Healing and the Role of a Therapist: What Fracturing My Arm Taught Me
When psychotherapist Dr Ajay Khandelwal fractured his arm, he learnt about different mechanisms of healing
Here he wonders what this means for the therapy process and the different roles of a therapist
In the last few years I’ve broken my thumb in a cricket match, and my left wrist in a bike crash. I decided to take up playing tennis as I was in search of a safer sport. Tennis appeared a perfect game for an off-duty psychotherapist. It was easy to arrange at short notice with other self-employed individuals, allowed for conversation, and kept me away from cars, cricket balls and other potentially trauma inducing objects. I enjoyed its creative and competitive nature; its integration of play and aggression.
In between completing household errands on a Monday afternoon, a few texts were exchanged, and I found myself playing a game against a friend in the autumn sun. The trees were rustling. The air was languid. I felt relaxed. There were no clouds in the sky. The only interruption was a young woman who appeared and began to blow away the autumn leaves with a noisy contraption.
My tennis partner suggested we move court to enable her to finish her job. I took a position deep behind the baseline. I was playing looping top spin forehand. My right arm was stretched fully. I was on my toes. My body was twisting through the air. I made sweet contact with the ball indulgently imagining myself to be Roger Federer in his pomp.
At that moment I felt the most excruciating pain I had ever experienced. I fell to the ground. Was I being punished for absconding from my household chores? Or for likening myself to the king of tennis? I screamed in pain. This was a totally new experience. My mind searched furiously for antecedents. What could this be? What did this mean? I imagined I had snapped a tendon. I recalled many years ago reading an article in a Sunday paper about the gunshot sound of a tendon snapping. I tried to feel myself through the lens of words to diagnose my injury. I wondered if the pulsating throbbing sensation in my arm right arm was due to the tendons trying to stitch themselves back together. Is this what an octopus feels like when it loses a tentacle I wondered?
Understandably the ambulance service algorithms placed me at the lowest priority. The call handler told me I should make my own way to A&E. Well, I would if I could! But I was unable to move. Those around me wanted to lift me up and move me to a car. But any attempt to move would leave me screaming. I settled in for a four hour wait. Other tennis players brought me tea blankets and pain killers.
I felt totally helpless. A club official came to take my name and put it down in the injury register. I found this rather annoying but complied. In my mind I felt like I was the tragic actor in a climbing drama stuck in a crevice on Mount Everest waiting for a rescue team. Sure it was a balmy 19 degrees rather than minus 40 and yet I had the strange feeling of being in no man's land. I knew something was terribly wrong and yet I could not communicate it in words or experience. I was in an unknown area as were the group around me.
Fortunately the ambulance service were experiencing a quiet time on that Monday afternoon. I was very lucky. After an hour I was attended to by a paramedic and a trainee paramedic I was given a pain relieving gas miraculously I could walk to the to the ambulance. The paramedic was a climber in his spare time, which allowed me to cling onto the idea I was felled by a mountaineering tragedy rather than a fluffy yellow ball. He told me he planned to strike over pay and conditions.
Morphine provided me with further sustenance. The involuntary gasp of the X-ray department team of a local A&E hospital illuminated me further. I had fractured my humerus. Snapped it in two.
Yes I am writing this piece by voice recognition software. By losing use of my dominant right arm, I am forced to draw on my inferior function, i.e. my left hand. Incredibly the psyche adapts. Often, when patients come to us psychotherapists, their 'dominant' way of being in the world is no longer effective, and we are alongside them as they find new ways to be. Sometimes this process is gradual and sometimes, as in my case, it is instantaneous. A job loss, a relationship breakdown, sickness, freak weather, can all knock us off our feet. It would be rather grandiose to think of my broken arm as an act of god, but my ego certainly didn’t see it coming! I guess one thing is for sure, most of us end up having to make friends with our inferior functions by choice or necessity at some point. Normally I’d be in my body, on the court, but instead I’m using my mind, voice and left hand to write this piece.
From a psychoanalytical perspective the research on fractures is fascinating. Various studies show that there is not a great deal of difference between surgical intervention and the body's own natural healing process. In 80% of cases the arm heals itself. In 48 hours blood flows to the affected area. Overtime a soft jelly forms. Eventually the bone begins to harden and heal itself. Even with a fair bit of inner deformity the arm is able to regain most of its function. So how does one decide between the natural healing properties of gravity and rest versus a knife and metal?
How does therapy work? Should the therapist simply provide the equivalent of a humeral brace which provides a container for the healing arm? The humeral brace exerts a gentle and continuous pressure around the broken bone; the body does the rest. Is this similar to the therapists consulting room? Does the therapist provide a field which facilitates healing?
Or is therapy more like surgery? Do the therapists interpretations act like surgical incisions? Is the therapist responsible for introducing psychic metal work to stitch together a profound wound? Should the therapist get the patient back on the tennis court of life as soon as possible?
As part of further investigations into my arm I had an MRI. This was an uncanny experience. It was claustrophobic, regressive and terrifying and at moments poetic and sublime. The MRI is clearly a very expensive an advanced piece of machinery. It allows deeper investigation into the nature of bone and muscle. It is more forensic than the data that can be produced by an X-ray. It allows us to examine pathologies that are hidden from even the best trained eye.
Psychotherapy uses an ordinary piece of kit. Well, both ordinary and extraordinary. The human mind. The analyst and the patient are constantly scanning each other both consciously and unconsciously. At moments it may be true to say there is a form of magnetic resonance between the two. Uncanny things happen. Suddenly there are moments of depth and infinity. In my experience the unconscious can be a more powerful machine then both an X-ray and an MRI.
In the rich western world MRI scanner sales people are enjoying boom times. Everyone loves the idea of a machine that can see deep into you and tell you what is wrong with you. Perhaps it's also something to do with the fact that the machine does all the work? And yet there is still a place for the low tech kit of the human mind.
Perhaps a really good therapist has a mind like an MRI scanner that can really see into us? But of course the patient can also see into the mind of the therapist. Perhaps a less good therapist has a mind like an X-ray which can only pick out major breaks and traumas. But of course therapy involves the meeting of two subjectivities. It involves two minds and two bodies.
Nowadays of course we also assume that the patient has a mind with X-ray or MRI like qualities. Both the patient and the therapists minds are constantly interacting and resonating in the therapeutic field. It is this interaction which perhaps makes the therapy most efficacious. The MRI report from a psychotherapy session is the joint production of two parties. Just like a game of tennis requires two players. Sure, you can play against a ball machine, or do therapy with a chat bot, but that’s not really real is it?
We all face break points in our lives. We may lose. We may breakdown in body or in mind. And yet we may also regenerate and find a way to get back onto our feet. I feel hopeful about the ability of the human body and mind to bounce back.
Dr Ajay Khandelwal is a verified Welldoing psychotherapist in London and online