Barrett L. Dorko, P.T.

          Every day for at least a few minutes I play a harmonica. I took lessons a few years ago and then found I could continue to learn tunes on my own or with the help of a few books and recordings.

          There are two aspects to this instrument that make it unique. The first is that you not only blow to produce a note, but that you draw in your breath as well. In this way, playing is like breathing, although, depending on the tune, it might be a rather unusual way to do so.

          The second is the size of the instrument itself. Were I to play a trumpet for instance, my exhalation would have to move through several feet of tubing before it came out of the bell. There's a notion that the further your breath travels before it produces a sound, the less it represents your own voice. My harmonica releases my voice about an inch from my mouth, and I can't help but express myself openly when I play. It's too small to hide behind, and when you hear it, you're hearing the player simply breath and sing.

          I've written several essays about the courage it takes to manually manage people in pain. In a culture where touching another is increasingly dangerous, many therapists find that doing something else has certain advantages. I recently heard the McKenzie system described as a "hands off" method, and this was seen as something good about it.

          But my career has always included manual contact, and I can't imagine that such a thing doesn't have an effect unknown to any other form of care. With touch we can convey a kind of acceptance and encouragement that may be difficult to measure, but is often essential for recovery.

          Long ago I noticed that the harmonica was difficult to play casually or with indifference. I could no more do this than speak in a monotone. I found that every phrase of a tune drew from me an intensity of expression and attention to detail I normally reserved for important conversations. When I cradled the harp in my hands, I immediately sensed a familiar fear of self-expression that precedes any lecture at a workshop, and I soon saw its connection to the handling of patients.

          When I touch another I cannot help but reveal a variety of things that are unique to my current being. The less coercive I am with my hands, the more of myself is evident to both of us. The patient's underlying inclinations become evident only after I've expressed some of my own in this way. Hopefully then, self- correction and recovery proceeds in its ideal time.

          I can play some pretty fancy fiddle tunes after all these years, and their speed and intricacy are reminiscent of the manipulative techniques I once taught. But I've found that I much prefer to play plaintive ballads that require patience and subtle nuance of breath and rhythm. In the midst of such a tune, a single note requires of me the same attention and creativity my technique of manual care demands.

          With a single touch, therapists can convey something the patient will find nowhere else, and since the distance between this tactile voice and the one who speaks it is virtually non-existent, the therapist cannot hide behind a protocol or modality. No wonder "hands off" care attracts a large portion of our community.

           One more thing. I never really play my harmonica for others. I find that this much personal expression interferes with my appreciation of the playing.

          I save that for when I handle patients, and the notes I play with them reveal most of what we both need to know.