Curiosity in the context of pain part 4: Examining an ethics of care.

In her 1989 book ‘Simians, Cyborgs, and Women,’ Donna Haraway critiques the prevailing categorical division between scientific medicine and cultural norms. Despite the 30-year period, Haraway’s writing is highly relevant to modern-day healthcare practice, which is predominantly because of the enduring legacy of hegemonic western medical practices.

Through her examination of the intersection of power, gender and technology, Haraway emphasizes how historical discourses have led to the scientific developments that have shaped our understanding of what the body is and how it should function. The body, through the lens of science and empirical investigation invites a particularly way of viewing the body. I should emphasize here that Haraway is not against medical science, she is a strong proponent of it. Her objection is towards the prevailing views of medical science. Firstly, that bodies are treated in the same way, no matter who does it. This leads to objectification, deskilling and oppression. Secondly, that medical science has the same effect on bodies irrespective of culture, ethnicity and gender.

In chapter 10, Haraway highlights how biomedicine has fundamentally shaped our understanding of the human body. She writes:

‘Bodies, then, are not born, they are made’, (pg. 204)

Her work has provoked further discourse into traditional biomedical practices and the impact this has had upon culture, gender and disability.

To the reader who is familiar with biomedical practices and the associated body-as-machine metaphor, it is within this powerful line that specific constructed norms and standards about the body are proposed. The prevailing and predominant position of the biomedical/biomechanical body is that a deviance from the “normal” body is pathological, and the solution is the offering of biomedical practices (Fox, 2012). Additionally, the language that accompanies biomedical practices describes the human body as something that requires repair, replacing, or removal. What emerges from this language is the mechanical concept of the body as machine.

Haraway is not suggesting that scientific advancements limit our understanding of the body but more that these advancements establish normative practices, creating rigid ideas about what a “normal” body is, excluding diverse experiences and perspectives. Is it serendipitous that a 1989 author would be making predictions about how our practices will be increasingly influenced by predominant models of care and scientific practices into the future? The evidence base over the last decade would confirm Haraway’s predictions, particularly through increasing qualitative research highlighting a lack of confidence in healthcare professional ability to recognize or be cognizant of the affective nature of illness and disability (Barlow, 2021; Daykin and Richardson, 2004; Killingback et al., 2021; Mescouto et al., 2022; Synnott et al., 2015; Zangoni and Thomson, 2017).

This line of inquiry about our practices makes me think of the French philosopher Henri Bergson, who coined the phrase:

“the mechanical encrusted upon the living” (Bergson, 1911, pg11).

Bergson was referring to the tendency in human thought to apply mechanical, deterministic explanations to living organisms (for any physio reading this, recall the metaphor body-as-machine and you’ll understand the link), that life is characterized by a continuous, vital impulse he called “élan vital,” which signifies a kind of creative force driving the evolution and development of life beyond mere mechanical processes. By contrast, mechanical processes are those that are repetitive, predictable, and determinable by simple cause and effect. In his work he referred to the internal workings of a clock. When Bergson talks about “the mechanical encrusted upon the living,” he is critiquing the tendency to apply mechanical understanding and methods to areas of life (including human existence and consciousness) where such approaches are not only inadequate but can be reductive.

This phrase suggests a tension between the fluid, dynamic nature of life and the rigid, static frameworks often used to understand it. Bergson argued that life, particularly human life with its rich consciousness and creativity, cannot be fully understood through scientific or mechanistic methods alone. Instead, he advocated for a recognition of the spontaneity and unpredictability inherent in living processes, which standard scientific methods might overlook or suppress.

Overall, Bergson’s phrase underscores his philosophical effort to challenge the dominance of a scientific-mechanical worldview that, in his opinion, fails to capture the essence and complexity of life. This remains a significant and influential perspective in debates about the nature of consciousness, free will, and the methodology of sciences dealing with human and other forms of life.treating them as if they were simply machines. Bergons’s ideas challenged the reductionist view of life as purely mechanical and emphasizes the dynamic, creative, and unpredictable nature of living organisms.

Interestingly, where we can draw parallels between the two quotes from these scholars, the theory that underpins each differs significantly. Where Haraway can be regarded as a social constructivist (knowledge and understanding is influenced by social interactions and cultural contexts), Bergson was a continental philosopher (knowledge and understanding is characterized by a diverse range of philosophical movements including existentialism, phenomenology, hermeneutics, post-modernism) and where Bergson’s concept of the “mechanical encrusted upon the living” suggests that mechanistic thinking forms a hard, inflexible shell around the living, obscuring the true nature of the body, Haraway’s quote speaks directly to challenging patriarchal and hierarchical structures within healthcare practices that fail to consider the needs and perspectives of women and marginalized groups.

Now you might be asking, “where does curiosity (and indeed care) fit into all of this?”

Where Haraway refers to ‘bodies are made’ she concludes that bodies have become socially constructed through predominant patriarchal voices and discourses. Women and marginalized groups have been oppressed for centuries. As far back as Ancient Greece, curiosity was regarded as meddlesome and prying, a sickness of the lower class, primarily displayed by women and slaves (Zurn, 2021). To have true intelligence and a desire to know, was to demonstrate a rational wonder. However, wonder was possessed and reserved for those with higher moral standing – the upper classes but primarily white men. Curiosity and wonder were related to class. It is not until the Renaissance period that curiosity becomes the savior of the scientific method. However, as we have identified, Bergson felt the scientific method failed to capture the full complexity of life. Not to leave it on a cliffhanger, but I want to pause here and provide a practice of curiosity in part 5 of this series that proposes a creative process that Bergson described through Elan Vital.

I wish to finish with a quote from Nicholls, (2021) from his book Physiotherapy Otherwise. Until we rupture the status quo, as I discussed in part 3 of this series, we will continue to:

‘Face a crisis of care, not of cost, in healthcare’ (pg. 254)

Thanks for having a read. More to come in part 5

The Curiouser

References

Barlow S (2021) The lived experiences of physiotherapists in their encounters with people with chronic pain : a phenomenological enquiry. Epub ahead of print 2021. DOI: 10.25918/thesis.182.

Bergson H (1911) Laughter: An Essay on the Meaning of the Comic. MacMillian.

Daykin AR and Richardson B (2004) Physiotherapists’ Pain Beliefs and Their Influence on the Management of Patients With Chronic Low Back Pain. Spine 29(7): 783–795.

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

Killingback C, Thompson M, Chipperfield S, et al. (2021) Physiotherapists’ views on their role in self-management approaches: A qualitative systematic review. Physiotherapy Theory and Practice 44(0): 1–15.

Mescouto K, Olson RE, Hodges PW, et al. (2022) Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis. Qualitative Health Research 32(6): 902–915.

Nicholls D (2021) Physiotherapy Otherwise. Auckland University of Technology. Available at: https://ojs.aut.ac.nz/tuwhera-open-monographs/catalog/book/8.

Synnott A, O’Keeffe M, Bunzli S, et al. (2015) Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. Journal of Physiotherapy 61(2). Korea Institute of Oriental Medicine: 68–76.

Zangoni G and Thomson OP (2017) ‘I need to do another course’ – Italian physiotherapists’ knowledge and beliefs when assessing psychosocial factors in patients presenting with chronic low back pain. Musculoskeletal Science and Practice 27: 71–77.

Zurn P (2021) Curiosity and Power: The Politics of Inquiry. University of Minnesota Press. Available at: https://books.google.co.nz/books?id=wqAiEAAAQBAJ.