What Went Wrong:

Postmodern Thought and Physical Therapy Practice

Barrett L. Dorko, P.T.

 

The Universe is not an idea of mine;

My idea of the universe is an idea of mine.

Night doesn’t fall before my eyes;

My idea of night falls before my eyes.

Apart from my thinking and my having thoughts

The night concretely falls,

And the stars’ shimmering exists like a weighable thing.

 

                                                          Fernando Pessoa

                                                         1 October 1917

 

Seated at a recent convention of the American Physical Therapy Association I heard a speaker say, “Native American Shamanism is no less valid than Western scientific thought.” This was a well-attended lecture. The speaker had a master’s degree and was a certified specialist in hand therapy. I watched as several therapists around me wrote this statement down, some nodding their assent, leaning forward slightly with expressions of encouragement for these and similar words about the theoretical basis for “mind-body” therapy.  

I will admit that I said nothing at that moment though I soon spoke to a few friends about what I’d heard. I wrote it down too, though I can’t imagine that my body language was very encouraging to the speaker. I’ve found that questioning the speaker aloud during a lecture like this gets me nowhere, so I save my public comments for a forum such as this. My thoughts at that time were the same I’ve had for quite a while. I was wondering how on earth my profession got to the point where a statement like this was common, to say nothing of the fact that my objections would be considered nothing more than a rude interruption by a member of the heartless research community. I’m not even a researcher, but I know how those who support speakers like this perceive me, and it’s not pretty. 

I left the convention, returned to my office and found three magazines waiting for me. The first, Advance for Physical Therapists & PT Assistants June 26, 2000 contained a description of a certificate program in “holistic practice” that proposes to centralize a database for the study of alternative, complementary and “less traditional” medicine. It will offer classes that formalize the study of every known method of care not currently accepted by the scientific community or (as yet) based on established principles of physical reality. Whether or not these methods are truly effective is also very much up in the air. (See Program Offers the Brass Tacks of Holism pg. 28) 

I opened the second magazine, Orthopaedic Physical Therapy Practice Vol. 12 No. 2, and found these words in an article entitled Putting the Movement System Back in the Patient: An Example of Wholistic Physical Therapy on page 16: “How we position or ask the patient to position their body has a direct and powerful effect on their spirit.” And “…you can create critical spiritual shifts by how you direct (your patient’s) movement and body position.” The author defines “spirit” as “that intangible energetic essence that has sparked our DNA since conception and will continue to do so until we take our last breath.” Altering that “intangible essence” predictably and for the good of the patient with various postures and movements is what this man’s practice is mainly about, I guess. For me, it was painful to read in its entirety, though I did it anyway. 

Growing depressed, I then opened the third magazine, and my spirits began to lift. It is interesting to note that no one had directed me to alter my posture. I suppose I began to feel better because of what I read, because of what I came to finally understand, and that, essentially, is what this essay is about. 

Postmodernism in Physical Therapy

 

The third publication I opened was The Scientific Review of Alternative Medicine Volume 4 Number 1 Spring/Summer 2000. This is a relatively new journal published by Prometheus Books that seeks to critically examine the claims and practices of, shall we say, “less than traditional” medicine and shed some light on the research and thinking done by its advocates and opponents. I’m fairly certain that many for reasons both philosophical and financial dislike it, but I find it to be a wonderful resource, and never timelier than it was that day. 

A special section entitled Postmodernism and Medicine spread out before me like a treasure. Within it I found the answer to the question that plagues me every time I come across therapy practices and philosophies like those I’ve been describing. The question is, “How did physical therapy become a place where even the most irrational and superstitious practices could easily find a home? And this despite an insurance and research industry bent on making us more evidence based.” 

The answer lies hidden in something that surrounds us, something so insidious and constant within our everyday lives that we no longer see it though it colors our actions, opinions and thoughts of reality. Like any fish constantly in the water, we can’t see the water. The answer to my question is the influence of postmodern thought. This is defined a number of ways, but most commonly as an emphasis on humans and their experience as purely subjective. This belief precludes the possibility of science discovering the objective truth. Postmodernists are suspicious of authoritative definitions and are willing to accept all worldviews as equally valid, true and worthy of investigation and use no matter the cosmology, ancient story, superstition or misinterpretation of natural events with which they may have begun. To the postmodernist, all thought is to be honored equally. Our job is to know it, not question the reasonable nature of its presumptions. Such questions, in my experience, indicate a kind of rude close mindedness. Having learned this years ago, I kept my mouth shut at the aforementioned lecture, even when the speaker said “Descartes invented geometry.” 

I think you get the idea. It might help to remember that “modernism” came into being with the renaissance and that the first real challenge to its tendency toward the scientific method was the emergence of “mesmerism.” Mesmer’s claims of the existence of “animal magnetism” were soundly debunked by a committee appointed by the French government (a committee that included Benjamin Franklin, by the way), only to reemerge in the 1970s in the guise of Therapeutic Touch. Not surprisingly, this is a favored form of practice of the founder of the “holistic” certificate program mentioned earlier.   

Postmodern thought is by no means confined to medicine. It has influenced many other disciplines and you can read a great deal more about this in the Resources section of this essay. The point I want to make here is simply this: without realizing it, the profession of physical therapy has been overwhelmed by postmodernist doctrine. Those in the forefront of this movement are probably unaware that such a thing even exists. They would read Pessoa’s poem at the beginning of this essay and simply disagree with its sentiment, that our thoughts are separate from the things around us. Instead, they would see that as a refutation of several forms of “energetic” medicine. Well, it is. 

Unless and until the subject of postmodern thought and its consequences is recognized and discussed, science will continue to have its influence and reputation dismissed as just another way of seeing the world. It will not be thought to be any more reliable or valid than some ancient form of “healing” that, in fact, never even discovered the healthfulness of simple sanitation.  

Remember, the fish don’t see the water, and it will take some daring and some willingness to risk a friendship or two with colleagues invested in alternative therapies to mention this next time you hear the kind of thing I heard at the convention or read it in our own literature. For me, being able to say, “You are the victim of postmodernism and you don’t even know it” is a distinct improvement over “You’re nuts” and I’m grateful for that. 

Now all I need is for some of my fellow fish to step out of the water with me.

 

Resources

 

Aside from the issue of The Scientific Review of Alternative Medicine already mentioned, I recommend two texts from Johns Hopkins University Press by P. Gross et al, Flight from Science and Reason and Higher Superstition.

 

There are also numerous web sites devoted to Postmodernism, its influence and its study.