58 Intersectionality

The emergence of Foucault’s writings coincided, almost exactly, with the rise of neoliberal economic reforms in the 1980s and 90s. Part of their appeal stemmed from the somewhat moribund state of critical theory, which had become fractured by infighting and the general decline of progressive politics. Foucault offered new ways to critique power and, along with others like Pierre Bourdieu, Jacques Derrida, and Jürgen Habermas, revived sociologists’ interest in the professions. Foucault’s work also coincided with the belief that the radical sociology of the 1960s and 70s had put too much emphasis on peoples’ identities. And although this approach proved ‘almost too useful’ ^[1] as a way of countering biological explanations of things like class, gender, ability, and race to want to abandon, and a ‘strategic necessity’ ^[2], it relied on the idea of identity as a ‘stable subject’ ^[3], in order to signal oppression and fight for people’s emancipation. This unwittingly brought about the breakdown of radical sociology internationally because it could not speak to the experiences of people who were women, as well as being racialised, poor, elderly, queer, or disabled. So, although many activists have mourned the loss of identity politics of the post-war years ^[4], many embraced the new possibilities offered by intersectionalism.

Beginning in the late 1980s, theorists like Judith Butler, Jane Flax, Stuart Hall, Kimberlé Crenshaw, and Iris Young began to challenge the idea that people had a core, singular, autonomous, and sovereign identity that became overlaid with multiple other identities through life experience and our being in the world. Intersectionality theorists argued that while beliefs in identity as a ‘point of origin’ ^[5] had been perpetuated in society, especially by health professionals using diagnostic labels and normalising categories, the belief that people could share common traits with others only served to reinforce the kinds of Enlightenment reason that lay at the heart of modern forms of discrimination and oppression ^[6]. So while labels like ‘deaf’ and ‘disabled’ had served as anchor points for advocacy and resistance, intersectionalists increasingly saw them as reinforcing stereotypes and stigma. Rather, as Crenshaw’s work on the experienced of Black women suggested, our multiple identities operate like a traffic intersection (hence intersectionality). At any moment, the ‘traffic’ of one identity may be flowing one way, while another may be flowing in a different direction ^[7].

Judith Butler’s work on performativity was also crucial here. Butler was also one of the most important voices arguing that second wave feminists had been wrong to politicise the idea of ‘woman’ as a distinct social identity in efforts to bring about gender equality. Her work centred on the way gender was ‘performed’, but has spread to many other areas of critical theory and postmodernism since ^[8][9][10]. Butler argued that there was nothing ‘natural’ or biological about sex or gender, and the way that we expressed our sexual differences was really a social or cultural phenomenon. People ‘performed’ their gender through ‘stylistic acts’, but the person does not ‘choose’ their gender in the way they might choose which clothes to wear. Rather, their gender identity is created by forms of power circulating in society. To use Butler’s own phrase; ‘Performativity is the way that discourse produces its effects’ ^[11]. Gender, therefore, has little to do with biology or individual choice, and more to do with ‘scripts’ that may be passed down through generations. Butler argued that gender was far more fluid than traditional binary stereotypes allowed.

Many postmodern theorists picked up Butler’s ideas of performativity, arguing that race and ethnicity, social class, sexual preference, and bodily ability, should also be seen as the effect of circulating cultural values and beliefs, and had little to do with biology or behaviour. This is not to say that material differences between bodies do not exist, only that these differences are ‘always already signified’ ^[12]. In other words, there are no structures, concepts, or processes we can think of that are not based on language and discourse. A person’s sex or race is not a genetically invariable foundation onto which we overlay gender and ethnicity. One is no more real than the other, since both are discursively constructed. Postmodernists, therefore, argued that we needed to take much more account of the way people’s subjectivities were relative, and historically and socially constructed. Judith Butler expressed this argument perfectly in her book Gender Trouble when she argued that ‘sex’ cannot be thought of as coming before gender because to think about sex as a biological precursor derives from a particular patriarchal scientific view of bodies ^[13].

From the 1990s, postmodern ideas began to appear in the healthcare literature, where the assumed ’naturalness’ of ideas like physical impairment, sex, and race, were seen as ‘dangerous’ technologies of discipline ^[14]. Disability activists were important here, arguing that the medical model had failed to recognise the ‘lived challenges’ of disability, particularly for people in the Global South ^[15][16][17], and the social model for ignoring problems grounded in pathology ^{[18][19][20][21][22][23]}. For many disabled people in low- and middle-income countries, for instance, basic survival featured much more prominently in their concerns than the need for accessible environments ^[24].

