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26 Controlling systems

Harry Braverman’s studies centred on the deskilling of modern work in America [1]. Long before the neoliberal economic reforms of the 1980s and 90s, Braverman began asking why Marx’s critique of capitalism had not brought greater equity and respect for the true value of work to Americans. Braverman could not reconcile why people had simply accepted capitalism as inevitable, even when their society seemed to be drifting towards ever greater alienation and consumer fetishism.

Has physiotherapy always been an ally of capitalism?

The managerialisation that swept through healthcare in Europe and North America after the 1980s followed closely to Taylorist ideas. Healthcare, it was argued, had to become more efficient. Advocates of this approach argued it needed to be thought of as a complex machine with many interconnected parts, each of which – including the clinicians and patients – had to operate optimally at all times. (Do you see any echoes of functionalism here?).

Healthcare had to be seen as a process of inputs and outputs, of money flowing in and out, like a factory or a high-performing business. Out went the messy, relational and subjective parts of healthcare, like listening to a patient’s story or spontaneous acts of caring, and in came outcome measures, KPIs and best practice guidelines.

Given physiotherapy’s historical focus on treating the body-as-machine, objective measurement, optimal movement and function, it’s hard not to see the profession as a key ally in the Taylorisation of healthcare.

At the heart of the problem faced by American workers was the capitalist desire to control their work. In order for business owners to obtain the ‘full usefulness’ of their employees labour power offered by people in society, it had become ‘imperative to exert control over the labour process in order to maximise the productive potential of labour and therefore profits’ [2]. Unlike the work of a machine or horsepower, human labour was ‘intelligent and purposeful’ (ibid, p.56), and so capable of being harnessed for almost unlimited gain. Thus, what the capitalist business owner is buying is not tangible labour power, per se, but ‘potential’.

One way to harness this potential, and maximise surplus value (profits for the business owner) had been pioneered by Frederick Taylor, founder of the ‘scientific management’ movement, and the Taylorism mentioned in Chapter 2. Taylor believed in ‘gathering together… all the traditional knowledge which in the past had been possessed by the workmen and then classifying, tabulating and reducing this knowledge to rules’ [3]. Armed with this knowledge, business owners could employ ‘large central bureaucracies’ to collate, organise, and study the data, and advise managers on the best course of action. Critically, a new management class could take away from the workers the knowledge that had once defined their craft, giving the managers a ‘monopoly over knowledge to control each step of the labour process and its mode of execution’ (ibid).

Central to the process of ‘scientific management’ of work, then, was the transfer of all mental labour from the worker to management, and the subsequent creation of transferable, reproducible, and standardised programmes of work that could be easily quantified — a process that has been highly prevalent in Western healthcare, and physiotherapy practice specifically, in recent decades. Braverman saw this as an act of ‘deskilling’, designed to maximise the efficiency of the worker, whilst standardising their tasks to the point where their labour becomes entirely replaceable. In this way, the bourgeois business owner could reap all of the benefits of maximising the surplus value derived from people’s labour, without having to invest in social programmes that took care of those who experience a drop in competitive performance, through illness and injury, for instance. The worker becomes a mere vassal in service of profit making, and the social welfare system provides the means to ensure that there were enough fit and active workers to fuel the machinery of capitalist production. What capitalism encourages, then, is the idea that people can be viewed as objects and things, stripped of their humanity, and as means to an (economic) end. Humans become ‘instruments’ in what Gramsci, Adorno, Marcuse, Horkheimer and other members of The Frankfurt School called the ‘instrumental reason’ of capitalism.


  1. Braverman H. Labor and monopoly capital: The degradation of work in the twentieth century. New York, NY: Monthly Review Press; 1974
  2. Malin N. Developing an analytical framework for understanding the emergence of de‑professionalisation in health, social care and education sectors. Social Work and Social Sciences Review. 2017;19:66-162
  3. Taylor F. Scientific management. New York, NY: Harper and brothers; 1947

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