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Special Issue Article

Postmodernism and physiotherapy research


David A. Nicholls
School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand

Postmodernism is a notion that causes as much confusion as it does consternation, yet in recent years it
has become one of the most widely debated philosophies in health care research. Based on skepticism of
grand narratives and an opening towards diversity and inclusiveness, postmodern research provides a set
of tools and some distinctive ways of thinking that encourage researchers and practitioners to critically
analyse the taken-for-granted obviousness of life. What is more, postmodernism offers a way to liberate
people to think differently about their experiences, ideas and practices. In this paper I provide a brief
review of postmodernism as a philosophy and as an approach to research. Taking as my starting point the
need for reform in the physiotherapy profession, I explore some of the key principles underpinning
postmodern research. Drawing on a case study of a recently published postmodern study, I offer a critique
of the modernist assumptions underpinning physiotherapy, and present an example of how a postmodern
study may be undertaken. Postmodernism has much to offer physiotherapy. It encourages us to ask
questions of those things that normally pass unnoticed beneath our gaze, and it calls us to examine the
discourses that have made the present possible. In examining how postmodern research may be applied
to the study of physiotherapy practice I hope to encourage readers to move away from ossified ways of
thinking and consider what might be possible if physiotherapy were otherwise.
Keywords: Postmodernism, Grand narratives, Physiotherapy, Research

Introduction be of use to physiotherapy practitioners, researchers,


There has been an explosion of interest in qualitative students and teachers. In this paper I explore some of
research in health over the last 30 years, with a vast the principles underpinning postmodernism in health
array of methodologies and methods emerging.1,2 research and offer an example of how postmodern
Phenomenology, critical theory, ethnography, dis- research may be undertaken.
course analysis, ethnomethodology, narrative analy-
sis, grounded theory, and a host of other approaches Background
cater for many of the ways in which the world has The roots of postmodern thinking can be found in the
come to be known and understood by individuals and writings of late nineteenth and early twentieth-century
groups in society. Some approaches are concerned German philosophers like Friedrich Nietzsche, Max
with how individuals make sense of their world, Weber and Martin Heidegger. What we now know of
others with the way the world is socially constructed; as postmodernism, however, owes more to a radical
some are concerned with culture, others with power, movement among French intellectuals in the 1960s
oppression and marginalization. Postmodernism is that sought to break with traditional forms of philo-
concerned with critiquing the power that resides sophy. Drawing extensively from architecture, design,
beneath the things we take for granted in our performance and visual art, music, theatre and cinema,
everyday world. It challenges our assumptions about philosophers like Michel Foucault, Gilles Deleuze,
what we understand to be true, and questions what François Lyotard, Jacques Derrida and Georges
we know and how we go about our lives, and it asks Battaille began to explore the relationships between
how the present has become historically and socially language, power, truth and subjectivity in new ways.
possible. It is one of the most recent philosophical These ways saw people not as sovereign, autonomous
and methodological influences in qualitative research originators of meaning in the world – the prevailing
and it offers some stimulating and potentially view in Western philosophy since the Enlightenment –
valuable ways of thinking and practicing that may but rather as the effect or result of social and historical
processes.3 This approach began to find favour with
Correspondence to: D. A. Nicholls, School of Rehabilitation and other writers and theorists who were attempting to
Occupation Studies, Auckland University of Technology, A-11, 90 engage with the rapidly changing world around them
Akoranga Drive, Northcote 0627, Private Bag, 92006, Auckland, New
Zealand. Email: davidnicholls@me.com in the latter part of the twentieth century.

ß W. S. Maney & Son Ltd 2012


360 DOI 10.1179/1743288X12Y.0000000045 Physical Therapy Reviews 2012 VOL . 17 NO . 6
Nicholls Postmodernism and physiotherapy research

