62 Criticisms of postmodernism

Consistent with their underlying belief in the importance of ambiguity and difference, postmodern approaches are diverse and variegated. They do, however, share in common a desire to move beyond older ways of thinking and practicing. For this reason alone, they have garnered no shortage of critics.

Perhaps the first and most significant criticism of postmodernism is directed at its relativism. Because it rejects the idea that power is something people can have and hold and use against others, postmodernism undermines one of the main tenets of critical theory. Postmodern thinkers are often less interested in campaigning for the rights of the marginalised and dispossessed, seeing that this often replaces one bad hegemony with another ^[1]. Critical theorists argue, though, that this means critical issues like gender politics, race relations, and the rights of disabled people, are effectively ignored. Kevin White has accused Foucault, for instance, of operating with a phalocentric, ‘masculinized’ model of the body by showing no interest in gendered bodies or patriarchal power ^[2].

Postmodernists have also been accused of nihilism. Because they see knowledge as the effect of discourse, and distrust approaches that look to apply ‘rational thought to the dilemmas of contemporary society’ ^[3], they have been accused of being more interested in unsettling dominant views and providing ‘tools to allow people to establish a distance from their taken-for-granted world and see things differently’ ^[4], than agitating for progressive social change or speaking up against oppression and injustice. Critics suggest that when new forms of knowledge are seen as neither better nor worse, only different, from what went before, postmodernists convey the sense that all social reform is naive or futile. So, as Matt McManus suggests, ‘While some forms of resistance may be possible and even admirable, we should look on them with caution and recognize that they may just conceal deeper drives towards new kinds of oppression’; a condition that, he argues, reflects a ‘depressingly totalizing approach to power and our limited capacity to resist it’ ^[5].

Others have argued that postmodernism struggles to locate where resistance actually emanates from. Foucault, for instance, argued that there could be no real power without resistance, but also argued that the body was either ‘a wholly historical phenomenon and has no ‘nature’’ ^[6], or was too ‘analytically thin’ ^[7] to explain how resistance actually came about. So, where does resistance actually come from, then? If it is people that do the resisting, surely they must do that with their bodies? But if bodies are only discursive ‘effects’ and have little material significance, what is it that blows up an oil pipeline or pepper-sprays a protester?

The confusion over what the body actually is, has led some to suggest that postmodern approaches lose both the specificity of the biological body in Western science, and the experiential, subjectively-experienced body of the humanities ^[8]. This has particular resonance for disabled people and their professional colleagues, who have seen postmodernism undermine both the biological and socially constructed body. And yet, some argue, the disablism that disavows ‘morphological imperfection’ persists ^[9]. As a result, we now have ‘no notion of a clear or stable power discrepancy between professionals and clients or between dominant professions and subordinate ones. Power is dispersed, it cannot be simply and easily located in any elite group’ ^[10].

Some postmodern approaches have attempted to maintain links to more traditional ideas of identity. Intersectionality, for instance, goes some way to maintaining the legacy of critical theory, but some argue that it also struggles to reconcile performativity and identity ^[11]. This is particularly evident in addressing the social determinants of health. Poverty, polluted environments, discrimination and violence, poor quality education and housing, limited access to basic services like healthcare and transportation, are things that billions of people around the globe are born into and have to live with, and have little to do with their ‘lifestyle choices’, but are forced upon them and their families against their will. The social determinants of ill health cause some remarkable health disparities. Economic and racial inequality, for instance, kills more people than cigarettes, the poorest Australians are twice as likely to die before age 75 than the richest, and mould and damp health costs are three times greater than those for sugary drinks^{[12][13][14][15][16][17][18]}. The problems of the social determinants are so massive that The Lancet recently calling for ‘A radical shift of life sciences funding priorities, away from the biomedical bubble and towards the social, behavioural, and environmental determinants of health’ ^[19]. Given this, many critical theorists dislike and distrust postmodernism for its seeming indifference in the face of ongoing and pervasive injustice.

Along a different line, the work of Bourdieu, Giddens, Baskhar, and other ‘third way’ thinkers, has been critiqued for failing to reconcile the problem of structure and agency that they set out to resolve. Baskhar’s work has been accused of understating people capacity to change the world ^[20], and focusing more on the ‘is’, and the practical world of people’s experience, than the ‘ought’, which would presume a strong moral position ^[21]. Giddens work, by contrast, has been criticised for overstating people’s ability to change their circumstances; ‘The overall charge is that Giddens gives too little attention to all those situations where actors really do lack the power to alter their circumstances for the better’ (ibid, p.171).

And intersectional approaches have not avoided criticism either. Advocates for classical critical theory have argued that the problems of the social determinants of health can only be tackled by advocacy and action, highlighting, for instance, the links between the oppression of the myriad marginalised groups ^[22]; the medicalisation of healthcare ^[23][24]; the tyranny of while colonial power, ableism, patriarchy, and the capitalist status quo ^[25][26][27]; and the barriers that healthcare policy has created between people ^[28]. But postmodern intersectional approaches reject classical ideas of oppression in favour of performativity and the diffuse nature of power, and this has left some to argue intersectionality has created a theoretical vacuum that has allowed many of the ‘old’ injustices to resurface^{[29][30][31][32][33][34][35][36]}.

Part of the ‘problem’ for postmodern approaches is that they focus more on differences than similarities, and so the critical power of the collective struggle seems to be lost in an atomistic individualism, whilst, at the same time, individual subjectivities are seen only as outcomes of discourse ^[37]. Postmodernism rejects the power of oppression and people’s lived experience as valid forms of knowledge. Because of this, some argue it fails to provide a better alternative to the structure/agency binary that it set out to critique. Bourdieu’s work, for instance, has been critiqued for being too bound to habitus; for not giving enough attention to people’s individual agency, how they become expert, or ‘escape’ from a field of practice ^[38].

Given all of this, rather than seeing postmodern approaches as ‘answering’ all of the criticisms of positions outlined in the previous four chapters, it would perhaps be more accurate to think of them as offering an alternative. An advocate for postmodernism might argue that it shows just how complex and uncertain our thinking has now become, and how risky it is to embrace decisive ways of thinking common in Western health professions like physiotherapy ^[39]. Undoubtedly, the world we operate within as health professionals has elements that might be interrogated very successfully by approaches like postmodernism. But that does not mean that functionalism, Marxian, neo-Weberianism, critical theory, or any of the other approaches to the sociology of the professions do not also, at times, provide insights.

In the following chapter, I want to bring all of the various theories set out in the book up to date, and reflect on the current state of the health professions. This chapter will introduce the idea that we are entering a post-professional era, and will explore what this means and why. Then, in the final two chapters, I will relate all of this work back to physiotherapy, and ask what the sociology of the professions might tell us about the future for the profession.