This is not to say, however, that postmodernism revived interest in the biomedical sciences. For much of the last half century, there has been ‘a growing disillusionment’ with the effectiveness and assumed benevolence of scientific medicine on the part of both intellectuals and some consumers’ ^[25]. Medicine’s claim to ‘inaccessible and arcane knowledge based on objectivity and political neutrality’ (ibid) was challenged by Eliot Freidson and others, who argued that, in reality, ‘the medical profession had no more right to decide on health-related issues than any other group in society’ ^[26].

In rejecting much of what had gone before, postmodernists sought new ways to define concepts like sex and gender, race and ethnicity, impairment, and barriers to participation in ways that acknowledged the biological basis of many health issues, whilst also recognising the ‘global histories of power inequalities and exploitation’ ^[27]. The main way this was achieved was seeing identities, or rather ‘subjectivities’, as discourses ‘produced and shaped through various social and political power relations’ ^[28]. ‘Bodies participate in social forces and social forces participate in shaping bodies’, as Raewyn Connell put it ^[29].

Intersectionality and postmodernism brought ‘the natural ambiguity and complexity of modern life’ ^[30], to the fore by emphasising the multiplicity and complex interplay of our various subjectivities. Alongside globalisation, the Internet and social media, their rejection of the traditional binaries used to define nature as distinct from culture, men from women, black from white, science from art, and so on, has contributed to the opening of long-held borders to a new ‘traversal’ politics. And the insistence of intersectional and postmodern thinkers on difference and inclusiveness, and the ‘dynamic, situational, and provisional’ ^[31] nature of reality, have shifted the focus away from the idea that we have a stable ‘identity’ acting in ‘opposition to power’, and more multiple, context-specific, culturally constructed, unstable, and fluid subjectivities that are constituted by power ^[32].

The traversal politics of intersectionalism has important implications for health care practice. Because subjectivities intersect across multiple axes, we can no longer think of people as individual biological sovereign and autonomous entities, overlain with cultural experiences. Nor can we view them as defined by class, gender, age, race, and ability. Raewyn Connell suggested in 2011, that ‘We need a concept, which I call social embodiment, to refer to the collective, reflexive process that embroils bodies in social dynamics, and social dynamics in bodies’ ^[33] because, ‘Biology and society cannot be held apart; but also cannot simply be added together. A much deeper and more complex interconnection must be acknowledged’ (ibid). Gilles Deleuze suggested we should be talking about aggregated, measured, distributed, multiple, plural, and diffuse ‘dividuals’ (as opposed to ‘individuals’) ^[34].

Rosi Braidotti saw the body as the site where a host of physical, cultural, social, political, spiritual, and other forces converge, and become embodied. For her, the body was better seen as an interface, threshold, or field through which these forces converged ^[35]. The presence of anomalous bodies in society, then, ceases to be something needing to be fixed, repaired, or rehabilitated, since ‘human variation is a fundamentally good thing’ ^[36], and the work of health professionals can become one of rehabilitating society to respect and value diversity.

In many ways, this is a radical re-imagining of trans-disciplinary practice; a ‘trans-disciplinary space’, as Carol Thomas called it ^[37], which breaks boundaries, deconstructs and decolonises the power that currently divides professionals and the public, and opens healthcare to more than just medicalised understandings of health and illness.

As Margrit Shildrick and others have argued, we can now engage with an enormous array of concepts and ideas, drawn from ‘feminism, postmodernism, queer theory, critical race theory or long-established perspectives like the phenomenology of the body and psychoanalysis’ ^[38][39] to explore the ‘inherently transgressive’ kinds of ‘anomalous embodiment’ (ibid) that physiotherapists claim lie at the centre of their professional work ^{[40][41][42][43][44][45][46][47]}.

Margrit Shildrick has also suggested that ‘the key to the new scholarship is critique, not in the sense of the destruction of old certainties, but as a bold and risky enterprise that subjects all the conventions to potentially disruptive analyses’ ^[48]. Sar Salih and Judith Butler have echoed this sentiment, arguing that;

‘What critique is really about is opening up the possibility of questioning what our assumptions are and somehow encouraging us to live in the anxiety of that questioning without closing it down too quickly. Of course, it’s not for the sake of anxiety that one should do it… but because anxiety accompanies something like the witnessing of new possibilities’ ^[49].