Løgstrup's thinking: a contribution to ethics in physiotherapy.

Ethics is ever-present in all aspects of human interaction and, in any physiotherapy situation there is an inherent claim to act and care for the patient in the best possible way. The physiotherapy profession is provided with rules, guidelines and codes to support and ensure ethical professional conduct. In recent decades however, physiotherapy literature has emphasized how ethical agency is immersed in clinical reasoning in each particular situation, in the doing of physiotherapy. The Danish philosopher and theologian Knud E. Løgstrup offers a bottom-up approach to ethics, which may augment the philosophical underpinning of this development in ethical thinking. Løgstrup departs from the given pre-conditions of life; a point of departure where the ethical claim emerges from sensation in the concrete situations. This paper introduces Løgstrup's situational ethics and its ontological framing, with four foci: how we can tune in to sensation and sense the ethical claim of the other; how human interdependence can be heard in what Løgstrup calls sovereign life utterances; relational responsibility and ethical norms; and the metaphorical importance of poetic understandings of the world. In four themes we reflect on how these ethical issues are at stake in physiotherapy practice with regards to: (1) uncertainty, tuned sensation and therapeutic attitude in physiotherapy; (2) sensuous, narrative and poetic meaning-making in physiotherapy; (3) physiotherapy and coming to oneself in new embodied experiences; and (4) ethical claims and codes of conduct in physiotherapy.

Towards living within my body and accepting the past: a case study of embodied narrative identity.

This narrative case study, created from several qualitative sources, portrays a young woman's life experiences and an eight yearlong therapy process with Norwegian Psychomotor Physiotherapy (NPMP). It is analyzed retrospectively from an analytical angle, where NPMP theory is expanded with Løgstrup's phenomenology of sensation and Ricoeur's narrative philosophy. Understanding Rita's narrative through this window displayed some foundational phenomena in a singular way, illuminating embodied experiences in inter-subjective relationships in movement, sensation and time entwined. It illustrates how traumatic life experiences may cause pain, suffering and ruptured narratives with fragmented physical and sensuous reactions, chaos and loss of temporal coherence with consequences for a person's sense of identity. Rita's narrative also illuminates how intersubjective interaction has healing potentials when there is time and space for trust to emerge and to support new bodily-based experiences. Embodied sensuous experiences in present time may help clarify past and present and support chronology in narration and the sense of identity. With this exemplary case study, we argue that Løgstrup's and Ricoeur's thinking may add valuable perspectives to understanding suffering and healing processes in the field of embodied therapies like NPMP.

To be held and to hold one's own: narratives of embodied transformation in the treatment of long lasting musculoskeletal problems.

This study elaborates on narrative resources emerging in the treatment of longlasting musculoskeletal and psychosomatic disorders in Norwegian psychomotor physiotherapy (NPMP). Patients' experiences produced in focus group interviews were analyzed from a narrative perspective, combining common themes across groups with in depth analysis of selected particular stories. NPMP theory expanded by Løgstrup's and Ricoeur's philosophy, and Mattingly's and Frank's narrative approach provided the theoretical perspective. Patients had discovered meaning imbued in muscular tension. Control shifted from inhibiting discipline and cognitive strategies, towards more contingence with gravity and sensation, and increased freedom to be what and who they were. Trust, time, open speech, and being respectfully listened to were described as therapeutic pre-conditions. The body was experienced as the source of their voice as their own. As tension patterns transformed, novel experience in sensation appeared to feed narrative imagination, reshaping past plots, embodied identity and future prospects. NPMP was disclosed as a treatment integrating detection, battle and repair as narrative subplots, but the core narrative was the journey of transformation. Novel embodied narrative resources nourished the quest for a life and identity in tune with the body as one's own.

Bodily cleanliness in modern nursing.

Why are bodily washing practices the way they are in nursing? Michel Foucault argues that modern democratic societies discipline human bodies in accordance with political interests. In the extension of that argumentation we will show that bodily cleanliness in modern nursing may have been used as a disciplining tool. The first part of our discussion takes as its point of departure the second half of the 19th/the beginning of the 20th centuries, the period in which modern nursing emerged. At that time scientific theories on hygiene seem to have legitimized the political effort to produce a clean, pleasant-smelling, decent, obedient, and productive population. Doctors, nurses and teachers played important roles in the implementation of hygienic bodily washing practices. The second part of the discussion focuses on the post-war period. At that time humanistic needs theories seem to have legitimized political argumentation for independent patients who washed themselves if possible. Those who could not manage on their own, should, as far as possible, be washed by cheaper staff, so that nurses could concentrate on medical treatment. Finally we argue that present day bodily washing practices in nursing are in accordance with the norms of appearance and smell that arose in the second half of the 19th and the first part of the 20th centuries. We further argue that staff with little or no education perform much of the bodily nursing work. Self-care seems to be of interest only when it reduces public expenses.

Touched in sensation--moved by respiration: embodied narrative identity--a treatment process.

The aim of this theoretical article is to elaborate on the underpinning of Norwegian psychomotor physiotherapy (NPMP). With a narrative and hermeneutic point of departure, we explore the unfolding of a 10-year-long treatment by analysing a particular narrative from this treatment context in relation to some foundational perspectives on movement, sensation and time. A woman in her late thirties suffering from muscular tensions and pain, depression, anxiety and anorexia, came for NPMP. The investigation of her treatment experience is based on the journal written by her physiotherapist and first author of this article. We suggest that new experiences in movement and sensation as well as changes in movement patterns can contribute to retuning in sensation and restructuring of narrative time. Feeding the fictional space and narrative fantasy with new experiences in movement and sensation can help counteracting delusional ideas and assist changes, supporting embodied narrative identity. Ingrid's experience is discussed in the light of Trygve Braatøy's understanding of muscular functions, Knud E Løgstrup's phenomenology of sensation and Paul Ricouer's narrative time.