The language of the body is amazing… I couldn’t hear it but the physiotherapist could.” Jenny Powell
Like the ‘disembodied lady’ described by Oliver Sacks, poet and teacher Jenny Powell has lived her life without a sense of body. Confused and frustrated by her inability to feel connected to her joints and her movements, she started to investigate, piecing together a comprehensive picture of her condition. The result is a fascinating and informative book: The Case of the Missing Body (Dunedin: Otago University Press, 2016)
Three years ago, an acute relapse of a recurrent shoulder injury led Powell back to her physiotherapist. He sent her to the gym, where what should have been a straight-forward rehabilitation of a musculo-skeletal problem turned into an intense and difficult journey in the mysterious land of body. There were many times when Powell felt so lost and dispirited she doubted her ability to continue with the programme. She watched others in the gym and saw that they had a kind of fluent communication with their bodies, whereas she herself was utterly deaf to the body’s messages. In despair, she wondered how her physiotherapist could be bothered even trying to work with her.
But he did not give up. He set about refining his approach, finding ways to communicate ‘body’ to someone with no concept of body. One day, a small miracle occurred in the gym: Powell discovered she had shoulder blades. It was like suddenly understanding a phrase in a language you’d always heard as gobbledygook. It made sense!
But useful competency in this new language was to prove frustratingly hard to achieve. Through the months of hard work that followed, Powell was frequently overwhelmed by the difficulty and confusion of the work. Sometimes it seemed she would always be a stranger in a foreign country. What kept Powell on-track through this vulnerable time was her physiotherapist’s willingness to keep on trying to understand the situation from Powell’s perspective, to learn to ‘speak Jenny’, as it were, and in doing so find comprehensible ways to translate ‘body language’. His approach changed everything for Powell. Indeed, his compassion, empathy and commitment became the trigger for writing The Case of the Missing Body.
I wrote it to show physiotherapy students that there’s an ‘X factor’ to physiotherapy. There’s the unexpected that you always have to be prepared for. And there’s the humanity and the compassion that would keep someone like me going.” Jenny Powell
The book tells the story of Lily, who has a profound proprioceptive disorder. This means she can never know where the parts of her body are unless she can see what they are doing. Anyone who has ever sprained an ankle will know a little bit about how that can feel. Damage to position-sensitive receptors in the ankle joint lead to a loss of normal automatic awareness about how the foot is angled as you take a step. Even after the sprain has outwardly healed, proprioceptive damage can continue to make walking hazardous, especially in the dark or on rough ground. This is why post-sprain rehabilitation includes balancing on a wobble board, or practising standing on one foot with the eyes shut.
When The Case of the Missing Body opens, Lily’s proprioceptive disorder is undiagnosed. Indeed, she doesn’t know it’s a disorder; difficult is just the way life is. Despite her physiotherapist’s careful explanations, Lily cannot manage the simplest of exercises. She is clumsy with the equipment, becomes tangled in her clothing, can’t co-ordinate her limbs. She thinks she must be an idiot. What Lily’s physiotherapist sees, however, is an intelligent person seriously affected by an invisible condition. He is determined to help Lily identify and restore, as much as possible, her missing sense of body. The first step is to find a way to communicate. It’s pointless, for example, telling Lily to “pull your shoulder blades together”. What shoulder blades? What do you mean, ‘together’?
As in Powell’s own experience, one language that speaks most usefully to Lily is metaphor. Standing straight rather than slouching is ‘being a totem pole’. But it’s trial and error. Sometimes the physiotherapist’s first chosen metaphor is unhelpful, as with a marionette image which only tangles Lily’s ‘strings’. This same exercise successfully translates when the physiotherapist re-imagines it as ‘be a dead bug’.
Throughout, the physiotherapist’s most consistently useful language is the wordless one of touch.
On the pulley he tells me my shoulder blades have to go across and down. Down? Down? I can only do across. He puts his fingers on the base of the blades. The pressure is just right. This is a special touch. It lets me venture inside my body. I move my shoulder blades across. I move them down. Across and down, across and down.
Triumph.” The Case of the Missing Body, p24
Alongside Lily’s story, Powell provides medical facts about proprioceptive disorder (and related disorders such as dyspraxia). The narrative and biomedical modes work hand in hand, each giving context to the other.
It’s often said that listening and communication skills are vital to good healthcare. It’s such a routinely expressed ‘value’ that we can forget what it really means. The Case of the Missing Body clearly and movingly illustrates that intelligent listening and communication is a commitment to paying attention to context and subtext, and responding with creativity, flexibility and imagination.
Jenny Powell is a Dunedin creative writing teacher and poet, with eight published volumes of poetry: Sweet Banana Wax Peppers (HeadworX, 1998), Hats (HeadworX, 2000), Double Jointed (with 10 other poets of her choice) (Inkweed, 2003), Four French Horns (HeadworX, 2004), Locating the Madonna (with Anna Jackson) (Seraph Press, 2004), Viet Nam: A poem journey (HeadworX, 2010), Ticket Home: 30 poems (Cold Hub Press, 2012) and Trouble (Cold Hub Press, 2014).
Sue Wootton is co-editor of Corpus.