Sara K. Schneider's Skin in the Game

Reflections on body, culture, and spiritual practice

Practice on “Having an Offline” While Online

Have something to eat while working at your computer. This may be nothing new for you.(I certainly can’t pretend I don’t do this. That delicious coffee- house Hot Peppermint Mocha three computers ago? Well, it had a solidifying effect under the keys of that laptop. An expensive wintertime treat!)

Variation: Have a meal over Skype with a distant relative or friend. What can you tell about how the food tastes to them?

October 13, 2010 Posted by | Body Culture in the U.S., Insight Practices | 1 Comment

Body Swapping (Thanks, Technology!)

The most exciting breakthroughs of the 21st century will not occur because of technology but because of an expanding concept of what it means to be human.
~ John Naisbitt
The reason nobody likes you driving while you’re talking on your cell phone is that, in the speaking and even the planning to speak, you’re readily beset by “inattention blindness,” and the physical world, including the rush of oncoming cars and fixed objects, just feels less real than your virtual conversation. It’s not that safe. While many of us may tune out just as readily during a leaden conversation with someone we’re with, inattention blindness just doesn’t seem to be that much of a problem when your interlocutor is the passenger sitting right next to you. All but the least sensitive passengers see and mention the road, can take the lead in conversations, and pause when an especially demanding driving decision-point turns up. They also fall asleep next to you and let you drive in peace.

Setting aside for a moment your commitment to public safety, it’s possible for technology use to worsen yet your sense of what’s real, driving beyond where you think “real” is, to where you think “you” are. Recently, researchers at Sweden’s Karolinska Institute figured out how to apply virtual reality technology to convince participants to perceive someone else’s body as being where their sense of “I” resided.

This is all it takes for to create a “body-transfer illusion”: A participant gets herself decked out with a camera, a pair of virtual reality goggles and a few electrodes, while her human (or mannequin) partner mounts a companion camera on his head. Through the manipulations of what they see through the goggles, participants actually begin to feel what they see and to “body swap.” Through various camera manipulations,

Andrew Ketterer Body Swapping with a Mannequin.
Andrew Ketterer Body Swapping with a  Mannequin

they may experience their partner moving to shake their hand as if they themselves were doing it, or see a stick touch their partner’s abdomen and believe it’s their own stomach that’s being touched. Lead Karolinska researcher Henrik Ehrsoon commented that the experiment “shows how easy it is to change the brain’s perception of the physical self. By manipulating sensory impressions, it’s possible to fool the self not only out of its body but into other bodies, too.” This technology application is so sophisticated in its ability to make us lose sense of our own bodily reality that seeing actually becomes (false) sensing.

Perceiving another's  body to be one's ownNot just Fun With Computers to take us farther and farther out of our bodily reality, these technologies may also help restore us to a sense of self within a living body. Karolinska health professors envision the opportunity to help limb amputees or stroke victims integrate their use of prosthetics through practice with virtual limbs. Another promising application may lie in the treatment of people who suffer with body-image disorders to use their perception of someone else’s body (where there is no problem) to correct their own distorted body image: others’ bodies seem more real in these cases even before the goggles are strapped on. (See “This is Not the Body I Ordered.”)

Technology may have the capacity to bring us back to our essential humanness as well as drive us out of it. It could even enhance our capacity for meaningful contact with others. What if urban kids experienced a rival group member’s body as if it were their own? Could this experience help re-sensitize kids overexposed to violence in their communities and the media, helping them feel — and through this, recognize — that any pain that happens to another happens to themselves as well?

In what ways have the technologies to which you’re currently attached enhanced your experience of being in a (your) body?

September 27, 2010 Posted by | Body Culture in the U.S. | Leave a comment

Maurice, the Klutz

Our own physical body possesses a wisdom which we who inhabit the body lack. We give it orders which make no sense.
~ Henry Miller

Why should a man’s mind have been thrown into such close, sad, sensational, inexplicable relations with such a precarious object as his body?

~ Thomas Hardy

When Maurice was in his 80s, he would recount at family celebrations the story of his parents’ failed attempt to make a social dancer of him. As his wife, my adopted grandmother, Ella, seized her lips together in a low underscore, this proudly unschooled self-made man would tell how, in the earliest years of the twentieth century, his parents took him to dancing school to put the finishing touches on his preparation for adulthood.

He stood opposite the young ladies in his class; he accepted the aggravated partnering of his teacher. After the second lesson, she called his parents in for a talk. “Mr. and Mrs. Labovitz, there’s no point. Your son will never be able to tell his right foot from his left. To continue would be a waste of your money and my time.”

