THE RELATIONSHIP BETWEEN THEORY AND PRACTICE IN ADORNO’S PHILOSOPHY, AND WHAT IT CAN DO FOR PHYSIOTHERAPY ETHICS ANNA ILONA RAJALA A thesis submitted in partial fulfilment of the requirements of the University of Brighton for the degree of Doctor of Philosophy May 2021 Timolle: The miserable have no other medicine But only hope. (Claudio in Measure for Measure) 2 Abstract This thesis is a philosophical criticism of physiotherapy ethics through the work of Theodor W. Adorno that adds to the growing literature on critical physiotherapy—a physiotherapy research field that draws on philosophy and critical social science. This is the first extended reading of Adorno in the context of physiotherapy and, more broadly, in healthcare. The thesis falls broadly within applied philosophy and ethics. My purpose is to reconfigure the understanding of theory and practice in physiotherapy ethics. I aim to answer the following: 1) How might the relationship between theory and practice be understood in physiotherapy? 2) How does Adorno’s thinking help to clarify the relationship between theory and practice in physiotherapy? 3) How does the sort of understanding that emerges help to advance critical understanding of physiotherapy? The central ideas from Adorno’s thinking that frame my argument are the following. First, Adorno’s philosophy criticises objects ‘immanently’—from within them rather than using external criteria. Second, Adorno criticises ‘identity thinking’—the tendency to attach concepts to objects to categorise them—to emphasise the importance of the non-conceptual for rationality. Third, to open up rationality to the non-conceptual, Adorno uses the notion of ‘constellations’ to surround the object with concepts rather than simply attaching a definition to the object. Fourth, Adorno insists on the ‘priority of the object’: theory must begin with its object which mediates the response of philosophical practice. Finally, Adorno was an adamant critic of positivism. Chapter 1 frames the thesis by tracing Adorno’s thinking about the relationship between theory and practice. Adorno argues that theory is a form of practice: theory must place its object as primary and aim at affecting change in a world that is antagonistic to its core. Theory must not prescribe the path to a better world but analyse why change for the better is not happening. Chapter 2 extends Chapter 1 to outline the idea of theory as practice for physiotherapy ethics and to defend theoretical analyses both against the notion of ‘evidence-based ethics’ and mistaken views of philosophical theory. Chapter 3 is a criticism of identity thinking in the claim that clarifying what the concept of ‘person-centredness’ is leads to the related practice becoming better. A direct path from clarified concept to practice is not guaranteed. Instead, I argue for placing ‘person-centredness’ in a constellation. Chapter 4 criticises immanently the four principles approach—a liberal theory of healthcare ethics that enjoys endorsement but has also been criticised widely. My criticism reveals that instead of placing the principle-abiding subject as primary, the priority of the object offers a basis for physiotherapy ethics. Chapter 5 focuses on Adorno’s somatic philosophy and how physiotherapy ethics might be anchored in the body, its vulnerability and suffering. Keywords: critical physiotherapy, Adorno, ethics, theory, practice, critique 3 Contents Abstract 3 Contents 4 List of abbreviated works by Adorno 6 Note on translations 7 Acknowledgements 8 Author’s Declaration 9 Introduction: Adorno and critical physiotherapy 10 1. Why Adorno? 10 2. Thinking with Adorno: immanent criticism and constellations 19 3. Critical physiotherapy and physiotherapy ethics 27 4. Scope, contribution, and aims 35 5. The structure of the argument 37 Chapter 1: Theory and practice in Adorno’s philosophy 42 1. Introduction 42 2. Practical elements of theory 45 3. Philosophy and the antagonistic reality 58 4. Negative morality 64 5. Conclusion 71 Chapter 2: Theory understood as critique and resistance is a practice in itself 73 1. Introduction 73 2. Why theory as practice? 75 2.1 A ‘crisis of theory’ in biomedical ethics 75 2.2 Against a narrow view of theory 85 3. Theory as practice in physiotherapy ethics 93 4. Conclusion 105 Chapter 3: Contra identity thinking: ‘person-centred’ practice and constellations 107 1. Introduction 107 2. Can ‘person-centred’ practice be defined? 110 3. Adorno’s critique of identity thinking 115 3.1 The nonidentical and identity thinking 115 3.2 Constellations 121 4 3.3 Problems of positivism 124 4. An anti-positivist constellation 131 5. Conclusion 142 Chapter 4: Immanent criticism of the four principles framework 144 1. Introduction 144 2. Immanent problems of the four principles approach 147 2.1 The common morality argument 147 2.2 The justification of universality 156 2.3 The practice of the principles 166 2.4 Drawing the principles from common morality 173 3. The priority of the object 180 4. Is simple practical? 