Barrett L. Dorko, P.T.
Occasionally we become conscious of something or someone and sense that these will remain with us until we are conscious no longer. I found two novels recently that have had this effect on me, each with a story and character that continues to haunt my thoughts in ways that have altered my perceptions and practice. I’ll talk about them here.
When we first meet him, Christopher Boone is 15 years 3 months and 3 days old. We know this because he thinks that providing such information is a good way of beginning a conversation, what his teacher at the special school calls “chatting.” Chatting is something Christopher struggles with mightily. As he says, “I find people confusing…They often talk using metaphors (which is) a word for something that it isn’t…it should be called a lie.” Christopher also struggles with the meaning of any facial expression. The voice in which he writes is uncommonly flat but matter of fact and brutally honest. There are things he doesn’t like and carefully avoids, like being touched, yellow or brown things, being in small places with other people or any movement of the furniture. He is the narrator and central character of Mark Haddon’s The Curious Incident of the Dog in the Night-Time (David Fickling Books 2003). Christopher has Asperger’s Syndrome and this accounts for his aversion to touch and inability to decipher the social cues around him. It also accounts for his genius at math and intense interest in detection and logic. The title of the book is a line from a Sherlock Holmes story and refers to the opening scene-Christopher finds a neighborhood dog impaled by a pitchfork.
Christopher decides to use his knowledge of detection to discover the story of this crime and finds ways of communicating with the world around him without fatally disturbing his sense of order or the sameness of his life.
Daniel Pecan Cambridge lives alone in a small apartment in Santa Monica (The Pleasure of My Company Hyperion 2003). He stays very close to home but makes occasional forays to a Rite Aid where he admires the pharmacist and stocks up on bulbs so that his apartment is constantly lit with exactly 1125 watts of light at all times. Despite his isolation and difficulty with normal human relationship, there is no autism evident in Daniel. He yearns for the company of others and has a gift for discerning the meaning of nonverbal communication. The author, Steve Martin (better known as a comedian), also bestows upon him a genius for metaphor and simile that kept me laughing throughout this small, touching book. Daniel is obsessive-compulsive, having grown increasingly so in the years before we meet him.
Any list of his compulsions would be long, incomplete and useless by itself. Another character simply categorizes them as “tolerable, intolerable and hilarious.” Of greater interest to me was Daniel’s own insight into their purpose. He speaks of his relationship to the psychology student assigned to visit him weekly: “Oddly, I knew more about my shrink than my shrink did about me, since I had never allowed her to penetrate my habits, which of course is the point of their existence.” Elsewhere he admits “I sensed that my fear(s) had been an indulgence so that I might feel special.” For whatever reason, Daniel has built walls around his psyche and physical self, but at least he is aware of this and understands that such a structure lacks the permanence of Christopher’s genetically acquired ways of being. He says,
I guessed that one day the restrictions I imposed on myself would end. But first it seemed that my range of possible activities would have to iris down to zero before I could turn myself around. Then, when I was finally static and immobile, I could weigh and measure every exterior force and, slowly and incrementally, once again allow the outside in. And that would be my life.
Both Christopher and Daniel penetrated my own sense of living and practicing as a physical therapist that cannot or will not conform to the traditional methodology proposed by his surrounding academic and clinical communities. Like Christopher, I find what they say confusing in light of my own knowledge of the literature and, like Daniel; I rarely allow others in the field to penetrate my habits. Not that many make the attempt. For instance, my colleagues often express a great deal of satisfaction when they feel they’ve truly helped a patient, but I know that, for me, the comfort I find in problem-solving and study far exceeds this. In fact, I find it difficult to feel anything one way or another about the patient’s recovery or lack thereof. My passion lies in the quest for more knowledge about processes I cannot see, not in the appreciation expressed by someone who believes I have helped them. By that I am not totally unmoved, but it does little to motivate me.
Each story ends with the main character content despite the difficulty of their lives. Christopher’s inability to change fundamentally so that those around him might be more comfortable with his demands doesn’t drive those who love him away but makes them examine their own choices when so many are available to them. He appears as he is; a stable being in an otherwise chaotic world of “normal” people, and he refuses to live any other way. Mark Haddon helps us understand that Asperger’s Syndrome is a personality variant, not a disorder. It might even be considered a gift, as long as we admire its unique nature and look for the best in it.
Daniel shakes off those compulsions that reduce his interaction with those he cares about while keeping dear the ones that satisfy his mind’s distinctive need. In my opinion, this makes him no different than most of us. What’s interesting to me is that his path toward a workable life is made clear through the demands of a toddler entrusted to his care. I found Martin’s insights here arresting and strangely familiar.
Are these books about physical therapy? I think that as long as we treat actual people and seek to find some way of melding our thoughts and perceptions with theirs in an effort to achieve some mutual goal books such as these should be read, discussed, savored and argued about-if only to help us understand our own motivations to practice as we do.