As a retired retail magnate in his 80s, perhaps Maurice could afford to admit to a failing, especially in such a feminizing sphere of activity as dancing. Indeed, being a poor dancer could arguably raise his masculine status. He had no sense of rhythm, he boasted, then or now. No ability to differentiate his feet. The steps would just not sink from his head down into his body. Everyone should know: Maurice Labovitz was a klutz! (Ella’s chagrin during this inelegant display of her husband’s ineptitude was palpable.)

Henri Bergson — a French philosopher writing before and after Maurice’s curt dancing days — said, we laugh when a someone appears to be a something, when there is a “mechanical incrustation” that seems to have taken hold of living things. What’s funny is when the fall arrives just after the pride. It’s the smug Rob Petrie of the early Dick Van Dyke Show, tripping over his own living room rug after, as the man of the house, having made some decree to his submissive wife, Laura. Gerald Ford’s periodic walking into other people or his tripping down the stairs of Air Force One. Rhianna’s onstage falls.

Scenes like the one Maurice painted of his dance lessons tickle us to imagine. We spend so much time trying to look like we have it all together, when someone messes up — especially when he seems to hold an intention to move quickly, surely, or unobtrusively — it amuses us. It’s such a classic strategy for cultivating laughter — perhaps best known in slapstick comedy — that Toastmasters in Honolulu advises budding public speakers with solid bone mass to pretend at clumsiness to enhance the humor of their presentations.

An advice column on the Internet addresses nurses who habitually break things and have begun to question whether they can succeed anyhow in their chosen profession. An inherently clumsy nurse admonishes: Just be sure to hold thermometers quite firmly. Keep your presence of mind and pay attention to where you are, where you’re going, and what’s happening now: avoid thinking into the future. Practice complex motions in advance so that you’re not quite so anxious when it comes time to really do them.

While clumsiness is usually cute or endearing when we see it in other people — I’ve even heard it described as sexy in men — being clumsy often feels mortifying or frustrating when it happens to us. It is as though we’re trucking along, expecting the body to be right there with us, when it’s secretly holding a “V” sign up behind our head. Or, the brain, driving the front car, leads a caravan of friends behind us to a restaurant they’ve never been to before. Without thinking to see if any of our group is behind us, we hang a right. Something, and a bunch of someones, are missing.

Where was the body when we thought it was with us? Why is it spilling, breaking, tripping over things and misjudging how far away things are — and doing these things so much more often when we’re pregnant, pre-menstrual, or male? (Boys are four times more likely than girls to be labeled as seriously clumsy.)

Blogger Tara Whitney writes, “I was born with the clumsy gene. My body grew faster than my brain could catch up. And so growing up I was all long lean spidermonkey limbs flailing about poking people in the eyeball. I can’t tell you how many times I have
broken/sprained my pinky toes. Or how many times I have tripped over something invisible in public. Embarrassed myself in front of huge crowds. Or stepped off of curbs/stairs just at the right angle to tweak my ankle. There was even a family I babysat for in high school, who eventually bought me my own special plastic cup to use at their house, because no joke–every time I sat for them, one of their glasses would go slipping from my butterfingers and crash onto the tile floor. Even if I tried not to USE one, if I did the dishes or cleaned up? CRASH ONTO THE TILE. It’s a huge family joke that I’m this big ditz when it comes to paying attention to my body vs. its surroundings. Or at least it used to be, thankfully I have grown out of a LOT of this stuff. And guess who inherited this from me? Drew. My poor, gangly, long-leanspidermonkey-limbed child. Who just doesn’t know where his body ends and where the pavement begins.”

Other than a few bruises and breakages, all this is only a “problem” if we assume the body is supposed to be the slave of the master brain, intended to be the submissive Laura to the traditionally manly Rob. It may be that the body gets the message, but refuses to treat it as important. The underclass rehearses the revolution.

What would happen to clumsiness if we didn’t believe in the body as willing servant to the mind’s orders? (One strong possibility: we’d have to find a lot of other things to laugh at, and disturb the rest of both Maurice Labovitz and Henri Bergson.)

What if mind and body were roommates rather than master and slave? Who or what is it that would serve as landlord to them

What metaphor do you like for the relationship between your mind and your body when you move in relation to other people and to the objects of the world?

