by Tim Parks
My husband and I recently visited some old friends of his and stayed over. ‘David’ (who is 59) went to bed early because he was having pain from his prostate problem.
Concerned, the narrator ‘works’ with David to construct a series of encouraging formulas he can repeat to himself when things are bad. Standing balefully over the loo, for example, he must say:
Even though my pee might come out slowly, I deeply and com pletely love and accept myself and my penis. I forgive myself and my penis for anything that I may have done.
There was something very funny about this. I have never thought of my penis as a separate entity to be loved or forgiven. But was I in a position to be ironic? I read on.
Reminder phrases (I had David alternate these phrases while imagining positive images):
Even though it may come out in a dribble
And then again it may come out like a race horse
And sometimes just a dribble
I relax and let it flow like Niagara Falls
And sometimes it’s slow and I relax
And let it flow like a fire hydrant
I just let it flow and go easy on myself
If I feel angry because it isn’t flowing, I just let the anger flow easily out of my penis
After a week or so, David gets huge benefits from this rigmarole. His pain declines, his urinary flow improves, he feels altogether better about himself, reactions compatible with the short-term improvements frequently described when administering placebos to prostate pain sufferers. Absolutely against the grain, I decided to take the approach seriously. Or at least to try to. It’s an easier route than faith-healing, I thought. David is encouraged to open up the bathroom taps full blast, the better to visualise a rumbustious pee. Despite all my scepticism, not to mention the fiasco during the urogram, I opened up the taps. Rather than Niagara (which for me evokes images of kayaking catastrophe), I remembered the happy plash of my son peeing that morning before we set off on holiday together. And I invented a few determinedly optimistic formulas to repeat . . .
I shall spare you the formulas. All I can say is that doing all this stuff at two in the morning and at three and again at four and certainly at five is no joke. You have to feel gung-ho. To keep at it you’d need to get quick results. Unfortunately, the only effect it had on me was to wake me up to the point that I couldn’t easily get back to sleep. Lying in bed, I wondered whether David hadn’t exaggerated the positive effects of EFT because he liked having his friend’s wife hanging out in the bathroom with him, the sound of those taps covering any hanky-panky they might have got up to. Impotence was not among David’s listed symptoms.
On the last pages of Il bell’Antonio, after Catania has been bombed and Fascism overthrown, Antonio gets his libido back. Sort of. Outraged by the news that Barbara has married an ageing but wealthy rake, he imagines giving her a good thrashing. And finally something stirs. But I had no such violent feelings to turn me on. Nor wanted them. Who did I have to be angry with? Why does one have to be angry to have sex? The truth is, that after all this time, all these doctors, all this research, I hadn’t the slightest idea what was happening to me.
Lives of Quiet Desperation
I WAS ON Blackpool beach with friends. They were hesitating. So, show them how it’s done! I stepped back, whipped off my clothes and started a heroic run to the sea. But I’d forgotten my trunks. I was naked! Far from impressing them, I was making a fool of myself. Plunge into the sea then! My feet pounded across the sand. No sea. The tide must be miles out. Suddenly, incongruously, in the huge expanse, I was running into a small barrier, the kind workmen set up round a hole in the road. It appeared from nowhere and I went over it and fell in. The hole was deep and dank with black, evil-smelling mud. I woke and hurried to the bathroom.
I was dreaming a lot. Almost every time I woke I had dreamed. Six times a night. And more and more these dreamscapes seemed to be telling me something. Why was I always dreaming of water? Or rather, of water that had run out, of mud and sand and slime. And why the constant element of embarrassment? I dive excitedly into a lake, only to find underwater weeds so thick and woody that I can walk on them, but awkwardly, foolishly. These watery scenes seeped into my nights. On more than one occasion, waking, I recalled the winter view of the Yamuna, trickling through broad sands behind the Taj.
It was on a morning like this, in the slightly hallucinatory state dreams leave you with, that that vast ocean that is the internet tossed up a dry page that I almost felt I had written myself, so accurately did it describe my condition and state of mind. It was by the authors of A Headache in the Pelvis.
