When you type "physiotherapy" into a search engine and look at the images, what do you see? You see smiling older people on yoga balls, a CGI spine with angry red shading where the pain might be, smiling, clean-cut therapists moving patients' limbs through space, and people smiling as they exercise. I've never seen a single person smile when they were doing a kettlebell row but apparently they do. Maybe I need to pay better attention. The people in these photos are tall, taut and tanned. The therapists all look like the same person poured into a different coloured shortsleeve polo and a pair of chinos. This is the Image. This is the Look. This is what physiotherapy and health wants to be, what it presents itself as.
Look at the webpages of big national and international providers - it's more of the same. Smiling people doing exercises while young, fit and beautiful therapists guide them through their movements at arms' length, still with that same rictus smile on their faces. I haven't seen someone smile in clinic for two years because everyone's still wearing masks. These images online, in brochures, in advertisements and in powerpoints are all selling the same thing: they're selling a look. They're selling a lifestyle. They're selling an image of health that's implicitly accessible through engagement with their service. If it wasn't the case then why are all the therapists in these photos wearing uniformed polo shirts? It's marketing, designed to do the Landlord's Special and slap a fat coat of thick white paint over any cracks and cockroaches that might catch the eye so that the walls and windowsills look presentable in the listing. This is advertising doing what advertising does best - emphasising an element of a product so people bite the bullet and shell out their coin.
My problem with this is that advertising done for healthcare services and clinics emphasises the relationship between therapist and patient. Don't get me wrong, this is an important element of patient management and rehabilitation, but it's not everything. In fact, it's a very small thing. If you see your physiotherapist twice a week, you're only seeing them for one hour out of the one-hundred and sixty-eight hours that make up a week. That's less than one percent of the week. What do you do when you're not smiling when you're being guided through your exercises by a creepy cardboard person in RM Williams boots? You do your exercises at home. You take care of yourself. You get better by yourself. The problem is that you can't advertise that - well, the more accurate truth is that nobody wants to advertise it because empowering people to do their exercises at home, independently and with the knowledge of what they're doing and how to approach their problem won't make anyone any money. So instead, we focus on the clinic - look at our foam rollers! We focus on the therapist - look at our fancy shirts and logo! We focus on the aesthetic - look at our honeycomb wall rack and our monstera at reception! Look at how vibrant, energetic, and health-focused we are, and you can be all of those things and more if you come to our clinic and work with our therapists.
I'm getting ahead of myself.
The Cachet of Queerness.
June is Pride Month. It's one-twelfth of the year where company instagrams retool their logos with rainbow gradients and everyone gets flag pins and we spend time acknowledging people form the LGBT+ population. You know, the same people who get bullied by politicians and industrial leaders every time they want to distract the general public from a business or political scandal. Also, so long as those company profiles aren't being broadcast in Saudi Arabia, Malaysia, Iran, Indonesia, Syria and a host of other places where homosexuality and the expression of gender-nonconforming activity is punished by imprisonment, corporal punishment, and death. Those are the places where it's still illegal to be queer. I guess Pride Month is more of a wealthy democratic kind of thing.
Until recently, Australia only began granting domestic partnership benefits and relationship recognition to same-sex couples from 2003 (when I was ten years old) onwards, with federal law recognising same-sex couples since 2009 (when I was sixteen years old) as de facto relationships, and legalising same-sex marriage in 2018 (when I was twenty-five years old.) Homosexuality was federally decriminalised in 1973, but it still took 24 years for anti-sodomy laws to filter down and be repealed across the states and territories. Tasmania was the last state to decriminalise homosexuality, on the 1st of May, 1997. I was four years old. This happened in my lifespan. Are we supposed to forget about all of this because of rainbows and corporate overtures? Are we supposed to forget that while homosexuality was decriminalised in 1973, historical criminal convictions for those indicted under anti-sodomy laws were only expunged between 2013 and 2018, all while individuals found liable under scrapped legal code were discriminated against when travelling and applying for work? Maybe we're not meant to forget, but maybe we're meant to accept the presented corporate aesthetic of reconciliation, now that the truth of peoples' lives isn't being debated in the courts and that being queer is socially acceptable.
The first Pride was a riot. Pride Month started as a riot against police brutality at a small dive bar in New York City called the Stonewall Inn where NYC police attempted to arrest gender-non-conforming individuals and got bricked by the patrons of that bar in June 1969. People fought the street cops and then the TPF. This lasted for two days. Two days in which the lived grievances of people who had been pushed to society's edges had boiled up and over and then spilled out in violent conflagration, physical brutality, and affirmative resistance. The first proper Pride march happened a year after Stonewall in 1970. There wasn't a riot, but there was forward movement. There was recognition, realisation and reification of people who had been trampled by the social and legal machinery of society. Now that queerness has cachet and a legalised and socially transformed veneer of social acceptability thanks to the first people brave enough to throw burning garbage on police, it's acceptable to market it. Pride is marketed to the communities as a socially and community-driven means of engagement by corporate entities. Pride is marketed to those outside the queer community to allow them to engage in visible allyship with a community that legally wasn't allowed to exist fifty years ago. Contemporary Pride Month and its aesthetics represent the corporate recuperation of a rebellious, sincerely urgent movement, and its recycling as marketed and marketable content. Pride means different things to different people, of course, but in the neoliberal context of late-capitalism, Pride means an opportunity to drive brand engagement through demographically-targeted content, pasting rainbow colours over what are still open wounds.