Since the 1960s a host of new writers and theorists Skepticism towards metanarratives
have explored postmodernism.4–12 One of the most If we take these in order, the phrase ‘skepticism
fertile areas of postmodern scholarship has been in towards metanarratives’ derives from French post-
health, where traditional practices, values and beliefs modern philosopher Jean-François Lyotard whose
have come under sustained critical scrutiny.13–19 ground-breaking book The Postmodern Condition34
Among other areas, researchers and theorists have synthesized much of our present understanding of
focused on dominant discourses [The word discourse postmodernism. Lyotard expressed a growing interest
is used commonly in postmodern research where it in the way knowledge, power and truth operated in
refers to ideas and ways of thinking and practicing society: particularly those grand truths that had such
that cohere around a particular meanings.20 Thus powerful, yet subtle influences on our lives. These
the discourse of biomedicine embodies certain ways were the meta- or grand-narratives that are referred
of thinking and certain specific practices that dis- to so often in postmodernism.
tinguish it from other discourses in health care.] like For centuries, metanarratives like science and
biomedicine and on the power this has afforded religion have dominated people’s views of the world
elite professions like medicine and nursing;21,22 on and their place within it. They have guided how we
patients as health care consumers and producers;23,24 organize our worlds, what we believe to be true, how
on ways of speaking and practicing health care;25,26 we function during the day, and how we organize our
on disability and the limits of language;27–29 and on social relations, and they play an important part in
the changing meaning of bodies and embodiment defining our moral compass. We have come to believe
in an age of uncertainty and seemingly boundless in the wisdom of experts, we have learnt about logic,
possibility.30 reason and faith, and we value our autonomy and
Such is the depth of interest in postmodernism, that freedom. All of these are highly practical and com-
it has become one of the most important influences monplace hallmarks of the effects of dominant dis-
on contemporary health research.31 Postmodernism is courses upon our every-day lives.
a philosophy not a methodology thus it cannot be Biomedicine is a metanarrative that has had a
categorized as either quantitative or qualitative. Rather, powerful influence on physiotherapy’s professional
its tenets can be applied across methodologies or identity. Biomedicine is a broad term for certain ways
methods. Its focus is on an unrelenting criticism of of thinking and acting towards the body and disease
any particular claim to truth, whatever its origins. Thus, that have emerged in Western civilizations since the
every view held by patients or practitioners, every Enlightenment.35 Among other things, biomedicine
practice with its underlying belief systems, and every emphasizes the virtues of scientific objectivity, the
separation of the body and mind (Cartesian dualism),
structure and operation that is undertaken is fertile
specific aetiology (or the belief that illness can be
territory for the postmodern researcher.
traced to a malfunction within the body, rather than
Postmodern is not nihilistic, however. It is not
in ‘society’ per se), reductionism (the dividing up of
criticism for its own sake. It is, in many ways, a very
the body – and consequently health care – into
positive approach to philosophy, since it also seeks to
separate bodily systems), and the pervasive view
create space for diversity and inclusiveness. In the
of the body-as-machine.36,37 Biomedicine privileges
place of traditionally dogmatic views of the world,
certain ways of thinking (reason, objectivity, value-
postmodernists attempt to install creative uncer-
neutrality) and certain ways of practicing (assess-
tainty; an openness to new ideas, innovations and
ment, diagnosis, treatment), it defines what is normal
creativity; a playful acceptance of the productive
and abnormal, who is sick and who is well, who is
possibilities of irrational, illogical, even seemingly
mad and who is sane. It is also largely responsible for
stupid ideas.32 Regardless of this, postmodernism has
the day-to-day working of the health system (the
been accused of being little more than cynical, eso-
design of hospitals around medical sub-specialities),
teric and relativistic.5,18,33 Given the novelty and
the language of health care, and the way that health
uncertainty of postmodern research, it is useful to
care is taught.
unpack the principles that underpin postmodernism a
As well as making certain ways of thinking and
little more before exploring how postmodern research
acting possible, biomedicine makes other thoughts
in health care might be undertaken.
and practices impossible, or at least inappropriate. A
Principles of Postmodernism whole raft of ‘other’ ways of thinking about health
and illness are currently marginalized by orthodox
Two of the main principles of postmodernism research
biomedicine. Thus, complementary therapies like
are:
1. a skepticism towards metanarratives; homeopathy and naturopathy are discredited, while
2. an opening towards diversity, inclusiveness and other approaches that place a premium on cultural,
doing things otherwise ecological, mental and metaphysical understandings

