Physiotherapy and The Marvel Effect

 “Heroes are made by the path they choose, not the powers they are graced with.”

–Brodi Ashton / Iron Man(Attribution)

Superheroes have fueled the imagination and inspired us. We are currently in the cinematic age and renaissance of superheroes. Since 2008, when the first Iron Man movie was released, Marvel have released no less than 23 superhero movies with another coming out this week (Spiderman), a further two for 2020, three for 2021 and three for 2022! That seems like an unprecedented amount and so it’s interesting to know why there is so much fascination and appeal. There are many theories. Most interestingly for me is the movie’s portrayal of superhero challenging exaggeration of the adversity that is faced by humans and the similarities viewers can thus share in their own reality.

If we look closely at superheroes, we can see that all of them have a back story, they display characteristics of past experiences that have molded their present-day behavior and personality, a human trait. Viewers of superhero movies are inspired and drawn to the characters because of their relatable displays of altruism. I.e. Iron Man diverts a missile (that will destroy New York City, killing millions of people) up into a portal to another realm. Ultimately, he is willing to sacrifice his own life to save millions of people. So, what does this mean to the viewers? Superheroes enthrall and inspire us; their altruism can then filter into everyday life.

Despite the displays of altruism, superheroes also have their troubles. I refer to Iron Man again. Tony Stark is rich and intelligent but also obnoxious, egotistical and selfish, opinionated and over-confident. Yet, Tony is vulnerable requiring a sophisticated pacemaker to keep him alive. At the same time, it also assists him with the power behind the Iron Man suit. Without the Iron Man suit Tony stark is a human selling weapons, tools that bring physical harm to others.

So, what’s this got to do with physiotherapy? What do physiotherapists and superheroes have in common? Aside from the costumes!

Under a biomedical paradigm, physiotherapists are a form of superhero. They aim to end human suffering following the infliction of harm by an insidious or tortuous agent.

Why are they superheroes?  … because of some pervasive narcissistic belief central to physiotherapy’s philosophy? … because of a profession wide misconception that we can end human suffering? … because of an ongoing societal and public belief that healthcare will end human suffering?

I aim to explore these questions for the remainder of this blog.

But first…

The Marvel effect.

N.B. – I make reference to the Marvel effect because it’s a catchy name, however I will also include superheroes from DC comics.

The Marvel effect is likely several things, such as the metaphorical representation of human societies relationship with adversity in the world and the relatable life-changing experiences that people identify with superheroes. Superheroes share the struggles of humans trying to get by in the world.

In relation to this blog, the Marvel effect relates to physiotherapists self-perception and society’s perception of physiotherapists. Whilstthis is becoming less common, for a time physiotherapists themselves were seen as being able to “fix” the struggles of others.

Society understands that superheroes have special abilities, a kind of “technical expertise” if you will, similar to that of the medical and healthcare fraternity.

What of the parallel’s physiotherapy shares with superheroes?

Physio’s have at times (and some continue to) portrayed themselves as being able to fix (implicity or explicitly) and end human suffering. We believed that we had an ability to end suffering outside of the multi-disciplinary medical team. We strived to be autonomous practitioners establishing private practice, being first responders, believing we had an ability (powers) to use our hands (tools) to fix and save a generation of people with our “superhuman” skills. Like many superheroes that possess a unique set of skills or tools, the physiotherapist over the decades has also possessed a unique set of skills or tools (electrotherapy, manual/manipulative therapy, massage, taping, Acupuncture, exercise) to address physical harm inflicted by an insidious agent.

I think a parallel that physiotherapists have with a particular superhero, is that of Ironman. Consider Ironman as a metaphor for the physiotherapist. He begins as a selfish, dogmatic, narcissist. He believes he can take on all foes from the terrorists we see in the first Ironman movie to stronger more powerful foes in the second; he continually reinvents himself (and his mechanical suit) to defeat the increasingly powerful foes.

How does this translate to physiotherapy?

We are independent, autonomous, having the ability to assess, acquire diagnostic skills, understand mechanics (biomechanics), deliver treatment intervention and that we also know what is right for the suffering that attend our private clinics. The biomedical paradigm draws parallels with what superheroes do for humanity from the perspective of physical harm. The superhero saves the innocent victim of the physical event but not the psychosocial trauma i.e. the anxiety or challenges the individual faces in expressing the physical trauma. Ironman shoots the baddies and saves the day … but ultimately others end up having to clean up the mess afterwards. Something that Marvel themselves acknowledge in Spiderman’s villain, Vulture’s, origin.

Physiotherapists affinity with medicine has led to a generation of clinicians taught to “treat” the physical injury making people “feel” better, with little appreciation of the psychosocial responses that often accompanies the physical trauma, and with little understanding of helping people learn to live well.

