88 Vernacular physical therapies

I suggested earlier that perhaps one of the reasons why physiotherapists had always sought to capture the physical therapies, was because they are so vibrant and pregnant with intensities. Western Judeo-Christian societies have always had a complicated relationship with the sensuality of touch and movement, and so ‘taming’ the physical therapies allowed the profession to claim social prestige, by addressing at least one important social anxiety. But because the physical therapies also possess exuberance and fecundity, they fed tremendous latent power to the profession, which was able to make enormous profits from the physical therapy intensities.

Attempts to impose order on the physical therapies, though, was always going to be challenging, especially when the model of elite professions was one of coherence and uniformity. Physiotherapy’s answer was to select forms of physical therapy that it could contain and control, and then set about legitimising and consolidating its framework, and exporting it as a unified image of professional practice around the globe. Still, to this day, international physiotherapy curricula and scopes of practice are remarkably consistent.

Asserting the uniformity of physiotherapy has been a century-long project in socialisation and social closure, that has demanded enormous effort and significant conformity from physiotherapists. But the amount of time and energy that we have had to give to controlling the physical therapies, has only served to reinforce how unnatural and problematic this kind of action is, and how concerned the profession must be with the latent intensities of the physical therapies themselves.

But the problem of physiotherapy’s lack of diversity is really only a problem mirrored throughout our ecosystem now, where species diversity is under significant threat. When there are thousands of banana varieties, for example, but we choose to draw 99% of the world’s exports from only one variety (called Cavendish) ^[1], the risks to local ecosystems becomes obvious. Not surprisingly, many are now calling for an approach that is vernacular and attentive to a locality’s history and culture, built on new forms of solidarity and piecemeal change ^[2].

Increasing diversity can only occur when intensities are understood as local, contingent and vernacular. ‘Vernacular’, here, means practices that are harmonious, responsive, or close to a particular community. In architecture, it means buildings that blend into their surroundings, often made from local materials. High-rise tower blocks in the middle of the rainforest are the opposite of vernacular. Ivan Illich saw vernacular forms of art as colloquial, instinctual, and, often, untaught ^[3].

Vernacular physiotherapy would respond directly to a particular locale. In Ezekiel Emanuel’s latest book, for instance, he asks Which country has the world’s best health care ^[4]? After surveying 11 countries (Australia, Canada, China, France, Germany, Netherlands, Norway, Switzerland, United Kingdom, United States, and Taiwan), Emanuel finds, of course, that what constitutes the ‘best’ healthcare depends on where you live and what you want. Some people prefer centralised universal health coverage, others will be most concerned about the cost. Some will be most interested in choice, or access to the best specialists, clinics, and hospitals.

In vernacular physiotherapy, therapeutic priorities derive from the community, rather than the practitioner, the market, or central government. Physiotherapists can play an important role here, by using their social capital to improve people’s access to the kinds of physical therapies that can bring social equity and justice locally, and addressing the social conditions that predispose to poor health (hunger, poverty, discrimination, poor access to services, sub-standard education, pollution, etc.). But they can also use their experience and wisdom to strip away the fantasy that there can only be one physiotherapy and open the door to a thousand (local) alternatives.

Jettisoning the idea of a coherent and singular professional identity will be, perhaps, one of the most significant steps physiotherapists can take towards liberating the physical therapies. And while this sounds an immensely complex task, work has already begun on de-centring the profession ^{[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]}. These works offer pointers to the ways we might begin the transition, but much more is needed if we are to arrive at the point where the physical therapies are common to all.