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The physics and metaphysics of chronic back pain

  • Italian writer Carlo Pizzati’s new book chronicles his search for a cure for chronic back pain
  • The quest took him all over the world, including India, where he found love while looking for a remedy

Participants of a yoga class doing a back stretch
Participants of a yoga class doing a back stretch

For a condition that is so common, back pain is yet to be fully understood. If it is not triggered by obvious physiological reasons, its causes can be difficult, inscrutable, even impossible to diagnose. According to one study, at least 80% of the global population suffers from back pain at some stage. The back pain industry in the US alone is valued at $100 billion (around 7 trillion now), as the book Crooked: Outwitting The Back Pain Industry And Getting On To The Road To Recovery (2017), by Cathryn Jakobson Ramin, points out. And while spinal surgery and prescription of opioids account for the bulk of these costs, alternative healing techniques, which are not covered by insurance in most parts of the world, also add to the burden of mounting expenses.

Journalist and author Carlo Pizzati
Journalist and author Carlo Pizzati

As a sufferer of chronic back pain for over a decade, and having spent a fortune on allopathic and alternative treatments, it was out of a personal interest that I picked up journalist and writer Carlo Pizzati’s new book. Bending Over Backwards: A Journey To The End Of The World To Find A Cure For Chronic Backache takes us through a wide spectrum of the global back pain industry through Pizzati’s personal experience of it. Scientifically trained medical practitioners, psychotherapists, shamanic healers, yoga teachers, chiropractors, trance dancers—he gives us the works. The quest for a remedy for chronic pain in the neck, shoulders and along his spine sends Pizzati into a downward spiral. Along the way, he is made to reckon with the possibility that the choices he has made so far, especially with regard to his tormented love life, and the past traumas he is still haunted by, may have been the triggers for the crippling pain.

“Our best understanding of low back pain is that it is a complex, biopsychosocial condition—meaning that biological aspects like structural or anatomical causes play some role but psychological and social factors also play a big role," Roger Chou, a back pain expert, told the US news and opinion website Vox last year. History bears out this hypothesis in the case of other forms of pain, among celebrity patients too. Italian dictator Benito Mussolini, for instance, was known to suffer from acute stomach pain, especially after inflicting egregious acts of brutality on his opponents. His physicians suspected he had stomach cancer, but no trace of the disease was found in the autopsy conducted after his death. There is more to our aches and pains than meets the eye.

Bending Over Backwards: By Carlo Pizzati, HarperCollins India, 216 pages,  <span class='webrupee'>₹</span>399.
Bending Over Backwards: By Carlo Pizzati, HarperCollins India, 216 pages, 399.

For Pizzati, it all starts in the city of Vicenza in Italy, his homeland, in his early 40s. By the end of this slim book, which packs in his travels of over a decade, the back pain has taken him to spiritual healers in Argentina via massage therapists in Boulder in the US, before finally landing him in India, where his search for a cure through Ashtanga Yoga in Mysuru leads him to meet his future wife—the poet, writer and dancer Tishani Doshi—with whom he now lives in a small village in Tamil Nadu. It’s the story of an urbane man of the world, with a troubled childhood and affinity for complicated women, who has to step out of his comfort zone to discover a solution to his nagging discomfort.

The arc of Pizzati’s wanderings isn’t unfamiliar. The stereotype of the spiritually lost Westerner coming to India to seek a path in life is a dime a dozen. Pizzati doesn’t have any qualms admitting that he came to the country nursing such a hope, too, nor is he unaware of the ironies in his choices. He opens his narrative with an account of a visit to a “posturologist" in Vicenza who believes that the root of his back pain lies in his teeth. Once you allow yourself to believe in such a diagnosis, it’s a slippery slope. It may not be long, or implausible, to find yourself among shamans and exorcists. “I set off into my journey with an open mind, but was careful not to fall into the many traps of the irrational," Pizzati says on email, speaking of the tussle between the rational and the irrational, an abiding theme of the book.

To understand the impulse behind Pizzati’s peregrinations, it’s obvious from the start that we have to go beyond his lumbar spine and deep into his psyche. The strain of a disintegrating first marriage, the uncertainty of when he would next see his young son, and the trepidation of quitting a decades-long successful media career to give a shot at writing are serious enough stressors to make many people not want to leave their beds. Kudos to Pizzati, though. Not only does he take the plunge into the unknown but he also sets off to find a remedy for his long-standing affliction with dogged persistence. The material of his memoir is close to the bone (no pun intended). The deeper Pizzati digs into it, the more vulnerable he must make himself, sometimes his family and friends too. It is in this confessional mode that the appeal of his writing shines through; his dithering confusions and occasional meltdowns, caused by teeth-gritting frustration, endear him to the reader.

“Rather than dressing up my narrative with the phantoms of imagination, I prefer to eviscerate the fictional nature of our life experience," Pizzati says, “To expose how fictional our reality is, and, ultimately, to investigate the fact that identity may just be a fictional character." His story, at times, is indeed stranger than fiction, unfolding in a nebulous zone between faith and disbelief. It involves exposing himself to practices and systems that his Western, rational and scientific mind finds hard to grapple with. But chronic pain, as most of us know, can often turn the sanest sceptic into a broad-minded agnostic.

Still, there are some awkward moments. One of Pizzati’s early trysts with alternative healing takes place in Los Angeles, where he submits himself to the ministrations of Katherine, “an attractive, svelte blonde in her late thirties". She uses on him a device called Scientific Consciousness Interface Operating System (SCIO), which, as she explains, “employs ‘minuscule electrical discharges in order to read the human spirit and recharge it with energies’". Her analysis of Pizzati’s back pain is based on a picture thrown up by his “karmic knot", which traces his affliction back to the year 1658, when Pizzati was, as it emerges, most likely incarnated as a Frenchman who committed a social crime somewhere in South America. It’s a bit odd that it takes Pizzati a Google search when he is back home to establish that SCIO is “clearly bogus".

Then again, sufferers of back pain are often willing to go the extra mile. In his 2010 book, Teach Us To Sit Still, Tim Parks also embarked on a journey similar to Pizzati’s, though, in Parks’ case, it was in search of a cure for an obscure and long-standing pain in the pelvis. After years of consultation with physicians, medication and the advice of surgery, the cause of his pain is revealed not to be a malignant tumour in the prostate (which he had feared all along) but rather an excess of nervous energy, the inability to relax and let go of pent-up anxiety, and, most of all, to live in the present. It is finally in meditation, particularly vipassana, that Parks finds reprieve. Is that the gift of learning to sit still and calm the mind? Or is it the power of faith?

The question of science versus belief, and the nocebo versus placebo effect, runs through the pages of Bending Over Backwards too, even though the situations these come up in may be bizarre and bleakly funny. “There has long been a Manichean approach towards cures that are outside of Western science and medicine, and, I think, by now it is clear that there should be, instead, more research done on the positive effects of cures like Ayurveda or practices like yoga and meditation," says Pizzati. “Once you study them, you can see there are chemicals at work—just not the way chemicals work in the way they are administered with the Western method."

Have yoga and meditation cured Pizzati of his back pain at last? To know the answer, you have to read the book. While it may not offer any magic cure, it will at least make you feel less alone if you are among the fourth-fifths of humanity smarting from a delicate back as you read this.

Bending Over Backwards will be available from 25 November.

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