The Substance of Style

[Barrett Dorko]

It’s been a quiet week in Cuyahoga Falls…

Apparently my personal appearance hasn’t changed significantly since I was 18, despite my best efforts to the contrary. I know this because I’ve recently attended two meetings of the committee organizing the 40th reunion of Westlake High, class of ’69.

This activity coincides with some reading I’ve done the past year by Virginia Postrel, a brilliant and influential writer that I referenced in a thread titled Therapy and Glamour a few months ago. Go there and you’ll find out what you need to know about her thinking.

There are ten of us so far - all living close enough to gather in a restaurant one evening a month. We’re trying to find the remaining 240 of our classmates for an evening and a day late next summer to do what many people do as they reach late middle-age; look back, wonder aloud about what life has meant and reveal carefully how we felt about things we’ve hidden all these years. That last one isn’t on the official agenda.

Postrel wrote a book in 2003, The Substance of Style, that I have filled with red ink as my pen underlines passages and makes notations in the margins. I feel that her carefully designed premise has enormous implications for the practice of therapy today and want to discuss that. My reunion committee meetings have brought much of what she says to mind and should generate an interesting post or two, along with yours, of course.

I’ll begin with one of the many passages I underlined in the book and we can go from there:

The trick is to appreciate aesthetic pleasure without confusing it with other values.

More soon.

[Mary C]

I'm presently trying this with a fibromyalgia patient. She works in a clothing shop. Her assignment was to look for items of merchandise that she liked, stop and appreciate them for a brief interval before resuming her work.

Not much progress after 3 weeks. Hmmmm......

She was advised to find counseling.

Mary

[Barrett Dorko]

Mary,

I believe that I see what you're saying here. Perhaps this thread will help us understand that a personal style can and should be chosen though not judged or obsessed upon. Without an appreciation of its place in our lives something is lost - something authentic and personal.

[Barrett Dorko]

I’ve put together a few definitions for the word style, both as a noun and a verb. Perhaps if we can agree that this is what we’re talking about the thread will remain cohesive and to the point.

Style: with reference to form, appearance, or character. Examples: elegant, fashionable, or luxurious. Also, the mode of expressing thought in writing or speaking by selecting and arranging words, considered with respect to clearness, effectiveness, manner or tone adopted in discourse or conversation; a distinctive or characteristic mode or form of construction or execution in any art or work. As a verb: to design or arrange in accordance with a given or new style.

I’m focused on all of this because Postrel has convinced me that style is not only important and markedly effective when we seek to communicate something, it is inescapable. To me, communication is our primary job as clinicians and how we do that plays an essential role. That's essentially my point. I’ll paraphrase her here:

We are by deep, biological nature visual and tactile creatures, and our sensory side is as valid a part of our nature as the capacity to speak or reason. The issue is not what style is used but that style is used.

As I walk about various therapy departments these days I try to discern the style chosen by those who practice there. Often it’s not obvious or consistent in any way but when it is it’s not the sort of thing I would personally choose. If, for instance a therapist doesn’t understand the significance of threat or what the nervous system is capable of doing or the laws of physics their style will not reveal a thoughtful or respectful approach to their patient’s bodies or psyches.

Instead, I see laconic, self-absorbed and robotic styles of practice that are, to me, appalling.

Some attention to the power and nature of style would alter this, I’m sure. What do you know about your own style and what does it reveal?

[John W]

Robotic therapists tend to teach their patients robotic movements, which are the antithesis of corrective ones.

Any therapy is an accident brought about by the patient's instinctual need to move.

Of course, this delays recovery, which is just fine with the practice owners/administrators.

[Diane]

(First, a personal context):
I'm up to my eyeballs in listing books for sale and self-managing my own distress at having to discard so many books to the recycle for being worth nothing anymore - can't even give them away, there is such a glut. No one wants them, not even the library.

Anyway, as I sit here and, by turns, delight in checking the monetary value of a book that I consider perfectly useless and finding out it's worth a small fortune, then despair that one (or forty-one) of my most beloved books is/are worth only a cent and there are hundreds already listed, I occasionally decide to be less ruthless, look inside, see if I want keep one for myself.

(Finally, to the point, and on the topic of this thread):
I picked up my ancient (1982) copy of the Tao of Pooh, and it flipped open to page 67, a chapter called The Pooh Way. Here is what I read.

Now we come to what could be called the most characteristic element of Taoism-in-action. In Chinese, it is known as Wu Wei. It is also the most characteristic element of Pooh-in-action. In English, it is not known as much of anything in particular. We believe that it's time that someone noticed it and called it something, so we will call it the Pooh Way.

Note: this is not to be confused with any "woo way". It just sounds the same.

Literally, Wu Wei means "without doing, causing or making." But practically speaking, it means without meddlesome, combative or egotistical effort.

