Healthcare and the society of indifference
‘These findings suggest that physiotherapists should develop a good understanding of patients’ concerns, and take them into consideration, before delivering their reassurance. This will require that physiotherapists be responsive to patients’ concerns and adapt their communication to the individual needs of the patient.’
This quote, which I find quite extraordinary, comes from a recent paper by Ian Cowell and a raft of physiotherapy notables (Cowell et al, 2025, my italics).
The fact that physiotherapists still need this basic principle of empathic care pointed out to them speaks volumes.
On the one hand, it suggests physiotherapists are still anchored to the idea of treating the body-as-machine.
But I think the authors’ call for a more humane, inter-subjective approach to healthcare is equally problematic, because it harks back to the language of individual choice, agency, self-care, and personal responsibility that was the hallmark of neoliberal biopolitics.
Thankfully, this ‘difficult’ period in the history of healthcare is now coming to an end. But what is replacing it could be even more pernicious, more injurious to social cohesion, and more divisive.
Over the last few months I’ve been working on a monster paper for Social Science & Medicine that tries to address the question of where health care is going and what it might mean for the future of the healthcare professions.
The paper argues that we’ve now entered a post-professional era in which the health professions are increasingly pushed to the margins of practice and decision-making.
Here’s a brief outline:
The health professions have known continuous disruption and change since the 1970s, but nothing like they are seeing now
Sociology has been unbundling the professions’ claims to goodness and expertise for decades
But the recent neoliberal atomisation of the body and health has really pulled the plug from the bathtub
Add to this the potent effects of digital disruption and you have a recipe for some dramatic changes just around the corner
Foucault did a lovely job explaining how social institutions like the family, the school, the asylum, and the professions had developed new forms of disciplinary power after the C17.
He explained why professions like physiotherapy came to exist and served as powerful disciplinary technologies; returning people to work, oiling the wheels of industry. Most of the book The End of Physiotherapy was about this.
Deleuze followed this in his seminal 1990 paper Postscript on the Societies of Control (Deleuze, 1990/1992) arguing that new forms of neoliberal subjectivity and surveillance had made many of the institutions Foucault described redundant. The book that followed EoP — Physiotherapy Otherwise1 — tackled this question and argued that a new post-professional era was unfolding in healthcare.
But recently something has shifted with COVID and the stratospheric rise of AI and LLMs that has really set the cat amongst the pigeons.
The gist of the issue is this:
Neoliberalism promised us greater personal choice and freedom of expression. This choice was not, in the first instance, driven by a desire for greater individual autonomy, but by a desire to fuel economic consumption, particularly in high-income countries that had seen growth stagnate in the decades after WWII
But the explosion of personal choice has not led to growth in consumption. Instead, it fuelled a ‘tyranny of choice’ (Schwarz, 2025), in which people were overwhelmed by their options. Choice has became burdensome and had, paradoxically, become a brake on consumption
There are lovely examples of this in Ori Schwarz’s recent paper (Schwarz, 2025) where he summarises the paradigm shift seen with the rise of TikTok and, closer to home, David Armstrong’s history of risk in healthcare (Armstrong, 2023).
But the consequences of this problem have appeared in lots of other places too in recent months.
In a piece in Harper’s Magazine just a few days ago, celebrated autofiction author Karl Ove Knausgaard bemoaned our saturation with digital media;
‘It feels as if the whole world has been transformed into images of the world and has thus been drawn into the human realm, which now encompasses everything. There is no place, no thing, no person or phenomenon that I cannot obtain as image or information. One might think this adds substance to the world, since one knows more about it, not less, but the opposite is true: it empties the world; it becomes thinner’ (Knausgaard, 2025).
In a separate unrelated piece, the luminous Scott Alexander made a related point;
‘If you wanted to see Lippi’s Madonna and Child when it was first painted in 1490, you would have to go to Florence and convince Lorenzo de Medici to let you in his house. Now you can see a dozen Lippi paintings in a sitting by typing their names into Wikipedia… An ordinary latte might blend beans from Ethiopia, Ghana, and Suriname with sugar from Brazil and vanilla from a rare orchid found only in Madagascar; by now, it’s so unbearably boring that you can find dozens of Reddit threads asking how to spruce it up, make it feel new again… It’s all amazing, and we’re bored to death of all of it’ (Alexander, 2025).
