מחברת: מיכל ריטר ז"ל
Yuval (pseudonym), a 65 years old man, came to my office with a complain of low back pain. From the moment he came in, I had a feeling that Yuval had Parkinson's disease. He moved without differentiating between his main body parts; his chest and pelvis moved as one unit and his knees were nt. His movement pattern was of severe muscle stiffness. There was no expression in Yuval’s face and his voice sounded unclear. These signs are all typical presentations of Parkinson's disease. According to his answers to the routine questionnaire, filled by all students arriving at my office for the first time, I understood that Yuval has not yet received any diagnosis and that he doesn't take any medications. According to his answers, Yuval considered himself to be a “healthy person”.In our first meeting, during the FI lesson, Yuval began to feel the ability to move at a greater ease and with less effort. He became aware of his breathing, accompanied by the movement of his ribs and diaphragm. By feeling the balance between the antagonist muscles, Yuval was able to differentiate between his chest and his pelvis, which at the end of the lesson, contributed to his uprightness during standing and walking. He was aware of this significant difference himself. Discovering the jaws’ ability to move with ease has changed Yuval’s facial expression and he reported with a hint of a smile that he has almost forgotten of his back pain.
Yuval willingly accepted my suggestion to meet twice a week for the beginning of the learning process. I was thrilled after our first meeting; it was surprising to observe such a change during one lesson. I wondered whether the lack of information and diagnosis of his condition enabled Yuval to improve so much. I was impressed by how receptive and open Yuval was to the options I suggested during the lesson, he embraced it with great curiosity and optimism.
We continued to work together for three months. Yuval felt much better, his back pain disappeared completely and he enjoyed feeling a significant improvement in performing his daily life activities. Dancing to the sounds of rhythmic music was a regular part of our lessons. Yuval enjoyed every moment of it, his body responded to the music with a soft and smooth motion. I suggested that he would ask his wife to dance with him, but he determinately refused it claiming that his wife will not be happy to dance with “such a clumsy man like me”. I felt that the safe learning environment and the fact that he was not yet given any diagnosis allowed Yuval the freedom to learn and make progress. I was impressed by his willingness and openness for learning.
Every so often Yuval would tell me that his wife had different complaints about his appearance and functioning. She was not happy with the way he moved, saying he was walking with a bent back and did not move his hands while walking. She said that his facial expressions were different from what they used to be before. She urged him to see a neurologist in order to diagnose him and understand what had been causing these changes. I thought that Yuval’s wife had already assumed what Yuval's diagnosis was. This has prevented her from noticing the major improvements that he had achieved during the lessons. Fearing of what the future may bring, she was not able to recognize the progress that Yuval had been making.
Yuval finally gave into his wife’s insistence and visited a neurologist. The title that doomed his fate came as a surprise. Just when he was experiencing ease and free movement, feeling more secure and enjoying his ability to dance, the bitter diagnosis was given – he has Parkinson's disease.
I was really surprised when I saw Yuval at our next lesson just after he was diagnosed. Yuval walked in with bent knees and a stiff walk which reminded me of our first encounter. I didn’t understand what had happened. When he sat down to take off his shoes, his right hand began to shake vigorously, and it took him a long time to carry out the task. Then, without looking at me directly, in a hoarse voice and frozen face he claimed “I have Parkinson's! Now I understand why my wife was complaining all the time”.
“And what about the tremendous progress you have experienced during the past months?” I asked. “I don’t remember that I made any progress. With a sickness like this we just decline and go backwards” Yuval answered in a sad voice.
Without many more words, I asked him to lie on the FI bed and placed a flat round air cushion behind his chest. I gave him an FI lesson in which every movement was freely passed through his chest, thanks to the air cushion which was placed under his ribs. The movement was transmitted freely throughout his body and his breathing pattern has changed to a full expansion of his entire chest.
However, at the end of the lesson, when Yuval stood up and began to walk he returned to the same stiffness he had at the beginning of the lesson. He thanked me for the lesson and left with a sad look in his eyes. I felt that the entire journey we went through together so far was lost and wondered whether we would ever be able to achieve the same joy of dancing we had experienced only a few days earlier.
I wondered what had happened; why had there been such an extreme worsening in Yuval’s condition? The answer came to me at once: the diagnosis and title made the difference. The title "Parkinson's disease" was like a judge’s verdict for a death penalty.
Considering the case of Yuval, along with similar responses of other students of mine to diagnoses and titles, I would like to highlight a dilemma about the positive and the negative aspects of making a diagnosis. Diagnosis is a title, a heading at the top of the list of symptoms that fills various specific criteria. Nowadays, mainly in the western world, it is common to search for, and give a diagnosis when one feels bad, sick or experiencing any strange changes in their health. In this case study I would like to raise questions such as: why is there such a vast necessity for a diagnosis? Why do patients and doctors search so hard for a diagnosis and what effects can the diagnosis have on our bodies and abilities?
As soon as complex symptoms appear, such as pain and physical changes, the feelings of worry and helplessness quickly arise, as well as a need to name it, find a title which we believe will also lead us to a solution, an answer. During the process of finding a title we are left in an unknown and unfamiliar situation. This situation produces fears of what may happen in the future. The imaginary ideas about the future may cause anxiety which can be unbearable at times.
