The Re-Enchantment of Therapy

Barrett L. Dorko, P.T.

 

The magus of the past was a devout, intelligent, well-read, thoughtful and compassionate individual, sincere in his or her quest to explore all the powers of nature, especially those hidden by our focus on reason and purely mechanical means of control.

Thomas Moore in The Re-Enchantment of Everyday Life 

I’ve been thinking about introducing a little magic into my workshops. Years ago I took a course in close-up magic offered during the evening at The University of Akron, joined the International Brotherhood of Magicians and learned all kinds of things. Upon occasion I’d perform a trick or two. I found that there was a certain satisfaction in knowing something those around me didn’t but that the deception inherent to this art did not emerge from me easily. I don’t like to pretend, and fooling others isn’t my idea of a good time.

Despite those misgivings I’ve been imagining a lecture that begins with the passing of one solid object through another. I can do this several ways, not by defying the laws of physics but because in the performance of magic things are never quite the way they seem and because every magician has a license to lie. If I do this well the class will come to understand that their lack of knowledge of the materials I handle lies at the root of their confusion. Keeping that knowledge to myself is my job as a magician lest I risk being drummed out of the brotherhood. 

After this bit of deception I’ll place my hand on someone’s head and it will soon begin to move of its own accord without this person’s plan or willful attempt. This effortless motion will result in growing warmth somewhere in their body, a softening of their musculature and a reduction in their discomfort. Admittedly, it looks like magic, and there have been times in the past when some in the class assumed the “patient” was a shill employed by me. After all, how else is this response possible? 

I address these concerns and questions by explaining very carefully and in a variety of ways how the body normally functions in a self-corrective manner that few in our profession are aware of though the movement itself has been described and studied extensively for 150 years. What I’ve done isn’t a magic trick and I’m not bound by any oath to keep the method a secret. Once explained, the “magic” is gone and only the knowledge remains. For some, this wrecks the effect. For others, it opens their mind to the possibility of movement long sought for their patients in pain. They realize that with some study and effort on their part this “trick” could be performed in their own clinic. 

All they need to do is learn something more about the materials they’re actually handling.  

  

There is no essential conflict between enchanted living and practical, productive activity; they can serve each other: one delighting the spirit of ambition, the other comforting the heart 

Thomas Moore in The Re-Enchantment of Everyday Life 

The modern therapy department is full of activity, the sounds that accompany effortful, painful movement and the invisible but nearly palpable sense of judgment that always occurs with the measurement of progress. I think there’s a direct correlation between the amount of all this and the billing being done. The more the merrier as far as the administrator is concerned. 

I like Moore’s phrase “the spirit of ambition” above. It could be made into a poster and quite appropriately placed on the wall of most departments, and I have no problem with that. But what I’m suggesting here is that there should be room and time for something else and although I have some reservations about the word “enchantment,” Moore describes the concept in ways that, to me, are reminiscent of an essential aspect of care for enduring pain relief. He says that a culture dedicated to enchantment seeks out experiences that quiet our mental ambitions and sharpen our perceptions. The sort of thing that enchants us contains more charm than practicality and appeals strongly to our imagination while offering comfort and attachment. An enchanting activity is distinct from the striving, serious and hardworking environment of the gymnasium, and if you have any appreciation for the subtleties of creativity and art you know what being enchanted is about. A football game may excite us but we are more likely to be enchanted by an actor’s performance. 

In relation to therapy, I’m talking about care that doesn’t ask for painful effort yet requires attention and active movement. I think that Feldenkrais’ Awareness Through Movement qualifies and the discipline of Tai Chi does as well. Ideomotor movement fits here perfectly. I know that there’s plenty of justification to use these methods in learning theory and the intricacies of neurobiology and biomechanics, but the patient’s sense of them and their understanding of how they actually work to produce the desired affect will never match the therapist’s. We may in the clinic reserve our reasoned arguments based upon scientific theory for our colleagues and instead offer the patient an image that proves more meaningful and thus more powerful to explain how therapy works. Of course, the image shouldn’t include ideas that violate physical law though our examples often become a matter of taking imagination seriously and not literally. The use of metaphor and the simplification of complex topics is part of the therapeutic art of communication with the patient, and when we do it well, they find what we say interesting, engaging and, most importantly, relevant to their own sense of themselves. 

When the therapeutic environment creates this kind of connection there is something we might call enchanting about it, and for the patient in pain this alone may provide considerable comfort.   

 

A conjuror is not a juggler; he is an actor playing the part of a magician

Robert-Houdin 

A few years ago I read a book entitled “Working in a Very Small Place: The Making of a Neurosurgeon” by Mark Shelton and Luann Walther. It was the story of Peter Janetta, the surgeon in Pittsburgh who perfected the technique for operating on the root of the trigeminal nerve in order to relieve the pain associated with tic douloureux (trigeminal neuralgia). It was fascinating throughout but one scene in particular has always stuck with me; a day or so post-surgically the doctor would visit the patients he’d last seen while they slept in the recovery room. They were still complaining about various things, certainly of post surgical trauma but also of remnants of their original complaint. Sweeping through the wards full of confidence and a blazing smile, the neurosurgeon said a word or two, gestured meaningfully to the residents in his wake and signed his name to the chart. Immediately afterward there would be a measurable reduction in requests for pain medication and every patient’s mood seemed to lift. The nurses called it “The Janetta Effect.” 

I know there’s nothing new about such a story and you probably have a few of your own that seem to demonstrate the power of personal contact on painful problems. But I liked this story especially because it followed a careful description of this man’s skill and knowledge. I had the feeling that The Janetta Effect wouldn’t have been necessary in a less painful and debilitating problem. The important mechanical and physiologic changes had been accomplished but one final, charming appearance by the master was needed in order to banish the mysterious remnants of chronic pain. I think we understand something about how this may happen centrally but it often appears and remains largely mysterious and unpredictable nonetheless. 

In the world of manual therapy for painful problems the skills necessary to elicit the movement that will provide pain relief are no less important than those in neurosurgery though clearly they aren’t as hard to acquire. In fact, I contend that they aren’t really difficult at all, and I speak from experience with thousands of students. What takes time and work is the creation of a manner that “charms” the patient. Patients tend to respond unexpectedly to our words and manner and this forces us to alter them continuously. The intricate art of charming communication can take years to master unless the therapist is especially gifted. Many are not. Me, for instance. 

In the world of magic you can acquire tricks that are “self-working” and I own a few. When performing these it is your presentation that fascinates the audience and not your skill, though you may convince them you possess some. Other tricks require subtle skills that take a long time to perfect though the effect is seen as the result of something else to the audience. This persistent duplicity is inherent to magic performance and, in fact, it is also common when one is “charming” another. Maybe that’s why I’m so awful at it. Many of us are wary of the charming stranger for this reason. For me, correction of neural tension in the body is like performing a self-working trick. I don’t need much skill, and if I can just find a way of acting that doesn’t violate my own values I might become charming enough to enchant the patient. They’ll perform the “magic” themselves. 

In a therapy that uses the qualities of enchantment the therapist plays a role that may at times appear mysterious and magical. However, there is no deception. All questions are answered, nothing hidden from view goes unexplained and there are no sudden surprises. 

When this attitude is brought into the clinic what the therapist reveals about the patient’s own ability to function will enchant them both.