of critical theory

If functionalism is a theory of consensus, then critical theory is about conflict, or dissensus, as Jacques Rancière called it^[1]. Rather than society being about the slow, progressive, drive towards harmony and order, critical theorists argue that it is about power and the often invisible social structures that privilege some at the expense of others. These beliefs stem from the upheavals and disillusionments of the first half of the twentieth century, but the influence of Marxian ideas has also been strong. People genuinely wanted to believe in a fairer society, where the divide between the ‘haves’ and the ‘have-nots’ was not so great. But this is not how Western societies have progressed.

Critical theory emerged across many disciplines and took many forms after WWII, but its many iterations hold six principles in common. Critical theorists argue that:

1. That power is structural, meaning that it is more concerned with the way society shapes people’s experiences, than the agency, actions, or behaviours of any one individual or group ^[2][3]. Critical theorists believe that although people’s actions are important — after all, it is a real person that uses sexist language or directs a water canon — these actions come as a result of social structures: they follow on from systems and organising principles that are built deep into the way society works;
2. These structures are often invisible to us. The way society operates often feels natural and obvious. Cars drive on this side of the road, people say “please” when they ask for things, and children go to school. Often the most powerful (and perhaps the most dangerous) structures, then, are those that shape the world and feel most natural to us because, critical theorists argue, it is the ability of a social structure to become intuitively obvious that is its most potent weapon in the process of social ordering;
3. Social structures are human constructs, or ways of organising the world, that have been built by people to achieve certain ends. Sometimes those ends are about making the world safe. Sometimes they are about making things work more efficiently. But sometimes they are also about preserving a certain set of privileges for one group at the expense of another;
4. Social theory and social change should focus on some of the real inequities in society, most especially the unremittingly demeaning treatment of women, racialised people, the LGBTQ+ community, disabled people, immigrants, and the working classes;
5. We need to recognise that, for inequities to persist, the work of maintaining privilege and advantage must be ongoing. People often come to accept that certain kinds of disadvantage are unavoidable conditions of existence, and so become unwitting architects of their own fate ^[4]. So, the work of critical theory has been exposing these entrenched structures of power and privilege, and helping to mobilise, emancipate, and give voice to those who have experienced oppression and often had to suffer in silence ^[5][6][7]. Thomas Foth has suggested, for instance, that critical theorists confront the ‘strangeness of existing reality’, making ‘blindspots visible and open(ing) systems to change’ ^[8];

6. Some reflections on bullet point #6

   Did you ever receive any training or even discussion of these ideas in your physiotherapy training?
   Given that so much of our work is about healing injustices you would imagine these things would have been part of the core curriculum. For most physiotherapists though – like most other health professionals – these subjects are entirely absent.
   Why do you think that is?

   Critical theory is ultimately about action, resistance, opposition, emancipation and advocacy for everyone who is the victim of oppression, bigotry, hatred, stigma, and prejudice. Elizabeth McGibbon said that critical theory is more than a set of tools designed to assess and diagnose power in society, it is also about the ‘many forms of cultural and political resistance’, struggle, and emancipation needed to change the world for the better ^[9]. Critical theory is also, therefore, a form of social treatment and therapy, directed at systems of injustice, marginalisation, abuses of power and prestige. Dave Holmes, Bernard Roy and Amélie Perron put it this way;

‘Research that aims to be critical seeks, as its purpose of inquiry, a confrontation of the injustices in society as well as a questioning of the status quo, while giving a voice to vulnerable persons (including marginal/ized discourses). Critical researchers believe that the knowledge developed in their research may serve as a first step toward addressing such injustices. As a consequence, the research aims for a transformative outcome, and therefore, is not interested in knowledge for knowledge’s sake. In fact, some critical researchers argue that such a “neutral” stance toward research can too easily play into the conservative agendas of those who would rather preserve than challenge the status quo’ ^[10].

The medical profession was recognised early on as a prominent and powerful vehicle for the articulation and expression of white, male, Western values, and so quickly became the subject of a torrent of critical theory work. From Robert Merton’s study The student physician ^[11] and Howard Becker’s 1961 work Boys in white ^[12], through Eliot Freidson’s groundbreaking work on medical power ^[13][14], Ivan Illich’s Disabling professions ^[15], and Anne Witz’s Professions and patriarchy ^[16], on through the work of Donald Light, Mike Saks, Deborah Lupton, Bryan Turner, Elianne Riska, and others ^{[17][18][19][20][21]};‘the institution of medicine’ has been repeatedly critiqued for ‘reinforcing class, gender, and ethnic inequalities’ ^[22].

Critical theorists argue that Western medicine, and the professions that subscribe to it, including physiotherapists, have been remarkably effective in locating illness within an individual’s body, and hiding the social causes of ill health; training professionals to objectify people and treat bodies as machines; claiming to be public-spirited and altruistic, whilst amassing enormous economic and political power for themselves; using practices of ‘othering’ and normalisation to create a demand that only professional allies could address; demonising non-Western understandings of health and marginalising traditional healing practices; and promoting independence and productivity in service of industrial capitalism. Why do the health professions, ‘mainly serve the interests of a (middle-class, white, English-speaking) minority? What is it about our science, our practice and our education that allows for us to be complicit in creating inequities and in reproducing its effects over generations’ ^[23]?

To begin thinking through this question, we should consider how critical theorists explain the origins of the health professionals, and how professions like physiotherapy have managed to build social structures that afford them the privileges and economic capital that they now enjoy.