91 Physiotherapy as an act of enclosure

So how does the existence of the physiotherapy profession relate to the question of the commons? Elliot Freidson showed in the 1970s that any discipline making claims about its professional status relied on being ‘deliberately granted autonomy, including the exclusive right to determine who can legitimately do its work and how the work should be done’ ^[1]. Freidson believed that this showed that the fight for professional autonomy always came with a degree of deference to a higher authority. In physiotherapy’s case, higher authority represented the twin powers of the state and the medical profession. But physiotherapy was not alone in this. Pamela Abbott and Liz Meerabeau argued that ‘a sector of the middle-class — including caring ‘professionals’ — [was] prepared, indeed in some cases eager, to accept the historical constraints of professional status in order to acquire what it sees as its freedom of action’ ^[2]. This included obedience to ‘patriarchal assumptions and definitions which then became incorporated into the new profession’ (ibid).

But the pursuit of autonomy carried with it the implicit necessity to demarcate a professional territory and assiduously police these manufactured boundaries. In some cases, boundaries were crafted around inventions and discoveries that built on common knowledge and resources, and put the dividends in the hands of specialists. But in many other cases, professional enclosures have been, in George Bernard Shaw’s famous phrase, ‘a conspiracy against the laity’ ^[3]. And all too often, ‘freedom for the wolves has often meant death for the sheep’ ^[4].

‘It is important to note’, David Bollier reminds us, ‘that enclosures are not just appropriations of resources. They are also attacks on communities and their practices of commoning’ ^[5]. Anything, in theory, can be enclosed if a large enough group of people have the will and the strength to do it. The idea of terra nullius, for example, was a term meaning ‘nobody’s land’ that was set down in European law to justify acts of empire and colonisation.

Physiotherapists have historically laid claim to the body, movement, posture, physical function, rehabilitation, and a host of other commons. And in claiming the body, they follow the colonial convention of declaring it terra nullius, (or, in this case, soma nullius?). By adopting the idea of the body-as-machine from medicine, physiotherapists were able to treat everybody as virgin territory. The person’s beliefs, culture, history, social context, spirituality, and personal values could be suppressed, allowing the focus to fall almost entirely on the landscape of pathology, and the expertise of the therapist in mapping it. The therapist creates a border between themselves and the patient, who is asked what they have to declare (the patient assessment), before being offered the passport into treatment. And these ever-shifting boundaries are policed by regulators, educators, and peers, to ensure the profession’s enclosure remains intact.