Top

Published in:

01-11-2014 | Scientific Contribution

To be held and to hold one’s own: narratives of embodied transformation in the treatment of long lasting musculoskeletal problems

Authors: Randi Sviland, Kari Martinsen, Målfrid Råheim

Published in: Medicine, Health Care and Philosophy | Issue 4/2014

Abstract

This study elaborates on narrative resources emerging in the treatment of longlasting musculoskeletal and psychosomatic disorders in Norwegian psychomotor physiotherapy (NPMP). Patients’ experiences produced in focus group interviews were analyzed from a narrative perspective, combining common themes across groups with in depth analysis of selected particular stories. NPMP theory expanded by Løgstrup’s and Ricoeur’s philosophy, and Mattingly’s and Frank’s narrative approach provided the theoretical perspective. Patients had discovered meaning imbued in muscular tension. Control shifted from inhibiting discipline and cognitive strategies, towards more contingence with gravity and sensation, and increased freedom to be what and who they were. Trust, time, open speech, and being respectfully listened to were described as therapeutic pre-conditions. The body was experienced as the source of their voice as their own. As tension patterns transformed, novel experience in sensation appeared to feed narrative imagination, reshaping past plots, embodied identity and future prospects. NPMP was disclosed as a treatment integrating detection, battle and repair as narrative subplots, but the core narrative was the journey of transformation. Novel embodied narrative resources nourished the quest for a life and identity in tune with the body as one’s own.

NPMP is a post graduate specialization taught at the University College of Oslo, and as a clinical master at University of Tromsø. Some courses have are run in other Scandinavian countries. Patients are referred to NPMP by their medical doctor. It is one of the physiotherapy methods practiced within the National Health Service and covered by national insurance with its own financial rate.

Braatøy (1904–1952), Norwegian psychiatrist, was one of the first psychoanalytically trained doctors in Norway. In his attempt to bridge the diverging opposites between experimental medicine and psychology, he searched for what they had in common, which could transcend the divide between body and mind. Central to the theory of NPMP is that muscular functions of posture are molded by social and cultural norms and, express a person’s attitude to his emotions. In nervous minds muscular conflicts between posture and spontaneous movements may thus express that a person is in conflict with himself, the attitude may arrest the motions of emotions and inhibit the person from being aware of how strongly impressions have affected him/her. If muscular conflicts are dissolved, emotions and memories may emerge. Braatøy was also known for introducing a client centered approach to the medical practice in Norway.

Aadel Bülow-Hansen (1906–2001), Norwegian physiotherapist, discovered how muscular tension was associated with respiratory inhibition. Together with Braatøy she explored the connection between respiratory inhibition and emotional regulation and social adaptation. With her practical skills and in depth knowledge of anatomy and the moving body as a comprehensive unit, she developed NPMP as a method, which she then taught her colleagues, who subsequently developed a system of education and training. In the passage from clinical practice, where it originated, to becoming a clinical master program, claims as to documentation and theory have increased. It is likely that practice has changed somewhat over time, but no studies have documented this.

A wide variety of conditions and illnesses may be referred to NPMP, such as: long lasting low back pain and shoulder/neck pain, asthma, headaches, migraine, fatigue, fibromyalgia, anxiety, depression, anorexia, post-traumatic stress syndromes, Multiple Sclerosis, hemiplegia, or complications after surgery or accidents i.e. whip lash injuries. Many patients will have complex conditions involving several diagnoses at the same time. They are often referred after many attempts with general physiotherapy, chiropractor treatment, acupuncture, or various alternative treatments. Some have been to or, are attending psychotherapy simultaneously. When applicable, NPMP therapists and psychotherapists collaborate. NPMP is directed more towards how a person reacts and adjusts as a whole, rather than the diagnosis.

Anthropologist Cheryl Mattingly Professor, Department of Anthropology, University of Southern California, USA and Aarhus Institute of Advanced Studies, Aarhus University, Denmark. Based on ethnographic studies she has written about how clients, families and clinicians work together in rehabilitation processes. She has also studied how narratives help clinical reasoning and therapists endeavor to tailor treatment for the individual clients’ particular needs.

