Symbolic meanings in Physiotherapy

1. Symbolic meanings in Physiotherapy Hazel Horobin November 2018 The images in this presentation are shared under Creative Commons License

2. Aims • To explore ‘culture’ in ethnography • To explore the meanings held within cultures and recognise the symbolic meanings invested in everyday activities (via Geertz) • Deepen understandings of culture (Bourdieu & Nice, 1977) • Use these constructs to consider the potential meanings contained within physiotherapy treatments using ethnographic research showing the structural aspects that contain practice and the symbolic meanings it consequently represents

3. Ethnography • Anthropology is a comparative study of cultures and sociability and ethnography is a type of anthropology • Ethnography studies people in a society or culture by observing them in their natural setting • Meanings are often unspoken or implied and these implied meanings are considered symbolic https://www.sisinternational.com/expertise/resumes-of-experience/resume-of-experience-in-ethnography-studies/

4. Examples of Symbolism in Ethnographic studies Symbolic interaction theory (e.g. Geertz, 1973a) analyses the subjective meanings that people place upon things, events and behaviours (Geertz, 1973b) https://commons.wikimedia.org/wiki/File:COCK_FIGHT.JPG (Hildebrand, 2012) https://www.midwiferysupplies.ca/products/mayo-scissors-curved-5-5?variant=33692587791

5. Suggested pre reading • https://www.sfu.ca/~palys/Miner-1956-BodyRitualAmongTheNacirema.pdf • Miner, H (1956). Body Ritual Among the Nacirema. American Anthropologist 58(3), 503-507

6. Example of Symbolism Smoking (Blue et al, 2016) https://pulmaosarss.wordpress.com/2012/02/22/has-anyone-ever-explained-why-you-have-copd/ http://www.amsterdamcannabis.co.uk/lindsay-lohan-smokes-pot/

7. My research context • I taught on an MSc in Physiotherapy (2005 – 2014), where most of the students were from India. Their learning and practice customs appeared very different in the UK compared to home https://commons.wikimedia.org/wiki/File:Indian_flag_).jpg

8. Deepening understanding of culture – ‘Habitus’ • Habitus differs from the notion of ‘culture’ as shared understandings, because it represents a more complete view of the structural and environmental in addition to the social (Bourdieu & Nice, 1977) • The results were the professional understandings and beliefs around who they thought they were, what their role and function was as physiotherapists and what they were there to do with their clients

9. Pierre Bourdieu As a framework for understanding interview Data (Bourdieu, 1986 http://slideplayer.com/slide/6092297/)

10. Results • The absence of electrotherapeutic modalities within the course was a key, observable difference in physiotherapy approach in the two countries. These quotes are typical of the group: • ‘..I was expected to do er electrotherapy quite a lot [in India]..’ SB 2 • ‘..in India mostly practice is ... based on electrotherapy… I mean er here [in the UK] during my studies er we are more like into manual therapy using technique like McKenzie, Maitland so that is a change I feel has been after I have done this course..’ Nick 2

11. Meanings offered for Treatments in India • Electrotherapy as something ‘taken’ for pain: • ‘..it’s a mind-set in India that electro.., electrotherapy works ... it’s like er, a mind-set there that people more are focussed and the patient also they have bought into like er from er beginning they have been given electrotherapy and they feel that it is u.., useful..’ Nick 1 • ‘..they don’t know that it’s [electrotherapy] not curing the cause, it’s a temporary treatment. So when patients, just they come and they tell ‘I don’t want exercise, I want this [electrotherapy], this gives me relief, exercise doesn’t’, so you have to give them that then..’ Sam 2

12. Meanings offered for Treatments In the UK • Treatments were both ‘hands on’: • ‘..moving away from the electrical modalities and now being able to treat with your own hands and your own skill..’ Sue 1 • And exercise based: • ‘..I’m gonna focus more on exercises and er, mobilisation techniques as compared to modalities and er, and my reasoning is much more better now, I could reason conditions out and I could explain the patient better and explain the patient better after doing the Masters..’ Kevin 1 • Movement (and return to work) focussed

13. Electrotherapy vs. Manual therapy • Electrotherapy has declined over the last 30 years and this decline has coincided with the emergence of manipulative practices (Shah et al., 2007). • Government’s changing requirements from health services. • Figuratively they represent the aim of treatment, which is for greater joint movement and mobility.

14. The move from ‘passive’ to ‘active’? • Participants classified the change in their treatment approaches as a move from ‘passive’ to ‘active’ techniques: • ‘..in that culture [India] the patients are er, more used to a more passive kind of treatment, rather than taking control over their treatment..’ Sue 1 • ‘..I’m a lot more prone to sort of active treatment, and passive treatment like modalities now, I don’t rate the modalities er, so much as compared to the exercises..’ Kevin 1

15. Both electrotherapy and manual therapy are symbols of physiotherapeutic power • Like electrotherapy, the utilisation of manual therapy runs contrary to government requirements of practice based in scientific evidence and patient involvement in health care (HCPC, 2015)

16. conclusions • Through their narratives professional work was suffused with meanings and there existed an interplay of cultural and symbolic capital between patient and physiotherapist (Bourdieu 1986) • Depends on the context/habitus (both structural and individual issues): establishes the expected and shared meaning of treatments for the practitioner and recipients • Wider practice contexts (structural, social and political issues) shape the power relations concomitant to physiotherapy, and thereby strongly influence its practice in different locations • The patient therapist relationship has great importance

17. References • Blue, S., Shove, E., Carmona, C. and Kelly, M.P., 2016. Theories of practice and public health: understanding (un) healthy practices. Critical Public Health, 26(1), pp.36-50. • Bourdieu, P. and Nice, R., 1977. Outline of a Theory of Practice (Vol. 16). Cambridge: Cambridge university press. • Bourdieu, P., 1986. The forms of capital Handbook of theory and research for the sociology of education (pp. 241–258). R.(1974). The Power Broker: Robert Moses and the Fall of New York. • Creswell JW. Qualitative inquiry and research design; choosing among five approaches. Thousand Oaks: Sage; 2007. • Geertz, C., 1973a. The interpretation of cultures (Vol. 5043). Basic books. • Geertz, C., 1973b. Deep play: Notes on the Balinese cockfight. The interpretation of cultures, 101, pp.412-37. • HCPC. 2015. Standards of proficiency - Physiotherapists. Retrieved on 28/04/2015 from http://www.hpc-uk.org/assets/documents/10000dbcstandards_of_proficiency_physiotherapists.pdf • Hildebrand, V.M. 2012, "Scissors as Symbols: Disputed Ownership of the Tools of Biomedical Obstetrics in Rural Indonesia", Culture, Medicine, and Psychiatry, vol. 36, no. 3, pp. 557-570. • Shah, S. G. S., Farrow, A., & Esnouf, A. (2007). Availability and use of electrotherapy devices: A survey. International Journal of Therapy and Rehabilitation, 14(6), 260-264.