PROLOGUE: How do you do something you have never done before?
Liv Johanne Nikolaisen1
Mahitsonge Nomusa Ntinga2
1UiT The Arctic University of Norway
2Physiotherapy Division University of Cape Town
3Community of Practice in Ecosystem Approaches to Health (CoPEH-Canada), Canada
Како писати на начин на који никада раније нисте писали?
Uyenza kanjani into ongakazeh uyenze ngaphambilini?
Hvordan tenke på noe man aldri har tenkt på før?
Comment imaginer quelque chose d’entièrement différent
de ce que vous connaissez et pouvez voir aujourd’hui ?
These are the questions we are faced with as healthcare students, professionals and colleagues setting out to engage in healthpunk. The preface to any answer, if we ever arrived at one, would have to be that it is not easy.
This, at least, is what we have experienced in working through the different stages and tasks involved in the creation of this new collection of stories in Healthpunk Vol 2: Fiction + Healthcare + You. And it has been as true for the writing of healthpunk stories, as it has been for the writing of commentaries aspiring to something beyond peer review, and even for the writing of different openings and enditorials that could frame such a collection.
To take an example from the physiotherapy program from which these collections originated, we have, this year, been struck by the difficulties that come with encouraging students to give free reign to their imagination for more socially and environmentally responsible healthcare futures. Almost nothing inside a physiotherapy education program invites, let alone prepares, physiotherapy students to imagine their future profession beyond the exact image that they have of it before they even begin to study. They come to us precisely because they have a clearly defined image of physiotherapy, predominantly revolving around individually oriented musculoskeletal rehabilitation. And for the most part, that is what we deliver.
Against this backdrop, it can feel like a near magical achievement when students’ image of physiotherapy gradually expands to include, for example, paediatric, neurologic, cardiopulmonary, or palliative physiotherapy. But even amidst this broadening of perception, social and environmental challenges rarely make the cut. They are often even resisted, by students and teachers alike, for allowing them in implies a deeply uncomfortable disturbance of that very image and reason-for-study-and-practice of physiotherapy, if not its disintegration beyond the point of recovery. It seems more comfortable to turn our back and claim ‘That’s not physiotherapy!’, with all the cognitive and affective gymnastics this might entail, than to admit and consider how profoundly social and environmental challenges affect the health of the very people we are meant to work in service of.
Everything I let go of has scratch marks all over it.
Decide for yourself if these ‘imagination challenges’ resonate with experiences related to your own healthcare profession or preferred brand of planetary, eco, one, sustainable, geo, more-than or other health (Gabrysch, 2018). Whatever stance you have, the first challenge in the way of doing something we have never done before, be it even just writing in a way we have never written before, is letting go of how we have done things before. We must get lost, though this is usually neither accomplished easily nor quickly, if at all (Akomolafe, 2015). And it is compounded by the second challenge, which consists in envisioning the new, a view that is, in turn, all too often obscured and ridiculed by the seemingly sober (but dissociated) pretext of pragmatism.
But it’s not realistic. You’re being foolish. It can’t be done. It’s not how the world works.
Here, fiction as a catalyst for imagination presents itself as the paramount means for overcoming the twofold challenge of letting go of a dominant status quo and envisioning alternative futures. Writing fiction, or just diving into writing fiction irrespective of prior experience, can enable and embolden us to imagine the new. And, in so doing, it helps us leave behind a world that is not working as well as that pragmatism of the realistic would have us believe.
