A CASE HISTORY: Some Observations About Self-Image and Adversity

©2001 Gay Sweet Scott
The following article appeared in the Feldenkrais Journal, issue no. 13, 2001.

The notion of self image, rather like the notion of posture and the idea of self esteem seem often regarded as an attribute to be judged: "good posture", "bad posture" , "good self image", "bad.." -- as if posture or self were independent of history, environment and circumstance; as if self image or self esteem were. One rarely hears – she has a competent / adventurous / humorous self image. Popular usage implies a static quality as a photograph or likeness is fixed, perceived and judged by values that may be at odds with the experience of self in the world instead of a measure of adaptability: potentiality. Improved self image is not a nicer picture of oneself -- a more flattering photograph -- but the capacity to incorporate diverse reflections of self. It is informed by learning to make distinctions that are meaningful, and the practice of abilities that emerge from engagement with others and the world.
At the time of the accident Garreth was 38, a master carpenter, married and the father of an infant son. He’d been a competitive swimmer in college and had continued to distance swim in San Francisco Bay in addition to backpacking in the Sierras. He had a degree in architecture from UC Berkeley; he was regarded as something of an underachiever by himself and others as the gifted often are. He was unusually bright, beautiful, skilled, and quick.

One day while cleaning the street after a construction job, Garreth was hit by a car going 40 miles an hour. Both his legs, C2 and C3, and his right hand were fractured; the right shoulder's rotator cuff was torn. Both knees were seriously injured. His right eye socket was crushed, the eye injured so that it is still, after surgery, perpetually dilated, and he experienced severe brain sheer. No ribs were broken. He was in a coma for five weeks. The neurologist told his wife, a nurse, that at best she could look forward to changing his diapers and spoon feeding him for the rest of his life. She sat by his side in the ICU and talked to him day and night. Garreth says, smiling, that he came to, to tell her to stop talking. At the time he regained consciousness he was paralyzed.
A mutual acquaintance paid for Garreth’s first lesson. During the initial telephone interview he explained with equanimity that he had recently completed the last of nine operations; this last to fuse C2 and C3. He was, against all odds, put back together again. However, he was impatient with poor coordination, as well as with short term memory loss and difficulty multi-tasking. His voice was strained and his speech, while clear, was slow. He sounded bemused at hearing the Feldenkrais Method would not "fix" him but could provide an opportunity to explore improvements. He explained, "I’m a no pain, no gain kinda guy" and I laughed. "This experience may be a little different then", I cautioned. Garreth would provide the opportunity to know someone who was articulate, humorous and courageous in constructing their life anew.
As Westerners our first myth pertaining to self image, or image of self, is often the story of Narcissus -- a tale frequently presented as cautionary. Narcissus, we are warned, was so entranced by the apparition of the beautiful youth reflected in the river that he drowned; his death a result of becoming enamored with his own reflected image. Numerous and varied schools of psychology describe Narcissism as one of the more stigmatized and disagreeable disorders: the seduction by a reflection of self portends disaster of one sort or another – frequently fatal. Princess Diana, Marilyn Monroe are cited. But, one wonders, had Narcissus been more fully acquainted with the image he beheld, perhaps he might have maintained his balance on the bank. Narcissus is vulnerable to a flattering mirror, albeit a transitory one, as well as curiosity that brought him to the brink. Many myths and stories instruct us not to be curious—from Pandora’s Box to the Curious George stories for children. But one may argue that Narcissus perished because he was ignorant of his own beauty as much as that he died of vanity and curiosity. Had he understood or felt his own loveliness, would he have been fatally entranced by a transitory image. To develop self love is a task for many of us under any circumstances; to muster it after severe injuries even more challenging. One of Garreth’s gifts, however, was his appreciation of having survived against all odds; another was the self knowledge gained through athletics and practice of a craft.
My friend, an MSCS in a primary school in western Massachusetts, tells me that when teachers bring her a child who has difficulty reading they frequently say, "He has low self esteem." My friend says, "William has trouble reading." They say, "He has low self esteem." She says, "William has trouble reading", to address the particular issue at hand. Reading skill is not William. Having trouble acquiring a skill is, for most of us, a fairly common experience. While particular accomplishments may inform "self esteem" and "self image" as reflected by others' approval, more significant is that most of us gradually own a sense of self from the process of encountering challenges. To believe certain accomplishments, particular goals, are the source of self esteem may reduce our understanding of learning -- and teaching -- to merely the reflection of accomplishment vis a vis others' standards.
Garreth presented himself with the composure of someone accustomed to learning. He arrived on the doorstep wearing a heavy backpack. At forty he had a surprisingly youthful quality. His wife had driven him to the appointment but he planned to walk home. His chest was elevated even without the weight of the pack; his neck pulled straight back and to the right without cervical curve. His right leg stood wide, the knee hyperextend. His neck had been in a brace for months as had his right leg. His left leg appeared even less present. The habit of protecting his neck imposed rigidity in his torso akin to an infant’s startle reflex. A scar ran the length of the cervical spine. He appeared to have almost no rotation in his torso – as if there were just a front side and a backside. Garreth sat with his weight on the back of the sit bones, his lower back rounded, feet drawn back under him, his head elevated and inclined to the right.. His face and jaw strained. A bright scar above the sternoclavicular notch marked the site of the tube that had once sustained him. Elegant scars curved from his pelvis, his legs were scarred as well. He was a Cubist collection of parts precariously cambered together; even his uneven coloration accentuated the impression of dis-location. They were parts, he told me, that he was accustomed to inhabiting with skill as a competitive swimmer, a backpacker in summer and a skier in winter in the Eastern Sierras. Now he lurched.
That first day he was profoundly frustrated with what seemed endless attempts at an illusive recovery. He had undergone nine surgeries and considerable physical therapy with an unusual appreciation of his physicians’ and therapists’ expertise and good intentions. The loss of short term memory had served him in surviving pain and anxiety. His wife was supporting the family; he had worker’s compensation but no way to look forward to future employment. His desire was to reestablish a relation to the world that included independence and responsibility for his family. He was close to despair. His first request was to be able to walk with greater ease. He said, "I can only walk left side, right side. There is no connection between them." Thus our initial goal was to facilitate walking.

