Complexities and intersections

Foucault, the professions, and the state — Technologies of discipline — Intersectionality — A third way: Bourdieu, Giddens, Bhaskhar — Postmodern thinking and physiotherapy — Criticisms of postmodernism

Beginning quietly in the 1970s, postmodernism, post-structuralism, and various other ‘posts’, have now come to play an increasingly important role in the ways people think about society – particularly in the West. More than anything, the ‘posts’ challenge the kinds of binaries that had long dominated the way people thought. Distinctions between nature and nurture, biology and society, male and female, straight and queer, right and wrong, non-disabled and disabled, good and bad, have all been the subject of skeptical inquiry over the last half century. And this has been especially true in health care, where earlier ways of thinking about society that separated those who believed in the power of social structures (functionalists, Marxists, and critical theorists), from those who emphasised people’s individual beliefs and actions (symbolic interactionists, ethnomethodologists, and phenomenologists), have been seriously challenged in recent years.

The seeds of this change began with the critical theory movement of the 1960s, with its critique of the ‘old’ ways of understanding society, and the concurrent emergence of entirely new ways of thinking about and researching the social world. The methods that had gone before (positivism, empiricism, functionalism, Marxism, existentialism, etc.), began to seem too linear and simplistic. Society had become too messy, too uncertain, and dynamic. Added to this, there was a growing sense of distrust towards traditional forms of authority (from the family, to the church, doctors, politicians and teachers), most strongly expressed within the print media, radio and, increasingly, television. This phenomenon has only accelerated in recent years with the growth of social media and the Internet. And we have also seen a growing appetite for new forms of knowledge and power that allow for more diverse forms of individual expression, no longer bound by traditional constraints around what is normal, possible, or desirable. The various ‘posts’, then, are a direct response to these tensions. They attempt to analyse and, in some cases, anticipate, the myriad ways societies now operate.

There are, perhaps, six main principles governing the ‘posts’:

1. A distrust of singular truths, particularly grand claims about the nature of reality. Jean-François Lyotard defined postmodernism, for example, as a ‘scepticism towards metanarratives’ ^[1], or a suspicion of anyone who believes they have the answer for anything. This scepticism strikes at the heart of what it means to be an expert or a privileged professional;
2. A belief that knowledge is socially constructed and mediated through language. So while ‘real’ things might exist regardless of whether we perceive them or not, we can only access these things through some kind of language;
3. That people ‘grasp for emergency supplies of meaning’ ^[2] because life is messy, complex, unresolved, ambiguous, and uncertain. Science, religion, and consumerism have all, at times, offered promises of the truth, clarity, reason, comfort, and certainty, but postmodernists argue these are only ways of ‘addressing the wound of non-meaning’ (ibid). But since true meaning is impossible to capture, our pain and frustration comes from our hubris in wanting (and failing) to command and control the world, and from putting too much faith in certainty;
4. People do not create the world, they are created by it. Ideas like personal or professional agency and ‘identity’ assume that a body or a mind creates the meaning we give to things ^[3]. But postmodernists argue that this is a fantasy of the Enlightenment. Rather, we are the effect, or the achievement of a series of competing subjects, objects, concepts, and strategies — what postmodernists call ‘discourses’ — that define who we are. This belief holds whether we are talking about individuals, groups like physiotherapists, social structures like healthcare, or concepts like the body and illness;
5. That history is not progressive. Most history is written as a story of progress, suggesting that we are slowly becoming more sophisticated and enlightened. Postmodernists dispute this, arguing, instead, that we respond to the myriad competing discourses that confront us here and now (immanence), and that reality is specific to a particular situation (contingent) ^[4].
6. We have given too much authority to the voice of experts and are too ready to accept what they say. As well as overstating the power of social structures like gender, race, and class, we have also given people’s personal accounts and opinions too much attention. Postmodernists believe that we need approaches to understanding the social world that do not default to social structures or individual narratives.

Postmodernism is, first and foremost then, an attempt to break away from the dogmatic ways we have come to think about ourselves and the world around us; to find ways to break the stranglehold of structural and interpretive thinking that says we are either governed by social structures we cannot see, or that we hold in our own hands the power to change. In the following chapter, I will look at three different approaches to this problem that have emerged over the last 40 years. Each comes at the postmodern problem from a different position. First we have the iconoclastic work of Michel Foucault, then a partial return to Chapter 4 with the development of intersectionalism, and finally, some discussion of some ‘third way’ theorists, notably Pierre Bourdieu, Anthony Giddens, and Roy Bhaskar.

Before launching into Foucault’s work, I should clarify some terminology. There is a lot of overlap in the literature between postmodernism and post-structuralism. The difference between these two is unimportant here. What matters is that they refer to something coming after an event. Postmodernism refers to something after modernism. In the case of medicine, modernism is the period since the Enlightenment that provides the foundation for Western healthcare. It gave us the ideas of reason and logic that underpins modern science, as well as the concept of the sovereign, autonomous human being that is the basis of Western beliefs about disease and illness. Some authors prefer to think we are now in a different new era, or in an era of ‘late’ modernism ^[5], but these are largely discussions for purists and need not concern us here.