75. Voluntary Torture

Sara and I have been close friends since 2006. When I first became disabled and struggled to find care, I spent most weekends at her apartment, where she and Mary would massage me for hours. After Sara became a Pilates instructor, I began seeing her at a Pilates studio every week for massage- and movement-based bodywork. This recorded 2019 session occurs years after she (and no other physician or caregiver) located by palpation the hard, mobile lump in my pelvis — the walled garden my appendicitis had erected for itself — but it similarly exemplifies the tactile intuition she developed by massaging my specific bodymind, and the compliant stillness I developed under her specific hands. The bodyworker-client relationship is bidirectional, and that bidirectionality affects touch-based therapies by combining self-sensing and kinesthetic empathy (Schleip et al., 2014). Fascia-based therapies are collaborative and (re)generative; as Dumit and O'Connor (2016) establish, every somatic experience in relation to the fascia produces a new affective, kinesthetic self-sensing (p. 36). But for patients with incurable, intractable pain — who will never be rehabilitated — touch-based therapies are a double-edged sword. In most cases, massage or physical therapy is a mandatory, routine component of care that requires patients to endure, work through, and think through pain as part of the painful process of treatment. Additionally, illness personification can complicate the bodyworker-client relationship and the patient's relationship with her own pain, and this is perhaps particularly (bidirectionally) fraught when the bodyworker and client are close.

In the Pilates studio, Sara is my beloved friend and the hour-long instrument of my pain. You can hear the empathy generated between us, but also how inexorable she is, albeit gently. She has to be. Every week, I present with the same incompatible motivations: (1) I am here voluntarily; (2) I'm a pain-averse, reluctant participant. That is, don't make me do it, which unfairly frames Sara as the person who will make me, though we both know she loves me and doesn't want me to feel pain.

In working through my pain together every week, we must navigate the subtle problems intrinsic to our bodywork sessions (and perhaps more generally to the field of touch-based therapy): (1) that by allowing my tissue movements to guide her hands, Sara can't avoid absorbing intimate, hands-on knowledge about my physical pain; (2) that despite the experiential knowledge that I'll feel better when we're done, I can't avoid feeling forced to submit to torture to get there; (3) that my abject endurance struggle is communicated through contagious affects, touch, and my unsuppressed vocalizations, so Sara can't avoid experiencing herself as brutal captor and must manage becoming the site of torturing personification and maintain her composure while treating me.

Illness personification is common to people living with chronic pain, who develop a relationship with their medical conditions and variously describe their pain as a sensation and a self: an external obstacle, an unwelcome intruder, a vicious invader, an internal blight, a traveling companion, a lover (Scarry, 1985; Morris, 2000; Reventlow et al., 2006; Barker, 2005; Baszanger, 1998; Kleinman & Kleinman, 1985; Huber, 2017; Khanmalek & rhodes, 2020). In keeping with the human inclination to anthropomorphize objects and events, I tend to personify my chronic pain in ways that represent my constructive and destructive relationships with it, ranging from torturing personification (imputing the characteristics of a torturer to pain sensations) to bodyworking personification (attributing the ambivalent characteristics of a bodyworker to pain sensations) (Tsur et al., 2017).

Maybe you can tell from the way Sara talks to me that our sessions summon both.

I am not a victim of torture, but postmemory and intergenerational trauma furnish me with imagined military interrogators, and as a fibromyalgic Eelam Tamil, torturing personification of pain culturally makes sense and, on bad days, is nearly instinctive. Fibromyalgia is a protagonist/deuteragonist whose pain sensations originate in the body and can't be controlled or escaped, recalling the dependency of the tortured subject on her torturer (Tsur et al., 2017). Scarry (1985) suggests the torturer is defined by an absence of pain that expands his dominion while his infliction of pain obliterates the victim's world. Torture is a dramatization of distance between the torturer and tortured subject, where "the most radical act of distancing relies on his disclaiming of the other's hurt" (p. 57). In this destructive relationship between self and pain, pain attains a malevolent agency, objectifying the pained body through this infliction and disavowal, amplifying its hopeless, confining qualities (Tsur et al., 2017, paras. 3-4). Consistent with biopolitical strategies that disown and silence the body in pain, chronic pain and its expressions are framed as personal failures: of health, of strength, of bodily control, of civility (Sheppard, 2020, pp. 8-9). Tsur et al. (2017) note that torturing personification may transpire in people who have never been subjected to torture, such as chronic pain patients, and correlate different illness personifications with different degrees of adaptive coping and emotional adjustment. For instance, negative personification — pain as punishment, enemy, torturer — is associated with increased pain intensity, anxiety, and pain-related depression, while even ambivalently positive personification — pain as value, challenge, restorative bodywork — can reduce pain intensity and depression and improve quality of life (para. 5).

Effective, compassionate bodywork acknowledges the tortured subject's pain and stays close to the suffering body. The bodyworker's task is to notice pain and address it by encouraging the fascia to cunningly reshape itself into new, fluid postures. In this constructive relationship between self and pain, pain attains a restorative dimension, offering instruction that will, in the long run, diminish its manifestations. I purposely yield control but, more like BDSM than torture, control is always mine (Sheppard, 2020).