As we talked we began working in sitting. Lifting each leg in various planes with an eye for the relation of the knee to hip, ankle, shift of weight and organization of the torso, revealed that the tonus in his right leg was particularly uneven and corroborated the impression that the relation of the leg and hip was unclear. Excessive work in the right leg appeared to compensate for compromised structural clarity and for the injuries to the ligaments of the left knee.

Garreth chose to lie on his right side, which was interesting as it is the more "difficult" and the side that shortens, but the right eye has fixed dilation and is thus vulnerable. There were areas of remarkable suppleness and clarity along his spine and areas that were clumped and torqued; his right hip felt to have forgotten many planes of movement.

After this initial exploration of the spine Garreth lay on his back with feet standing. When rotating his knees in and out, then each in opposition to movements of the ankles, the left leg appeared clearer and more open to innovation. The right hip still felt gluey. Garreth’s shoulders felt wedded to the table. So as to avoid challenging his head and neck it seemed safer to continue though the legs, first feeling the direction of the muscles, then angling compression behind the trocanter to access the opposite shoulder. As the pathway through the spine became clear the tonus in his neck eased a little. There was a little movement in his head; the shoulders lifted from the table quite easily. Compression through the knee snaked a relation to his hip, pelvis, spine and head. He responded surprisingly easily to pulling the knee over the foot, beginning in the direction of the little toe and then successively towards the big toe, so as to clarify weight bearing and balance in standing. An intention was to suggest the possibility of movement in the pelvis for certainly the pelvis seemed absent from the picture.

The lesson on the table concluded with pushing through both knees and pulling each so he might feel the connection of his legs, hips, pelvis and spine; and then compression through each leg to organize for standing. The concern was to work minimally to insure there was just the suggestion of movement in the head -- so as to just imagine safe mobility . During the lesson Garreth was very alert. We concluded in sitting again. Indeed both feet were more even on the floor. Compression through his right knee now revealed the connection to the opposite shoulder to be clear. Garreth noticed the movement with surprise. "I told you I’m a no pain, no gain kinda guy," he reminded me. But when he got up to walk about he looked more comfortable. There was much more movement in his torso to permit counter rotation; his walking appeared easier.
What was most striking was how quickly he responded. His years of training as an athlete would prove a blessing and a source of frustration. Unusual kinetic intelligence informs his learning and at the same time often makes his daily post accident accomplishments bitter. He compared how it was before with now without self pity but also without, it seemed, appreciation of present accomplishments. A recurring conversation would be how to use the knowledge and skills he had enjoyed in the past to serve new learning.
A few days later our mutual friend called to say he had coffee with Garreth the day after the lesson and that Garreth was thrilled because, while he had no idea why, he could walk without the conscious effort of "right side, left side." He had walked the six miles home into the hills easily. Would more lessons would help him? When Garreth called again to make an appointment I guessed that he did despite worry about payment.

The second lesson was three weeks after his first. While compensation was necessary for his sense of himself there was a way out. As a matter of professional ethics there has always been at least one pro bono client in my practice; the person with whom I had recently worked on this basis had recently died of old age. When Garreth could arrange for workman’s compensation that would be fine; in the meantime we would continue. "But I’m sure there is someone more deserving than I am," he said.

