Post-professionalism - Part 5 - The politics
We can read the history of the professions in a number of ways. They have been a:
reflection of a desire to bring order to society;
mirror of a feudal, patriarchal, Western social order;
tool for emancipation pursued by previously marginalised people — women, working classes, racialised minorities, etc.;
vital cog in the machinery of soft colonisation;
way to humanise the alienation of wage slavery;
vehicle to provide healthcare, education, and public administration in the most efficient and trustworthy way.
But however one looks at the professions, what is clear is how closely they have been tied to the idea of modern forms of governmentality.
Securing people’s health and vitality was both a means to maximise the population’s productivity and efficiency, but also a way to manage the inherent contradictions of modern life. (We want cheap coal but hate the idea that mining is dangerous, so we offer healthcare as a way to ameliorate our ethical conflict.)
So the link between the health professions and ‘the state’ has always been strong. In fact, I’ve suggested in recent years that without the state, some professions like physiotherapy would likely not even exist (Nicholls & Harwood 2016a; 2016b; 2017; Nicholls 2022; 2023).
By contrast, one of the driving forces behind post-professionalism today is the belief that there is a growing distance between ‘the state’ and the professions.
As Deleuze pointed out, the disciplinary society has largely been replaced by a society of control.
In the disciplinary society, a person’s life was marked by their passage through a series of regulated institutions — the family, school, the barracks, the university, the factory, the office, the professions, etc. But with the advent of digital technology and many new forms of remote surveillance, it’s no longer necessary for a person to be held within these institutions in order to be governed.
Now, it’s even desirable that the person explores far and wide beyond the boundaries of institutions if only to test the system’s ability to keep track of them and monitor their consumption and feed their desires.
In a society of control, professions no longer work as a central plank of government but act only as one of its many arms: an arm that looks increasingly inflexible and too muscular to be of use in the slippery plastic world of person-centred healthcare.
Crucially, this shift happened regardless of political ideology and the forces of reform have come from both left and right.
On the right, the established professions have been criticised for their monopoly power, for being expensive, statist, controlling, unionised, for promoting passivity and dependence in people, and for being ineffective in boosting economic productivity.
On the left, the professions have been criticised for being in service of capitalism, ableist, misogynistic, racist, elitist, colonial, conformist, and Victorian.
Neither left nor right, it seems, want to hold on to the virtues of an enabling middle class whose place in the social order was once taken for granted.
Who, then, speaks up for the professions?
Without the same political support that the professions enjoyed during the greater part of the 20th century, only the professions themselves are now advocating for the continuation. They have done this since the 1980s in a number of ways:
by promoting evidence based practice and hierarchies of evidence;
in claims to now being person-centred (with the implication being that they believe they were not before);
through new territorial claims to holism and biopsychosocial;
through inter-, multi-, and trans-professional collaboration;
greater openness to complimentary and alternative approaches, and so on.
The salient point here though, is that these responses are a stark reminder that the professions are an effect or achievement of shifting social discourses. They are not, themselves, the agents of their own destiny.
They are an answer to a series of problems that have been posed in largely high-income economies over the last 150 years.
But as Foucault reminds us, they are neither the only nor necessarily the best solution to the problems that society faces. They are merely one contingent response amongst many.
The likelihood is that we are in the late stages of the professional era and that many new solutions will emerge in the coming decades for concerns like the accelerating planetary health crisis, growing inequality, and the mind-boggling complexity of health.
The professions may form part of a panoply of solutions, but without their political patrons – of any stripe – it is likely their role will be significantly curtailed as years go by.
The question that the professions themselves should be asking, then, is how can they best democratise and share the privileges and benefits they have acquired over the last century or more?
In the next piece, I’ll look at some of the ways the professions are actually responding and show that, sadly, their instinct to preserve their status appears to be currently overriding their desire to nurture the greatest access for the greatest number of people. Ironically, of course, this kind of reaction is one of the main drivers of post-professionalism in the first place. Something we will return to next time.
References
Nicholls, D.A. (2023). Is physiotherapy a luxury? What can the perplexing absence of the physical therapies tell us about the profession’s future? Physiotherapy Theory & Practice. https://doi.org/10.1080/09593985.2023.2211675
Nicholls, D.A. (2022). Physiotherapy Otherwise. Tuwhera Open Access Books. https://doi.org/10.24135/TOAB.8. ISBN (online) 978-1-927184-91-2. Accessible from https://ojs.aut.ac.nz/tuwhera-open-monographs/catalog/book/8
Nicholls, D.A. & Harwood, G. (2017) Physical therapies in 19th century Aotearoa/New Zealand: Part 3 – Rotorua Spa and discussion. New Zealand Journal of Physiotherapy 45(1): 9-16. doi: 10.15619/NZJP/45.1.02.
Nicholls, D.A. & Harwood, G. (2016b). Physical therapies in 19th century Aotearoa/New Zealand: Part 2 – Settler physical therapies. New Zealand Journal of Physiotherapy, 44(3), 124-132. doi: 10.15619/NZJP/44.3.02
Nicholls, D.A., Harwood, G. & Bell, R. (2016a). Physical therapies in 19th century Aotearoa/New Zealand: Part 1 – Māori physical therapies. New Zealand Journal of Physiotherapy, 44(2), 75-83. doi: 10.15619/NZJP/44.2.02.