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Nicholls Postmodernism and physiotherapy research

of health and illness are considered ‘fringe’ medicines. need not be the case and that all knowledge is
Biomedicine is powerful not only because of what it temporary. Drawing on lessons from history, all
makes possible, therefore, but also for what it denies. present forms of accepted knowledge are paradigms
Postmodernists are sceptical of metanarratives like that will be challenged and replaced by ideas and
biomedicine, believing that their claims to elite status understandings that will seem obvious and necessary
are, in fact, highly contextual and historically specific. to the culture that is defined by them.
In other words, they believe that the ability of a To take a postmodern position, therefore, requires
metanarrative to offer the ‘truth’ about anything is an openness to the possibility of thinking otherwise;
contingent on a specific set of social and historical of thinking in new ways about different things; about
conditions and that metanarratives are therefore creativity and innovation; about purposely thinking
much less ‘stable’ than they seem. Even our beliefs against the received or conventional wisdom; of be-
in what we think of as true or false, right or wrong ing open to the impossible, the antithetical, even the
are the ‘effects’ of these metanarratives and are likely ridiculous. In contemporary Western societies, this
to change as old narratives are replaced by new ones. means acknowledging our debt to reason and logic
To go even further, postmodernists question whether and sometimes thinking against the constraints they
people are actually the autonomous, independent impose. In biomedicine this may involve critiquing
originators of thought and action, as science has evidence-based practice, randomized controlled trials
taught us to believe, and not themselves the histori- and the other hallmarks of reductionism, positivism
cally and socially contingent product of metanarra- and Cartesian dualism that operate so powerfully in
tives. Thus, rather than humans being the originators health care, and promoting new directions with a new
of knowledge and understanding, we become ‘our- imagination.
selves’ as the result or effect of a wide range of At times, postmodernism has been criticized for
competing and overlapping discourses. being nihilistic – for only promoting criticism (and
Not surprisingly then, postmodern research has a particular form of criticism that never wants to
had a mixed reception among researchers, orthodox propose solutions because they themselves might
scientists and social commentators who find some of imply a fixed position that draws the critical gaze of
its principles unpleasantly destabilizing. Postmoder- other postmodernists).38 However, it may be argued
nism represents a significant challenge to ideas that that this is a misreading of the philosophy. The
many of us take for granted, such as our beliefs in the postmodernism of Foucault, Deleuze, Derrida and
value of logic and reason, rational ideas and the others is not nihilistic. Indeed in destabilizing pre-
objectivity of empirically-supported evidence. Post- viously taken-for-granted assumptions, postmodern-
modernism sets out to question all of these assump- ism may represent one of the most significantly
tions and bring to the surface ideas that run counter positive forms of philosophy. It opens space for a
to biomedicine and modernism. thousand alternatives and places no arbitrary restric-
Importantly, postmodernists do not attempt to tions on the appropriateness or suitability of these
decide whether metanarratives like biomedicine have alternatives. It makes no claims to any moral authority
been merely good or bad for us. They do not seek to to judge whether something is right or wrong. As
resolve the question of whether the discovery of germ Gilles Deleuze and Felix Guatarri wrote in their book
theory, for example, has been a social bane or a boon, Thousand Plateaus, our task is to create the condi-
or whether hospitals have improved our health or tions where it might be possible to bring ‘something
made it worse. Arriving at such conclusions would incomprehensible into the world’.39 How, then, might
only serve to replace one metanarrative with another. this relate to physiotherapy?
The task of the postmodernist is not to resolve or
conclude anything, because to do so would risk The Breathing Works Study
closing off options for thinking otherwise, which To illustrate how these two principles can be applied
brings us to the second principal or postmodernism. in research, I have outlined below an investigation
into the work of a pioneering clinic that was looking
Openness towards diversity, inclusiveness and to practice physiotherapy in some interesting and
doing things otherwise
innovative ways.40
The second principal of postmodernism derives from
a belief that there are no absolute truths; that Background
knowledge is unstable, historically and socially con- In 1999, a private clinic was set up in Auckland, New
textual, and thus likely to be different tomorrow to Zealand with a focus on the treatment of breathing
what it is today. While certain forms of knowledge pattern disorders. The clinic, called Breathing Works
can become dominant and seen as both obvious and [Permission from the founders of the clinic and ethic
necessary (as biomedicine has been seen for much of approval has been given by the *** Ethics Committee
the last century), postmodernism reminds us that this to use the real names of the clinic in this paper.], was