189 5. Conclusion 196 Chapter 5: The object’s priority and its implications for universalism in physiotherapy ethics 198 1. Introduction 198 2. Problems of principled global liberalism 203 2.1 Reproducing coloniality 203 2.2 Applying or adapting? 211 3. The vulnerability of the body as a moral remainder 213 4. Towards an object-prioritising ethics 221 5. Conclusion 227 Afterword: Adorno and critical physiotherapy? 228 1. A theory-practice constellation 228 2. From omissions to new directions 231 3. Restrictions 234 4. The ongoing challenge 238 Bibliography 240 5 List of abbreviated works by Adorno AE Against Epistemology: A Metacritique. Translated by Willis Domingo. Cambridge: Polity, 2013. CM Critical Models: Interventions and Catchwords. Translated by Henry W. Pickford. New York: Columbia University Press, 2005. DE Dialectic of Enlightenment. Translated by Edmund Jephcott. Stanford: Stanford University Press, 2002. (with Max Horkheimer) HF History and Freedom: Lectures 1964–1965. Translated by Rodney Livingstone. Cambridge: Polity, 2006. HTS Hegel: Three Studies. Translated by Shierry Weber Nicholsen. Cambridge, MA: MIT Press, 1993. ID An Introduction to Dialectics. Translated by Christoph Ziermann. Cambridge: Polity, 2017. IS Introduction to Sociology. Translated by Edmund Jephcott. Cambridge: Polity, 2000. JA The Jargon of Authenticity. Translated by Knut Tarnowski and Frederic Will. London: Routledge, 1973. KCPR Kant’s Critique of Pure Reason. Translated by Rodney Livingstone. Cambridge: Polity, 2001. LND Lectures on Negative Dialectics. Translated by Rodney Livingstone. Cambridge: Polity, 2008. MM Minima Moralia: Reflections on a Damaged Life. Translated by E. F. N. Jephcott. London: Verso, 2005. ND Negative Dialectics. Translated by E. B. Ashton. London: Routledge, 1973. NL1 Notes to Literature. Volume One. Translated by Shierry Weber Nicholsen. New York: Columbia University Press, 1992. PD The positivist Dispute in German Sociology. Translated by Glyn Adley and David Frisby. London: Heinemann, 1976. (with Hans Albert, et al.) PETS Philosophical Elements of a Theory of Society. Translated by Wieland Hoban. Cambridge: Polity, 2019. PMP Problems of Moral Philosophy. Translated by Thomas Schröder. Cambridge: Polity, 2001. 6 PT1 Philosophische Terminologie. Band 1. Edited by Rudolf zur Lippe. Frankfurt am Main: Suhrkamp Verlag, 1973. PT2 Philosophische Terminologie. Band 2. Edited by Rudolf zur Lippe. Frankfurt am Main: Suhrkamp Verlag, 1974. TNM Towards a New Manifesto. Translated by Rodney Livingstone. London: Verso, 2011. (with Max Horkheimer) Note on translations I use the standard English translations of Adorno’s works, which occasionally suffer from some inaccuracies. I have checked each citation in the German editions (Gesammelte Shriften 1–20, Frankfurt am Main: Suhrkamp) and amended the standard translations where appropriate. All amended translations are mine unless otherwise stated. 7 Acknowledgements I am grateful to my lead supervisor, Bob Brecher, who supported me to finish this thesis and offered invaluable advice to improve my writing and commentary to improve my argumentation (on several occasions, but especially on the final draft). I got there finally, thank you. I am also grateful to my secondary supervisor, Andy Knott, who often went above and beyond reading and commenting my sketches and drafts and offering useful commentary on the final draft. I have learned a lot from both of you, thank you. My amazing and talented colleagues at Tampere University, Anni Kangas, Mikko Poutanen, Anna Heikkinen, Iuliia Gataulina and Tiina Vaittinen, deserve a special thanks: without your encouragement, collegiality, and friendship this thesis would not have seen the light of the day. Tiina encouraged me to ‘get on with it’ on several occasions, of which I am eternally grateful (the debt will be paid in the shared academic interest in human waste). I’m also grateful to the Critical Physiotherapy Network colleagues, especially David Nicholls, without whom I would not have had the courage to write about physiotherapy in the first place. When I was beginning this project in 2014, I thought there would not be an audience for critical theory among physiotherapists—have I been proven wrong! To my colleagues at Brighton: Megan Archer, Melina Sadikovic and Marina Espinoza, thank you. Thank you, my friends at Seahaven Dance, for making me feel at home in Seaford: Mechele Lefkaridi, Georgina Hill and Debbie Moy. To my friends, Nora and Terhi, thank you for being there for all these years. To Jonna, thank you for your friendship and support, and numerous critical (and often saucy) discussions. Most importantly: my family, I love you. My critical companion, Timo Uotinen, who introduced me to both Hegel and Adorno, convinced me to push on, supported me through pints and pints of tears, read and commented numerous drafts, and meticulously (how else) proofread my footnotes and helped me finish my bibliography. As usual, this work is dedicated to you. Tässä tää ny ois, kiitos ja anteeksi. 8 Author’s Declaration I declare that the research contained in this thesis, unless otherwise formally indicated within the text, is the original work of the author.