The efficiency of Wu Wei is like that of water flowing over and around rocks in its path - not the mechanical, straight-line approach that usually ends up short-circuiting natural laws, but one that evolves from an inner sensitivity to the natural rhythm of things.

When we learn to work with our own inner nature, and with the natural laws operating around us, we reach the level of Wu Wei. Then we work with the natural order of things and operate on the principle of minimal effort. Since the natural world follows that principle, it does not make mistakes. Mistakes are made - or imagined - by man, the creature with the overloaded Brain who separates himself from the supporting network of natural laws by interfering and trying too hard.

Not like Pooh, the most effortless Bear we've ever seen.

When you work with Wu Wei, you put the round peg in the round hole and the square peg in the square hole. No stress, no struggle. Egotistical Desire tries to force the round peg into the square hole and the square peg into the round hole. Cleverness tries to devise craftier ways of making pegs fit where they don't belong. Knowledge tries to figure out why round pegs fit round holes, but not square holes. Wu Wei doesn't try. It doesn't think about it. It just does it. And when it does, it doesn't appear to do much of anything. But Things Get Done.

I think this is probably akin to the substance of style, at least as far as manual therapy is concerned.

[EricM]

This thread and your post Diane, reminded me of another fairly recent discussion about Shibumi.

[Barrett Dorko]

Diane,

I think your post is directly to the point. In '94 I wrote Winnie-the-Pooh P.T. wich contains much the same sentiment. Did you know about this?

[Diane]

Diane,

I think your post is directly to the point. In '94 I wrote Winnie-the-Pooh P.T. wich contains much the same sentiment. Did you know about this?

Barrett, why am I not surprised that you went around that bend in the river 15 years ago?
I probably have seen your essay, but didn't remember it. Not a reflection on the essay, rather on my memory.

[Barrett Dorko]

That's quite alright Diane. I forget some of the stuff I've written myself.

I want to add at this point another word closely related to style but not often used when discussing communication; aesthetic.

I introduced the term in my first post but want to expand upon it here. What it brings to mind for me is the work of Elaine Scarry, the Walter M. Cabot Professor of Aesthetics and the General Theory of Value at Harvard University. I quote from her book The Body in Pain whenever I teach and wrote about her work specifically here.

When considering aesthetics as opposed to style alone we are focusing on the look and feel of things. Being visual and tactile creatures at heart we can’t help but notice our surroundings and gain a personal sense of what they imply about the designer. Scarry writes convincingly of how “physical pain deconstructs the territory of creating-it brings into sharp focus the relation between it and the ability to imagine.” She is a strong proponent of pain relief as a creative act, and so am I.

If a patient in pain enters a therapy department that displays no creativity in its design and deals with a therapist as imaginative as a robot how can they be expected to easily come up with their own creative acts?

The aesthetic of our appearance, which is closely related to our style (consciously chosen or not), and the look and feel of where and how we practice are all intertwined here.

Let’s see what your thoughts are now before I add some more to the subject in a few hours.

[Diane]

I used to hate working in other therapy spaces, crowded with noise and people bustling around. I didn't have my own space yet, but knew that I had to keep moving - as I moved to the next one, and the one after that, I knew I'd get closer to having my own some day.

I've had three therapy spaces of my own. My favorite was the very first one, a huge 500 square foot room with a treatment table in the center, on a rug. Lots of good things happened in that space, the walls painted a light mauve color. The next one was smaller. But it was still a good sized room, space for a desk and bookshelves, painted white. The one I'm in now is smaller again, painted warm beige, but there is still room for me to walk/work all round the table, including head and foot ends - something I must be able to do or I feel completely hampered. Each move has brought me increased environmental control (and higher rent unfortunately).

Things that are crucial:

• clean, no smells, fresh air when necessary/desired (I am sensitive to disgusting perfumes/lotions etc.)
• natural light, pleasant colors, clean laundry visibly available, a laundry hamper nearby but out of sight
• quiet - minimal sound coming in or going out - a door that locks
• a screened area where people can change clothes
• control over temperature
• no one else inside the treatment space except therapist and patient
• a polite sign asking people to turn off their cell phone

Things that are nice to have, but secondary:

• a pleasant receptionist stationed well away from the room, or else a phone whose ringer can be turned off to decrease noise.
• clocks that tick

[Barrett Dorko]

Diane,

In my past life I had 98% of your ideal aesthetic in the office I worked in alone - for 28 years.

Now I find the aesthetics of the several departments I visit diametrically different from what I had designed so carefully. But as I write about style the last few days I've come to realize that it's portable.

I carry it from place to place, and this explains some of the looks I get.

[nari]

I agree totally with Diane's environment requirements. Perhaps, as an aid for PTs who look at their room/s for improvement, consider this:

How much of the room is devoted to the patient's wellbeing and sense of comfort?
How much of the walls is cluttered with PT promos and catchy do's and don'ts?
Is there glairy flourescent light immediately above the patient when supine?
Is there ample room for the patient as well as the PT?
Are there pleasant pictures of landscapes, etc around? In my mobilising days, I placed a scene of a beach under the gap in the Rx table.
Weights, therabands, pulleys and other strengthening stuff, if they must be used, should be in a cupboard out of sight to lower the patient's expectations of boring repetitive exercises ordered by the PT.