In a few hundred words they gave their take on pelvic pain or so-called chronic prostatitis. What they offered was neither the official medicine of the hospitals nor the New Age alternatives. It was neither psychosomatic nor unaware of psychology. Neither mechanical nor mystical. It did not give importance to dreams, star charts or works of art, but nor did it propose to drive a motorway through my urethra or radically alter my body chemistry. There were no obscure herbs or expensive drugs. No difficult diets. It did not promise a quick recovery. It did not promise recovery at all. It said recovery was possible, up to a point, if I worked at it. Above all, it described my symptoms accurately. All of them. Even the ones the urologists had written off as irrelevant. It took the pains seriously. And it was the first thing I had seen written by doctors with Ph.D.s that accepted the glaring discrepancy between official explanations of this complaint and reality. It addressed itself to women as well as to men. So this was not a prostate problem. In short, in just a few minutes, I realised I had stumbled across a completely new story, a different version of events, one I could perhaps believe in, and that might even be true. Or at least helpful. That said, I had no idea at the time what it would mean to engage with this vision of things, nor how much I would be expected to change in myself. Nor did I understand how it could have taken me so long to find this page; if it really was a valid approach, why wasn’t it the first hit on all the pelvic pain searches?
Their names did not inspire confidence. David Wise and Rodney Anderson. Together they had the ring of a charlatan double-act dreamed up by Mad Magazine. And what a mistake to dub their treatment The Stanford Protocol, which immediately suggested a pompous bid for patent status, the better to sell. But perhaps this was just an innate resistance on my part; I don’t give trust easily. On the web, they wrote:
95% of patients who are diagnosed with prostatitis do not have an infection or inflammation that can account for their symptoms . . . the prostate is not the issue.
Just to read this was a considerable relief. Not only had I not gone crazy, I was not even an unusual case.
Once the condition starts, the symptoms tend to have a life of their own.
I had never formulated the thought quite like this but there was definitely something capricious going on: intense pains came and went without relation to external circumstance; urinary frequency varied enormously irrespective of what you drank. Doctors had never wanted to go into detail over this, as if afraid that an exhaustive description of symptoms would mean losing themselves in a labyrinth of highly nuanced but irrelevant sensation. Inevitably, this made you feel more alone with the problem. You were complaining about things that had no objective referent nor any apparent consequence beyond the pain itself, you weren’t wasting away. As far as others were concerned you might perfectly well be making it up. So you learned to keep quiet. It was weeks since I had bothered my wife with the latest developments. She was growing tired of it all. Understandably.
‘Symptoms may be intermittent or constant,’ wrote Wise and Anderson, ‘and few people will experience all of them.’ They listed twenty-three. I had sixteen. Nor was there any symptom I had that they didn’t mention. What most impressed me was that they included ‘relief after a bowel movement’. Nobody else had corroborated this impression of mine; I felt like printing off the page right away and driving straight to Milan to slap it
down on the urology ward operating table.
‘The effect on a person’s life,’ the authors continued, ‘has been likened to the effects of having a heart attack, angina, or Crohn’s disease . . . Sufferers tend to live lives of quiet desperation.’ Depression, anxiety and ‘catastrophic thinking’, they said, were the norm.
It may seem strange to say that I was cheered on reading this grim assessment. I would certainly never have made such comparative claims for my sufferings, nor did I consider myself desperate, not yet. But it was definitely a plus to be told that I hadn’t been wildly exaggerating. My father, I remember, confided something of the like to me in more dramatic circumstances when the doctors finally told him that the radiotherapy had not cleared up his cancer and his condition was terminal. Previously informed, in order to ‘keep his spirits up’, that he had been cured, he was made doubly miserable because any expression of what he was feeling seemed like whining. Told he must die, he knew that everybody could stop wondering why he wasn’t more cheerful. In literature too, I’m convinced, a clear-sighted pessimism is always more exhilarating and liberating than soft soap and denial.