A Practice on Making Missteps

Here’s a chance to look at your assumptions about how your body is supposed to execute your intentions out in the world. Pick up something from your kitchen that’s not easy to hold: a can opener that doesn’t fit well in your hand, a metal tray that would do better in two hands than one, a coffee thermos that never felt quite right when full.

Caveat: Don’t pick something that’s sharp.
Advanced practice: Use something that’s breakable.

Walk out of rhythm (think Steve Martin in The Jerk), passing the object from hand to hand. (If that’s too easy, toss it from hand to hand.) And, as the Toastmasters suggest, if you don’t have strong bones, take the difficulty level down a bit.

Where was your mind when your body was doing its thing — When was it “there,” following or staying with your body? When was it “gone”? What, if anything, could be considered “right” about the awkwardness, the spilling, the dropping, the tripping, and even the breaking? Was your mind or your body the “boss,” or does a more apt metaphor come to you for how mind and body co-existed in this practice?

How did it go?

September 27, 2010 Posted by | Body Culture in the U.S., Insight Practices | Leave a comment

This is Not the Body I Ordered

There’s a reason people like me don’t have children. When I learned in college there was a psychological condition in which
people grappled with distorted body images — perceiving their bodies as being heftier than they actually are — I got excited. How interesting it would be to induce yet a different perceptual distortion through mindful child-rearing!

Perhaps I had Lewis Carroll’s tale Through the Looking Glass on the brain, with Alice’s continual changes of size in relation to her environment. You could have a child, I figured, then keep getting new furniture that kept enlarging in proportion with him as he grew. You could arrange it so that he only came into contact with environments that maintained the same proportional relationships with him as when he was an infant. As the child grew, so would the trees, storefronts, restaurants, home interiors. With all this carefully controlled, he might never feel “bigger” than he once had been — at least not in relation to the objects the world is filled with.

John Tenniel drawing for Lewis Carroll's Through the Looking Glass

Of course, there was always the people problem: what if a new baby came into the family, one observably smaller than the existing child? The child’s perception of his new brother or sister’s size would be difficult to control without a lot of prosthetics. What if the child noticed his own limbs were getting longer in relation to his torso over time? And — just working this through — wouldn’t you, as the parent, have to be careful to growexactly in proportion with your child? How much could you really manipulate that?

Clearly, the whole thing was feasible, if expensive and time-consuming, all for the sake of controlling children’s perceptions — that is, all except for the people part, which was where the whole experiment in child-rearing breaks down. If what psychologists say is true, that we get a sense of self in relation to other people, the experiment was doomed to failure from the start.

In “body dysmorphic disorder,” the mind-body distortion that so fascinated me in Abnormal Psych, sufferers hold an image of
their bodies as being grossly defective in some way. Probably the most common form BDD takes is in those with eating disorders such as anorexia and bulimia, in which sufferers’ image of their size and shape is out of keeping with the observable reality. We think of the girl who squeezes off her food intake, or who binges and then forcibly purges, in a terrible spiral that, unchecked, can be fatal.

Photo by Ross Brown.

The girl looks in the mirror, flanked by a friend. What her nearby companion sees, both in the mirror and beside her, is a thinning or vanishing figure, while what an anorexic sees in her reflection is grotesquely fleshy. As someone with BDD complained on website Experience Project, “It makes me feel angry to know that the world sees a different person when they look at me than I do. … Ridiculous, I know, but when someone calls me beautiful, how can I possibly believe them when my reflection shows a monster?” Treatment would tear her uncomfortably away from her compulsion, as it “would mean losing the ability to see my flaws.”

People who see their bodies as detestable can focus on other things besides weight. A high school senior may spend more than an hour per day checking the size and shape of his nose in various reflections, hoping for an impossible reassurance that it has changed. Humanistic neurologist Oliver Sacks described asomatognosia, a condition in which sufferers, not recognizing one of their limbs as their own, may long to have the disowned appendage amputated.

While men may also unrealistically perceive themselves to be overweight, another variation of BDD has been noted in some men, called muscle dysmorphia or body dysphoria. Ever dissatisfied with the size of their muscles, they may dive into body-building and train beyond any rational point. Some Japanese men believe their body odor to be so socially unacceptable that they have made themselves recluses rather than offend others or draw attention to themselves.

BDD may be a disorder not about the body at all but rather about a distorted, unrealistic compulsion toward perfectionism. Some researchers paint it as a disorder of overuse of the left brain — when sufferers look at what others would see as “big pictures,” they see only the details, treating all visual information as if it were “high-frequency” information. Instead of seeing their bodies as wholes, those with BDD may see it as a dumping ground for defective parts.