Superheroes are tormented and challenged by strong adversaries, often being close to death. Some superheroes (like in the Batman trilogy – Batman Begins, The Dark Knight, The Dark Knight Rises) are forced into exile to seek guidance, gain new knowledge, strength and rise again. Physiotherapists gain knowledge from experience, education and learning from peers to implement newly learnt skills the following Monday morning. Often these skills are utilized but become seldom over time.

In some sense although possessing super powers, superheroes are isolated, they are freaks), a scourge and a threat to the existence of the human race (In the original X-Men Senator Kelly declares mutants as freaks and a threat to humanity).

Now, am I suggesting that physiotherapists are a risk to the health of humanity?

I want to say no, but there is a body of work that would argue yes. Swain, French and Cameron, in their 2005 publication, ‘Controversial Issues in a Disabling Society’ refer to the ‘parasitic’ nature of professionals because of the unequal power relationship they impose upon their clients, with the intention of restoring the ill or abnormal to the normal. Consider physiotherapy practice. Physiotherapists have chosen to practice autonomously and independently. Isolated away from other Allied Health Professionals. Their ability to work independently and the paradigm that continues to pervades it’s philosophy sees it’s very existence perpetually challenged. To this end without evolution do we (perhaps unintentionally) contribute and intensify the rising health crisis of chronic disease?

Superheroes face some adversaries that are just too powerful (or complex) and recent Marvel films like the Avengers or X-Men see superheroes joining forces to use their individual strengths to combine knowledge (and behavior) in “tackling” one strong adversary.

Consider chronic disease (Pain, Diabetes, Obesity, Heart Disease, Cancer), from a population health perspective these are the biggest threats and persistent “foes” of the present day that impends humanity and healthcare . Chronic disease is not a singular phenomenon (like the petty thief), it is emergent from multiple systems from genetics, society, culture, environments, health and physical activity (or lack of), mind and body interacting with each other to create an insidious and tortuous agent. As such it is not as simple as flicking a switch (taking out Magneto), mobilizing a joint, taping a knee, massaging a shoulder.

Crazy as it sounds, I believe there are strong parallels between superheroes and the clinical fraternity as expressed above. Societies struggle in the world means that from one perspective we lean on healthcare for guidance and support. The perception of healthcare is not helped by physiotherapists that continue to go rogue, practice independently and isolated with the belief they can continue to save and fix people.

There is hope, management of chronic disease involves the union of healthcare professionals to form their own Avengers. Physiotherapists reuniting with Occupational Therapists and Psychologists. Developing new connections with Social Workers and Dietitians to gain new knowledge, collaborate and support their team members and help society manage the adversary that is chronic disease.

I’ll admit I’m not an advocate of battle metaphors, today’s healthcare continues to view chronic disease from a biomedical perspective expressing metaphors such as the war on cancer or the war on pain or the war on obesity. I appreciate that not everybody feels the same way and that some do perceive their struggles with chronic disease as a battle.

The End Game

Are clinicians really superheroes that serve to fix and save the people? How could we if we claim to be treating people and not machines. Is this a misrepresentation from superheroes in respect to how we should deal with adversity?

Adversity crops up everywhere, and when it does, we have support networks, families, friends, religion, charity organizations for support, help and guidance.

Ultimately, society faces the struggles of adversity, with guidance people can find a path that supports personal growth, that develops understanding and can teach us how to live with life’s struggles. In the end, are physiotherapists superheroes or are the superheroes a metaphor for connection amongst all of society at a time of adversity.

I want to end with a quote from X-Men.

Charles Xavier/Physiotherapist of past:
Is this what becomes of us?  Nature was right. Humanity does this to us.

Professor X/Physiotherapist of present:
Not if we show them a better path.

Charles Xavier/Physiotherapist of past:
You still believe?

Professor X/Physiotherapist of present:
Just because someone stumbles and loses their way, doesn’t mean they’re lost forever. Sometimes, we all need a little help.

Charles Xavier/Physiotherapist of past:
I’m not the man I was.

Professor X/Physiotherapist of present:
You’re afraid. I remember.

Charles Xavier/Physiotherapist of past:
All those voices… so much PAIN.

Professor X/Physiotherapist of present:
It’s not their pain you’re afraid of. It’s yours. And as frightening as it can be, that pain will make you stronger. If you allow yourself to feel it, embrace it, it will make you more powerful than you ever imagined. It’s the greatest gift we have: to bear their pain without breaking. And it comes from the most human part of us: hope. We need you to hope again.

Thanks for having a read.

TNP.