But Wise and Anderson were not bringing bad news. They had an entirely new theory as to what caused this condition. Here I began to doubt. It seemed too simple to be true. It also seemed to be leading very directly to my spending money on their book and visiting their no doubt expensive clinic in California.
Basically, they took the view that the entire problem was muscular in origin, then, consequently, neurological. It was a well-recognised, instinctive human reaction, they claimed, particularly on the part of males, to raise the muscles around the pelvis in response to excitement and stress. A defence of the genitals. Some people did this constantly, compulsively, with the result that the muscles of ‘the pelvic floor’ never relaxed. A sedentary life and, in particular, a job that meant sitting day after day at a desk exacerbated the problem by restricting blood flow to these contracted muscles, which, as a result, suffered fatigue and eventually lost their natural elasticity, tightening and pulling in areas where they shouldn’t, compressing the complex bundles of nerves that threaded the area.
I wasn’t sure what to make of this. I had never seen the expression ‘pelvic floor’ before. What was this thing? All the medical diagrams I had studied restricted themselves to showing the relevant organs – bladder, prostate, kidneys – floating inside a transparent skin and linked by nothing more than the thin tubes that shifted fluids from one to the other. None of the doctors I had spoken to had said anything about how these organs were held in place or what lay in the spaces between them. Rather they took on the quality of heavenly bodies, miraculously fixed in emptiness. Finding it difficult to visualise what was being talked about, I went on Google images, typed in ‘pelvic floor’ and found this:
It was decidedly unattractive and hardly helpful. On the other hand, this business of getting relief after a bowel movement suddenly made sense: the big muscle round the anus relaxed, allowing all kinds of other things to shift and resettle. Each muscle, each area of muscle, Wise and Anderson maintained, if frequently and unnecessarily contracted over many years, could spark off pains in places that might be some distance away.
I thought about this. It was true that I had spent many hours of many days of many years sitting on my butt. There was a general consensus that I was a tense guy. When I write, for example, my body is far from relaxed. I might have one hand thrust hard into my hair – what’s left of my hair – while my right knee is constantly bouncing up and down on the ball of my foot and my jaw working open and closed, open and closed; because I get excited about what I’m writing and I get frustrated when it’s not going well. On the other hand, I had no sensation that the muscles in my body were tense. It all felt pretty normal to me.
But if chronic muscle fatigue was the problem, what was the treatment? Again the answer was suspiciously simple.
Relaxation and massage.
Nothing else. No drugs. No operations. ‘We have never seen a satisfactory surgical intervention for these pains,’ the authors claimed. Just relaxation and massage. It was true they gave fancy names to these things – paradoxical relaxation and myofascial trigger-point release massage – but that, I feared, was merely to create the impression that you couldn’t be expected to achieve relief without direct help purchased from Wise and Anderson Inc. The massage was highly specific. And included anal massage. It required trained experts. The relaxation procedures were so complex, the authors insisted, that they would not sell tapes to guide you because you’d never be able to make use of them without expert assistance; the last thing they wanted was for sufferers to give up in frustration and write off The Stanford Protocol along with all the other cures they had tried in vain. This was a treatment that took many months, even years, and required considerable effort and commitment on the part of the patient.
I was deeply suspicious. What could be so damn complicated (or ‘paradoxical’) about relaxing? What effort could possibly be required to get yourself massaged! Financial effort, obviously, EFT as we know it. I looked through the book’s endorsements, most of them from doctors and Ph.D.s. Friends no doubt.
A Headache in the Pelvis is a lamp in the dark human suffering of chronic pelvic pain.
If there is one virus a writer is naturally immune to, it’s blurb-talk.
A Headache in the Pelvis is a very important contribution to understanding and treating pelvic pain. It is also an illuminating discussion of the relationship of mental and physical interaction in the production of disease, and an approach to a truly comprehensive treatment of illness that has relevance to a whole range of contemporary morbidities.
