A few weeks ago a facebook post by Mike Stewart and a blogpost by David Nicholls were each looking at the question of 'What lies at the heart of physiotherapy?' in their own way. Being a topic I am really interested in, I thought I'd chip in myself and do the arguably unphilosophical thing of providing a kind of shorthand answer to the same question inspired by Emmanuel Levinas, the key philosopher that I have drawn on in my doctoral thesis.
Emmanuel Levinas has published a large body of dense philosophical works that is impossible to deal with briefly in any way that would do it justice. Yet his work is also famous for continuously revolving around one simple, though incredibly profound sensibility that he explores 'with the infinite insistence of waves on a beach, return and repetition, always, of the same wave against the same shore, in which, however, as each return recapitulates itself, it also infinitely renews and enriches itself' (Derrida, 1978). So to keep it really short, I will extrapolate from his work quite bluntly and directly apply it to the field of physiotherapy. Even though neither healthcare nor physiotherapy where Levinas's fields of interest, his central point then is that...
...it is the relationship with the other human that lies at the heart of healthcare.
Levinas would also refer to this relationship as the ethical relation, or even more poignantly, ethics. I will say right away that I do think that if you are a veterinarian you could of course easily swap the word human for the word animal. And in fact, Levinas's primary focus on human relations has been criticised and debated extensively, so there is a lot of leeways here to think about different conceptions of who or what might be considered 'the other' (Guenther, 2009; Kalmanson, Garrett, & Mattice, 2013). But the more critical, first point to note is simply that, in following Levinas's philosophical investigations, it is the relationship, the ethical relation, or ethics, that lies at the heart of healthcare, and therewith also medicine, physiotherapy, Shiatsu, TCM, psychotherapy, you name it.
This point has already been taken up by other researchers investigating the implications of Levinas's work to different healthcare professions (Clifton-Soderstrom, 2003; Kunz, 2007; Nortvedt, 2001). Going forward, I also hope to gradually add to our understanding of his work with regard to physiotherapy, and a range of other fields that I have been quite involved in over the last 20 years, including qualitative healthcare research, Shiatsu, Zen-meditation, the martial arts, etc. For the time being, however, I will leave it here, and share just one more paragraph by Alphonso Lingis with you.
The paragraph might seem a bit lengthy, but I think it is worth taking some time for and I have been and continue to be hugely inspired every time I read it again, so I hope you will enjoy it too. To give you some background, Lingis is an inspiring philosopher and writer himself, as well as one of the foremost translators of Levinas's work into the English language, so the quote is really great in more ways than one. I really like it because implicitly reiterates the central sensibility of Levinas's philosophy in a beautiful and poetic way, but also builds on this and paints an inspiring vision of its practical implications for the art of healthcare practice. So here it goes...
"What the face of the other asks for is not the inauthentic and inauthentifying solicitude with which I substitute my skills for his, take over her tasks for her, view the landscape for him, formulate the answers to the questions in her stead. He does not seek his or her contentment in the content that will satisfy his needs and wants, which I can supply from my place and my resources and with my skills – the contentment which, when he has been displaced by me and disburdened of his own tasks, will leave him only the weight and depth of the inorganic. In seeking the support of my upright stand on the earth, the agile luminousness that shines in my eyes, the warmth in my hands, the ardour in my face and the spirituality in my breath. The other seeks the pleasure that is enjoyment in, involution and the dying in, the elemental. The other seeks the contact and the accompaniment" (Alphonso Lingis, 1994, The Community of Those Who Have Nothing in Common, p. 131-132).
It goes without saying that just quoting this paragraph and Levinas's central theme leaves a lot of questions unanswered in regard to the things they propose and that would need to be addressed more fully. These include, for example,'How exactly are we to understand this ethics or ethical relation?','How are we to refrain from substituting our skills for another's?', 'How are we to provide this contact and accompaniment, and what exactly are they?', 'What kind of healthcare (physiotherapy, etc.) are we left with if we were to truly acknowledge and put this ethic at the heart of our practice?', and 'What does it mean for the education of future healthcare professionals if we put this ethic at the heart of our work, and maybe even at the heart of our educational programs and methods' and many many more.
Whatever the answers to these question might be though, I find it really exciting that it is even possible to ask these questions. And the prospect of what might be possible in answering them inspires me enough to put Lingis's quote at the forefront of this page here, matching the fact that all this keeps coming up as a guiding light in much of what I keep exploring. Maybe you'll find something of value in it too.
Filip Marić (PhD)
Bergo, B. (2007). Emmanuel Levinas. In E. N. Zalta (Ed.), The Stanford encyclopedia of philosophy (August 2010). Retrieved from http://plato.stanford.edu/entries/levinas/
Clifton-Soderstrom, M. (2003). Levinas and the patient as Other: the ethical foundation of medicine. The Journal of Medicine & Philosophy, 28(4), 447-460. doi:10.1076/jmep.28.4.447.15969
Derrida, J. (1978). Violence and Metaphysics: An essay on the thought of Emmanuel Levinas (A. Bass, Trans.). In Writing and difference (pp. 97-192). Chicago, Il: University of Chicago Press.
Field, M., & Levinas, E. (1993, June 29). Interview with Levinas (Video file). Retrieved from http://www.youtube.com/watch?v=Zvnk6moRmEA
Guenther, L. (2009). Who follows whom? Derrida, animals and women. Derrida Today, 2(2), 151. doi:10.3366/E1754850009000499
Kalmanson, L., Garrett, F., & Mattice, S. (Eds.). (2013). Levinas and Asian Thought. Pittsburgh, US: Duquesne University Press.
Kunz, G. (2007). An Analysis of the Psyche Inspired by Emmanuel Levinas. The Psychoanalytic Review, 94(4), 617-638. doi:10.1521/prev.2007.94.4.617
Lingis, A. (1994). The Community of Those Who Have Nothing in Common. Bloomington and Indianapolis, IN: Indiana Universtiy Press.
Maric, F. (2017). Physiotherapy and Fundamental Ethics - Questioning Self and Other in Theory and Practice. Auckland University of Technology (AUT), Auckland, NZ. Retrieved from https://aut.researchgateway.ac.nz/handle/10292/11051
Nicholls, D. A. (2018) What is at the heart of physiotherapy? Retrieved from https://criticalphysio.net/2018/10/10/what-is-at-the-heart-of-physiotherapy/
Nortvedt, P. (2001). Clinical Sensitivity: The Inseparability of Ethical Perceptiveness and Clinical Knowledge. Scholarly Inquiry for Nursing Practice: An International Journal, 15(1), 25-43.