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ian s
24-04-2004, 01:13 PM
I am posting this review for consideration .......
My opinion is that a new training and education is necessary for the realities of life in the 'post modern era'. What I mean is that physio as a profession is geared largely towards identifiable problems -- works fine and well if protocols are required ......Fine if you want to fit everything into a protocol (which is what my employer and bosses want).....However what we deal with is largely illness behaviour ,senistivity problems and people living in bodies ill suited for the demands placed upon them ......
Education needs to embrace science of stress for sure but other narratives are equally valid .....David Morris is both a Dr and Professor of Humanaties........
I am more interested in the stories people tell me than anything else, it is usually in the story of the patients lifestyle and behaviour that the solution lies .....for those willing to reflect and alter something the brain often resets itself.......
Here is the review .........

Illness and Culture in the Postmodern Age


David B Morris

University of California Press, £17.50, pp 360*

ISBN 0 520*20869*2



Rating:

The postmodern view of our world is simultaneously terrifying and liberating. By the start of this century, the great explanation of religion, promising perfection in an everlasting life after death, had given way to the big utopian political visions, which promised a perfect society in this life. Through the middle part of the century, these visions were inexorably corrupted into monstrous dystopias, and now, in our postmodern world, the resulting disillusion has fostered a deep distrust of all comprehensive explanations of, and solutions to, the human predicament. The notion of absolute truth has given way to an acceptance of multifaceted truths and the legitimacy of a range of approaches to the same problem. This challenge to the big explanations enriches our understanding but shakes our security. Patterns dissolve, leaving us bewildered and disorientated but with seemingly endless possibilities of creating new patterns and finding new truths and new ways of relating to the world, each other, and ourselves.

The central thesis of David Morris's fascinating book is that illness is a mental, emotional, and bodily event constructed at the crossroads of biology and culture. He argues that, as our culture changes, so must our view of illness, and that the postmodern gaze introduces both new terrors and new freedoms into the arena of health and health care. Many of the terrors seem to arise from our undiminished yearning for perfection. The focus has simply shifted from society to the individual and from the soul to the body. Our obsession with the utopian body makes anorexia nervosa a quintessentially postmodern illness and, more broadly, fuels a fear of illness and disease that is out of all proportion to the unprecedented health and longevity enjoyed by those in the developed world. Biomedical science clings to the wreckage of an all embracing, essentially modernist explanation of the human experience of illness and disease, while simultaneously promising much more than it can deliver. If the explanation aspires to be comprehensive, it follows that death will come to be seen as a failure of science, and ultimately the desperate excesses of medical intervention drive the calls for legalised euthanasia.

Biomedical research, with its insistent prioritisation of the methodologies of the randomised controlled trial and frequentist statistics, perpetuates the notion of absolute truth. But in a postmodern world all generalisations, all categories, and all classifications are open to challenge, and slowly this new perspective is infiltrating medicine. The doctor's claim to knowledge of objective fact is challenged by the immediacy of the patient's subjective experience. Insights from anthropology, sociology, philosophy, psychology, and poetry challenge the medical annexation of truth and profoundly alter our understanding. Each discipline uses words in a different way, and so each can contribute to reducing the dimension of suffering and pain that remains beyond language. Healing must always seek to give voice to suffering, and the greater the range of words and meanings we have at our disposal, the clearer the voice becomes.

Morris eschews a conclusion as being incompatible with the open ended nature of the postmodern view, and a summarising book review may be a similarly suspect endeavour. Perhaps all I can say is that my view of the world, and my work within it, is more complex, and my life proportionately richer, for having read this book.

nari
24-04-2004, 02:36 PM
Ian
It is good to hear from you again and thank you for posting David Morris's comments.

It is yet another example of the brain/body's response to society which is hell bent on turning itself inside out in search of nirvana. But who is doing all this? The media, politicians, the IT industry...? Advertising has quite a lot to do with it, as well. Where is medicine and the health industry? Desperately trying to keep up with the flood of pharmaceuticals, research; throwing money at keeping ICUs with 'good' outcomes when there are not the resources to care for those who survive ICUs? Trying to keep people alive for longer when there are not enough places for them to live out the extra 10 years or so?

Small wonder that the individual has become self-focused, and when a society largely consists of a focus on earning more and spending on and for oneself, something has to give.

Physiotherapy needs to change, and shift focus to embrace overwhelming evidence that a great deal of what happens to the body is not palpable, visible or obeying the rules for the masses(protocols). The response to that could well be: Someone has to do the nittygritty of fractured limbs and handing out walking frames, etc. True - but can we do it differently?
Can we treat the priorities for that person? Can we see why an 80 year old is falling - not just because she has wobbly legs or balance is crook, but because she is isolated, fearful of the future and her son/daughter only help out when she timidly (and fearfully) asks?

OK, this woman needs a social worker/psychologist. She might need an OT to check out the house; she may need wound care from a nurse. Her GP needs to review medications. Six people later -where is she? maybe better, maybe worse - each one has said something different and she is confused.

Wouldn't it be good if the same person, specialising in aged care, did it all?
Impossible? I believe some countries are looking at this aspect, to save money (1 person is cheaper than 6). I am wondering where that will leave physiotherapy...if it happens.


Nari :?:

bernard
26-04-2004, 08:03 AM
Hi All,

It is certainly true that physiotherapy need a shift but in what direction? We know actually that technical progress, as RMI, augment the indications of spine surgery and the fear avoidance of patients and practitioners. It is difficult for the majority of us to resolve ourselves to accept the placebo role in medicine. It is difficult to forget these visuals proofs. Visuals proofs are often virtual pain bringers!

Our modern materialist medicine use more and more technology to help diagnose illness and loose humanity and understanding of human beings.
Those who reject, a bit, modern scientific diagnosis will be shown as obscurantist people, charlatans and pseudo-scientists but is it true?

The only way, I see, is a reversing approach of human beings. We have, now, to learn some cheap methods as Feldenkreis and Hanna, Alexander... These methods are poorly studied but are certainly a soft issue to a announced crash of health systems.

Diane
26-04-2004, 04:14 PM
Ian, just wanted to say I've ordered both David Morris books and can't wait to read them. He wrote (I think it's called) Culture and Pain also.
Diane