We go toward the most unknown and the best unknown, this is what we are looking for when we write. We go toward the best known unknown thing, where knowing and not knowing touch, where we hope we will know what is unknown. Where we hope we will not be afraid of understanding the incomprehensible, facing invisible, hearing the inaudible, thinking the unthinkable, which is of course: thinking. — Hélène Cixous¹

This is an exercise in writing, not to be interpreted and understood, but to produce something which is affective. “… all mistranslations result in beauty. This is a good way to read: all mistranslations are good”². A staccato, “roughened” rhythm in writing removes automatism in thought, creates a straining in knowledge between what is known and not known: “a straining of one’s whole language toward something outside it.”³ This is an attempt at bilingualism, a minor use of language, a stammering: “being like a foreigner in one’s own language. Constructing a line of flight”². With enough resistance and friction, I hope “…a spark can flash and break out of language itself, to make us see and think what was lying in the shadow around the words, things we were hardly aware existed.”³ Nothing interesting begins with knowing, but with not knowing. This is an attempt to produce a little machine which plugs into other little machines, producing flows that can “…bring things to life, to free life from where it’s trapped, to trace lines of flight. “³

Art is fundamentally ironic and destructive. It revitalizes the world — Viktor Shklovsky

Why Betray Physiotherapy?

Every field needs a bit of betrayal - a bit of Judas - if it desires to have movement⁴. Complacency, conservatism, and dogmatism opposes change and the new. Writer Jorge Luis Borges imagined a Judas who he describes as intuiting the necessity of the divine plan and thus the crucifixion to incite a rebellion⁵. He describes Judas as sacrificing his own reputation for the divine plan. God became fully incarnate, not through Jesus, but through Judas.

My betrayal is an intentional repealment of my discipleship, no longer being a follower of Physiotherapy as it currently stands. However, this is not an act of hate but an act of love. I believe in physiotherapy. I believe it can be better. I believe that a new direction might lead to movement with greater potential.

This critique elucidates the ethical and political reasons why radically cutting ties with a number of the philosophical underpinnings of the profession and becoming a traitor prophet might be necessary for physiotherapy.

The Evangelical Fundamentalist Physiotherapists

Believers in “Evidence-Based Practice” have discussed at length how a relatively sizable proportion of the profession practices using outdated modalities and rituals despite overwhelming evidence that many of these interventions are no better than placebo⁶. Snakeoil Salesman. They insist “I see it work!” as they continue their faith healing.

Thank you Plato! It is the ontological obsession with identity we take for granted which has led us to this cal de sac of thought.

Posing motionless like physiotherapists, awkwardly holding a strained smile for a lifetime, waiting for God knows who to take our picture hoping we fill the empty frame.

Like Sartre’s Waiter with Bad Faith, we act inauthentically, by yielding to the external pressures of society to adopt false values and disown our own innate freedom as sentient human beings. As a physiotherapist our movements and conversation might be a little too “physio-esque”. Our voice oozes with an eagerness to inform, correct, and educate; we demonstrate exercises rigidly and ostentatiously; our movements a little too precise, a little too certain. It is a clear give away, our exaggerated behaviour illustrates that we are play acting as a physiotherapist, as an object in the world: an automaton whose essence is to be a physiotherapist — ⁷

Standing on their mound of meta-analysis, randomised control trials, and Cochrane reviews, the post-positivists point and laugh. “How narrow-minded!” they remark contemptuously: “if only they could question their own fundamental beliefs”⁶.

“Science is the Way to Truth!,” they prophecy. “We can all achieve enlightenment, just give up your sinful flesh, your false perceptions, your ways in the world, your biases, so that you can see clearly.”

Truth, pure Truth, is thought of as having asymptotic fidelity which we can approximate when we exorcise our sinful corporeal selves with the double-blind randomized controlled ritual. It will wash away our “faulty subjectivity” and lived experiences so we can get at “the things in themselves”⁸. Truth is omnipotent, omniscient, omnipresent, all hail.

How much easier would it be if humans stopped making the world filthy with their lived experiences, ugh.

A New King

We constructed a hierarchy, an ontology of transcendence, and rendered ourselves subordinate to God who we placed on an imaginary throne. Having become enlightened, now a scientific people, we thought God a figure much too archaic and primitive for our taste. We overthrew the king but left the phantasm of the throne. Once empty, Truth crept onto the already warm comfortable seat. So familiar and recognisable, we let Truth stay.

Although the symbols have changed, our underlying ontology (belief apparatus) has remained much the same.

