I am reading a book called “The Man Who Mistook His Wife For a Hat” written by the late Oliver Sacks. It is inspirational. He is Inspirational. He has now been added to my list of people I would invite to a dinner party if I had the opportunity.

Oliver Sacks was a Physician, an author, a Professor of Neurology in the NYU School of Medicine. He was fascinated by the brain. But what fascinates me about Oliver Sacks is that he is “equally invested in diseases and people”. He felt an equal gravitational pull from both the scientific and the romantic as he continually saw both playing a quintessential role in the human condition of sickness. This spoke to me and it reinforces how I aim to help my clients. I aim to assist them as humans, with feelings, and emotions, ideas and goals. Not as a scientific subject.

Sacks writes in his introduction “Animals get diseases, but only humans fall into sickness”. I was hooked. How fascinating. Why is it that we, as humans, fall sick when animals merely get disease? What is it that makes us sick? Is it our minds? Our brains? Is it our nervous system? Is it the negative connotations and experiences we associate with sickness and pass onto our friends and families? Is it the negative experience and story of such disease that makes the bigger impact? Without emotion, or experience or feelings, how would disease or pathology impact humans?

“Animals get diseases, but only humans fall into sickness”.

Oliver Sacks

And so, when I think about pain, how does that transfer? Or symptoms of prolapse? When an animal gets wounded, is he left with a lifetime of chronic pain? When an animal gives birth, do they experience prolapse? And if so, is it considered a pathology or is it considered normal? When there are emotions such as shame, guilt, fear or embarrassment is it plausible that these negative connotations could be more debilitating than the pathology itself?

When we look at Sackett’s Levels of Evidence, level 5- “Case report” the lowest level. But why is that? Do  case studies not have the potential to be extremely valuable. I say potential as, in case studies in recent years, the individual has been removed. In dealing with humans, the scientific and the romantic have equal effect. And so why is it that we only want to know about one half of it? Unless a case study tells us of the person, the struggles and the afflictions this person is dealing with, then I would wonder how much use it is at all? We are talking about a real person, an essential being as they relate to the disease and the physical. And so here we have a beautiful opportunity to explore and investigate this disease and it’s effect. The impact of this disease. And why this disease may no longer just be physical but may be an illness, or a sickness, or a debilitation through pain or other symptoms. In real life, disease and the human cannot be disjoined. So why are we trying?

Sacks speaks of a man suffering from severe amnesia. So severe that he is a “man without a past or a future. Stuck in a constantly changing, meaningless moment… He was a man who, in effect, had no day before”. And again, I ask myself? What does this mean for him? If someone has no day before, no past experiences to remember, do they experience pain and symptoms in the same way? They do not have negative experiences with which to relate, and so will stepping on a plug be equally as painful the second time? Without prior experience, can our nervous system predict an outcome? Can it protect in the way it is designed? Is ot altered in the same way?

We are influenced by those around us. How often do people come in with back pain and say they don’t want to end up like their mother because she has been crippled with back pain for years? How is that impacting their very own experience of back pain? But with someone who cannot remember what they ate 10 minutes ago, how does that transfer? For someone who cannot remember anyone’s experience of back pain, be it their own or others? Is our nervous system still sub-consciously impacted and changed?

This man with no memory, no experience, said “He himself did not feel ill”. And so it begs the question, if he did not feel ill, was he ill? How do we even express that? Suffering from a pathology of the brain? But yet he reports he is not feeling unwell and so surely suffering is inaccurate. Not feeling ill. Someone has the “signs” of a bladder prolapse on internal examination, but they do not feel it? What does that mean? Does that mean there is anything wrong? Do we diagnose them with a prolapse? Is this an example of a pathology without a negative impact of an individual? Or is it just a normal phenomenon and within their realms of normal?

You look at the lady who does have feelings of prolapse but who has considered these feelings to be normal. She has purpose and carries out that purpose and function fully. What then? Are they symptoms if there is no negative connation with them? Or the man with signs of a “slipped disc” on MRI but without correlating symptoms. The man with right sided back pain and a left sided disc bulge? What do these mean in the context? How do we go about “treating” these? Or do we treat the person? Do we aim for function? What do they want to be able to do? How can we help to get them there?

What about the language we use with these people? Surely this can impact the experience of this person. Are we over pathologizing? Are we focusing too much on the “signs” and less on the symptoms and the function?

Are we listening to our clients? Are they being heard? Are their fears and afflictions being listened to? Allayed?

Before beginning this book, I would have had a very black and white opinion of neurology. There is a lesion. We do what we can to reduce the size of a lesion or adapt with compensations. We generate new connections with neuroplasticity. But just as my work with Musculoskeletal and Women’s Health Clients, Neurology is about the person. How can we facilitate them to fulfil their purpose?

Maybe physiotherapy isn’t all that different from any other healthcare discipline? Maybe we all need to really begin to focus on people and not disease. On function. Not on pathology. On Purpose. On life.

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