When a diagnosis is given, there is finally a certainty, even if it is difficult or fatal. The diagnosis is something tangible to hold on to. The diagnosis is a solution which fulfills the needs of both patient and doctor: when a patient visits a clinic frequently with complaints and complex symptoms, the doctor feels the need to find a solution that will satisfy the patient so they will stop complaining. The patient demands a solution for their suffering, and expects the doctor to help and find an answer to the problem. As soon as the diagnosis is given, there are protocols that include clear instructions on how to deal with the problem. For the patient, the moment the diagnosis is given, control over their life is finally regained. The patient gets the title, a name, which describes their problem and they can address it. At times, the patient receives the prognosis which enhances and fulfils the need to know how much time is left until their death. The fear of death becomes framed by this knowledge.
Diagnosis is a form of illusion. The patient solely relies on the treatment offered to them as the only option or solution. They become more distant from their own body and more dependent on a treatment given by an external source. This dependency blurs their ability to define and feel what is right for them. The patient lets the treatment do the work. That way they can continue to live according to their previous behavioral patterns. These patterns may have contributed to the development of their present condition, and their continuation may cause more stress and damage.
When a diagnosis is given, many patients read about the illness on the internet and gain information about further characteristic symptoms that may appear as part of this illness. They then anticipate these symptoms or even begin to feel them. The patient starts to act according to what is “expected” of a person with this diagnosis. Their freedom of choice is taken away. The diagnosis is a kind of “prison” in which a person puts themselves. They lose their self-image and inner perception of what is good for them.
These phenomena can be seen in various conditions throughout life. For example, a child decides, following a discouraging remark from a teacher, that they are useless at math. This "title" prevents them from learning and experimenting in this field.
The diagnosis is made at a point in a person's life when they are temporarily weak and fragile. It perpetuates this state even though the conditions which have led to the diagnosis may have changed and are no longer relevant.
I know of a child who used to go to kindergarten happily every morning and started the day by drawing a picture. One day a little girl, a friend of him, sat next to him and asked him why he was making that stupid scribble. From that day on, the child didn't draw any more, and refused to touch a crayon until this day. For him it was a definitive diagnosis, a fatal title.
When I was 16 years old, my dance teacher told me, in a definitive manner, in front of all the class, that I would never be able to become a dancer. Taking this phrase as an absolute diagnosis, I resumed from dancing for many years. Studying Feldenkrais enabled me to place a huge question mark on the diagnosis I was given. Nowadays, dancing is one of my favorite activities in my life!
Diagnoses of mental disorders can change a person’s entire fate. Who is considered normal and who is not? Why is one person given the right to decide if another person is normal?
Social norms are often different in different cultures and societies. Certain behaviors are considered normal in some societies and in others they are absolutely taboo. By the same token, diagnoses may vary according to the time and place where they are given.
In the beginning of a lesson in the Feldenkrais method, we may feel a difficulty to carry out a function, and some activities even feel impossible to us. During the lesson, after some reorganization and new experiences, we discover that the activity is possible and can even be carried out easily and with pleasure. Imagine what would have happened if we allowed our inability to become our definitive diagnosis? We would never try new ways of carrying out actions and we would live a life of limitations and avoidance.
Looking backwards, most of us can remember a diagnosis that was given to us during our life, and how it has limited our ability to function. Only by becoming aware of this limitation, can we act to reverse this process and regain control of our lives.
In the Feldenkrais method lessons, the student experiences new options of motion, and finds the way which is most suitable for them, in order to perform the activity with minimal effort.
The investigation carries out by the student in the “laboratory” of their body’s mobility, enables them to respond to changing situations. The student learns that various organs seem to function in a kind of mutual support commune, where they are considerate of each other, give support and share the tasks. When a certain organ is under stress, others may carry out the action for it and allow the damaged organ to rest and recover.
Therefore, if no fatal diagnosis is given, it is more likely that one can discover new paths to self-treatment which are tailored to one's specific needs. Instead of viewing the symptoms as a dark cloud which we cannot see through, we let them function as a red traffic light, ordering us to stop our habitual behavior. Then we can become aware of our condition and look for a different way of moving along.
In this manner, a person can perhaps help themselves in a better and more efficient way than the medical protocol, which is given uniformly to everyone who has received the same title, the same diagnosis.
Years have passed since Yuval was first given the diagnosis of Parkinson's disease. Slowly, with a lot of awareness, Yuval has gone through a long process of dealing with the diagnosis.
In every lesson Yuval feels the ability to move with more ease. He experiences the ability to breathe deeply and thoroughly. He tries out the differentiation between his chest and his pelvis which enables him to use the center of his body in order to mobilize his limbs. Moving his ankles and hip joints has taken some effort away from his knees allowing them to be less bent when he walks. Moving his eyes and tongue in various directions has contributed to more facial expressions. Attempts at transferring his weight in different directions have improved his balance. Working with a mirror enables Yuval to image the movement of his shaking hand as if it moves like the “better” hand which he sees in the mirror, and helps him with fine motor activities. Dancing to music at the end of the lesson, integrates the experience of the lesson.
Yuval’s awareness and understanding of the negative impact of the diagnosis on his self-image enables him to behave in a manner that is different from what is expected from an ordinary Parkinsonian patient , but it is clear, without doubt, that the diagnosis is always in Yuval’s mind and accompanies him wherever he goes. Awareness of the advantages and the disadvantages of the diagnosis may create an opening for therapy and cure.
