Rituality of a body-healing physiotherapy practice: the technique of “autocorrection”

I suffer from scoliosis. It was diagnosed when I was eleven years old. Because the curves of my spinal column were significant, I wore a corset for almost three years. During that time, I also practised a lot of physiotherapy exercises. In the context of the seminar Anthropologies of Technique, I decided to regain a technique that I learned in those times: the technique of autocorrection. This technique consists of performing certain movements of the body (particularly of the back) with the aim of counteracting the curves of my spinal column. I was fortunate that my scoliosis was caught in the right moment of growth, so I don’t have particular repercussions and problems now. Like most people, I suffer from backache quite constantly also due to my lifestyle as a student in which I sit for prolonged periods of time.

To regain the technique of autocorrection, I had a physiotherapy session a few months ago. Because it has been a long time since I learned the technique and the shape of my spine has changed, bettering, I readapted the technique of autocorrection to the current situation.

After an introduction to the activity, the physiotherapy exercises and the technique of autocorrection I practiced in the last months, I propose a theoretical reflection on the technique. I define this technique as a technique of care of my body. It became an embodied experience of self-care and empowerment. I examined the technique of autocorrection trough the lenses of some scholars we faced during the semester. John Tresch’s concept of anthropotechniques helped me to think about physiotherapy practices as social and cultural technologies. Marcel Mauss’s reflections on the techniques of the body allowed me to understand physiotherapy as an embodied knowledge with symbolic, social and cultural significance. Bruno Latour’s and Tim Ingold’s contributions were useful to think about my relation to the objects and materials I engage with during the practice of the exercises. In conclusion, I will argue that physiotherapy practices represent a rich field which can be productively explored ethnographically. The contributions of medical anthropology and questions about how cultural norms and expectations shape individuals’ experiences of pain and their relationship with their bodies would be fundamental for a possible ethnographic fieldwork research in physiotherapy centers.

Activity:

Daily-physiotherapy-exercises (20 minutes) with a particular focus on the technique of autocorrection.

Multimodal Documentation:

Photography: two photos everyday (one in the position of autocorrection and one not)
Drawings
Writing: diary

Objects and Materials

Mirror
Table (wood)
Chair (wood and leather)
Bed

Sequence of exercises:

A theoretical reflection on a technique of “autocorrection”

Physiotherapy as an anthropotechnique?

In choosing this physiotherapy practice, what immediately came to my mind was a text that I had read for the very first session of the course Anthropology of Techniques. I am referring to John Tresch’s Article Anthropotechnics for the Anthropocene (Technosphere Magazine, HKW, 2016). By questioning about the existence and possibility of wisdom techniques the author names the “anthropotechniques”, a term used by philosopher Sloterdjik. Tresch defines anthropotechniques as some ‘intimate techniques’ that include actions which transform the body and the mind. These concern the interior milieu more than the exterior world. Some examples of anthropotechniques are ascetic disciplines, gymnastics, and yoga (Tresch 2016, 2). The concept of anthropotechniques is useful for considering physiotherapy practices not only as biological and individual therapeutic interventions but also as social and cultural technologies. It is arguable that the physiotherapy exercises I practiced may be considered as anthropotechniques or wisdom techniques. I do not want to advance such classifications, but rather share my personal experience of performing this kind of exercises. I often combined them with some other practices (such as yoga, for example) and I really had the feeling of doing something good, both for my body and for my mind, connecting with my body in an intimate and meditative way. Certainly, there are some valid alternative practices to achieve this kind of overall wellbeing. I chose physiotherapy because I wanted to better my situation of quasi constant backache and because I had a certain familiarity with this practice.

Physiotherapy practices became central in Western medicine as rehabilitation forms from illness and chronical diseases. Therefore, they are intimately linked to medicine and are recognized as an integral part of many healthcare systems. In ancient Egyptian, Persian, and Japanese manuals of medicine some information about manipulative practices to solve traumas and illnesses has been found. Also, in the Chinese text of Kong Fu (III millennium BC), there are descriptions of exercises and various types of massages that were used effectively to achieve psycho-physical balance. Even in the holy text of the AyurVeda (XVIII century BC), it is written that massages are fundamental for therapeutic purposes. Therefore, physiotherapy has ancient origins. Perhaps, a way of rethinking and transforming the actual western physiotherapy can start by regaining some of these old knowledges, as John Tresch would suggest. Certainly, some paradigm changes are auspicious since physiotherapy practices carry some problematic aspects. I observed and intuitively understood some myself, starting from the fact that for the physiotherapy session I had in Italy a few months ago, I spent 100 euro. Furthermore, the costs that my parents had to afford when I was a teenager for the medical and physiotherapy treatments I needed, were big and sometimes problematic. Physiotherapy practices are historically and culturally shaped. In this context, questions about changes and “evolutions” of the discipline and, e.g., about the exclusiveness of physiotherapy services arise. Who has access to physiotherapy services and who has not? How do structural factors (e.g., healthcare systems, policies, and social inequalities) impact access to physiotherapy? (Framer, 2005). How are these practices distributed worldwide? A comparative study would be useful to understand something more about the uses and distributions of physiotherapy practices. Furthermore, one may question what is meant with ‘physiotherapy` itself in different contexts.