If you’re in an experiential mood tonight and want to put yourself into a state of more conscious body dysmorphia, check yourself out on the “Human Aesthetics Calculator” on If you really want to put yourself through this, you can measure your wrist and then compare the resultant calculations the site will perform for your ideal chest, neck, waist, hip, thigh, calf, bicep, and forearm measurements, depending on whether you want to emulate Michelangelo’s David, Mattel’s Barbie, an American body-builder, or a Polynesian Islander (listed as a now-vanished ideal). Just see if your body stretches the 7 head-lengths favored by Rembrandt, the 7.5 head-lengths Dürer preferred, or the 8 of the perfect body of classical times.

The Human Aesthetic Calculator graphically shows how the disparities between the images we hold of our bodies and the bodies themselves are mediated by cultural ideals. In our weight- and image-conscious media culture, most of us experience some dissonance among how we’d prefer to look, how we think we look, and how we actually look. Whereas those with eating disorders associated with body dysmorphic disorder see themselves as conforming less to the cultural ideal than they really do, our everyday dysmorphia may make us seem (and feel) better than the real. It’s well documented that women tend to underrate their attractiveness, while men overrate theirs. My style seems to be more like a man’s in some respects. For example, I only realized quite recently that it’s not a mistake every time I catch sight of myself in a yoga studio mirror or shop window and see that my legs have not gotten any longer in all these decades of delusion.

Familiar Norman Rockwell image.

There are many other ways in which our idealized images of our bodies fail us. We pass by a shop window and suck in our bellies because the image doesn’t correspond to the one we prefer to hold — we may walk off clinging to the hollowed-out image, writing off the we just saw as a mistake. And is it not a form of dissonance when, as we age, we keep scanning the mirror for signs that yesterday’s sunken face will have been an accident of the last two and half years?

How odd and yet how common not to recognize our bodies –especially our changing bodies — as our own. What would it feel like to recognize ourselves in the mirror, or in our bodily experience, as someone other than someone else — as ourselves?

What has been your experience of the visual fact of your body?

September 25, 2010 Posted by | Body Culture in the U.S. | Leave a comment

Frances Kuffel’s Passing for Thin: Losing Half My Weight and Finding My Self

Passing for Thin is the story of the gradual adaptation of a woman’s psyche to losing 188 pounds in midlife. One might think that falling more into line with cultural norms of beauty and desirability would occasion only
pleasure, but even good things can be big.

Frances Kuffel's Passing for Thin: Losing Half My Weight and Finding My Self

For Kuffel, food had beenFor Kuffel, food had been “animate, a completely mutual and unfailingly loyal friend.” It was the only thing she longed for that she believed she really could have, yet she knew that her fat had “infantilized my body, with its pillowy curvelessness and the pudge that made my face ageless.” Enrolling in a 12-step program for overeaters after more than 40 years of being overweight, Kuffel had to re-engineer not only her self-image and her approach to dating, but also her relationships with her family and the built universe. And, as she slimmed down to a healthy weight, Kuffel became visible in new ways to her family members, to men, and to herself.

Not everyone enthusiastically supported the changes in her: Kuffel’s weight had been the basis of her brothers’ lifelong teasing. Her mother founded aspects of her own identity on Kuffel’s being larger than she, responding to news of her daughter’s progress on her diet, “Gee, I better get busy. You’re almost as thin as I am.” A friend in her 12-step program advised her from experience, “Don’t talk about your size with people who’ve known you a long time.”

Kuffel had new challenges to face with the sudden desirability of a face and body that both she and others had previously written off. With her weight down significantly, she also had to learn to walk differently: “My ankles were bruised because I kept knocking my heels against them, not yet adjusted to the new center of gravity in my body.” And, thin for the first time, at a restaurant, she saw the seating options anew: “I adored booths, a cheap trophy of the thin. I fit. Not only that, I could lounge, intimately. My breasts didn’t push at the table, I didn’t have to inch in and sit at odd angles. I could-this was cool-lean across the chasm between the seat and table and cross my legs.”

Most of all, Kuffel’s sense of self had to be reinvented in line with the social reality her body now represented. There had been stereotypical roles to choose from among the American archetypes of the overweight: the Zaftig, the Perfectionist, the Best Friend and Confidante, the Orphan, the Drab, the Queen Bee, the Careerist, the Fag Hag. As a thin woman, she wanted
to be post-archetypal.