Managing these personifications is easier said than done, especially on the massage table, where (as in torture) my world is obliterated. But unlike torture, this is a voluntary collaboration, where pain is an unfortunate byproduct of healing touch-based therapy. I experience the pain of this painful process as excess, as too much, a down payment for future reward that feels like an unjustifiable disciplinary technique (Levinas, 1998, p. 158). Levinas' (1998) theory of useless suffering, specifically of collective trauma, paints suffering as passivity, no longer a consciously performed act of cognizance but a submission to suffering, or a submission to the submission of suffering. The pain of this painful process might be useless, merely a waymarker to pass on the way to rehabilitation, but it isn't meaningless. Chronic pain still signifies (Morris, 2000). At minimum, "pain delivers to consciousness a body as its lived-body: the experience of pain carries with it the awareness that the body-in-pain is precisely my own lived body" (Geniusas, 2020, p. 136).

I always feel better after our sessions, but for the duration, Sara must assume a temporary burden of guilt for hurting me, and I the same, as I feel like I'm making her, even though (like me) she participates voluntarily.

Between instructions, encouragements, and reassurances, Sara reminds me to let go, warns me of impending pain sensations, becomes, necessarily, a connoisseur of my pain as expressed in every tissue movement, breath, groan, whimper, shout, cringe, jackknife flinch. I am acutely aware of how loud I am, unable to silence myself even when other clients are in the studio. At a reading of Sophocles' Philoctetes by Paul Giamatti at the Y, most of the audience cringed, instinctively mortified, at his roars of pain, while I leaned in for the sound. Excessive displays of pain are pathologized and considered immodest in polite society, but if pain is not expressed, the sufferer's pain is doubted (Halttunen, 1995).

In pre-anesthetic culture, pain expressions were normal and socially acceptable, if traumatizing to witness (Morris, 1991; Halttunen, 1995). Late 1800s hospitals were sites of visible, aural agony. Surgeons were torturers, steeling themselves against the screams and flinches of their patients, who had to be restrained to prevent them from struggling against the surgical scalpel or amputating saw. This spectacle was unavoidable, but the fact that surgeons were able to cope led patients, critics, and researchers in the medical humanities to accuse them of universally lacking sympathy or acquiring a sadistic taste for screams (Bourke, 2014, pp. 231-233). But for their patients, they had to accept the torturing personification.

It's not really formally acknowledged, perhaps because bodyworkers aren't considered experts, but the encounter between bodyworker and chronically painervated client is similarly world-destroying and -renewing for both parties. Sara touches my pain and is touched by my pain in turn. But even this is further complicated: Sara also lives with chronic pain, and while this informs her tactile approaches and kinesthetic empathy, it also means her pain and mine — two ambivalent protagonists — meet. Pain flows between us as an intensity that must be processed, accepted, commuted, and returned through touch, touch being the only sense that is localized within the body and experienced as a double sensation: that is, the touching body touches and feels itself touching. Like King Midas, who changed any object he touched to gold, my chronic pain — a self-reflexive, localized sensing fundamental to the lived subject-body's constitution — "envelop[s] the other's body within the field of my own sensings and transform the other's body into my own" (Geniusas, 2020, p. 136). But intentional morphological deformation of the fascia (through massage) can trigger biochemical, electromagnetic, and mechanical signals that reach the DNA of cell tissues in palpated and non-palpated areas (Bordoni & Simonelli, 2018, para. 8; Weig, 2020). What I call my chronic pain is regularly altered, at the cellular level, by Sara's hands. The field of her sensings enacted upon my body transform my body into the other's as well.

I joke, simplistically, that our sessions are voluntary torture, but as bodyworker and client, Sara and I operate in a profoundly complex bidirectional relationship of affect contagion, cellular transformation, and more than anything, trust. Levinas (1998) identifies an ethical subjectivity and sensibility in "suffering for the suffering of others" that endures through love and compassion, creating an inter-human order that "lies in the non-indifference of one for another . . . in the recourse that people have to one another for help" (p. 165). In altruistic, asymmetrical relation between self and Other, the inter-human perspective is the responsibility of the self to the Other, gratuitously, without concern for reciprocity or reward, even at the risk of suffering for the suffering of the Other by submitting to the evidence of their pain. In this consensual, voluntary exchange, I submit to Sara's hands (pain with a positive valence), and she inflicts pain and has to submit to its evidence (my submission to pain). Strapped into the Trapeze Table or lying on the Reformer, I undergo a guided exploration of the limitations and capacities of my body. Sara fashions prosthetic assemblages of foam rollers, cushions, bolsters, rolled towels, and her own body, kneading my soft tissue with fingers, knuckles, elbow. Like sitting for a tattoo or engaging in BDSM kink, the focused pains, though severe, are calming in their specificity. We can stop at any time. Maybe that small sense of control, despite my uncontrollable pain responses to massage, helps me persevere.

Bodywork circulates pain between both parties, and "sharing pain pulls it to the forefront of our conscious experience, not just for the pained bodymind, but for those with whom pain is shared . . . we become co-experiencers of our separate experiences through our emotions" (Sheppard, 2020, p. 18).

When I call this voluntary torture, I'm acknowledging not only the rehabilitative aspects of physical therapy but also the pain and compunction in the bidirectional bodyworker-client relationship; Sara's position as co-author of my fascia text; and the sense of misability in how a self with pain, once fascially manipulated, forever becomes a pair.