Sociologist Arthur Frank is Professor Emeritus of Sociology at the University of Calgary, Faculty of Art, Department of Sociology. His research is related to narrative inquiry and narrative practice of illness experience. It also encompasses health care and bioethics, sociology of the body and sociological theory. He was awarded the Writers’ Award from the National Coalition for Cancer Survivorship (Washington, D.C.) in 1996 for his book At the will of the body, based on his personal experience of surviving a heart attack and cancer. The Wounded Storyteller: Body, Illness and Ethics, which has inspired our article, is widely known within medical sociology and humanities in medicine.

Paul Ricoeur (1913–2005) is most famous for combining phenomenology with hermeneutic interpretation. He draws on several fields of research such as literature, history and linguistics, but also in-depth knowledge on and analysis of Freud’s work. Drawing on this he develops a narrative theory of identity.

Knud E. Løgstrup (1905–1981) is Denmark’s most famous philosopher next to Kierkegaard. He belongs to the Danish philosophy of life following Gruntvig. His philosophy encompasses extensive discussions with philosophers such Husserl and Heidegger. He also discusses with and opposes Kierkegaard and structuralist Hjelmslev. Løgstrup’s phenomenology is first and foremost inspired by Hans Lipps (a student of Husserl and Bergson), whose lectures he attended in Göttingen. Løgstrup is most famous for The Ethical Demand published in 1956. It is claimed to present an alternative understanding of interpersonal life upholding interdependent basic trust. Løgstrup’s phenomenology of sensation is developed later but is implicit in his thinking already in 1956. Løgstrup is much referred to within health care research in Scandinavia. Some of his work is available in English translation in: Løgstrup (1997) The Ethical Demand, Notre Dame, Indiana University of Notre Dame Press, Løgstrup (1995) Metaphysics, Milwaukee: Marquette University Press.

In The paradox of hope, Mattingly investigates how children suffering from fatal disease or sever handicaps, and their families struggling to cope. In The wounded storyteller Frank’s stories are related to people suffering with chronic disease or terminal conditions of various sorts.

Bair, M.J., J. Wu, T.M. Damush, et al. 2008. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosomatic Medicine 70: 890–897.CrossRef

Braatøy, T. 1947/1979. De nervøse sinn 1–2 [The nervous minds 1–2]. Oslo: J.W. Cappelens Forlag.

Braatøy, T. 1948/1952. Psychology versus anatomy in the treatment of arm neurosis with physiotherapy. The Journal of Nervous and Mental Disease 115:215–245.

Breitve, M., M. Hynninen, and A. Kvåle. 2008. Emosjonelle symptomer og helseplager hos pasienter som oppsøker psykomotorisk fysioterapi [Emotional Symptoms and Health Complaints Seeking Psychomotor Physiotherapy]. Fysioterapeuten 12: 19–26.

Bunkan, B., L. Radøy, and E. Thornquist. 1982. Psykomotorisk behandling [Psychomotor Treatment]. Oslo: Universitetsforlaget.

Bunkan, B., and E. Thornquist. 1991. What is psychomotor physiotherapy?. Oslo: Norwegian University Press.

Dragesund, T., and M. Råheim. 2008. Norwegian psychomotor physiotherapy and patients with chronic pain: Patient’s perspective on body awareness. Physiotherapy Theory and Practice 24: 243–254.CrossRef

Ekerholt, K., and A. Bergland. 2004. The first encounter with Norwegian psychomotor physiotherapy: Patient’s experiences, a basis of knowledge. Scand J Public Health 32(6): 403–410.

Ekerholt, K., and A. Bergland. 2006. Massage as interaction and a source of information. Advances in Physiotherapy 8: 137–144.

Ekerholt, K., and A. Bergland. 2008. Breathing: A sign of life and unique area for reflection and action. Physical Therapy 88: 832–840.

Frank, A. 1994. Reclaiming an orphan genre: The first-person narrative of illness. Literature and Medicine 13: 1–21.CrossRef

Frank, A. 1995. The Wounded Storyteller. Body, illness, and ethics. Chicago and London: The University of Chicago Press.CrossRef

Frank, A. 1998. Just listening: Narrative and deep illness. Families, Systems & Health 16: 197–212.CrossRef

Frank, A. 2012. Practicing dialogical narrative analysis. In Varieties of narrative analysis, ed. J.F. HJG, 33–52. Los Angeles: Sage.