Passing for Thin is about the unexpected demand to craft a fresh identity even as one conforms increasingly to cultural ideals, about the need to bring into some coordination who one has been and who one appears to be now.

September 25, 2010 Posted by | Body Culture in the U.S., Books | 1 Comment

A Re-membering Human

Sometimes I look to their bodies for a definitive answer to my ongoing prayer for understanding. I remember how I felt when I touched my grandfather’s scars, those deep imprints left by Cuba: I was a blind child reading the past in Braille, understanding for the first time the vast plantation, the raging river, the cattle, the dark jail, the soldier’s clubs. When I ask my patients to undress, I think of him. … Funny how I never feel [their] pain, though I can often reproduce it in them as I press and poke the indicated region. Pain must be too personal, held too deeply with the body, to be known without actually experiencing it. Though my grandfather’s smile emphasized a certain scar on his forehead, and therefore could feel like a blow to the head, so bitter and full of loss, I never felt the pain he must have known. I can only imagine it.

–Rafael Campo, The Poetry of Healing: A Doctor’s Education in Empathy, Identity, and Desire

Twenty-five years of virtually constant computer use: what do you expect? (Hint: If you’re thinking of something between the fingers and the forearms, you’re getting very, very warm.)

To give them credit, the office staff had mentioned that the diagnostic procedure might be “a little uncomfortable,” but nothing more than the slight shock to the system than one might expect from acupuncture needles. The NCV/EMG test would help us find out whether my carpal tunnel syndrome (so much for the pride of being an early adopter!) had involved any nerves in the neck. “More data”: I’m on board!

For the first portion of this test, the physician sets electrodes along the arms, chest, and neck and administers electric shocks; she wants to time the velocity by which the electric signal is conveyed along the nerve. In the second part, the examiner inserts needles into the muscles, asks the patient to contract her arm, and again tests conduction speed (of the pain impulse!). All I can say is, the speed of the pain impulse was something I understood a whole lot better through experience.

I was lying on the examining table when a white female physician and the medical resident who was shadowing her entered the testing room, the former brusquely and if she were determined not to waste a single motion. I wondered whether the force with which she moved didn’t include some overkill. I noticed my new doctor’s almost aggressive efficiency as she set up her equipment and slapped electrodes onto my chest, neck, and arms. Scarcely speaking to me, she instead directed her words to the medical resident, who I guessed was from South Asia. The language was technical, dealing (I think) with how to read the metrics they were about to extract from my body. The resident’s movement contrasted deeply with the doctor’s: she moved in a more spacious, diffuse way, as if uneasy of her place in the triangulated encounter.

When it came time to test my upper body nerves (so to speak), the doctor applied the shocks at different points as if searching for a stud behind drywall. I was astounded by how quickly I experienced what seemed a projection of inanimacy upon me. My new physician was testing my body as if my self had already left it. I hoped that happenstance was still years off but had to reckon with a moment of uncertainty as to whether I was perhaps the person or the state of consciousness she touched me to be. Fighting my own reactivity, I thought I would try some temperate inquiry, ultimately to try to learn not why the tests were being done, but why she was doing them in such a depersonalizing way.

Do you do these tests every day? I asked her. Pausing and staring past me for an instant, she replied, no, only on one day each week, on Wednesdays. Experience had taught her she couldn’t handle on a daily basis the volume of patient venom that would be directed at her during these tests; one man had even jumped off the table and fled the office, electrodes still on, for good. She offered that it worked better for patients if she administered the shocks quickly, as that would minimize the length of time patients had to experience pain.

Her pain or the patient’s? I wondered. The nerve conduction velocity test was physically arduous; after all, the point of the test is to cause and then study nerve pain! But the physical challenge of the test, I soon realized, was a relatively minor part of what I was feeling on the table, which largely derived from experiencing being touched as if I were not alive.

She didn’t “play me like a violin,” at least not in the seamless melding between player and instrument played, or the kind of unity experienced by the dancer who is also danced. Instead, she played me, as the Italian composers might have said, bruscamente: brusquely, abruptly. Dolores Krieger, the inventor of a bodywork modality called Therapeutic Touch, urges therapists to remember that, as humans, “we don’t stop at our skin.” The brutality of the touch had little to do with its mechanics, much more with with what led to each prick and shock and how that intention sank in.

