79 Intensive therapy

It would have been difficult to take a radically different view of physiotherapy, without some of the groundbreaking social theories and philosophies that have emerged over the last few years. The shift towards these new theories came with the work of theorists who turned their attention from the kinds of human-centred philosophies that had always been the basis of sociology in the past, to a more fundamental focus on the matter and objects that make up all things; human and non-human. These new ideas come from a wide range of theorists, including Pamela Alldred, Karen Barad, Jane Bennett, Rosi Braidotti, Judith Butler, Gilles Deleuze, Nick Fox, Félix Guattari, Graham Harman, Donna Haraway, Manuel de Landa, Bruno Latour, John Law, Gottfried Leibniz, Annemarie Mol, Baruch Spinoza, Isabelle Stengers, and Alfred North Whitehead.

The work of these new theorists begins with a rejection of the kinds of binary distinctions between what is real and virtual, human and non-human, body and mind, individual and social, quantitative and qualitative, that have beset the biological and social sciences for hundreds of years. They reject both the structuralism of Western biomedicine, functionalism, Marxian, Neo-Weberian, and critical theory, and the humanism of symbolic interactionism, ethnomethodology, and phenomenology. They especially reject efforts to reconcile these divisions found in holistic models of health and ‘third way’ social theories. Instead, they propose a radically different approach to our understanding of the world, beginning with a bottom-up reinterpretation of what constitutes matter, agency, affect, creation, being and becoming.

The first principle of these new theories is that human interests have dominated our thinking for too long. Our androcentrism (human-centredness), has encouraged us to think that people are more important than other entities. And so, not only have animals, plants, and inorganic matter been abused so that humans can prosper (leading to our present-day climate crisis), but we have also overstated the importance of human flourishing in our sciences. Once we create a hierarchy between humans, animals, plants, and things, it is only a small step to also extend this hierarchical ordering, and argue that some humans are more important than others (adding to the climate crisis with countless atrocities, acts of discrimination, and hatred). Rejecting this has been an important feature of these new theories, variously called post-humanism, new materialism, and object oriented ontology (OOO).

Instead of a hierarchical ordering, these new theories ‘flatten’ the relationship between all things, allowing all entities the same privilege. This becomes important because physiotherapists deal with more than human tissues. Their work also involves grappling with concepts and ideas, non-human objects, physical forces and biological flows, actions and intra-actions ^[1], individual thoughts and desires. And we have struggled in the past to see how these different ‘events’ might be given equal value in our practice.

These new theories focus on the idea that all things are made up of matter that is constantly circulating, and periodically condensing into recognisable forms. Crucially, though, these theorists argue that ‘matter’ includes things that are ‘real’ and imagined or virtual. They argue that ideas circulate and take ‘form’ just as much as atoms. This is a challenging concept for many people, especially those schooled in the objectivity of biomedicine. It is, perhaps, easy to imagine how ‘real’ entities are formed by matter, after all, 60% of human body mass is made up of oxygen that was taken from the atmosphere minutes before. And this oxygen was once merely cosmic dust. But there are deeper questions here too that are just as important.

For instance, we think of the human body as a solid, bounded entity, but when does an oxygen molecule floating in the room around us actually become part of ‘me’? Does it constitute ‘me’ when it is in the room, or only when it is in my trachea? Or maybe the blood or muscle? The biological and social sciences have struggled with concepts like this in the past. But our new concepts theorise ‘immaterial’ forms as no less ‘real’ than entities like cups and cars. So fictional characters like Harry Potter, are matter just as much as the ‘real’ patients in your clinic. And patients’ hopes and dreams are matter just as much as nerve synapses. The real advantage of this shift in approach, is that it opens doors to some new ways to theorise the complexities we know to exist in the physical therapies.