Halkier, B. 2010. Fokusgrupper [Focusgroups]. Oslo: Gyldendal Norske Forlag AS.

Ianssen, B. 2012. Norwegian psychomotor physiotherapy. Movement of life. Trondheim, Norway: Berit Ianssen (ed).

Kitzinger, J. 2006. Focus groups. In Qualitative research in health care, 3rd ed, ed. C. Pope, and N. Mays. USA: Blackwell Publishing.

Kristensson, B., and P. Kemp. 1992. Innledning [Introduction]. Från text till handling [From text to action]. Stockholm/Stehag: Brutus Östlings bokförlag. Symposion.

Krueger, R., and M. Casey. 2000. Focus groups: A particular guide for applied research. Thousand Oaks: Sage Publications.

Larun, L., and K. Malterud. 2011. Finding the right balance of physical activity: A focus group study about experiences among patients with chronic fatigue syndrome. Patient Education and Counseling 83: 222–226.CrossRef

Lærum, E., S. Brage, C. Ihlebæk, et al. 2013. Et muskel- og skjelettregnskap. Forekomst og kostnader knyttet til skader, sykdommer og plager i muskel- og skjelettsystemet [A Musculosceletal Accounting. Prevalence and Expenses Associated with Injuries, Diseases and Ailments of the Musculoskeletal System].

Løgstrup, K. 1956/2000. Den etiske fordring [The Ethical Demand]. J.W. Cappelens Forlag.

Løgstrup, K. 1968/1994. Opgør med Kierkegaard [Settlement with Kierkegaard]. Copenhagen: Gyldendal.

Løgstrup, K. 1976. Vidde og prægnans. Sprogfilosofiske betragtninger. Metafysik I [Width and reconance. Languagephilosophical reflections. Metaphysics I]. Copenhagen: Gyldendalske Boghandel, Fordisk Forlag A.S.

Løgstrup, K. 1978. Skabelse og tilintetggørelse. Metafysik 4 [Creation and destruction. Metaphysics lV]. Copenhagen: Gyldendal.

Løgstrup, K. 1983a. Kunst og erkendelse. Metafysik ll [Art and apprehending. Metaphysics ll] Copenhagen: Gyldendal.

Løgstrup, K. 1983b. System og Symbol. Essays [System and Symbol. Essays]. Copenhagen: Gyldendal Bokhandel, Nordisk forlag AS.

Løgstrup, K. 1984. Ophav og omgivelse. Metafysik lll [Origin and environment. Metaphysics lll]. Copenhagen: Gyldendal.

Løgstrup, K. 1987/1993 Solidaritet og kærlighed [Solidarity and Love]. Copenhagen: Gyldendal.

Løgstrup, K. 1995. Metaphysics. Milwaukee: Marquette University Press.

Løgstrup, K. 1997 The Ethical Demand. Notre Dame, Indiana University of Notre Dame Press.

Madriz, E. 2003. Fokus groups in feminist research. In Handbook of qualitative research, ed. N. Denzin, and Y. Lincoln. Thousand Oaks: Sage Publications.

Malterud, K. 2012. Fokusgrupper som forskningsmetode for medisin og helsefag [Focus groups as research method for medicine and health care]. Oslo: Universitetsforlaget.

Mattingly, C. 1998. Healing dramas and clinical plots. Cambridge: Cambridge University Press.

Mattingly, C. 2000. Emerging narratives. In Narrative and the cultural construction of illness and healing, ed. C. Mattingly, and L.C. Garro. Berkley and Los Angeles: University of California Press.

Mattingly, C. 2010. The Paradox of Hope. Journeys through a clinical borderland. California: University of California Press.

Morgan, D.L. 1997. Focus groups as qualitative research. London: Sage Publications.

Rendtorff, J. 2000. Paul Ricoeurs filosofi [Paul Ricoeur’s philosophy]. København: Hans Reitzels forlag.