Heresy, yes. Sensible - I think so.

Nari

[Barrett Dorko]

Ten years ago I wrote a letter to the editor of the American Physical Therapy Association in response to a request for thoughts about the profession’s future. I see now that it was essentially about our department’s aesthetics and the power they contain.

It’s titled The Rocking Horse Winner.

Check it out. See what you think.

[Diane]

Check it out. See what you think.

Prophetic. Except now there is more back manipulation being done first.

[EricM]

House at Pooh Corner



I couldn't resist adding this here.

[Barrett Dorko]

Thanks Eric.

A few more paraphrases from Postrel:

Aesthetics no longer imply an elite imprimatur. They are the result of personal expression, imagination and initiative. Ours is a pluralist age in which styles coexist in order to please the individuals who choose them. Ultimately, form follows instinct.

If all of this is true, and I think it is, the implications for therapy are huge. I especially like the “form follows instinct” phrase and I’m reminded that each patient has a unique and instinctive way of moving toward pain relief.

Our job is to encourage that and get out of the way. I think. I'm almost sure.

[Barrett Dorko]

From Postrel:

The more choices we have, the more responsibility we face – whether or not we want it – to define ourselves aesthetically.

I like this becomes, I’m like this.

Patients look around. They see us. They see the place we work.

What can we do about this?

[John W]

The other day, one of the female PTs I work with related to me an incident where a 70 year old patient literally asked her if he could "do something." Her response was apparently vague enough for him to reach around and pinch her backside.

She was, of course, mortified and proceeded to tell him that it was not alright for him to grab her butt. He apologized, and the rest of the visit transpired without incident.

Later the same day that she told me about this event that had occured a few days prior, she and another female aide were discussing getting tatoos, and were looking at some selections online. I had to wonder as they were discussing what designs they liked and where they would have them placed whether the existence of tatoos on a professional might not give certain folks from another generation a certain, shall we say, "stylistic" impression of the therapist. I should think that some, particularly from earlier generations, may associate tatoos with a somewhat "looser" style of interaction, and they may be more emboldened then to act on their impulses.

Of course, there are other "stylistic" mannerisms and behaviors other than tatoos that'll set off a pervert, but this thread started me wondering about the importance of both the verbal and non-verbal messages that we send our patients.

For all you tatoo-donners out there, I hope you don't think I'm questioning your right to self-expression. However, as professionals, who deal with a wide cross-section of society, I thinks it important that we at least think about the implications of our need to express our individuality.

[BB]

I like this becomes, I’m like this.

I recently read in Arthur Frank's "The Wounded Storyteller" about the mirrored ideal type who attempts to project health personified. Not that they're healthy necessarily, but they want to project health. This may involve doing the routines that demonstrate the healthy lifestyle, whatever the current popular portrayal of that might be at the time for that particular individual.

Many of the memes seem to be expecially skilled at projecting health. Maybe what we can do is embody health?

I'm reminded of the point Barrett makes of how the typical PT is disabled by pain yet does not do the very things that they advise their patients to do all day, every day.

[Barrett Dorko]

Cory,

Right again. This is a quote from something I wrote in '04:

In his remarkable book, Illness and Culture in the Postmodern Age, David Morris in the chapter titled “Utopian Bodies” says this; “Health no longer refers, via metaphor, to the ideal social state that generates it but instead signifies the perfection of a single private self. Further, good health is not exactly the issue. What matters is that the individual body appears healthy. Image is everything. The average family lives in a realm of pictures created with the favored postmodern technologies of camera and videotape where they cannot avoid versions of the same subliminal message: the healthy-looking body is the beautiful body; and the beautiful body is the healthy-looking body.”

What I like about Postrel is her ability to see the power and importance of style and aesthetic without forgetting that it can easily become superficial and misleading. Only a thoughtful approach to the issue will do it justice and allow it to be used to everyone's benefit.

[Barrett Dorko]

In the end, the projection of a discernible personal style is the end result of an equally personal attempt at creativity. In a certain sense this always succeeds, though it may not result in a style pleasing to everyone else. Still, we succeed in the attempt itself, whatever it may produce.

I think this creative effort from us implies something about what we expect from our patients. It follows that therapists looking for a creative act from the patient must display something unique in their appearance and/or the aesthetic of their surroundings. This doesn’t sound like a typical therapy department/gymnasium to me.

[Jason Silvernail]

Little-known fact about libertarian and author Virginia Postrel - she voluntarily donated a kidney to an acquaintence.
Here's a link to a video about organ markets she appears in: http://www.reason.tv/video/show/333.html