The fundamental violence of physiotherapy: Emmanuel Levinas’s critique of ontology and its implications for physiotherapy theory and practice

Abstract

The fundamental role of ontology, epistemology, and ethics is widely recognised across the healthcare professions. Yet what is less known in physiotherapy is how ontology and epistemology potentially undermine the ethical intentions of our theories and practices. In this article, we draw on the work of 20th-century philosopher Emmanuel Levinas to highlight this problem. Particularly Levinas’s ethical critique of ontology and the associated notion of thematisation enable us to highlight a violence that takes place in the philosophical foundations of physiotherapy. Using the overarching aims of physiotherapy, the theory and practice of diagnosis, and the notion and enforcing of professional identities as examples, we additionally show how this violence consequently pervades physiotherapy theory and practice. By exploring a range of critical and practical implications, we finally show how an application of Levinas’s critique of ontology additionally opens toward an otherwise physiotherapy grounded in a renewed understanding of self, other, and their relation. With this, we hope to highlight the core value and critical need for a deeper engagement with the work of Levinas in relation to all aspects of physiotherapy, and particularly its understanding and implementation of ethics that is so fundamental to its practice and a cornerstone of physiotherapy education.

Environmental physiotherapy and the case for multispecies justice in planetary health

“…It does not seek to direct, intervene, or interfere with the other. In this respect, it resonates with a Levinassian understanding of the ethical relation, in that it does not seek to reduce, restrict or limit the other to any single category or mode of being: be it human, biological, or otherwise (Maric and Nicholls, 2020b), since such categorizations cleave the other away from the highly complex and dynamic reality of this symbiotic planetary existence. Nicholls (2019b) recently published an article that attempted to explore how different respiratory physiotherapy might be if it embraced its full potential and moved beyond its anthropocentric tradition.…”

“…But as has been seen in the development of patient-centered care and critical insights from gender, postcolonial, and disability theorists in recent years, health professional interventions are often far more problematic than we like to think (Burns, 2019;Johnson, 1972;Larson, 1977;Susskind and Susskind, 2015). As we have recently argued elsewhere, for example, there is a real need to adopt more passivity in healthcare to reduce a fundamental violence embedded in the quick-to-act interventionism of much of healthcare science and practice (Maric and Nicholls, 2020b).…”

“…Key to this transformation are different kinds of physiotherapy practice that privilege company and support for movement -in all its forms -without the need to direct the movement according to standardized predefined patterns and rigid norms. These need to be practices of 'making-kin' with other human and other-than-human entities, and hearing a much more dynamic multitude of voices (Maric and Nicholls, 2020b). Rather than folding these back into conventional notions of human movement, new forms of mobilization concern the provision of company and support for the other, which, as another practice of solidarity, might be referred to as accompaniment.…”

Motor control and skill acquisition in pediatric physical therapy: an enactive proposal

“…In this view, the center of knowing resides in the mind (Thornquist and Kirkengen, 2015). Related to physical therapy, the current theoretical underpinning of physical therapy education is largely organized around a biomechanical view of the body, i.e., the body-as-a-machine, detached from cultural, social, and contextual surroundings (Nicholls, 2017;Maric and Nicholls, 2020;Richter and Maric, 2022). From the Cartesian view the main property of matter/body is its spatial extension while the property of mind is its capacity to think.…”