At the Social Level

The Parkinson’s triad (slowness, hypertonia, and tremor), the depression, and the fatigue caused by the disease are a social handicap for people suffering from PD. Anxieties about potentially falling cause the fear of going out of the house, and the difficulty in communicating one’s emotions puts social bonds at risk. Patients isolate themselves and complain of solitude. For them, social and psychological suffering is more important than motor suffering.

The Group

A recent study by Johnson and Dunbar (2016) confirms the importance of group and social environment in the liberation of endorphins and therefore in the fight against pain and anxiety for the appearance of joy and well-being. DRT offers Parkinson’s patients a group, as in traditional or tribal dances, which reinforces the social bond. Further, the cohesion of the group allow them to share a common rhythm. Synchrony, like sympathy, establishes attune-ment in the mother-child bond, the first interhuman bond (Stern, 1985). The sound space and rhythm that mark time not only have a container function but also give participants the desire to move and the pleasure of communicating. Every week they rejoice in the warmth of the group in dancing in unison. Their regular attendance is noticed by doctors who point out that it is a guarantee of success. Sophie confirms: “This workshop made me feel better; and it allowed me to meet again in a group where I have built relationships of friendship and solidarity.” These friendships continue outside the session, particularly in the practice of other activities.

Communication

Parkinson’s patients are often perceived as cold people because the disease freezes the muscles in their faces. We focus in our work on reviving expressiveness through the whole body. But it is also necessary to take patients out of their withdrawal from themselves and from disinterest in other persons. Thus, we multiply the interactions by creating two groups that dance face to face, thus allowing each one to see the other and to be seen.

Finally, the use of popular songs for circle dances makes it possible to identify with each other, to enrich oneself with the suggestions of others, and to share one’s origins and culture with others. It is a way to keep the link with the outside world and the news.

The Expression of Emotions

To make up for the lack of expression of emotions that hampers communication, we stimulate the expressiveness of the body and voice. We offer patients eloquent gestures that we frequently borrow from the theatre to give them strong symbolism: give/receive, escape/attack, tear/repair, separate/unite. But we also utilize facial expressions, which are particularly important for these patients. Often this is successful, leading to “no more frozen faces.” For instance, even Carole, whose face had lost all mobility, began to smile.

Quality of Life

Daily mobility is encouraged in DRT through space exploration exercises, movement management, self-confidence building, and relationships with others, therefore ensuring the body improves patients’ autonomy and quality of life. We must therefore give them the tools to face the obstacles of everyday life. Thus, all these points converge to improve their quality of life.

At the Psychic Level

Body and psyche are in constant interaction. Thus, as we have shown here, work on the social and physical levels has an impact on the psychological level. Paul shares with us his feelings after several years of participating in the workshop: "I see a clear improvement on the clinical and psychological level during the “movement” and in particular during the dance-therapy sessions.”

Self-Confidence and Autonomy

With the development of motor disorders, patients feel dependent on those around them to get out. This is very difficult for them to accept. Restoring self-confidence is essential. By repeating the same gestures over and over again, the patients gradually gain self-confidence.

When Paul first began attending the workshop, he would look at the dance-therapist to reassure himself about the movements and to keep the rhythm; for him, the dance-therapist was an important point of reference. As the sessions progressed, however, he no longer looked for the eyes of the dance-therapists. Instead he became self-confident, keeping the vocal and body rhythm on his own, even when there are several groups that make a different gesture and sound at the same time.

In group dances, everyone must anchor himself in the ground, and whether seated or standing,⁸ find his own support, particularly in the axis of the spine. Finding one’s axis and being able to rely on it, and therefore on oneself, is essential for autonomy. For example, the traditional dances based on “pas de bourrée,” which is simple and close to the step of the walk, is a magnificent tool that can be used by the body to find its verticality and regain its support and self-confidence.

We also use the remarkable imagination and creativity of the patients. Indeed, physical and psychological relaxation linked to a greater sense of security and self-confidence is necessary to enable them to express themselves creatively, as we will see later. As the DRT sessions progressed, participants gained the self-confidence to propose new ways of expressing themselves in an atmosphere of benevolence and relaxation.

Depression

The decline in body functions leads to increased self-deprecation and depression. The DRT treats this suffering in different ways.

