‘Decolonising’ – what does it mean for physiotherapy?

Black Lives Matter. And consequently, the discussions about ‘decolonising the curriculum’. Unfortunately the discussions have so far often centred on the difficulties of defining ‘BAME’, ‘decolonisation’ etc., which could be an excuse for inaction.

So what does ‘decolonisation’ mean in Physiotherapy? How do you ‘decolonise’ a profession that developed in the modern west, and at times, to be honest, as an occupation for middle-class girls?! ‘Decolonisation’ is hard to define, and certainly is not limited to issues of language. But in general, the physiotherapy textbooks in English are predominantly American, British or Australian. What’s more, we English-speakers in Coventry rarely bother to consult sources in exotic languages like French or German, let alone anything featuring non-Roman lettering. Thank heavens in neuro rehab for the Spinal Cord Injury website (https://elearnsci.org ) with contributions and case-studies from all around the world.

Paul Kalanithi

What of published illness narratives, my own specialist area? I comb through my bookshelf and my reading list of over 300 titles, and I try to spot any voices from a BAME background. Most of the personal illness stories that were originally written in a non-English language are by European authors: Jean-Dominique Dauby, Antoine Leiris, Bruno de Stabenrath, Marieke Vervoort, etc. What else can I find? There are several contributions by doctors whose forebears recently lived on the Indian sub-continent or Africa: Atul Gawande, Paul Kalanithi, Abraham Verghese. But these are also people who are part of the dominant Western culture with an excellent knowledge of English literature as well as of Western medicine. Significantly, Ved Mehta’s accounts of blindness (1958, 1982) could also be seen as the journey of an Indian from a Bombay orphanage through Oxford University and Harvard to become an established writer on the New Yorker, in other words of joining the white social elite.

There are a few narratives by BAME personalities whose personal disasters have made them even better known: Michael Watson (2004), Malala Yousafzai (2013). Very rarely there are classics in other languages from completely different cultures that are translated into English – like the accounts of autism by Naoki Higashida (2013). (Even then, would The Reason I Jump have been published in English if an established English novelist had not married a Japanese woman, and if they had not parented an autistic son?)

But there are very few BAME accounts of chronic illness in my lists and shelves. Are they around but I just do not know about them? Or is there a publication bias – they are written but rejected by publishers? Or is illness writing not part of some cultures – health is so important that ill-health is something to be ashamed of? Is it only the wealthy and highly educated that have the impulse, confidence and resources that might drive them to write about their misfortunes, and get those writings published? In other words, are we talking about the same recurring differences in wealth and class that inhibit BAME achievement in other fields?

Here is an instructive example: two accounts by young men whose brothers had epilepsy about epilepsy’s effects on the wider family. One is by an English aristocrat, whose brother could, and did, play seigneur at the annual fete in the family castle’s gardens (Fiennes 2009), and the other is by a son of the Windrush generation (Grant 2016). Powerlessness is a recurring theme in Colin Grant’s account of epilepsy within a North London Jamaican immigrant household. Colin himself becomes a medical student, and thus joins the Western educated club – but still cannot help his brother Christopher or discuss epilepsy easily with the rest of the family. (Epilepsy is in Jamaican culture a subject of mystery, magic and shame.) In some ways the two accounts run in parallel, for both epileptic brothers will eventually die in status epilepticus. And the narrating brothers both struggle with their feelings of impotence and loss. The account by William Fiennes is magical, with an unforgettable evocation of place. Yet, if I had to recommend one narrative for the physiotherapy student to read, I would have to recommend that by Grant, for its relevance to the people our students will meet.

Decolonising the curriculum will take effort. It will involve conscious deconstruction of societal barriers of inertia, and differences in wealth and advantage built over generations. Personally, I will have to search even harder for illness narratives from a BAME background. And I need to prioritise those BAME narratives that I have heard about but never read. So action number one: it’s time to overcome inertia and pre-order Audre Lorde’s Cancer Journals which are due for reissue in November 2020.

References:

Fiennes, William (2009) The Music Room, Picador

Grant, Colin (2016) A Smell of Burning: A Memoir of Epilepsy, Jonathan Cape

Higashida, Naoki (2013) The Reason I Jump, Sceptre

Kalanithi, Paul (2016) When Breath Becomes Air, Bodley Head

Lorde, Audre (1980, new edition Nov 2020) The Cancer Journals, Penguin

Mehta, Ved (1958) Face to Face, Collins

Mehta, Ved (1982) Vedi, Oxford University Press

Watson, Michael with Steve Bunce (2004) The Biggest Fight: Michael Watson’s Story, Time Warner Books

Yousafzai, Malala with Christina Lamb (2013) I am Malala, Weidenfeld

Grief and Bereavement

Bereavement and grief are inevitably a part of the current COVID pandemic. Infection control methods for COVID have even, by preventing normal visiting or funerals, exacerbated feelings of guilt or of things unsaid. I want then, with some trepidation, to recommend some of the best writings from experience.