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remarkable in a number of ways. Firstly, the clinic’s The founders of the clinic had promoted them-
focus was on a relatively new and hitherto largely selves aggressively through local and national media
unknown clinical problem. Breathing pattern disor- and had been very successful. It was normal for them
ders (BPDs) – commonly known as hyperventilation to see more than 1000 new patients each year and
syndrome – are very common problems in the general clients ranged from elite sports people and company
public, but in the late 1990s it was rare for a re- executives, to child performers and stressed middle-
spiratory physiotherapist to encounter them in prac- aged men and women with very rigid abdominal
tice. Patients with BPDs often present with diffuse, walls. Patients often went from having quite debili-
non-specific symptoms, including pain, anxiety, head- tating symptoms to being ‘cured’ within 3–5 visits.
aches, palpitations, a sense of being ‘spaced out,’ chest The two founders of the clinic grappled with the
pain sufficient sometimes to believe they are having a desire to retain their physiotherapy identity and to
heart attack, and shortness of breath. Patients often take advantage of the benefits of their orthodox status
spend a great deal of time and money investigat- (by continuing to take medical referrals, for example),
ing their symptoms and find the condition deeply but at the same time, they actively pursued appro-
debilitating. aches that allowed them to benefit from markets more
Conventionally, patient assessment and treatment of familiar to alternative and complementary thera-
people with breathing problems takes place in large pists. They published some very successful self-help
tertiary care centres, and to a lesser extent in commu- books, for example, rarely mentioning that they were
nity clinics, and focuses on either acute respiratory physiotherapists.41–46 They defined new terms for
problems like asthma, lung infection and post-operative classical breathing techniques and colonized practices
pulmonary complications, or chronic disorders like from Tai Chi, yoga, Zen meditation and a range of
chronic bronchitis, emphysema or cystic fibrosis. Typi- other breathing techniques. They still used evidence to
cally, respiratory physiotherapists see patients with pre- support their practices, and published widely in this
existing organic lung disease on hospital wards as part area too, but this took second place to a much wider
of a large respiratory care team. Thus when BPDs view of what physiotherapy was. Not unexpectedly,
began to appear more frequently in the late 1990s, most they came into conflict with elements within their
patients were seen alongside patients with organic lung profession, who found it difficult to recognize many of
diseases within the tertiary health care system. The the new practices they espoused. And yet in recent
founders of Breathing Works recognised early, how- years a growing body of practitioners have sought to
ever, that these patients were different and sought a new explore similar territory to Breathing Works and test
model of practice that became the focal point for this the margins of orthodox practice.47–51 The clinic,
study which explored how new practices were emerging therefore, represents a growing trend within the pro-
in physiotherapy.40 fession, which raises some interesting questions about
Firstly, the patients attending the Breathing Works what these clinics are doing, and what they are
clinic were outwardly healthy. They bore none of the deviating from.
cyanosis, thoracic deformity or respiratory muscle
fatigue seen in patients on the medical wards. Indeed Purpose of the study
patients coming to Breathing Works rarely had an Given the innovative and interesting deviation from
organic lung disease, and if they did, it was not the the norm being offered by the Breathing Works
principal reason for attending. The clinic they came clinic, I was interested to investigate how the clinic
to was located in a converted house in a very wealthy was different; what discourses were influencing the
suburb of Auckland, and a deliberate attempt had founders to branch out from conventional respiratory
been made to design the clinic with a different physiotherapy practice and do things differently; in
aesthetic to that found in hospital. The clinic rooms what ways were they resisting ‘traditional’ modes of
were bright, relaxing and colourful. practice; and what might their innovative approaches
While the practitioners in the clinic used some might now make possible for others in the profession.
traditional assessment methods (questioning, palpa- Almost as interesting, however, was the question of
tion, spirometry and pulse oximetry, for example), what it was that they were deviating from? If
there was no undressing to auscultate the chest, or Breathing Works was resisting traditional practice,
blood gas analysis. In fact it seemed that efforts had what was it that defined traditional practice in the
been made to dilute some of the more ‘clinical’ dimen- first place? In other words, by examining something
sions of assessment. Technical equipment, where used, that deviated from the norm, could we not learn
was concealed from view and many of the signs of something about ‘the norm’ that had previously been
clinical practice (anatomical wall charts, mechanical hidden from view? By examining how Breathing
treatment beds, etc.) had been removed or covered Works was different, could we establish something
up. about what had come to constitute orthodox

