Body politics: a Foucauldian discourse analysis of physiotherapy practice

This thesis offers new insights into physiotherapy practice by asking ‘How is physiotherapy discursively constructed?’ Physiotherapy is a large, well-established, orthodox health profession. Recent changes in the economy of health care in developed countries, added to an increasing prevalence of chronic illness amongst aging populations, and growing public distrust for the established health professions, are now challenging physiotherapists to consider how best to adapt to the future needs of health care consumers. Little is understood about the epistemological and ontological basis of physiotherapy practice and, to date, no research has been conducted to consider how historical conditions of possibility have made contemporary physiotherapy practice possible, or how some critical discursive formations have shaped physiotherapists’ subjectivity. To explore the discursive construction of physiotherapy practise, texts were generated for analysis to reflect the multiplicity of discourses emerging at particular moments in the profession’s past and present. Michel Foucault’s theorisation of governmentality was utilised as the theoretical framework underpinning the analysis of the texts, and provided the critical lens through which discourses, knowledge formations, relations of power, technologies of discipline and modes of resistance were explored. My thesis is that the adoption of a biomechanical discourse enabled the profession of physiotherapy to establish a licence to touch people (positioned as patients) without fear of impropriety when the profession was established in late-Victorian England. This legitimacy then created the conditions necessary for the profession to establish its orthodoxy and become recognised as a principal provider of physical rehabilitation within the welfare state in the middle of the twentieth century. I argue that these rationalities, strategies and technologies were advantageous to the early development of the profession, but that they have now induced a state of torpor, ossification or stagnation among physiotherapists, precluding opportunities to engage in critical self-scrutiny. Drawing on texts generated from the emergence of a new practice that appear to be operating at the margins of legitimate and orthodox physiotherapy, there is evidence of reform taking place within the profession; that a small number of practitioners are resisting the rationalities that have previously governed physiotherapy. In analysing the actions of a clinic, called Breathing Works, the practises of clinic staff reveal some of the previously taken-for-granted assumptions about the profession, whilst also providing valuable new insights into the future possibilities for physiotherapy practise. In problematising contemporary physiotherapy practice, a space has been created to enable physiotherapists to think differently about physiotherapy’s future as a recognised provider of state-sponsored health care. Physiotherapy is a discursive construction, and a critical history of the profession – informed by the work of Michel Foucault – has much to offer physiotherapists, other health professions, health policy advisors, and sociologists of health care