This sounded more interesting. Particularly ‘contemporary morbidities’. I realised that what I liked about this new paradigm was the way it accounted for a psychological component – the years of tension and bad living habits – without saying that my condition came in manipulative response to a specific psychological need (I fall ill to alter my relationship with my wife, for example, or to have an excuse for going back to England). There was also something fascinating about this clumsy title – A Headache in the Pelvis – as if it might have been precisely the thinking too much over the years that was the root cause of the pain. This reminded me of Leopardi’s beautiful line about thoughts drowning in immensity. Perhaps those desiccated dreams were telling me they couldn’t find water enough to wash away my arid lucubration.
But among a dozen endorsements it was the next that swung it.
This is the book to read before you contemplate surgery, drugs or resign yourself to continue to suffer with chronic pelvic pain. Return to health is possible. Drs. Wise and Anderson have developed an innovative clinical protocol that works.
I needed to believe this and clicked on the purchase button.
A Cat on Board
IT TAKES ABOUT ten days for a book to arrive by post from the States. Before it does and my life begins to change, I want to sing the praises of the only product that gave me some relief in this unhappy period. Benzodiazepine.
Here is a detail I had forgotten. When I had seen that Harley Street doctor, the first one, over twenty and more years ago, he had prescribed, along with the antibiotics, a milligram of benzodiazepine every morning and evening. I was offended. Why was he prescribing a tranquilliser for a prostate condition? ‘We’ve found it helps,’ he said. I never considered following his advice. How can a writer work on tranquillisers? The mind has to fizz like a firework. You have to be a fury of creative attention. But at the worst moment, in that spring of 2006, I tried it.
The frequency of my night-time trips to the bathroom had increased. Seven. Eight. Nine! I began to suffer from insomnia. I would lie in bed for half an hour, my mind raking back and forth over this and that, then go to the bathroom again without having slept. Then after another half-hour. Then another. There is a curiosity about our house that I haven’t mentioned. It’s a semi-detached and every now and then, from t
he party wall with our good and quiet neighbours, we hear a low, as it were electronic voice that speaks for no more than a few seconds. It has very much the sound of those battery-operated games for infants where you press different buttons to get nursery rhymes, or animal sounds, or jokes. But the words are muffled by the wall and I can never make out what is said. My daughters laugh and argue about it. It says, ‘Un gat-to è sa-li-to a bor-do,’ Lucy claims, mimicking the mechanical sound. A cat has climbed on board. But Stefi, who was first to notice it, is sure that it sometimes says, ‘Tro-va la chia-ve!’ Find the key. Or an indistinct, ‘Maw maw maw.’ The neighbours claim they know nothing about it.
Occasionally I had heard this voice in the middle of the night. It starts very abruptly, like those robotic instructions that surprise you in elevators or Japanese cars, repeats its six or seven muffled words, and stops. Now I began to hear it more often. Sleepless, I tried to make out what the voice said. The kids had got it wrong. They were imagining what they heard. We all make up things we’ve only half understood. Why would it produce words that were nonsense? The house was haunted perhaps. Stefi had floated that idea. The ghost was seeking to give me a message; tro-va la chia-ve, find the key. To my dreams? To my illness? Except I wasn’t sure it really did say ‘trova la chiave’, but something else. I listened. The problem was it spoke only rarely, briefly, and without warning. You couldn’t prepare for it.
I lay alert, uneasy. The church clock chimed the hours and half-hours. Streetlamp and moonlight sheened the dark. Over the hill, a scooter droned. My mother had been perfectly willing to believe in ghosts, I remembered. She was sure she had seen my father after he died. In his robes. For a while she had been enthusiastic about the idea of exorcising haunted houses. The spirits of the dead must be healed to allow them to move on. Perhaps this is a sophisticated, post-modern ghost, I thought, playing to my paranoia, mocking my obsessive attention to language, saying muffled words that might be meaningful but can never be deciphered. A poet, in short.