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physiotherapy practice in the first place? These Objects


questions formed the basis of a study that drew There are two meanings of the word object that we
extensively on the writings of postmodern philoso- must consider here. There are the objects that form
pher Michel Foucault to provide the analytical lens the everyday fabric of our lives that tell us so much
with which to ‘read’ the data. A more detailed about the discourses that define ourselves (stetho-
summation of the study can be found here.40 scopes, treatment beds, street signs, etc.), and there is
a second, equally important notion of an object being
Methods of data collection the target of someone’s interest. When a physiothera-
Because postmodern research is concerned with the
pist sees a patient, for instance, they become the
way discourses influence how we think and practice,
object of the therapist’s gaze; they are what the
it often begins with an examination of what currently
therapist observes and takes interest in. The patient
constitutes the ‘real world’ for the person or group of
(or their swollen knee, diseased lung, or dysfunctional
people being studied. Postmodernists believe that the
arm) becomes the object of interest. Postmodern
traces of powerful discourses can be found in the
researchers constantly question why the participants
way we go about our day-to-day lives, and so data
in the study privilege some objects and not other.
collection often begins with an interrogation of things
Postmodern studies, therefore, often focus on objects
that form the common fabric of our lives. The key is
as the things that give meaning to our practice.
to maintain a sceptical attitude towards the world
one is examining. Postmodern researchers are con- Concepts and strategies
stantly questioning the things that seem obvious to People have ways of working and ‘performing’ their
the participants in their study. A participant might practice that are at times unique and at other times
use a stethoscope and believe this to be the most stereotypical. Postmodern researchers are always look-
obvious and natural way to listen to lung sounds, for ing for the discursive influences on people’s conduct and
example, but the researcher must ask why is this so are particularly concerned with the kinds of knowledge
obvious (as Foucault did when he critiqued René that people valorise and the truths that they hold to.
Laennec’s invention as a means of keeping patients Again, postmodernists believe that what some people
‘at arms length’ in his book The Birth of the Clinic).52 called the truth are the effects of historically and socially
Or they may have unconsciously designed their clinic contingent discourses, and it is the interrogation of
to be less sterile and ‘clinical’ without realizing that these discourses that is the real purpose of our
their actions express powerful forms of resistance. investigations.
Gathering data in postmodern studies often begins, Returning to the Breathing Works study, I used
therefore, with everyday practice. Many Foucauldian some very familiar methods of data gathering to
studies make the complexities of this a little easier by identify the subjects, objects, concepts and strategies at
focusing on four main aspects of everyday life: play. Non-participant observation, document analy-
subjects, objects, concepts and strategies. sis and interviews are all well-established qualitative
methods, and, as with all qualitative studies, the
Subjects variations in the ways these methods are used lies in
Foucault was interested in how people became the underlying philosophy that drives the study. The
‘subject’ to particular discourses and the machinery non-participant observations I undertook involved
of power that made this possible. Foucault radically spending a number of days watching different ther-
redefined how people thought about power, arguing apists within the clinic during their assessment and
that it was not simply a form of oppression that one treatment sessions. I spent time observing the client/
person could possess at the expense of another. patients interacting with the other staff – particularly
Rather, power was a positive, all-pervasive influence in the reception area. I spent time exploring the
on us all; a force that defined what we thought and environment of the clinic and its surrounding area. I
how we acted. This revised notion of power is a part also worked for the clinic for a time as a respiratory
of most, if not all Foucauldian studies. Foucault physiotherapist and undertook participant observa-
believed that people go through their lives making tions based on my experiences as part of the staff team.
decisions and doing things as a result of competing The documentary analysis was probably the largest
discourses. We can study underlying discourses, and and most time consuming aspect of data collection.
the mechanisms of power that make them possible, I tried to find any and every form of text through
by beginning with how people act and what they which the clinic and its founders consciously or
choose to do. Postmodern studies often start by unconsciously expressed their purpose. I looked at
asking who are the subjects in this study, and how is the seven self-help and professional books produced
their subjectivity being expressed by the way they by the founders; more than 50 promotional inter-
think and act? views and media pieces either written by or about the