Physician-author Danielle Ofri writes of the “singular intimacies” between physician and patient, a connection that, though not a romantic one, “is an intimacy nevertheless.” But what of professional boundaries? Aren’t caregivers–particularly those with doctoral degrees–supposed to maintain an appropriate level of professional distance? As the progenitor of bioenergetics, a body-based psychotherapy, Alexander Lowen actually urges that professionals learn how to touch patients as part of both diagnostic and healing processes. I’ve substituted “professional” for “therapist” in sharing Lowen’s thoughts: “A professional’s touch,” he writes, “has to be warm, friendly, dependable and free of any personal interest to inspire confidence in touching. … One should expect a professional to know the quality of a touch, to recognize the difference between a sensual touch and a supportive one, between a firm touch and a hard one, and between touching that is mechanical and that which has feeling.” But the touch has to be with “clean hands”: free of the provider’s own need-seeking.

As a culture, we tend to give greater emphasis to outward transgressions of touch boundaries with vulnerable populations–violations of children’s sexual integrity by some clergy, the potential for sexual exploitation of students by teachers or college faculty–than we do to the opportunities for healing that are lost to professionals’ unwillingness to examine how their own needs may inhibit healing. The withdrawal or withholding of a touch that had an opportunity to heal can also be traumatizing.

Some argue that it is in the very nature of Western medical training to objectify the patient in order simply to be able to handle the constant onslaught of human suffering a professional faces every day, that the desensitization is a unavoidable and concomitant in the work. But how encompassing must this be to allow the health-care worker to provide healing to the patient before her and to maintain her own sanctity and integrity to serve future patients well?

Practitioners in many fields–teaching and spiritual guidance come to mind as readily as does health-care–might consider trying the practice following, allowing you to consider the healing power of your own professional touch–given, misgiven, and withheld.

How have you experienced the “singular intimacies” of the care given you by health-care, spiritual, or educational professionals? How have you known when and whether their touch, given or withheld, has helped or harmed you?

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April 30, 2010 Posted by | Health, Medical Practice, and Healing | Leave a comment

A Practice on Professional Touch

I once asked a massage therapist if she’d ever had a client she was loath to touch. Only one, she replied, in all the years she’d been giving massages. Though she had a hard time pinning down just what about the client had provoked her aversion, she experienced something about him as “evil.” She struggled through the massage, but required several days to recover and clear.

In this practice, you’ll pay attention to your reactivity to the people with whom you must engage in your professional life, especially those for whom you carry some professional responsibility for the well-being of their minds, bodies, and spirits.


  • To whom do you notice you want to get closer? With whom do you have some inchoate aversion?
  • How would you label what in them is “making” you react in the way you are? Is it something about their physical person? Is it something harder to define, something in their “energy,” whatever that may mean? How close can you get to labeling it?

Now, turn your attention to yourself:

  • How are you experiencing your desire to reach out to them, to offer them healing touch, acknowledging that it is not just they but you too who have a body? Why do you want either to touch them or not to?
  • What would happen if you thoughtfully, respectfully envisioned doing the opposite of your initial inclination –touching them compassionately if your inclination is to avoid, keeping at a mindful distance if you’re drawn to connect?
  • What might be impact on them, on you, of making this different choice–an impact that stems more from the how of what you do than from the what?

What did you find out?

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April 30, 2010 Posted by | Health, Medical Practice, and Healing, Insight Practices | Leave a comment

Anne Fadiman’s The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

The Spirit Catches You and You Fall Down

Although not a new book, Anne Fadiman’s The Spirit Catches You and You Fall Down (1997) classically highlights a life-and-death crisis that devolves from Western medical professionals’ living out an ethnocentric self-assurance and a hermetic professional worldview. Fadiman became intrigued by what she’d heard about the clash between the Western medical establishment of Merced, California and the concentrated group of Hmong refugees from Laos who had begun settling there in the 1970s, escaping persecution by the Vietnamese after their little-known contribution as guerrillas to the American cause.

The Hmong were involuntary migrants, not given to adopting American ways any more than necessary to survive. Some feared going to doctors whom they thought might rather study them than help them. To the Hmong, Western doctors engaged in hazardous practices. They extracted large volumes of blood from their patients. They opened the body in surgery and in autopsies, and inevitably and irreparably damaged the integrity of the person, not only for this lifetime but for future incarnations. They announced the probability of death. The Hmong mistrusted Western medications and took fractions of what had been prescribed, putting the physicians in the untenable position of trying to “game” how much they might have to prescribe to end up with a Hmong patient’s actually ending up taking the desired dose.