Rob Horning’s synthesis is particular interesting, I think;
‘As the world has been turned into media, into data, into information, it loses its context and becomes susceptible to predictive modeling, to be reproduced as a simulation by generative models and so on. All the representations of the world, the images we are inundated with, cut us off from a putatively direct indwelling with the world and force us to consume the world at a remove as information, as fungible data’ (Horning, 2025).
But what does this have to do with healthcare and the health professions?
The answer, I suggest, does not lie directly with digital disruption as such, as some are suggesting, but what these new approaches to knowledge and expertise build upon.
Because, after decades of neoliberal attacks on the welfare state, and a century of sociological critique of the professions’ ‘specious claims to special forms of empathy and caring’ (Witz, 1994, but see Physiotherapy Otherwise for more language like this), no-one wants the experts of old to help them make choices anymore.
Enter the Big Tech firms (Alphabet (formerly Google), Amazon, Apple, Meta, and Microsoft, especially) with their predictive algorithms, designed to make easy consumption ‘frictionless’ again.
Frictionless consumption finally severs the old bond between the individual and the wisdom of experts (doctors, psychologists, parents, teachers, therapists, journalists, and so on), replacing it with aggregated data based on clicks and likes.
But it also severs the link between the individual and choice. Individual subjectivity is of no interest to the Big Tech firms. In fact, personal choice is seen as a barrier to rational, bias-free prediction.
Ironically, the value Big Tech are placing on detached, putatively ‘bias free’ stats and epidemiological data farming, mirrors exactly the approach taken by medicine at the birth of the public health movement in the C17 and 18. But this time medicine is nowhere to be seen.
Many health professions are trying to find ways to shore up their prestige by making allies of Big Tech, but no-one now believes the doctor, physio, nurse, psychologist, occupational therapist, paramedic or midwife knows best.
But surely people won’t stand for this?
It’s unlikely, in my opinion, that this current phase will last long. Indeed, the ‘phases’ we have passed through as a society have only moved faster and faster as the years have gone by.
Foucault showed that sovereign power had lasted for millennia. Disciplinary power perhaps a few hundred years. Deleuze’s control society only lasted 50 years. Who’s to say this ‘society of indifference’ will not be over before the end of the decade?
I’m sure that, having gained their voice, people will not want to give it up quite so easily. I also think people will still want their health professionals, especially when the going gets tough.
My problem is that I can’t see how we will be able to sustain a viable healthcare system sufficient to train the next neonatal cardiac surgeon, TBI rehab specialist, or aged care nurse now that we have so thoroughly unbundled them.
References
Alexander, S. (2025). The colors of her coat. Astral Codex Ten.
Armstrong, D. (2023). The social life of risk probabilities in medicine. Soc Sci Med, 323, 115811.
Deleuze, G. (1990/1992). Postscript on the Societies of Control. October, 59(Winter), 3–7.
Galvin, R. (2002). Disturbing Notions of Chronic Illness and Individual Responsibility: Towards a Genealogy of Morals. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 6(2), 107–137.
Cowell, I., McGregor, A., O’Sullivan, P., O’Sullivan, K., Poyton, R., Schoeb, V., & Murtagh, G. (2025). A Detailed Analysis of How Physiotherapists “Give” Reassurance for Patients’ Concerns in Back Pain Consultations. Qual Health Res, 10497323251320874.
Horning, R. (2025, June 6). The endless slide show. Internal exile.
Knausgaard, K. O., Lasky, O., & Searls, D. (2025, May 21). The Reenchanted World. (Trans. Lasky, O. & Searls, D.). Harper’s Magazine.
Schwarz, O. (2025). The Post-Choice Society: Algorithmic Prediction and the Decentring of Choice. Theory, Culture & Society, 0.
Witz, A. (1994). The challenge of nursing. In J. Gabe, D. Kelleher, & G. Williams (Eds.), Challenging Medicine (pp. 23-45). Routledge.
There is a new digital workbook version of Physiotherapy Otherwise that’s also been released under a creative commons license so is free for you to use and consume. You can find a link to the book here.
What choices do most people have with regard to healthcare?