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founders and the clinic; I looked at promotional links were made back to the writings of Foucault and
flyers, clinical notes and information sheets, and any others who had used Foucault’s ideas. I drew heavily
other form of text generated by the clinic that might on the work of people like David Armstrong, Julianne
speak about their difference with conventional Cheek, Dave Holmes and Sarah Nettleton, who had
physiotherapy. done similar investigations in dentistry, medicine and
I also undertook semi-structured interviews with nursing.54–64
all the staff in the clinic and kept field notes of Slowly, analytical themes emerged that had their
conversations and verbal remarks made by the clinic origins in the practices of the therapists at Breathing
staff. The interviews were focused on the individual Works, but could be linked directly to particular
practitioner’s beliefs about their practice and the notions of discipline and governmentality articulated
purpose of the clinic. All of the data from the by Foucault. What became clear was that Breathing
observations, document analysis and interviews were Works’ resistance was directed at orthodox phy-
converted to texts in the form of field notes, siotherapy. What I needed to establish now was how
transcripts or text copies and data analysis began as the discourse of orthodoxy functioned in mainstream
the texts began to accumulate. physiotherapy, and so a second, larger study was
undertaken to look at the ways that orthodoxy
Methods of data analysis influenced physiotherapy practice in the UK and
While the methods of data collection may be
New Zealand during the twentieth century. This study
common to many forms of qualitative research, the
formed the basis of my doctoral thesis [More details of
methods of analysis used by postmodern researchers
the method of data analysis used in the study can be
are quite particular to the particular philosophical
found in a paper that reported the findings.65 And a
position one is taking. For this study, I drew heavily
more detailed explication of Foucault’s methods of
on Michel Foucault’s work on governmentality and
data analysis can be read in the works of Hook,
technologies of discipline. There is not space to
Danaher et al, and Tamboukou].66268
explore these concepts in detail here, other than to
say that I drew heavily on particular strategies such Outcomes
as examination, normalization and surveillance that The analysis of the study reflected the goals of
Foucault argued had become important means of postmodern studies in a number of ways. Firstly, it
disciplining and governing the population over the challenged some of the metanarratives that had his-
last three centuries53 [For a general introduction to torically come to underpin physiotherapy practice. It did
Foucault’s work, see Ref. 17]. Defining the philoso- this in two ways; by exploring some of the ways in which
phical lens through which one ‘reads’ the data serves the physiotherapists at Breathing Works were func-
at least two purposes: firstly, it enriches the analysis, tioning differently to mainstream physiotherapy, and
allowing the researcher to explore themes and ideas secondly, by uncovering some of the ways in which
that go beyond the obvious and everyday, and orthodox physiotherapy was being discursively con-
secondly, it helps the reader understand how the structed as a profession. If we unpack these outcomes
author arrived at their particular conclusions. Because in a little more detail, the study showed that the
qualitative research is so diverse, there should always physiotherapists at Breathing Works were influenced by
be some clear statement of the researcher’s philoso- a rejection of traditional biomechanical discourses, and
phical standpoint. operated their clinic as a form of resistance to orthodox
In this study, I was interested in how Breathing practice. Everything from the design of the clinic space
Works was striking out against the particular forms to the way patients were assessed and treated spoke of a
of discipline and governmentality favoured by ortho- challenge to conventional ways of doing things.
dox physiotherapy, and what their resistance revealed Although many of the changes made did not operate
about the metanarratives underpinning traditional at a conscious level, an un-orthodox approach was
practice. As with most forms of qualitative data inflected in virtually every way in which the clinic
analysis, the texts were read and an inductive process functioned, from the way that the practitioners thought
of theory building was begun. As I generated texts about breathing problems to the everyday operation of
from my observations, interviews and documents I the clinic.
began by identifying the subjects, objects, concepts Identifying Breathing Works’ resistance also served
and strategies at play. Some texts spoke more power- a second purpose, however, and this was to make the
fully about the way Breathing Works was resisting discourses that defined orthodox physiotherapy more
orthodox physiotherapy, and some texts revealed ways visible. There is an analogy here to the way in which
in which the participants in the study and physiothera- photographers sometimes view images. Sometimes a
pists generally used disciplinary strategies to govern photographer focuses on the object of the image in
their conduct. These texts were read in more detail and the foreground, and at other times they focus on the

