Mel's recent post about unifying various therapeutic fields, and the
obstacles to that kind of cooperation, led to this essay, so for its
presence you have him to thank or blame, whatever you eventually feel is
appropriate.

Since the discussion of this issue extends to both of the major PT
listservs, I'm sending this to both. My more recent writing on therapeutic
issues along with book reviews is now more often appearing on Rehab Edge
<http://www.rehabedge.com>

Barrett L. Dorko P.T.
<http://qin.com/dorko>

                                         The Duchess' Game

"It is and always has been an American zeal to be first in anything we do,
and to win and to win and to win."
Vince Lombardi

My tendency at odd moments is to leaf through books I've read and long ago
set aside. Every once in awhile my eyes light upon a passage that relates
to my current dilemma, and I find my mind easing. Often some writing will
rise from it, and, in time, the crisis passes. I then move on to the next
disaster.

This week the book was "Playing By Heart" by O. Fred Donaldson (Health
Communications Inc. 1994). This is one of those in my shelves that I should
re-read each year, it's that good.

Donaldson describes what he calls "The Duchess' Game" named after the
character in Alice in Wonderland. The Duchess' Law" rules the game, and it
is quite simply stated: "This more there is of mine, the less there is of
yours."

I like this. It's short and succinct. It would be hard to misunderstand.
And, Donaldson and I believe, these few words account for the motivation
behind human interaction in a wide variety of settings. This certainly
includes health care.

I have a good friend who practices orthopedic surgery in the building next
door to mine and we often meet for lunch to talk about our pathetic lives.
He's a man often torn between his loyalty to his patients and his partners,
his responsibility to the hospital administration and the providers who pay
him. All that these groups want from him produces an internal conflict that
wears him down, and, sometimes, lunch with me helps.

It helps because he and I don't play The Duchess' Game. We found long ago
that life contained, for us, an abundance of everything, and that our
knowledge was not acquired at the expense of another. We could share all we
had and not lose a thing. This, we felt, was equally true of the patients
in our community.

But eventually we must leave the safety of the restaurant and step back
into a world that is convinced there is a limited number of painful
problems to care for, and that arranges our business life in a way that
accumulates more and more money. This is done, of course, at the expense of
those portions of our life that generate no income. Dinner with our
families, for instance.

When I think about it, The Duchess' Game is just about the only one in
town. And my personal tendency to do so poorly at it lies in my desire not
to play that way.

Donaldson divides our activity in life into two categories; contest and
play. The former is essential to The Duchess' Game. Of course, our culture
favors by far recreational or business activity that is of this sort. Those
unwilling to or incapable of competing in such an environment are at a
distinct disadvantage.

>From the book; "Since competition becomes the ruling principle in our
understanding of reality... living persons become competitors. What counts
is not one's ability to be kind or to spare one from suffering; what counts
is whether one has triumphed."

"(We are taught that) "play" (contest, really) serves survival... and since
everyone plays, no one is able to see through the farce. In the normal
course of experience, we learn to adjust to contest relationships by
suppressing our inner need to trust life."

If this is true, and I believe so, relevant issues in therapy would include
the tendency to view disability as a contest between the patient's
dysfunctional body and their will to overcome it. We might also consider
the language or pattens of rehabilitation that create a constant contest
between the present state and that which is desired. The simple act of
acceptance at any point in the course of recovery is bypassed so rapidly
that it is hardly noticed. In fact, handling people as if they already
possessed all that they needed at that moment is virtually an act of
insurrection in today's physical therapy culture.

So, how much of your practice revolves around the rules and implications of
The Duchess' Game?



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