We cannot escape our essentialist history. Scientism is the new Being of God. “With enough inquiry we will eventually discover how things are in themselves” it insists. Through our ontology of being, we view Truth, Morality, and Justice as eternal, unchanging, and objective; out there somewhere and merely needing to be uncovered.

The evidence-based practice denomination and their essentialist agenda asks “what are human bodies actually and essentially like?” bringing with it assumptions that there exists a normal and ideal body we ought to strive for. Healthcare providers have the power to be the arbiters of bodies and minds. We sort the ideal from the non-ideal. The normal from the abnormal. The compliant from the deviant. The Christ-like from the not Christ-like.

We’re told we can know the world if we granulate it and study its little bits. Bodies and their bits. We can fix it once we find out where the screw fell out. To stop and measure, we need a world that stands still and we need concepts which can contain the world. But concepts solidify reality; they fix between rigid outlines like a camera freezes reality on the surface of the paper. To define is to confine. Concepts deform reality; reality, in its continuous movement, is richer than any concept. To quantify we need to create immobilities of the fundamentally mobile. We solidify flows⁹. When we ask wave-like questions we get wave-like answers and when we ask particle-like questions we get particle-like answers.

Very pragmatic indeed but we need to acknowledge immobilities where they exist. But devoted to our “models of health,” we are sat gnawing on the menu - having mistaken it for the meal.

This is our prerogative - qualifying the qualitative. We all swim in the waters of post-positivism, but no one knows they are wet. The same form, different content. Verifiability, falsification, and replicability are the new commandments and Cochrane reviews are the books of the bible. We follow our Messiah, Evidence-based Practice, he will lead us to Truth and it is only in Truth that we can ever be whole. From John 8:32 to John et al, 2008. As long as there is an ontology of Being and transcendence, every generation will have its religion.

Atheism is not so different from theism. It is a matter of preference for a God Being or a Truth Being.

“God is dead. God remains dead. And we have killed him. Yet his shadow still looms”¹⁰. God’s not dead, he wears a different crown.

(I feel compelled to defend myself and explain that I am not “anti-science”. (Why do I feel compelled to assure you I am not “anti-science”? What repercussions do I fear? Is this what self-regulation looks like? The panopticon perhaps Mr. Foucault?¹¹. What I am, however, is anti-fascist. Evidence-based medicine has a pernicious kind of micro-fascism that holds us captive ¹¹. But I guess that is the nature of the beast. Categories and identities make us comfortable.)

Enough of Socrates!

We dehydrated and dissected the body and embalmed it with the physiotherapy “regime of truth”¹¹. This taxidermied body did not sit well with those still living so we responded with “person-centered care”. But, person-centered care is a trojan horse that also infiltrates patients with the physiotherapy agenda.

If we obtain “buy-in”, if we lead the proverbial horse to water, maybe they will drink the stupefacient. We need to listen, foster trust, empathy, and care, so that we can lovingly show them the Truth. Educate them into submission. Tender fascism. “But hey, you win some and you lose some. You can’t fix everyone. They might come back in a few years with greater readiness for change.”

Love the sinner, not the sin!

Our words percolate through the husk of the person whom the dogmatic image of physiotherapy has emptied out. We now provide only that which benefits the profession: sick bodies and healthy bodies, predictability and conformity. Like Dr Ioannidis I am curious to know if evidence based practice will continue to lead “to more medicine, even if this means less health”¹².

As it stands, physiotherapy does not disturb thought. It keeps us very busy engaging our faculties in activities that refer back to objects of recognition¹³. Thought is filled with no more than an image of itself and its own internal logic, it recognises itself the more it recognises things¹³.

Deleuze insists that conformism of thought wed to representation and recognition has left us virtually no tools to break with that which everyone already knows⁴.

“The exercise of thought thus conforms to the … dominant meanings and to the requirements of the established order.”² Physiotherapy thinks for physiotherapists. It gives us norms, rules, and complicity. An image of thought.

One of the moral diseases we communicate to one another in society comes from huddling together in the pale light of an insufficient answer to a question we are afraid to ask — Thomas Merton¹⁴

An Immanant Creator

To be a creator is a “process of ‘becoming’ – the what might/could be – the creation of what is not yet, is achieved through thinking in new, perhaps previously unimagined, modes of thinking”¹⁵. The creator “will be destructive, will affirm difference, and will exist in chaos. They will reach into the unknown and produce what is unrecognizable.”¹⁵ A creator who is the same, creating nothing new, is no creator at all. The true Creator is never the same but always different. Not transcendent, but immanent. A theology of radical inclusion of difference (the sick, the outcast), not the exclusion of difference. To affirm difference is to affirm life.