"That may be, but they have not crossed my path." We agreed to meet once a week. My condition for the arrangement was that he not refer to the Feldenkrais Method as "touchy feely".

"I don’t know how else to describe it -- but I do know I need to be in touch with myself in new ways," he said. The strategy of expending more effort and working harder familiar to him from years of training failed now to effect the changes he wanted.
Garreth did two jobs at my house in the insuing weeks in trade for lessons until he arranged with his physicians for Workmen’s Comp. He did not like the idea of not doing something in return for lessons – not knowing that it is a gift to work with someone so open. He said the jobs were occupational therapy; they provided the opportunity for him to begin work again without pressure. They afforded me the opportunity to observe how he used himself and to appreciate more fully what impaired short term memory and impaired multi-tasking can mean. There were times when the details of a job overwhelmed him and he had to stop. Small parts like the fittings that supported shelves would disappear. Once a trip to the neighborhood hardware store for a missing piece of pipe took almost two hours and he returned defeated with the wrong part having listened to what he knew was bad advice. He said he did not have the confidence to persist in asking for the right part. "I feel like Forest Gump," he said. Too many visual details could cause him to shut down, he felt his mind "go blank". On these occasions he defaulted to hyper extension and his balance became precarious. However, sometimes projects went unexpectedly well. He began to take on numerous jobs for friends and neighbors.
Our second lesson we worked with flexion and extension in side lying . The intention was to provide the sensation of both the front and back of himself and to reduce unnecessary effort throughout the torso. At the end of the lesson we returned to flexion and extension in sitting initiated from the pelvis. The quality of the movement was quite nice. But at the end of the lesson he stood and again lifted his chest into hyper extension to brace himself upright. He felt the effort and abandoned it when my hand rested on his chest below his clavicles. His face was suddenly older, sadder. His friend who had sent him to me also has a posture of elevated chest -- they were sweet dudes together. "Look", I said, " there’s no one posture, you have a choice." Nuances of flexion and extension are a meta theme we have revisited in various ways during this year. Quite recently Garreth pointed out to me that he had discovered that he stiffens into hyperextension if he feels he is loosing his balance and that he has found that if he "stays loose" he regains equilibrium. In addition to the other injuries the vestibular organs in his right ear were damaged by the accident: balance with so many new factors has been a delicate and challenging process.

Prior to our third lesson Garreth went on vacation in the Eastern Sierras with his family and was able to take long day hikes. He had begun to swim again although not with the same fluidity he remembered. But he looked less desperate. His primary concern was still walking and balance. He said, "This is called a lesson, but I worry I am not learning what I should or doing my part." We talked about learning, effort, attention and how a Feldenkrais lesson is not the same as a lesson in school. Nonetheless his comment underscored that after all the interventions at so many diverse professional hands it was essential for him to feel responsible for his learning and to appreciate that it was his own – not some magic done to him.

That day we did the Artificial Floor, prefaced by the observation that it was a classic Feldenkrais lesson as it so clearly demonstrated providing conditions for the nervous system to learn. At the end of the session we returned to briefly recapitulate the first lesson, finding a stable neutral for each foot in standing on the table, and a pathway from each foot through hip, pelvis and spine to the head. This time there was much more movement in his head. Lifting his shoulders revealed clarified diagonal movement through his torso and the tonus in his neck was markedly reduced.

When Garreth sat he appeared fatigued but his face was free of characteristic strain. In standing there was a clearer line between his shoulders, pelvis and heels. As he walked alternately frontward and backwards he could look to all the corners of the room: his eyes were not fixed to the ground. Later in the week he called he to confirm our next appointment, "When I walked home I could walk and appreciate my environment for the first time since the accident. I think I understand the lesson," he said. " I trust my feet can search the path so my eyes are free. You don’t know how much that means."

The Artificial Floor proved significant: it was the first FI that Garreth felt he understood. He often remarks, "I don’t understand Feldenkrais but it works", as may we all, but the Artificial Floor was an epiphany. That he felt he could trust his feet on the ground marked the beginning of his return to the world of skills. As significant was that he understood that he was the person doing the work of learning even though it was within a new vocabulary. From then on it seemed he trusted himself to search a new path.

Our fourth lesson began with an abbreviated version of the ATM, Four Points, a lesson on hands and feet that presents the challenge of what initially feels to be an unbalancing of one's limbs in various combinations. The plan was to use a configuration that was closer to the ground and close to early developmental exploration to actively pursue possibilities of shifting weight, and diagonal organization. Each part of the lesson presented an unexpected puzzle; even standing on his feet and hands required negotiating complicated issues of flexion, not to mention letting his head hang, his pelvis elevate -- a challenging situation contrary to his history pre and post injury. However, Garreth is accustomed to challenges from his years as an athlete and he is used to doing all manner of exercises with PTs. He’s game. He discovered he could, in fact, organize himself to explore the variations and find increasingly reliable four points with less effort. He liked discovering how to move in ways that seemed at first blush to be impossible. The ATM had the advantage of novelty, it was not vulnerable to comparison with pre accident accomplishment, and it provided a safe situation in which to explore the counterpoint of stability/ instability essential to balance. We finished the lesson on the table, working again with the relation of his shoulder to opposite hip, hip to opposite shoulder, and ending with very lightly organizing through his head so he might sense standing on his left leg and then his right.