Fadiman began fieldwork with a particular Hmong family, whose six-year-old daughter Lia had been in and out of the Western medical machine since she was a baby because of her epileptic seizures. She inquired equally into the perspectives of the entourage of doctors who treated her and who attempted, to varying degrees, to communicate effectively with her parents.

Lia’s parents fundamentally disagreed with the doctors about the origin of Lia’s problem and about the impact of the medications that had been prescribed for her. To Lia’s parents, the troubles began when her soul was frightened out of her body when her sister slammed a door, and her seizures would be instigated by a spirit “catching” her. The cure would be perhaps a very short course of medicines, but ultimately would be carried by Hmong shamanism, animal sacrifices, and herbs.

Fadiman’s book sides neither with the native medical cosmology of the Hmong nor with the self-justifying medical culture of the West, situating Lia’s tragic decline in the very gaps between the two. If there was any fault, it lay in the failure of the Western physicians to give credence to the Hmong worldview or to incorporate it into a realistic treatment plan. Fadiman writes of the caricature–just an extreme of the actual–of the M.D., who is an “all-head-no-heart formalist who, when presented with a problem, would rather medicate it, scan it, suture it, splint it, excise it, anesthetize it, or autopsy it than communicate with it.”

While Fadiman concludes that “American medicine had both preserved [Lia’s] life and compromised it,” she wonders whether saving the body, as much of Western medicine is geared to do, or preserving the soul, as was part of the Hmong concern, could not both be considered.

Reading The Spirit Catches You and You Fall Down, I am reminded of the lyrics of “Walking in Space” from the rock musical Hair. Set against the backdrop of the Vietnam War–which the Hmong referred to as the American War–the song extols the visions possible under hallucinogenics:

In this dive
We rediscover sensation
In this dive
We rediscover sensation

Walking in space
We find the purpose of peace
The beauty of life
You can no longer hide

Our eyes are open
Our eyes are open
Our eyes are open
Our eyes are open
Wide wide wide!

It’s not that the singers saw nothing taking the hallucinogenics. The irony of the song is that they thought they saw everything–while only seeing some thing.

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April 30, 2010 Posted by | Body Culture in the U.S., Books, Health, Medical Practice, and Healing | Leave a comment

Clinical Empathy in Extremis

As has long been known in the field of undercover law enforcement, some information is easier to gather secretly than overtly.

In late 2008, three psychiatric nurses had themselves admitted as “pseudopatients” to a Dutch psychiatric hospital. In collaboration with an acting coach and a psychotherapist, they developed fictive biographies for their characters–“back stories”–much as do undercover cops. One of the players was admitted to the psychiatric hospital by his “brother” after a suicide attempt that was part of his back story; a history of aggressiveness was also part of his backstopping. Family members, played by professional actors, came to visit them while they lived in the psychiatric hospital as a patient would. Following the lead of a famous covert investigation of the patient experience by David Rosenhan in 1973–“Being Sane in Insane Places”–these undercover investigators were trying to understand the conditions under which psychiatric patients experience their illnesses.

Medical student Kristen Murphy living in a nursing home.

Medical student Kristen Murphy living in a nursing home.

Understanding the patient experience from the inside has become part of some medical schools’ training programs. The University of New England medical school sent (young) medical students in geriatrics for two-week stints as “patients” in regional nursing homes where they could experience the anomie, the longing for human contact, and the challenge of navigating often insensitively designed environments: what their patients live every day. While it was of course impossible to be in any way in deep cover at 50 years younger than the target population, there was still much for participant-observers to learn. Shower bars, for example, were too high for people in wheelchairs.

How far does a doctor have to go in feeling or experience to treat her patient effectively? And, practically, how close can a doctor get to experiencing what her patient feels without running the risk of being sucked into the morass of the patient’s suffering? Isn’t there also a peril of projecting her own experience of suffering upon her patient and blinding herself to the suffering that is truly the patient’s own?

All this is at the middle of an ongoing debate in medical practice and training–at least in the places where patient experience is considered part of the clinical picture. Some say, just recognizing, identifying, being able to label the experience the patient is “presenting” is enough to treat an illness well. Others demand that, in addition to the awareness of the patient’s state, the health-care provider’s being able to respond in the moment, with real emotional savvy, is what constitutes true clinical empathy. They posit that, not only are so-called clinical outcomes better when doctors and nurses experience and convey clinical empathy, but their own satisfaction in their work rises when they allow themselves to be moved by patients.