John Tresch offers an understanding of techniques as intertwined with human and non-human elements. His concept of anthropotechnique can be useful applied in examining physiotherapy techniques to point out that the latter involve a multiplicity of actors: the body of the patient and the expertise of physiotherapists, but also the exercises themselves, therapeutic tools, environmental factors, etc.

A bodily practice: education and training

Reflecting on my technique, I could not prescind from its central element: my body. Body theory advanced in the 1990s a reconfiguration of the idea of the body as a substance or an entity which would be distinctly human. Dutch anthropologist Anne Marie Mol (2002) defines the “body” not as a singular entity or substance but as what she terms the “body multiple”. Our bodies always extend and connect to other bodies, human and non-human, to practices, techniques and objects that produce different kind of bodies and different ways of enacting what it means to be human (Blackman 2008,1). These references helped me to think about my technique and are pertinent to some discussions we had during the semester. By performing physiotherapy exercises and the technique of autocorrection, my body interacts and interplays with many objects, different factors, embodied knowledges. An aspect that interested me in practicing the exercises regards its ‘rituality’. By doing the same sequence of exercises every morning at the same hour, I had enormous benefits that went beyond the mere physical wellbeing. I had a more general sense of wellbeing that made me focus better and helped me concentrate during the whole day. I relate this also to the fact that I developed a strong sense of self-discipline.

In Tresch’s article, which I named above, the scholar discusses the methods of training routines and disciplines and argues that training and conditioning are essential to human condition (Tresch 2016, 2). Indeed, it is also through such kinds of education[1] that particular groups of humans historically develop and embody their knowledge of particular practices and techniques. Bodily practices also interested the French sociologist and anthropologist Marcel Mauss. Recognizing the body as our first and natural technical object[2] (Mauss 1973, 75) he offers important insights into the symbolic and performative dimensions of bodily practices and rituals. His seminal work, “Techniques of the body” (1973), provides a framework for understanding bodily practices as socially and culturally mediated. The author stresses that techniques of the body, such as those that may be involved in physiotherapy, are learned practices and behaviors that are passed through generations and embedded within a particular cultural context. Using his words: “I call technique an action which is effective and traditional (and you will see that in this it is no different from a magical, religious, or symbolic action). (…) There is no technique and no transmission in the absence of tradition” (Mauss 1973, 75). Applying this to my physiotherapy technique for back healing, one can see that the movements involved are not arbitrary but carry cultural and symbolic, hence traditional, significance. These physiotherapy exercises may be seen as a form of embodied knowledge, shaped by cultural understandings of the body, health, and healing. Therefore, Mauss saw the importance of technical education as a central element in the socialization and transmission of the ways of use of the body. Particularly, he argued that education by imitation is dominant in the learning processes of techniques of the body (Mauss 1973, 73). To learn the technique of autocorrection and the other exercises when I was eleven years old, I had about ten sessions with a physiotherapist. Because I was a child, flexible and sportive, I learned these techniques quickly. The physiotherapist verbally explained the exercises to me, I performed them in front of him and he corrected me if I failed some positions or postures. Since those times I experimented a strong self-discipline by doing the exercises by myself every day. This self-discipline also regarded the way of performing the exercises in the making: I had to pay a lot of attention to my body, developing a sense of feeling the right and wrong positions. As I grew older, when I was about fourteen years old, I’ve lost interest and perseverance in doing these exercises. In the last years I have restarted practicing them quite often because I care of myself, starting from my body, and because I don’t want to have problems when I will get older. I think my approach today is different from the one I had when I was younger. Today I am doing it independently, just for myself, and I am finding gratification in it. When I was younger my constant performance of the exercises was mostly motivated by the fear of becoming humpbacked and I felt it more like an obligation which I fortunately managed to comply.

I define this technique (which has become “my” technique as I grew in intimate relation with it) as a technique of care of my body. Indeed, the physiotherapy practice goes beyond the mere physical domain and becomes an embodied experience of self-care and empowerment. More generally physiotherapy may allow the patients to reclaim agency over their bodies, negotiating pain and actively participating in their own healing processes.