Why trepidation? Well, partly because there are so many memoirs of grief, and partly because grief is, as novelist Julian Barnes has remarked, so individual and personal: “Other, supposedly parallel, cases of loss and grief are helpfully cited; occasionally they seem insulting, but mostly just irrelevant. As Forster wrote in Howard’s End: ‘One death may explain itself, but it throws no light upon another’.” The grief felt for a son who has committed suicide (Aidt 2019) is not be the same as the grief for a parent (McDonald 2014). Still, Julian Barnes went on to review a memoir of grief by Joyce Carol Oates (Barnes 2011) and to compare it with that of Joan Didion (Barnes 2012). So, at the risk of omitting obvious texts that would be useful, or of being seen to insult, or to be irrelevant, I make my own recommendations.

The sense that time has stopped after the death of a loved one is common. This altered perception of time, while everyday life continues, was the subject matter of poet Denise Riley’s essay Time Lived, Without Its Flow (2019) – my top recommendation. Short, but perfectly formed. It has been reviewed by novelist Max Porter (2019) and the two have combined Emily Berry for a podcast for the London Review of Books (2019).

Julian Barnes’ writings followed the death of his wife Pat Kavanagh in 2009, but it took him a few years to formulate Levels of Life (Barnes 2013) which tackles grief but doesn’t even mention Pat’s name. Like Barnes, Marion Coutts experienced the death of a partner. The Iceberg (2015) is her version of Tom Lubbock’s progressive loss of language due a brain tumour, and also of her sense of loss after his death whilst caring for their young son. Whereas her account to years to write, Antoine Leiris wrote down his immediate reactions to his wife’s death at the hands of terrorists in Paris in 2015 in a few short weeks (Leiris 2016).

Writing a personal journal is a common reaction to bereavement. It was part of the coping process for Aidt, Barnes, Coutts, Didion, Oates, and Riley. Extracts from Dannie Abse’s wonderful journal for the year following his wife’s sudden death were published as The Presence (2007). Fiction and nature writing can also speak to our emotions – one of the most eloquent being H is for Hawk , which Helen McDonald wrote after the death of her father (McDonald 2014).

One of the features of modern society is its compartmentalising and distancing of dying and death. Traditional preparations for the loss of a loved one, and the rituals which mark such a loss, have become diluted and even lost. Kevin Toolis’ memoir My Father’s Wake: How the Irish teach us to live, love and die (2017) is a wonderfully warm and touching piece that spoke strongly to me.

If you want poetry, or short pieces, Elspeth Barker has mined literature from Classical Rome onwards for an excellent anthology of poetry and shorter prose called Loss (1997).

Abse, Dannie (2007) The Presence, London, Hutchinson
Aidt, Naja Marie (trans. D.Newman) (2019) When Death Takes Something From You Give It Back, Quercus
Barker, Elspeth (ed.) (1997) Loss, An Anthology, J.M.Dent
Barnes, Julian (2011) ‘For Sorrow There Is No Remedy’, New York Review of Books 7 April 2011 https://www.nybooks.com/articles/2011/04/07/sorrow-there-no-remedy/
Barnes, Julian (2012) ‘Regulating Sorrow’ in: Through The Window, 17 essays (and one short story), London, Vintage
Barnes, Julian (2013) Levels of Life, Vintage
Coutts, Marion (2015) The Iceberg: A Memoir, Atlantic Books
Didion, Joan (2005) The Year of Magical Thinking, 4th Estate
Leiris, Antoine (trans. Taylor, Sam) (2016) You Will Not Have My Hate, Vintage

McDonald, Helen (2014) H is for Hawk, Jonathan Cape
Porter, Max (2019) ‘I felt changed’, The Guardian 27 Sept 2019, https://www.theguardian.com/books/2019/sep/27/max-porter-way-though-grief-denise-riley
Riley, Denise (2019) Time Lived, Without Its Flow, Picador
Riley, Denise; Porter, Max; Berry, Emily; (2019) ‘Time Lived Without Its Flow’, London Review of Books podcast, 9 October 2019, https://www.lrb.co.uk/podcasts-and-videos/podcasts/at-the-bookshop/time-lived-without-its-flow-denise-riley-max-porter-emily-berry
Toolis, Kevin (2018) My Father’s Wake: How the Irish teach us to live, love and die, Weidenfeld & Nicolson

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