The gesture

[Barrett Dorko]

It’s been a quiet week in Cuyahoga Falls…

After a period of relative passivity at the keyboard I’ve started writing a lot more. Range of Motion is the best example but there have been a few others. I’m especially pleased to see more discussion about the skin itself here. In my opinion, this cannot be emphasized too much.

In 1959 having filled our backyard pool with three feet of water, my father pulled a picnic bench to one side of it and told us to “shallow dive,” gesturing with his hand across his barrel chest in a manner I never forgot. It became the cover photo on the front of the second edition of my book here.

In ’94 I wrote this in the introduction:

I have the impression that many in therapy, especially in the manual end of it, feel a frustration born of the fact that although we are supposed to change various organs within a patient’s interior, our direct mechanical affect stops pretty much at the surface. Beneath the skin are many processes and bits of anatomy we would love to grip but we aren’t allowed to literally do this. Instead, we’ve developed many elaborate means of affecting change with devices other than our hands. I will admit that I don’t know much about that form of care…Whatever I might say about the profound effect manual care potentially has, it still begins on the surface, and what I do mechanically ends there as well…(But in fact), on the surface you can see a lot that can’t bee seen in the depths.

I’m still diving shallow, and the nature of my work will permit nothing more. But I feel that this approach has been sufficient to practice manual care effectively.

Today in numerous threads the skin’s qualities and connections are described in exquisite detail – all stuff I had no knowledge of when I wrote that. But even back then I knew that I had access to something special and, amazingly, it was ignored by people seeing the same patients that were sent to me.

I’m convinced that at the surface we have what we need in this business, and our choice of pressure, passive movement, instruction and manner should alter as evidence and reason dictate.

I’ll stay there and not pretend I can do much more, or that I need to. I certainly need to understand more – and I’m working on that.

It helps that every day I remember my father.

[Barrett Dorko]

Trouble in the brain is often heralded by the disappearance of feeling in part of the skin.

From Mortal lessons: Notes on the Art of Surgery by Richard Selzer

The edition I own has the copyright 1974 but somehow I remember reading the book while still in college, which I left permanently in 1973. I must have been toiling at my first real job in practice, working 12 hours a day, driving all over Portage County seeing patients in their homes and spending time in two separate clinics. I made $9500 that year and life was good.

Selzer’s book drew me in because of the nature of the writing. Elaborate and poetic, he made the simplest thing about the patient seem monumental – and he devoted an entire chapter to the skin.

Though he was a surgeon trained to cut through it, he always paused there and considered what it might reveal about the depths. I see no evidence that he understood how its stimulation might waken the brain except through remembrance. On that he spends some time.

As I’ve said, therapists are obliged to do less and understand more – and that’s okay with me.