‘Sometimes you have to imagine in a radical way that makes you seem a little crazy, that puts you in an embarrassing light, in order to open up a possibility that others have already closed down with their knowing realism’ (Judith Butler, in Gessen, 2020)
Not just sometimes though. Today. The arguably ‘knowing realism’ and the status quo it upholds – how we have done things so far and the stories we have told ourselves in this doing – are what got us to where we are today. But where we are today, the near-normalized 6th mass extinction, the climate crisis, yet another prolonged war, increasing radicalization, global air, soil, water, and plastic pollution, the drying out of riverbeds, the flooding of 1/3 of a nation that barely breaks the news, and countless other such crises, is clearly no longer tenable. In the face of this status quo, the only pragmatic approach is to recognise that we need to find entirely new ways forward and that we need to write the stories that will help get us there. In The Great Derangement: Climate Change and the Unthinkable, Amitav Ghosh succinctly summarizes the pragmatism of fiction today:
‘…the great, irreplaceable potentiality of fiction is that it makes possible the imagining of possibilities. And to imagine other forms of human existence is exactly the challenge that is posed by the climate crisis’ (Ghosh, 2016)
But we can speak even more boldly about the importance of this kind of fiction and the flavour of imagination that we need today. Far from being a waste of time or romantic escapism, we need new stories because ‘stories are compasses and architecture; we navigate by them’ (Solnit, 2014). For better or worse, stories guide and inspire our actions. Like that tale of a healthcare profession for which creative writing is just too childish. Or that emerging story that society and environment are, after all, something to care for if the health of people and planet is what we are after. Or that age-old ‘I am better than you’ story that is keeping us from truly coming together in solidarity. Or that story that money makes the world go round that suffocates the alternate narrative that we must care for each other. The story that the only stories worth hearing are told in words, or one or another language. That story that there is no time for telling stories that quenches the connections and radically new ways forward that can only be told as stories to begin with.
As the editors of Healthpunk Vol 2 we are deeply grateful for all the courageous stories that have been sent to us in this spirit and the way they might help us navigate to new places and new ways of doing things. Taking us out of the ordinary in an instant, the removal of time opens the door into a new world in which new technologies enable new assessment and treatment approaches, but also new problems to attend to. In this world, emotions might become a source of energy, and are recognized for always already having been that. Old connections to other species are reinvigorated, while antiquated taboos inhibiting health are finally laid to waste. New conditions require us to (body)work in entirely new ways, while the returning of land to indigenous peoples gives way to improvements in equity, justice, health, ecosystem integrity, schooling and more. And just as returning land to people prompts a cascade of improvements, so does returning health and healthcare as a common good, free to be shared by and exchanged with all. Indeed, health is recognized as not even belonging to humans in the first place but is made possible thanks to our close relationships with the sun, the earth, and the different beings we share it with. And so, it is also their sadness over our current crises that needs acknowledging, and their losses and their health that we need to remember as we seek to strengthen our mutual bonds.
The four commentaries that have come together for Healthpunk Vol 2 pick up the themes in the stories and carry them forward through further reflection about the necessary transition from individualism to relational becoming, the need to imagine our way out of capitalism and embrace the unknown, and the importance of stories to accomplish all of this. Finally, the enditorials represent two of our modest attempts to do at least a little bit of what we are asking of our fellow Healthpunkers ourselves, reflecting on what more socially and ecologically responsible Eco/healthcares might look like at different scales, from more fully participating in the world, to the worlds immediately around and within us. But neither the stories, nor the commentaries, or presumed enditorials lay claim to presenting a final answer on the way forward. If anything, we hope they will inspire you to get lost, seek and tell stories of your own that might help us navigate towards that otherwise health and care that we need today.
Akomolafe, B. (2015). Getting lost. Available from: https://www.bayoakomolafe.net/post/getting-lost
Gabrysch, S. (2018). Imagination challenges in planetary health: re-conceptualising the human-environment relationship. The Lancet Planetary Health, 2(9), e372–e373. https://doi.org/10.1016/s2542-5196(18)30169-4
Gessen, M. (2020). Judith Butler wants us to reshape our rage. Available from: https://www.newyorker.com/culture/the-new-yorker-interview/judith-butler-wants-us-to-reshape-our-rage
Ghosh, A. (2016). The Great Derangement : Climate Change and the Unthinkable. The University of Chicago Press.
Solnit, R. (2014). The Faraway Nearby. Granta Books.
Maric, F., Nikolaisen, L. J., Ntinga, M.N., & Webb, J. (2022). Healthpunk Vol 2: Fiction + Healthcare + You. Open Physio Journal. http://www.doi.org/10.14426/opj/202212hp0201
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