Ricoeur, P. 1984. Tale og skrift [Speech and Text]. In Sprog. Tale og skrift, ed. P. Kemp. Århus: Aros.

Ricoeur, P. 1991. Life: A story in search of a narrator. In A Ricoeur reader. Reflection and imagination, ed. M. Valdés, 425–437. New York: Harvester Wheatshaft.

Ricoeur, P. 1992. Oneself as another. Chicago: The University of Chicago Press.

Ricoeur, P. 2004. Memory, history, forgetting. Chicago: The University of Chicago Press.

Steihaug, S., B. Ahlsen, and K. Malterud. 2002. “I am allowed to be myself”: Women with chronic muscular pain being recognized. Scandinavian Journal of Public Health 30: 281–287.CrossRef

Steinsvik, K. 2008. Kunnskap om kroppen mellom grep og begrep [Knowledge on the Body between Grasp and Concept]. Yrkeskunnande förIndustriell ekonomi och organisation, 217. Stockholm: Kungliga Tekniska Högskolan.

Sudman, T. 2009. (En)gendering body politics. Physiotherapy as a window on helath and illness.. Department of Public Health and Primary Care. Dissertation for the degree of Philosophiea Doctor, University of Bergen.

Sviland, R., K. Martinsen, and M. Råheim. 2007. Hvis ikke kropp og psyke—hva da? [If not body and mind—then what?]. Fysioterapeuten 12: 23–28.

Sviland, R., M. Råheim, and K. Martinsen. 2009. Å komme til seg selv—i bevegelse, sansning og forståelse [To Come to Onself—In Movement, Sensation and Understanding]. Matrix 2: 257–275.

Sviland, R., M. Råheim, and K. Martinsen. 2010. Språk—uttrykk for inntrykk [Language—Expressions of Impressions]. Matrix 2: 132–156.

Sviland, R., M. Råheim, and K. Martinsen. 2012. Touched in sensation—Moved by respiration. Embodied narrative identity—A treatment process. Scandinavian Journal of Caring Sciences 26: 811–819.CrossRef

Thornquist, E. 2006. Face-to-face and hands-on: Assumptions and assessments in the physiotherapy clinic. Medical Anthropology 25: 65–97.CrossRef

Øien, A. 2013. Fortellinger mellom nærhet og avstand til kroppslig erfaring [Retrospective and emergent narratives of embodied experiences]. Fysioterapeuten 3: 22–26.

Øien, A., S. Iversen, and P. Stensland. 2007. Narratives of embodied experiences—Therapy processes in Norwegian psychomotor physiotherapy. Advances in Physiotherapy 9: 31–39.CrossRef

Øien, A., S. Steihaug, and M. Råheim. 2010. Communication as negotiation process in long term physiotherapy: A qualitative study. Scandinavian Journal of Caring Sciences 25: 53–61.CrossRef

Øien, A.M., M. Råheim, S. Iversen, et al. 2009. Self-perception as embodied knowledge—Changing processes for patients with chronic pain. Advances in Physiotherapy 11: 121–129.CrossRef

Title: To be held and to hold one’s own: narratives of embodied transformation in the treatment of long lasting musculoskeletal problems
Authors: Randi Sviland
Kari Martinsen
Målfrid Råheim
Publication date: 01-11-2014
Publisher: Springer Netherlands
Published in: Medicine, Health Care and Philosophy / Issue 4/2014
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI: https://doi.org/10.1007/s11019-014-9562-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

To be held and to hold one’s own: narratives of embodied transformation in the treatment of long lasting musculoskeletal problems

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2014

Healthcare professionals’ dilemmas: judging patient’s decision making competence in day-to-day care of patients suffering from Korsakoff’s syndrome

Epistemic injustice in healthcare: a philosophial analysis

Using non-human primates to benefit humans: research and organ transplantation

“Imprisoned” in pain: analyzing personal experiences of phantom pain

Scientific second-order ’nudging’ or lobbying by interest groups: the battle over Abdominal Aortic Aneurysm Screening Programmes

The donor organ as an ‘object a’: a Lacanian perspective on organ donation and transplantation medicine