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Back to the Forum Archives I begin this essay with a question. The question is , when does therapy become brutality? These thoughts come out of some recent experience of mine. A few weeks ago I underwent a procedure called total knee replacement surgery. This is a procedure I would hesitate to recommend for anyone. In my case it was a choice between surgery or a future of chronic crippling pain for the rest of my life. It was a no-brainer for me to choose surgery in this case. I have always been a very active person and the idea of being crippled and in pain to boot was more than I was willing to accept. I am severely arthritic and have had other surgical procedures as a result including two spinal surgeries and two total hip replacements. I though I had a good grasp of the pain and recover times involved in this. Let me just say, I could not have been more wrong, especially about the pain. It was an order of magnitude more intense than the pain of hip replacement surgery. I was taken completely by surprise. Okay, tough! So what? Well this essay is not about the pain. It is about recovery and therapy, physical therapy. My experience in the hospital led me to formulate my question, when does therapy become brutality? In order to begin recovery from this procedure, it was necessary for me to undergo what was called physical therapy for three days in the hospital. This therapy took place in a group environment with about 15 other patients and about a dozen therapists. Those numbers are approximations. I did not actually count the other participants. I was too busy suffering through the procedures. The procedures themselves were based on a book given each of us by the hospital. The book I had was called Knotebook for Knees. I assumed each of the participants had something similar. There is some confusion about this because the patients were not all knee replacement patients. There were also several hip replacement victims in the group. Again, I do not have an accurate count. I learned these things as we went along. The problem I saw with Knotebook for Knees was not the book itself. I found it to be a well written generalized guide to recovery therapy. Unfortunately, that was not how it was used. Once the therapists got the book, it became something of a bible. The procedures outlined in the book were treated as though they were carved in stone. This is stunning when you consider that we were dealing with two different surgical conditions, those being knee and hip replacement. In addition we had a broad range of patients involved, from young men to very old women. This seemed to matter not at all to the therapists. In their procedures, everyone was treated the same, more or less. It seemed to come down like this. "Everyone vill do der same ting at der same time in der same quantity." Instead of adapting the treatment to the individual patients, the patients were forced into the one fits all mold. A glaring example is that they had the hip replacement patients and the knee replacement patients doing exactly the same exercises in exactly the same way at exactly the same time. For many of us victims the procedures became an impossible chore, but we were caught in it. I wondered later about the motivations of some of these so called therapists. Why were they in this business? There was one in particular who seemed to have me singled out. Perhaps I looked a bit like her abusive father or husband. I don't know. I do know that on two occasions she took it upon herself to force my knee into positions that were extremely painful. She did not encourage me to do my best. She physically forced me knee beyond the point of extreme pain. I did not matter what I had done on my own. She was determined to take it further. Even Mrs. Gaffer, who is an RN, was much surprised by this behavior. The problem for me in this brutishness was its effect on my future decisions. What this kind of unreasonable brute force stuff does is cause people to stop doing therapy. I almost missed a great opportunity because of those people. I had had the therapists up to here! The doctor who did the surgery had prescribed follow on physical therapy for me with a local therapist, but I was fed up. I was convinced what had been done to me was unnecessary and brutal. With that, I decide to do my own therapy at home. Thanks to Mrs. Gaffer's persistent coaxing, I finally decided to try the follow up therapist. I am very happy Mrs. Gaffer won that one. That was when I discovered how wrong the hospital therapy had been. When I went for my sessions, the therapist was very concerned with my individual condition and my progress from where I was. As a result, my progress has been steadily upward and I look forward to a full recovery of my flexibility and strength. I do believe I could have done it on my own, but the help of a true professional therapist has had a profound effect on my effort. I am recovering much faster that I would have thought possible, and with less effort. Now I must return to my original question, when does therapy become brutality? By comparing the two situations, I concluded that brutality is a likely possibility when the therapy becomes about the therapist rather than the patient. These are the situations I saw. In the professional follow on therapy, the therapist was focused on my progress. She measured that from where I started, rather than some imaginary standard. In the hospital setting that was not the case. In fact, the atmosphere maintained by this group in the hospital was more like a motivational meeting for salesmen than anything else. They had this group of victims and they were going to bring them to a level of performance no matter what. The therapist had a goal for themselves rather that a goal for the patients. So far as I could discern, that was the only difference in the two situations. The hospital situation resulted in very unreasonable demands on a number of the victims. Now, I have encountered milder forms of these unreasonable demands in other medical situations. Too often it results in no therapy rather than more therapy. The patient simply gives up in the face of escalating unreasonable demands. I have seen doctors and therapists cause this situation. The fault does not lie with the patients. It lies mainly with the therapists and the doctors. It seems, no matter what you do, they escalate the demands and try to force you to do more until you are sick of it. In this situation, too many people will just give up. Just so I do not give a totally wrong impression, what I experiences
may not be true of any other hospital. I can only report on what
I have discovered recently. As to other situations, I know this
group therapy insanity did not happen when I was at Ford hospital
in Detroit. In that situation, the hospital therapy was individual
rather than in a group setting. I think that makes all the difference.
I'll have more on hospitals and hospital staff people later.
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