Some concerned with these issues have been using theatre training to improve physicians’ observational and receptive skills, helping them to listen for subtext, values, and strengths, and their performance skills, coaching them to express themselves fully and clearly through their voices and bodies and to use eye contact, breathing rhythms, and body positions to foster rapport with their patients. They distinguish between a surface-level and a “deep” acting, in which these skills have been internalized and become more automatic.

Yet the bodies of others are not only relational and physical, they are also cultural, and there’s evidence that physicians who fold all these elements into a treatment plan see better outcomes. Just as in On Killing, the book featured in Skin in the Game’s January issue that examines the conditions that make it easier for soldiers to kill, it is harder for doctors to feel empathy for those whom they perceive as being different from themselves-whose bodies and selves they perceive as “other.” The next phase of development in the humanization of the medical professions so that they become professions of healing is the encompassing of how the perspective of someone one may initially perceive as foreign, other–and, thus, inevitably “less than”–can transform into a collaborative relationship of inquiry, with two body-selves linked in a common humanity.

The Bodies of “Others”: Compassionate Care in the Health Professions will be presented at the American Holistic Nurses Association conference June 3 in Colorado Springs. Please contact Sara to schedule this workshop for your health-care organization.

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April 30, 2010 Posted by | Health, Medical Practice, and Healing | Leave a comment

Plying Exhaustion: Sleeping Together at Work (Twice)

It is a common experience that a problem difficult at night
is resolved in the morning after the committee of sleep has worked on it.

— John Steinbeck

In the days when companies could still afford to send their employees out of town to engage, free of other demands, in strategic thinking and planning, it wasn’t uncommon for planning sessions to last two days and to include an overnight.

When I’ve designed or facilitated such meetings, that first day would be about uncovering the “current situation” and the call for change — the reasons the strategic planning was needed in the first place. Faint visions of more desirable futures might begin to emerge toward the very end of that first day. However, one certainly couldn’t expect the assembled group to get anywhere near deciding how to move the organization from “here” to there” — to action steps or implementation — by evening.

Between the two days of hard collective thinking, those executives had to sleep. Sleep was perhaps “personal time,” a chance to get away, not only from the hard work of thinking but from the too-well-known voices of colleagues. But that night, a good number of those highly paid workers would no doubt dream about the stuff of the day — the conflicts, the skewed perceptions of reality held by their colleagues, the politics of coaxing a behemoth organization into a new gait.

The second morning was often when collaboration could really take off. Excited by the unfinished, broad-field visioning work of the first day and refreshed by sleep, group members would enter into the second morning’s work with zest and optimism, ready to make their vision whole.

Much has been made through the ages of the power of breaking bread together, of sharing meals; indeed, having meals together is regarded in many cultures as the way to build a sense of commonality prior to reaching important agreements. (If you like, take a look at the story on Nanette Sawyer’s book Hospitality in the November issue of Skin in the Game.)  But we rarely talk of sleeping together with co-workers, except as a euphemism for sexual relationships.

Yet sharing the cycles of energy and exhaustion, giving collective attention with co-workers to those bodily rhythms, is a key factor in building the energy for change in those retreats. The “Design Shops” that master facilitators Matt and Gail Taylor have run, as well as the “Future Search” method developed by Marvin Weisbord and Sandra Janoff, carefully build in sleep time for the socially creative process that’s required.

Weisbord & Janoff even recommend a three-day,  “sleep twice” design for meetings, saying, “It’s not the total hours worked, but the spacing of learning — the ‘soak time’ — that leads us to understand each other’s views, fully accept the high and low points, and do new things together.”

The intimacy of shared exhaustion, a mutual inability to speak or listen any further, makes wholeness of the talking, the advocacy, the standoffs. Sharing the bodily underbelly of conscious, vocal collective presence changes everything once the energetic “professional” self returns, transformed and integrated, in the morning.

What solutions have come to you in sleep or in shared quiet?


Comment from Mary Bast: I once did a retreat for an executive team whose leader wanted to move them from a competitive to a collaborative way of operating. After dinner the first evening of the two-day session, we arranged a volleyball game where, after about a half-hour of casual competitive play, I asked them to get together and figure out how to change the game of volleyball so it was collaborative instead of competitive. At first there were a lot of puzzled looks, but then they got into it. There was a lot of laughter, which was true of the competitive version, as well, but there were no more joking taunts about the “losers.” Instead, their energy went up several notches as they engaged together in a communal effort. This definitely changed our effort for the better on the second day.


March 30, 2010 Posted by | Physical Culture | 2 Comments