Each workshop proposes to get out of daily life. To get out of the gloom of a narrow life, we need strong, powerful proposals. The drum, the onomatopoeia and the proposed gestures refer to a primitive first register of an archaic and strong relationship with nature: hunting, fishing, picking berries, or cultivating one’s field. “We don’t feel like we’re in Paris anymore,” said the participants. We forgot the rain, the grayness and the cold to find the sun, the warmth, which was also mirrored in the relations of the group.

Primitive Expression strives not to put patients in a nostalgic mood that could reinforce their sadness. It can happen sometimes that a patient arrives at the workshop tired, angry, and sad; he doesn’t want anything. In this case, the dance-therapist gives him personal attention before and after the session. She supports him more during the session, she proposes a theme or a rhythmic exercise that will allow him to express the emotion that manifests itself, to give meaning to what he is experiencing.

Music and songs used in Primitive Expression are joyful and invigorating. Rhythmic movements, shared with others, bring patients out of themselves and their sadness. This type of dance-therapy is based on the revival of the rhythmic structures of the transitional area that make the child discover that he is not fused to his mother but a person in his own right, and that by rhythm he can articulate himself to her in a playful way (Winnicott, 2002). Rhythm has an empowering “fatherly” function that frees the child from fusion. This makes him rejoice; joy always being the sign of victory in life. It is repeated in the sessions, and we see it appear in patients who “de-fusion,” or free themselves, from their sadness. Dance brings a different type of joy than everyday pleasures. This is why joy is postulated in many traditional societies (in ancient Greece, in Africa, in shamanic societies) as coming from elsewhere, an extra-human gift. We call it enthusiasm, which means etymologically “possessed by a god.” But the god in question is none other than the god of dance, the rhythm, which raises the body and makes it light. The pleasure of dance and communication is manifested in the collective joy and energy that the group multiplies as a sounding board. Lise said:

Relations with the participants are very stimulating and warm. We conclude the session with

a circular collective figure that brings together all the energies. Very beautiful!”

The dances, always playful, have the subjects “playing” in every sense of the word. With the help of the drum, the tribal imagination comes easily, and we solicit its expression in several situations, such as:

• • The crossing of animals: each participant proposes an animal and an associated sound resulting from his imagination and adapted to his physical capacities. He finds a way to represent himself and to know himself, having recognized himself in a lion, snake, and so on and entering into a rhythmic and gestural dialogue with other animals. Every animal is played seriously, i.e., engaged and intense, without taking itself seriously.
• • The “snake dance”: the group walks in single file in the dance studio. Each of its members reproduces the movements proposed by the person in the lead. This can lead to surprising movements. Once when Paul led the group, he suddenly changed his forward gear for a reverse gear followed by a turn on himself. This is a movement rarely proposed by patients because of its difficulty in balancing and managing space.
• • The two tribes: the group is divided into two clans, and each chooses its animal totem then invents gestures, movements, sounds related to this animal.

• Choreographies in small groups of four to five people, which encourage creativity and create a group dynamic, where we have to work together for a common purpose. In these choreographies, the patients stage their difficulties but in a disguised way, transposed into metaphors. For example, as a small abandoned bear or a cat that a mother stops from going out. These creations are accompanied by a text that tells the story of the situation in a “rapped” mode, that is to say, rhythmically scribbled and often humorous.

The reorientation from sadness to joy brings about a change of perspective that continues outside of the sessions. Nietzsche (2003) calls it “the yes to life.” It is not an ad hoc adherence reserved for gratifying moments but an acceptance that life in all its moments, including the moments of suffering, is the affirmation of existence. Here is a clinical vignette to illustrate our words:

A few days after the death of her father, Marion arrives at the dance-therapy session accompanied by her husband. At first sight, I find her slow, inexpressive in her face. “I’m not well,” she says with a muffled voice and frozen eyes. I suggest that she settle down in a seated circle to begin the session with other patients, depending on her feelings and the possibilities of the moment. Soft music guides us through the breathing with slow arm movements. Marion follows the indications while remaining very slow. Then, the game of first names on a rhythmic pulse induces a movement of arms that twinkle towards a person called; everyone sends their attention to that person. Marion’s face clears up during this exercise; she is happy to receive so much attention. We arrive to the second part of the session with a folk dance. It takes time to learn to greet each other, to make the appropriate polka steps in front of one’s dance partner. Marion seems to enjoy herself and even sing the music of this little choreography. That day, Marion had to leave before the end of the workshop. She [got ready to leave] discreetly, and then suddenly started to jump around following the movement of the circle of dancers. Marion’s departure was very joyful, full of good energy and smiles. “Time is moving faster and faster,” her husband said when he left.