The Wealth of Wellness.
Holistic care is the most recent metamorphosis of the wellness aesthetic today. Holistic care is broadly defined as a means to provide support that looks at the whole person, not just their immediate needs. Holistic care is ostensibly meant to encompass emotional, mental and spiritual health as well as physical health. This consciousness of the multifaceted nature of human needs has resulted in the infiltration of non-medical professions and personalities into the health-delivery space. Celebrity Chef Pete Evans and his cryptofascist bullshit is a good example of this. Health and healthcare hasn't changed in the bones, though. The practice of medicine and physiotherapy have been slow to evolve because the human body and human needs haven't changed all that much, and with our existing scientific and technological capability we can handily address most of those needs and minimise the acute effects of deprivation otherwise. What I have seen is a change in health as a result of the rise of the wellness aesthetic as well as the increased privatisation of health in this country.
As time has gone on, healthcare has been less and less accessible for people as primary-contact practitioners move to an increasingly privatised model. Those people who do have the money to access healthcare are increasingly discretionary with their spending, as is their right, and healthcare as an industry is becoming increasingly aesthetic-focused as a consequence of that. It's never just medicine, never just physiotherapy, never just psychology, podiatry, or exercise. It's becoming service-plus, becoming something more, and becoming dressed up in an aesthetic designed to market to peoples' interest. It's hard to sell people on doing pushups at home. It's easy to sell people on a therapist-dependent relationship of care in which the responsibility for rehabilitation is placed on the therapist while the benefit of wellness is owned by the patient. Divorcing one form the other leads to externalisation of control in the hands of the therapist, the clinic, and the machines therein - removing power from the patient and putting it in places and people who can use that trust to build dependence. Therein, an aesthetic of wellness presented convincingly allows the therapist to assume ownership of the patient pathway, leaning on the existing patient-practitioner power dynamic in a pattern of behaviour that typically seeks to enrich the provider while providing health as a happy coincidence.
In the same way that the aesthetics of resistance, rebellion and community can be recuperated by corporate entities, so too can the aesthetic of health, wellness and equilibrium be recuperated by healthcare providers and marketing to suggest either implicitly or explicitly that engagement with their service is a path to wellbeing. Even if it's not done intentionally, it's still dangerous. Laws and regulations around medical advertising are strict because people in pain are people who are vulnerable, sometimes even desperate, and someone in distress is easily parted with their money. There's a lot of money to be made by selling quick-and-easy solutions to peoples' problems, and even more money to be made just looking like you have those solutions.
Democratisation and Celebration.
Unfortunately, for lifelong health, there is no easy fix. There's no triumphalism in saying that being healthy is the work of a lifetime, of attending to your body and making sure that it can address the needs of your life as the world around you changes and as you change alongside it. The key to living comfortably in the body and the world in which we find ourselves is empowerment of the individual - democratisation of health down to the level of the individual so that they can make as curated and as informed a decision as they can, free from marketed aesthetic and with the understanding of their clinician. Technocratic fetishisation and dressup games only serve to obscure the simple truths that are often-forgotten in a world as fast paced as ours - that it's a lot less sexy and a lot less difficult than it looks to be healthy and stay well.
Health, identity, and the self mean different things to different people. I've spoken to a lot of people, including my friends, academics, and critical writers to get their perspectives on Pride, the journey of community, and the story of the gradual, slow advance toward social equity in the process of writing this article. It's a bigger story than me, and a bigger story than fifty years. It's a lifetime, a thousand lifetimes, a story of histories known in reference and histories erased, of communities grown and tended in secret, burned down and then built back up. Pride is struggle, affirmation, hope, reification and realisation, and so much more. Pride is the response of a community that was told they were supposed to live in shame - they said we are not ashamed of who we are, we are proud. We exist, and having achieved existence, we will grow strong, thrive, and give the finger to those who would challenge the raw and unalterable fact of us. There is no definition of Pride, because what we see is the common denominator raised in aggregate, but it's way, way more than the rainbow, and some obsequious hashtags online.
What is marketed as wellness and health is the same thing - a market denominator. The most unoffensive, broadly-appealing aesthetic that could be decided upon by however many marketing firms independently to get as many people through the doors and on pilates machines as possible. It boils down the individual experience of health, wellbeing and the life-story into its most basic and simplistic units, so that everyone's smiling as they move through their motions. That's not life. Life is wonderful, awful, individual and indifferent all at the same time and all the time for everyone. Life is chaotic, difficult, and you're not always going to smile. Being well, being better, being healthy, authentic, and true to yourself are difficult things because confirmation of the self sometimes stands in opposition to what the world is telling you. It's hard to smile when the first act of self-care is an act of self-acknowledgement and an embracing of your individual truth. That's why sometimes you've got to grimace to get better, and that's the truth. Warts and all.
In loving memory of F. E. Breadmore, 1927-2022. Rest in Power.