To affirm is not to bear, carry, or harness oneself to that which exists, but on the contrary to unburden, unharness, and set free that which lives — Gilles Deleuze¹⁶

After all, it was Paul who in a moment of lucidity denied an ontology of identity (transcendence) for one of difference (immanence) allowing the possibility for the “new”: “Do not lie to each other, since you have taken off your old self [transcendence] with its practices and have put on the new self, which is being renewed in knowledge in the image of its Creator [Difference in itself]. Here there is no [identity] Gentile or Jew, circumcised or uncircumcised, barbarian, Scythian, slave or free, but Christ [Difference] is all, and is in all.” (Colossions 3:9-11(NIV)) [author added in brackets]

Where is the new to be found?

Making the Familiar Strange

Habitualization devours objects, clothes, furniture, one’s wife, and the fear of war. . . Art exists to help us recover the sensation of life, it exists to make us feel things, to make the stone stony. The end of art is to give a sensation of the object as seen, not as recognized. The technique of art is to make things ‘unfamiliar,’ to make forms obscure, so as to increase the difficulty and duration of perception. — Viktor Schklovsky¹⁷

The familiar blinds us and makes our fingers numb. Poets, writers, and painters aren’t artists but opticians. They help us see things as they are sensed and not as they are known (recognised). We are forced to look again, to see for the first time, from the outside¹⁸. “Seeing”, in this sense “is forgetting the name of the thing one sees.”¹⁹

Sometimes we need an optician to lead us by the hand out of the village into terra nulius, outside the city walls¹⁹. What if “there’s something wrong in the village”?²⁰ This is the function of the last guru: to reveal not their universal perspective, but the absence of a universal perspective.

He took the blind man by the hand and led him outside the village. When he had spit on the man’s eyes and put his hands on him, Jesus asked, “Do you see anything?” — Mark 8:23 (NIV)

Now outside the city gates - between territories - we are provided a perspective that was not afforded to us when we were complicit with the order of things. Becoming nomadic, becoming Moses (a stammerer) - “having a small plot of new land at all times”²¹. If we go to “the far side of the wilderness” we encounter the “strange” (Exodus 3:1-3 (NIV)), even if only for a moment. This is the value of getting lost and not knowing where to go.

To move from A to B, we have to go from A to not A. We do not go from certainty to certainty, but from certainty to uncertainty, from stability to instability. — ²²

Betray comfort - break the boundaries of a thing to create new limits and explore alternatives previously hidden by the city walls. Enter the transitional space between thought and unthought, not knowing what might appear, not knowing what to do next, like eyes before they open²³. The liminal spaces allow us to find new becomings. An ethics of betrayal demands a radical movement away from our faculties of memory, and reflection, rejecting the comfort of the status quo⁴.

The conditions of a true critique and a true creation are the same: the destruction of an image of thought which presupposes itself and the genesis of the act of thinking in thought itself — Gilles Deleuze¹³

What we need is “something in the world” to force us to think, not the recognisable (that which can be recalled, imagined, or conceived) but a “fundamental encounter”¹³. We require an outside thought which violates (an image of) thought that attempts to think on our behalf⁴. Thinking takes place out of reach of physiotherapy’s agenda. What forces us to think is imperceptible to “the physiotherapist” and is only available to the traitor prophet if they choose it: “the truth is not revealed, it is betrayed”²⁴. So that we might become “…someone - if only one- with the necessary modesty [of] not managing to know what everybody knows, and modestly denying what everybody is supposed to recognise. Someone who neither allows [them]self to be represented nor wishes to represent anything”¹³.

Thinking is trying to think the unthinkable: thinking the thinkable is not worth the effort — Hélène Cixous¹

Looking at physiotherapy long and hard enough allows it to recede and lose meaning. What was once familiar (physiotherapy) is now strange. The name is the same, but its character warps and becomes dissonant the further we walk from it. The word is now charged as if it both hungers for what it was and anticipates what it might become - a strange pulsing of both past and present. Bodies that were and bodies yet to come. Physiotherapists that were and physiotherapists that are yet to come. There is another world out there we don’t know - beyond the recognizable.

“Do you see anything [new]”? (Mark 8:23 (NIV))

Acknowledgment

I would like to thank Erin Tichenor and Duart Breedt for their critical feedback and rutheless editing.

References

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