Relation to “objects” and materials

When I perform the exercises and the technique of autocorrection, I engage with different objects and materials. These are mainly chairs and tables (wood), yoga matts (PVC) and mirrors. After a prolongated time of doing the exercises everyday and stimulated by the documentation of the technique, I started to pay attention to my relationship with these objects and to reflect on it. Particularly, I began to feel that the mirror had a particular power on me. The mirror represents an integral part of my physiotherapy experience, witnessing my body’s movements and changes. It allows to correct the forms and techniques during the practice of the exercises, enabling me to visually assess my body’s alignment. By doing the technique of autocorrection in front of the mirror I pay attention particularly to my left shoulder since I perform a movement of the back which tends to stretch it upwards on the left side. What I need to be careful of is that the left shoulder does not get up and remains aligned to the right shoulder. Therefore, the mirror helps me to control and coordinate my body and to develop awareness of it. But after I have improved my skills in performing such movements, my gaze started to focus on my whole image rather than only on my shoulders. So, how do I relate with the mirror? The mirror is an ambivalent symbol. It enables both the act of seeing and of being seen. It reproduces images but also contains them. Who is this image? Is it me? Sometimes I had the feeling that it erected a barrier between I and she, subject and object and I found myself scrutinizing the object. Sometimes it possessed me. But at the same time, in my gaze, there was knowledge and awareness[3]. These contradictory aspects of the mirror, the act of seeing and being seen, interest me. Furthermore, the mirror allows me to learn to embrace imperfections. In the end, it may be a powerful tool for self-empowerment and a source of introspection that may help to connect with thoughts, emotions, and intentions.

Thinking about the role of the objects and other factors (such as environmental factors, e.g., gravity, friction, etc.) involved in my practice, some reflections on technology and techniques, the dynamics of knowledge and agency and on embodiment of authors like Bruno Latour and Tim Ingold (which we encountered during the seminar), came to my mind. Both Latour and Ingold argue against the separation of subjects and objects, emphasizing their mutual interdependence. In “On technical mediation” (1994), philosopher Bruno Latour suggests overcoming the dichotomies human/non-human and subject/object to give an intellectual dignity to artifacts and techniques that are, in the end, us (1944, 64). The scholar uses the concept of mediator to describe both human and non-human actors involved in techniques. Applying this to my technique one can see that the “objects” involved, my body, my embodied knowledge of it (transmitted also by the expertise of the physiotherapists) and many other elements are deeply intertwined and co-create the possibility of the practice itself and of my healing process. With his “Actor-Network-Theory” (ANT), Bruno Latour emphasizes how knowledge is not confined to human actors but is distributed across human and non-human elements in a network. In the context of my physiotherapy practice, the network consists in what I have just described. Furthermore, in this sense, the exercises become much more than mere sets of movements because they are situated within a network of materiality, expertise, and knowledge. From this point of view, it appears clear that, in physiotherapy practices of rehabilitation, the agency of healing does not depend only on the experts and the patients. Instead, it is distributed across a network of mediators. Examining physiotherapy trough such lenses open questions about the role of technology in mediating bodily experiences and the complex of actors involved, emphasizing the interconnections between body, culture, and technology. Furthermore, the idea of making as an embodied and dynamic process proposed by Tim Ingold in “The Textility of Making” (2010) can be related to physiotherapy. In this context, making physiotherapy exercises may be seen as a making that involves continuous engagement with materials, body, and mind that are in constant dialogue with the material world. This perspective challenges the traditional notion of making as a linear process and isolated activity highlighting its fluidity.

Conclusions

Physiotherapy practices represent a ground on which bodily practices, the entanglement of body and technology and the dynamics of knowledge and agency can be observed and investigated ethnographically. Ethnographic research on physiotherapy could not prescind from an engagement and an in-depth study of medical anthropology. This discipline advanced, among others, questions about how cultural norms and expectations shape individuals’ experiences of pain and their relationship with their bodies. From the point of view of medical anthropology, physiotherapy may be seen as a complex and multifaceted sociocultural process which is deeply entwined with larger social and cultural norms, beliefs, and structures. It would be interesting for me to learn further the theoretical fundamentals of medical anthropology and anthropology of the body. This knowledge would allow me to refine a critical gaze on physiotherapy practices and perhaps to make fieldwork research in some physiotherapy centers in the future.

Bibliography:

Anzaldúa, Gloria. Borderlands / La Frontera. The New Mestiza, Aunt Lute Books (1999).

Blackman, Lisa. The Body, Berg (2008).

Farmer, Paul. Pathologies of Power: Health, Human Rights, and the New War on the Poor, University of California Press (2005).

Ingold, Tim. The Textility of Making, Cambridge Journal of Economics, 34 (2010): 91-102.

Latour, Bruno. On Technical Mediation, Common Knowledge 3, no. 2 (1994): 29–64.

Mauss, Marcel. Techniques of the Body, Economy and Society 2, no. 1(1973): 70–88.

Mol, Anne Marie. The Body Multiple. Ontology in Medical Practice, Duke University Press (2003).

Tresch, John. Anthropotechnics for the Anthropocene, Technosphere Magazine, HKW (2016).

[1] Techniques of training and of skills development are the kinds of education I am referring to. Sloterdjik (2013) saw training (of disciplines and practices) as the source of the biggest innovations in human history and relates an important contribution in this sense to monastic culture. For him, the most important actors in transforming humanity into spiritual athletes are the early modern theorists of pedagogy and instruction (Tresch 2016, 5).

[2] As many of Mauss’s, this is a problematic statement that should be seen critically.

[3] Some of these reflections were stimulated by my reading of the book “Borderlands/La Frontera” of feminist writer Gloria Anzaldúa (1999).