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Nicholls Postmodernism and physiotherapy research

space around the object in the foreground. Because of Significance


its resistance, Breathing Works stood apart from Postmodern studies look at the material effects of
orthodox practice and so came to the foreground. discourses in the present and look to trace their
Having defined the foreground and unpacked some historical antecedents. In other words, they are
of the forces that were holding Breathing Works concerned with how it has become possible to think
there, my attention then turned to the ‘negative space’ and act the way we do. Physiotherapy has never
around Breathing Works that was occupied by claimed to be a universal solution to people’s suffer-
conventional physiotherapy. In other words, conven- ing. It is a partial response to a specific set of largely
tional physiotherapy becomes easier to see – more physical impairments suffered by people, and it has
obvious – by first examining those things that are in been remarkably successful in offering therapeutic
direct resistance to it. and rehabilitative solutions to a range of health
Foucault’s own writings emphasized the need to problems. However, it is only one solution among
focus on modes of resistance as a starting point for many, and probably neither the best nor the most
inquiry, arguing that resistance exists in dynamic appropriate in every case of bodily dysfunction,
tension with power, and that this tension makes it injury or impairment, pain or movement disorder.
possible for new forms of knowledge to emerge; Where postmodern research comes into its own is in
asking how, given the myriad ways in which health
It is not the activity of the subject of knowledge that
produces a corpus of knowledge, useful or resistant and illness are experienced by people, has physiother-
to power, but power-knowledge, the processes and apy become such a dominant force in orthodox
struggles that transverse it and of which it is made physical rehabilitation? How has this become histori-
up, that determines the forms and possible domains cally, politically and socially possible? And impor-
of knowledge.53 tantly, how is the profession being forced to change
As with most forms of qualitative research, the in the early years of the new millennium?
aim is to generate theory that has relevance for Postmodern research is neither esoteric or engaged
other contexts and other situations. In this study, in high-minded trivialities,53 but rather it is concerned
the primary outcome was a greater appreciation with the every-day practices that reveal the matrixes
of some of the discourses that had underpinned of power, knowledge and discourse that are working
physiotherapists’ orthodox approach to practice. It away silently behind our every action. As a result of
became clear how historically stable physiotherapy this study, we have made some pragmatic and highly
had been as a profession and how its orthodoxy significant changes to the undergraduate physiother-
had been inscribed in every facet of its professional apy programme at AUT University in Auckland,
identity. In time, it would become clear that some New Zealand; reconstructing the curriculum from the
of the disciplinary strategies and approaches that bottom up and undertaking a root-and-branch review
Breathing Works was now resisting (like the of how we have traditionally taught students. We have
profession’s century-long affinity with biomechani- moved towards a more embodied view of health in
cal ways of thinking about health and it’s close place of the traditional biomechanistic curriculum;
relationship with orthodox medicine, for example), integrated pure sciences into clinically applied areas;
had echoes in the very first actions of the founders emphasized the humanistic and socio-political dimen-
of the Society of Trained Masseuses back in sions of practice; made the students more aware of the
1894.69 discourses that have driven the profession in the past;
As well as generating new theoretical understand- and we have sought to do this without losing any of the
ings that could be applied to other studies and other vital features of physiotherapy that have defined our
contexts, postmodern studies also create a space in profession in the past. We began the curriculum review
which it is possible to think otherwise. By offering a process in 2007 and have spent more than 1000 hours
critique of orthodox physiotherapy, and by showing in debating, discussing and developing the pro-
one way in which new modes of practice may be gramme. Our first cohort of students in the new
operating, postmodern research can serve to encou- programme will graduate at the end of 2013.
rage greater diversity in research and practice. There We have also begun a funded research programme
is clearly a political motive here, since postmodern looking more widely at ‘bleeding edge’ physiotherapy
research is constantly striving to create space to practices; using the Breathing Works study as a
think differently. As Foucault himself said, ‘I don’t methodological template for our methods of data
write a book so that it will be the final word; I write collection and analysis. We hope that this reveals
a book so that other books are possible, not some new and interesting ways in which physiother-
necessarily written by me’.70 How, then, did this apy practices are testing the margins of orthodoxy.
study open a space for new ways of thinking in my Our hope is that we challenge registration boards,
own practice? physiotherapy schools, and individual practitioners

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Nicholls Postmodernism and physiotherapy research

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