Phenomenology comes from the Greek “to bring to light”, or to study things as they appear. What has this to do with manual therapy?. I want to look at how chronic pain sufferers are treated in the healthcare system and how we can improve things using a phenomenological approach to their care.
Chronic pain sufferers are like other sufferers of chronic disease in healthcare and in life.Practitioners, friends and family, often without awareness, may label them as having their problem as a result of something that they have done, whether it is their upbringing, their lifestyle or the type of personality they have. As Arthur Frank states in his memoir of living through a heart attack and cancer at the age of forty (At The Will Of The Body),those who tell others that cancer is caused by their personalities, may be attempting to be their comforters, but are in fact their accusers. We are led to believe there are “cancer personalities”, full of suppressed emotion, and “pain personalities”- who are fragile worriers and the boundaries are wide enough that most sufferers can be fitted into them.
Frank argues that we do this because the well need to believe that there is certainty in the world, that it is safe and our own futures are secure in it if we do the right thing. Even those suffering might prefer to believe that they have done something wrong, than believe the the world is cruel and uncertain.Chronic pain sufferers can feel like they are the outcast, no longer quite fitting into the world in the way they did before their pain started.
Philosopher Thomas Metzinger states that our problems arose at the same time as a lot of the things that make our species so complex and amazing; the cognitive revolution. As our cortices became enriched in neurones, so we began to understand abstract ideas, one of them being the inevitability of death. Metzinger says ever since that moment we are continuously in the process of trying to heal ourselves. Chronic pain can be a vivid experience of what suffering is and can place you closer in metaphysical sense, to the doorway of death.
People living with chronic pain have often seen medics who have not only “blamed” them, but also have led them to believe that their bodies are damaged, that pain, instead of being an inevitable part of life,or there as a teacher, which would have been the worldview in previous generations, is something that needs to be extinguished by drugs or a knife and they are to be the passive recipient of their care.There is the paradox of living with a pain that as Drew Leder states can be certain and uncertain, present, past and future, mental and physical, ever changing and never changing, and in control and out of control.
An early phenomenologist, Heiddeger (1889-1976) believed that philosophy should be concerned with life as it is rather than some abstract ideas. It is a kind of role your sleeves up approach and perfectly suited to healthcare practitioners.The phenomenological interview rests on understanding a clients interpretation of events, and their understanding of the world.Interpretation will be based on their past experiences and the therapist needs to tune into that worldview.It seeks to see the person as a unified whole that is far greater than the sums of the parts.
Merleau-Ponty(1908-1961) introduced the idea of a “lived body” which had a blurred boundary between it and the world it moved through and consciousness of the world was due to the interaction between the world and the body and constituted the individuals meanings and perspectives.Pain therefore affects the body as a whole and its relationship to the world. Where the world might once have seemed safe and easy to navigate, now has become fraught with potential danger and threat.
Because the client may have experienced problematic previous encounters with healthcare professionals, they may exhibit distrust or see you as a potential threat to their already diminished sense of self. The ability to listen, without interruption, as far as is possible, is paramount. There may be no need to give wise words or educate them, but simply to allow them the space to tell their story and to feel understood. It is not enough to care or understand, the person needs to feel understood and cared for. Attunement takes the relationship further and allows the therapist to establish a kinaesthetic and emotional sensing of their client.
When the client has told their history, the therapist can begin to reflect back the story and using the clients language and worldview, pick up on any insights that the client has expressed. Inquiry can be used during the interview, the therapist asking the client at points that are important, questions such as “and how did that make you feel?” or “what emotions is this bringing up for you?”. This can take the client away from a cognitive state into an embodied state, where a representation of feelings and emotions can begin to be explored.
I personally like to use some mindful movement as a part of the approach, to help regain trust and a feeling of calm in the body and its relationship with the world, although their are many other techniques such as Tai chi, Qigong, yoga, Feldenkrais and body awareness therapy, that have similar effects.