82 Re-enchanting physical therapy

There is an enchantment to the physical therapies that has almost been lost over the years, as we have become increasingly concerned with governing people’s conduct, establishing our professional prestige, the efficiency of movement, and financial accountability. But most therapists still practice in the hope of what Jenni Aittokallio and Anna Ilona Rajala called ‘out-of-the-ordinary physiotherapy sessions’ ^[1]. Some of the disenchantment with physiotherapy comes from the layers of adumbrations we have added to the physical therapies. And this has two important effects: firstly, it conceals the vitality of the physical therapies, but secondly, it hampers change and growth. This is important because at the heart of any therapy is the idea of transformation. So to reimagine physiotherapy, and bring about radical new growth, we need to release the vitality of the therapies themselves.

The theories of Deleuze and Guattari, Spinoza, new materialism and OOO argue that all things have vitality and a will to persist and endure. The human version of this we might call consciousness or self-awareness. For centuries, people in the West have suggested that human cognition and reflexivity set us above animals, plants, and inert objects. But all entities possess what Spinoza, Leibniz, and Hobbes called conatus, or what Otto Schöndörffer called Bildungstrieb ^[2], Hans Driesch, entelechy ^[3], and Henry Bergson, élan vital ^[4]. So privileging only human vitality ignores the fact that the vast majority of things in the cosmos, have endured over the vast span of time, without having anything to do with human existence, and have done so without us having any conscious awareness of them.

What constitutes this concept of vitality, then? The vitality of every entity is a function of both its intensities and its surplus. This surplus is a form of possibility or potential which, by definition, may never be expressed. A stem cell, for instance, may never mature, but it holds a degree of ‘potency’, that means it could become a glial cell, myocardial tissue, or a newer version of itself. An oxygen molecule can become a highly flammable compound or the water that puts out the fire. All of this is held by the entity without being actualised, and different entities carry different surplus possibilities.

In Deleuzian terms, this surplus is a form of desire: not in the human sense of an emotion often borne of a lack of something — I want to be a millionaire, for instance because I don’t have any money — but in the more positive sense of latent potential. An entity’s surplus is where creativity and newness reside, and where properties and characteristics of an entity become realised. Deleuze gives a powerful example of this when he describes the hand as the deterritorialised paw. In other words, the essence of ‘the hand’ was already within the surplus of ‘the paw’, waiting to be realised. Which begs the question, what new entities lie within the physical therapies, waiting to be actualised, if we could only deterritorialise them?

For surplus potential to be realised, entities must ‘touch’ others. A flame touches cotton and it burns. The burning cotton does not become a small tree, or plan tonight’s dinner because these things do not reside within its surplus. But its potential to ignite and burn does. The cotton cannot realise its potential to burn on its own, however. It needs to touch another entity that also carries the right surplus. Touch a river, and the cotton will realise a different potential entirely.

Because all entities have the capacity to affect and be affected by other things, they operate in an ‘affect economy’ ^[5], based on the formation and collapse of endless assemblages. These assemblages become therapeutic when entities enhance another’s non-trivial capacities and tendencies to endure and persist, and open space for new entities to emerge, creating a host of new intensities and surpluses.

Judith Butler described assemblages beautifully recently, commenting on the idea, inherited from ‘liberal individual ways of thinking’, that humans ‘overcome the formative and dependent stages of life to emerge, separate, and individuate’, and ‘become this self-standing individual’. The liberal fantasy is ‘always an adult male in his prime, who, just at this particular moment when we encounter him, happens to have no needs and dependencies that would bind him to others’. Butler sees this as comic, in many ways, but also lethal because ‘who actually stands on their own?’;

’We are all, if we stand, supported by any number of things. Even coming to see you today—the pavement allowed me to move, and so did my shoes, my orthotics, and the long hours spent by my physical therapist. His labor is in my walk, as it were. I wouldn’t have been able to get here without any of those wonderful technologies and supporting relations’ ^[6].

Therapy, then, should be about opening space for the intensification, displacement, flow, and movement of entities across what Deleuze and Guattari called ‘smooth’ space ^[7] — or space unencumbered by rules, regulations, structures, and impositions. Physiotherapists can play a huge role in intensifying the physical therapies, and re-enthusing our practice, by allowing them to express their transformative potential.

Firstly, we should acknowledge that physiotherapists are by no means alone in feeling disillusioned with the changing world around us. From post-colonial Indigenous scholars, to Pre-Raphaelite and Dadaist artists, romantic poets, and new nature writers, there have been numerous attempts to re-enchant what seems to be an increasingly divided, fractious, and fatalistic world ^{[8][9][10][11]}. Max Weber suggested in the 1920s that disenchantment (Entzauberung) had been the West’s master narrative since the advent of Calvinism and the birth of the natural and physical sciences ^[12]. Charles Taylor argued that disenchantment began with the Enlightenment, and that, ‘the only locus of thoughts, feelings, spiritual élan is what we call minds’, and ‘the only minds in the cosmos are those of humans’ ^[13]. In this world;

‘the material cosmos is drained of meaning and animate vitality, available to be managed by the forces of instrumental reason and technological control. The human person herself is reconceived as a mechanism to be disciplined and policed, part of a social machinery that thrives on efficiency, homogeneity, and prudent calculation’ ^[14].

Jürgen Habermas believed that;

‘the most deep-rooted and serious problems modern societies face, from human exploitation to environmental destruction, were caused by the needs and values of ‘the system’ encroaching upon the ‘life-world’, thereby marginalising our capacity to effectively raise and address system-dominated values and practices’ ^[15].

So, how do we re-enthuse our practice and re-enchant the physical therapies? Our socialised instinct has always been to look for more control, more expertise, more definitional clarity, more prestige and power. But this has only distanced us from the essence of the physical therapies and the reasons we became therapists in the first place. My suggestion here, grounded, I hope, in the previous chapters of social theory and new philosophies, is that we look to doing the exact opposite of this: finding all of the ways we have added adumbrations to the physical therapies, and removing them; freeing them up so that their vitality can be accessed more easily by people.