Curiosity in the context of pain part 3: Becoming a Curious Body

If we were to examine our reality within healthcare, we would perceive, bring our attention to, form memories and recall certain bits of information to develop a knowledge framework. We can describe this to be the ontological (reality) and epistemological (knowledge) positions that form our world view of healthcare, and to a larger extent our bodies and how we engage in society. The world view of bodies in physiotherapy originates from biomedicine, largely determined biologically and reductively using the metaphor body as machine (Fox, 2012; Loftus, 2011). Physiotherapists have been taught a particular epistemological and ontological position that has been handed down through the professions one-hundred-year legacy (Nicholls, 2017). Understandably, as Nicholls discusses in his book ‘The End of Physiotherapy’ adopting the biomedical model and body as machine legitimized the profession, but the ideologies played out by the profession using the body-as-machine metaphor are now more aligned to the ideas and concepts of bloodletting. There are practices in Western Medicine such as phlebotomy and leech therapy that are still used today https://bcmj.org/premise/history-bloodletting, but this is a far cry from the ideology that underpinned the practice of bloodletting for over 3000 years (ibid).

The point here is the emergence of evidence-based practice (EBP) has challenged many of the ideologies developed by past figures in physiotherapy. In manual therapy, figures include Freddie Kaltenborn, Robin McKenzie, Geoff Maitland and Brian Mulligan, all of whom developed their understanding of the body and application of manual therapy using the body-as-machine metaphor (Bialosky et al., 2017; Karas et al., 2018; Lederman, 2015). What you can commend them on is each had a curiosity for understanding the body and pioneered their own methods of treatment. However, I would hasten to add that their curiosity was sedimented or trained to view the body in a particular way, the biomechanical body.

The body as machine drives the understanding that bodies require repair, restoration and realignment to function. This is a perspective of thought that has an enduring legacy (just the other day I encountered two examples of individuals “just wanting to be fixed”) in healthcare and society more broadly. For this blog, I am not interested in the argument for or against the reasons why people can’t request “wanting to be fixed” (although an interesting topic of debate nonetheless). I am interested in the style of curiosity that leads one to consider the body “as machine” and how curiosity itself becomes sedimented and trained in a way that leads us to only ask certain questions about bodies.

The body as machine metaphor provides us a way to reconcile the opposition between a ‘normal functioning’ and ‘pathological’ body (Fox, 2012), although I continue to grapple with this opposition because of several reasons such as the studies of individuals with asymptomatic findings on imaging, or that imaging on people living with (back) pain demonstrate decreased tissue health, or the poor relationship between pain and tissue damage. Nothing is black and white it seems in healthcare. We are encouraged to embrace the grey in between. I would argue then that healthcare professionals are not in the business of fixing; they are in the business of cultivating care. One of the most direct relationships between curiosity and care is through etymology. Curiosity comes from the Latin word ‘Cura’ meaning ‘care.’ Delivering care requires a natural curiosity. If we can understand curiosity deeply, perhaps we can reconcile the way that care can be delivered.

In part 1 of this series, I spoke about how the style of curiosity largely serves the acquisition or desire for knowledge. In this sense, curiosity can be regarded as being driven by a lack (Summa, 2023), such as a lack of knowledge or in the case of pain, a lack of the elimination of pain. The body as machine metaphor helps to set boundaries around our ontological (reality) and epistemological (how we think) perceptions of the body. It reifies our understanding of the body by linking something that can be understood, like the working parts of a functioning machine and something that is far more enigmatic, the human body. It makes sense then, that our curiosity would serve a desire to resolve something lacking – a ‘normal functioning’ body. The body as machine fundamentally shapes the way we think about able and disabled bodies and how it trains our curiosity and the care we provide. As Donna J. Haraway eloquently wrote, ‘bodies, then, are not born; they are made’ (Haraway, 1991, p.208).  

In part 2 of this series, I explored two styles of curiosity – curiosity about and curiosity with – and attempted to demonstrate their differences, their shared reciprocity and how curiosity is acquisitional and how it fundamentally connects. This proposes that curiosity is and can be multiple. It wants to make new connections. It wants to shoot off in different directions. Curiosity can be defined by what I should do or want, but by adopting this stance, it constrains where our curiosity can take us.  Curiosity wants us to explore what resides outside of our knowledge network. It asks questions such as, what else could I explore? What might I explore? What else can physiotherapy do? What if we were to leave the body as machine altogether? What other curious bodies might be opened up to us? What other ways might we care for bodies?

Fundamentally, these questions are curious in themselves as they ask the clinician to consider how physiotherapy, if at all, might think about the body outside of biomedicalism. Evidently, physiotherapy has drifted away from biomedicalism and adopted a biopsychosocial framework but retains a firm grip on biomedical mechanisms. The confluence of three ontologies into one has resulted in several criticisms of which I have blogged about here.

Departing from the body-as-machine and biomedicalism undoubtedly is likely to leaves us vulnerable, it means we will have to relinquish our relationship with medicine. For some, this will never happen. Biology and its many siblings (physiology, anatomy, pathology, etc) is fundamental, foundational, acquisitional. For others, exploring the curious body will open new connections, relations, insights and may even open up new paths to alternative forms of care. We will explore more in part 4.

Thanks for having a read.

TNP/The Curiouser

References

Bialosky JE, Bishop MD and Penza CW (2017) Placebo Mechanisms of Manual Therapy: A Sheep in Wolf’s Clothing? Journal of Orthopaedic & Sports Physical Therapy 47(5): 301–304.

Fox NJ (2012) The Body: Key Themes in Health and Social Care. Cambridge, UK: Polity Press.

Karas S, Mintken P and Brismée JM (2018) We need to debate the value of manipulative therapy and recognize that we do not always understand from what to attribute our success. Journal of Manual and Manipulative Therapy. Taylor and Francis Ltd.

Lederman E (2015) A process approach in manual and physical therapies: beyond the structural model. CPDO Online Journal May: 1–18.

Loftus S (2011) Pain and its Metaphors: A Dialogical Approach. Journal of Medical Humanities 32(3): 213–230.

Nicholls DA (2017) The End of Physiotherapy.

Summa M (2023) Desiring to Know: Curiosity as a Tendency toward Discovery. Human Studies. Epub ahead of print 8 December 2023. DOI: 10.1007/s10746-023-09698-y.