The next week Garreth said he had discovered he could do a flip turn in the pool, a movement heretofore lost. The turn depends not only on diagonal organization but complex orientation in space. He observed that Four Points "made it happen". It was evident that more ATM need be folded into our lessons as his schedule didn’t permit an ATM class. He said he had told his Physical Therapist that, "Feldenkrais is giving me back my pelvis and my procreators -- instead of proprioceptors." He laughed. "Ah, what a silver tongue I once had."

Because Garreth has had a host of therapists, many very skilled, we have taken into account his work with them. Thus when his PT had him lifting his pelvis in the air we did Spine Like a Chain -- and included attention to all the variations evolving from changing weight on the feet, placement of the feet, and breathing. We also worked hands on with the intention of first supporting his predilection for extension and for side bending to the right and then challenging it. At the end of the lesson we returned to Spine Like a Chain to observe the differences. In fact, it was easier for him to lift his pelvis in the air and to move it left and right. His feet were more reliable on the table; the movement of each vertebra clearer. His chest cooperated, his head responded to the movements. Finally we worked a bit in sitting so as to provide an opportunity for Garreth to feel his head translate right and left and sense his whole spine in sitting.

Two weeks later we did Pelvic Clock with little hands on work. After so much experience as the recipient of therapies for parts it seemed vital Garreth mobilize proximally. He did remarkably well. The effect was dramatic improvement in his head and neck. He was observant of the movement in his ribs and the relation of his pelvis to the rest of his self -- and he was surprised to discover that his head, heretofore held to a very limited range, moved easily in new planes. Subsequently he found he could look up without swinging his whole body into extension and to the right; his neck increasingly supple even in gravity. The bracing that resided for months after wearing a neck brace for over a year, not to mention the systemic response to neck surgery, subsides.

Recently there are themes that emerge to pursue in FI and ideas best addressed by enfolding ATM. For example, I have been slow to appreciate the degree to which compromised vision contributed to Garreth's organization. When he moves his eyes to the right or left he experiences double vision; until recently I was hesitant to perturb the use of his eyes. However, a significant improvement in his ability to rotate elegantly emerged from using the eyes to lead the movements. We're cautious to avoid eye strain and a host of complications his eye surgeon warned of -- but the very idea of the eyes initiating the movement has brought striking improvement both to his vision and freedom of movement.

Garreth's speech is now more fluid, his choice of words exact -- the man is silver tongued. He continues to patiently use everything he learns: he tests lessons in the pool, in walking, in his capacity to problem solve. He reports that previously impossible tasks are sometimes surprisingly easy and there there are moments when truly graceful movement returns. This spring he went downhill skiing for the first time since the accident. It was difficult as it was not skiing as he remembers it but he was pleased. During the summer he swam several miles each day in the SF bay; swimming continues to provide aerobic exercise and an index of improvement. His vision has improved enough that he can now drive a car. Last week he reported he hiked with a friend in the Eastern Sierras and felt no compulsion to carry a heavy pack. "I was glad," he said smiling, "that I can trust my friend. I didn’t need to prove anything; we took it easy." But despite these accomplishments, the return to activities in which he excelled before the accident often underscore loss. In contrast, a Yoga class is an occasion for new skills that do not invite comparison of accomplishment before and after accident. Fortunately, he is familiar with ambition, patience, attention, and slowly nurtured capacity. In an assessment for his physicians and case workers I mentioned that he was "kinesthetically astute". He laughed. "I’ll take astute anywhere I can".

Some months ago Garreth observered he no longer feels like Forrest Gump.

Illness and affliction can unveil assumptions about self image. Post operative or incapacitated before death, conventions and boundaries may become irrelevant. The body, vulnerable, requests recognition. Caretakers and acquaintances of the terminally ill or the seriously injured may, through their work or witness, discover the body anew-- not to control but to attended with new curiosity. Garrath, post operative, is in the process of constructing a body, a self, in the world. No one can put Humpty Dumpty together again save the self. The king's horses and the king's men are minions of authority, not learning. Happily for us, the Feldenkrais Method permits the opportunity to experience ourselves in ways that are sufficiently rich as to provide the opportunity to put ourselves together in new ways again and again.