It is an exciting time in the evolution of critical physiotherapy studies. Although physiotherapy is relatively late to the critical studies table, amongst the health professions it is, in many ways, leading the field. This is in a large degree due to the efforts of Dave Nicholls who, with the writing of this book, has once again challenged and invigorated physiotherapy by taking seriously the critical mantra of ‘things could be otherwise’. I have had the privilege of collaborating with Dave on a number of projects over the last decade, including our first paper together, The Body and Physiotherapy (2010), and the 2018 edited collection Manipulating Practices: A Critical Physiotherapy Reader. Through this work, I have had a front row seat to observe how Dave combines an impressive command of diverse social theories to re-think and move physiotherapy in exciting new directions. Through both his scholarship and his leadership of the international Critical Physiotherapy Network, Dave has articulated a clear vision to work towards a more positive, inclusive, and critical future for physiotherapy and has done so by bringing together like-minded scholars and clinicians from around the globe. Ultimately it is those who seek out physiotherapy services who will benefit most from this innovative work. This latest book is no exception.
Physiotherapy Otherwise is a treasure trove of provocations designed to challenge and disrupt the philosophical moorings of physiotherapy and healthcare more broadly. As an invitation to think and do differently, the text extends an argument that Dave began in his previous book The End of Physiotherapy in which he provided a critical history of the physiotherapy profession and sketched a series of challenges facing contemporary practitioners. In Physiotherapy Otherwise, Dave addresses these challenges by extensively engaging with the sociology of the professions to make a case for a radical rethinking of the profession. The book is ground-breaking in its scope, providing an unprecedented deep dive into how physiotherapy emerged as a profession, its blind spots, and its future. I suspect the book will unnerve some readers, but this is to its credit. Dave seeks to radically challenge thinking as usual, and in this respect he more than succeeds. What struck me most in reading the text was the sheer depth and breadth of the different knowledges Dave deploys in order to delineate a contemporary crisis in the health professions and the implications for the future of physiotherapy. Extensively referenced, the text systematically engages with diverse theories to provide a rich and detailed accounting of this crisis and culminates with a manifesto for ‘re-enchanting physical therapy’. This is unprecedented in our profession and is such a gift.
Arguably the role of critical work is problem-producing rather than problem-solving and Dave navigates this well. By conceptualizing the physiotherapy profession in unprecedented ways, he conjures new problems that can catalyze change. Without getting into the specifics, the future of physiotherapy that Dave proposes requires significant reform within and outside of the profession. My engagement with the text and agreement with the need for radical reforms raised a number of questions for me. Given that the future Dave envisions is unlikely to be realized in the short term, what can physiotherapists do today to begin addressing the problems he outlines? How can we begin the work of re-enchanting physiotherapy and the physical therapies? How can the neoliberal/managerialist straight-jacketing of healthcare that we find ourselves in be opened up? The text provides several points of departure for considering these questions and, as Dave says, ‘intensifying the physical therapies, and re-enthusing our practice’. My own modest suggestion for starting this work is the adoption of an ‘ethics of openness’ in the doings of physiotherapy. The more narrowly physiotherapy is conceived the more limited and limiting it will continue to be. An ethics of openness is an invitation for creative experimentation in the doings of everyday work. What do we take for granted as good, right, and true in our teaching, research, or clinical care? How could things be otherwise? Even small acts of inspired tinkering can be revolutionary.
The radical changes that Dave advocates entail giving up all the acts of bordering that limit the profession and what it can do. For example, shifts are needed in all the ways physiotherapy works to normalize bodies to the exclusion of other ways of understanding disability. Such open-ended work requires a deep humility, comfort with discomfort, and understanding the unwitting harms and exclusions that might be perpetuated by thinking as usual. An affirmative embrace of radical reform resists closure in all its forms and continually questions not only what we do but the basic ‘truths’ underpinning of our work. To do so, physiotherapists must more directly engage with all the obvious and hidden forces, assumptions, and systematized inequalities that pervade contemporary healthcare. Our collective ethical task, that Dave so eloquently reminds us, is to ‘secure the best possible physical therapies for people, even if this is at the detriment of the physiotherapy profession’s own power and prestige’. This should be an exciting rather than disagreeable task, and for me is the crux of the tremendous affirmative message in Dave’s astonishing book. Viva la Revolución!
Barbara E. Gibson
Professor, Department of Physical Therapy, Temerty Faculty of Medicine,
University of Toronto
Canada
November 16, 2021
