Among the disciplines and relevant techniques in administering physical rehabilitation to post operation/stroke/other injury patients, it is valuable to consider the benefits of psychological conditioning as an aid to the treatment.

          Typically this is thought of in terms of basic positive reinforcement that takes the form of telling patients that they are doing extremely well, no matter how poorly they may be performing. For some people this often obvious untruth is sufficient to keep them psychically engaged in the treatment process, and the better the lie is told, the more work you can get out of some doddering geriatric with one foot in the grave and another on a banana peel. If you are dealing with pre dementia patients, however, something more imaginative often makes progress attainable at much higher quality of performance.

          One should keep in mind that the patient is not simply a physical being, but also an emotional construct that can be stimulated in various ways to enhance the recovery prospects. Prospect enhancement accrues to the patient and to the rehab facility when therapists are astute about the manipulation of patient fantasies as part of the process and of the patient-therapist relationship.

          As a word of caution, however, it is important that the therapist remain aware of the limits to which one may go in stimulating fantasies in the male rehab patient. There is a prohibition against the establishment of personal or intimate relationships between patient and professional. This prohibition, if it is to be observed properly, limits sensual taunting to indirection, to double entendre, and things that, were they to be repeated in any dispute resolution proceeding, would not automatically register as improprieties in the mind of the tribunal members.

          Within these limits, however, there is a world of titillation potential, as the mind of the over the hill male is forever seeking any excuse to pretend to youthful possibilities. The old farts want all the women – no matter their ability to do anything with them if they had them – and constantly watch for any opening that might seem an invitation to a proposition opportunity. While a woman might want a man to fulfill all her needs and dreams, a male wants all the women to fulfill his only need and dream.

          In this article, I shall use the case study of one Seamus Ignatius Muldoon, frequently repaired and rehabbed consequence of an unenlightened lifestyle, to demonstrate the process, the effect and the result. Muldoon is a 72 year old half Irish, half Russian hard living person whose various indiscretions, inclinations and itinerant thoughts and opinions may more specifically be examined at www.SeamusMuldoon.com.

          In the past three years, Muldoon has had four back surgeries, including a spinal fusion using titanium pedicle screws plus one neck laminectomy procedure and a total shoulder replacement. He has required rehabilitation therapy after each of these, and he has gone to the same rehab facility each time. His frequent patronization of this facility is the consequence of their technical capability and high quality standards as well as the fact that the facility always provides rehab therapy performed by charming and rather erotic female therapists who are extremely adept at manipulating Muldoon’s fantasies. The names used here are not the real names of the personnel who were involved, for obvious reasons.

          The uses of fantasy in emotional conditioning and motivation in physical rehabilitation vary according to the gender of the patient.

          A physical rehabilitation clinic should always attempt, within the limitations of available personnel, to pair male patients with female therapists, unless the patient happens to be gay. Male patients are highly sensitive to attention being paid to them by women. When they are convinced through indirect suggestion that the female therapist may have a personal interest in them beyond that of patient and therapist their response to treatment is greatly enhanced. Of course the therapist never does have any extended interest in the deluded patient, but allows his fantasies to transport him into imagined realms of relationships forbidden and unattainable. Accordingly, as in any normal dating situation, the oblivious male seeks to impress the therapist and does this by progressing exceptionally well in the rehabilitation process. In truth he is not impressing anyone, because the most that rehab can do anyway is try to get him back to near what he was like pre op. This is usually/always a state in which no young woman would care to be involved with him on any level of personal interest except perhaps if he were extremely wealthy and extremely generous.

          Establishing a fantasy relationship in the mind of a male therapy patient is also useful in obtaining approval for additional periods of therapy, as they become dependent upon the therapist and crave approval for further treatment. Accordingly, they respond readily to reassessment sessions in which the therapist points out that greater progress is obtainable with additional periods of treatment, as their biggest apprehension is that the fantasy relationship they imagine with their therapists might be cut short. The financial benefits to the clinic should not be forgotten as a positive aspect of nourishing male patient fantasies. Properly managed, there is no excuse for any rehab facility not using up all the insurance benefits of any male patient through extensions of treatment requests. Keep the old farts droolingly delusional and profitability is assured. Many rehab facilities actually stop at telling the old fart what to say in response to reassessment questions, but that ethical mandate is not pervasive. In many, it is simply the way the reassessment questions are asked that inform the patient of the desired answer.

          In the textbook a reassessment question might be phrased “Are you able to walk twenty paces without difficulty?” In reality the reassessment question is asked “You are still having some difficulty walking twenty paces, aren’t you?”

          Exploitation of male narcissistic tendencies is extreme. When one enters a physical therapy great room, the first things you notice is that there are mirrors everywhere so that the fool can see himself as the therapist compliments his appearance and the manner in which he is doing today’s exercises. With the young lady standing beside him and looking at himself in a mirror, the old fart stands more erect and works harder to perform the instructions to do this, that or the other thing while squeezing his buttocks and tilting his pelvis. In post op back rehab, the obvious link between pelvis tilting and copulative motion enthuse the patient beyond description. Almost immediately the patient is doing his pelvic tilts in some absurdly extreme fashion, thinking that in so doing he is actually arousing the therapist. She in turn simply touches his shoulder “to help him balance” and tries to manage not breaking up in laughter at the old fool’s ridiculous gyrations.

          If one is observant, as is Muldoon from his years of being a trial lawyer and watching throughout a courtroom for the chemistry of every word and happening during a trial, he also watches through these many mirrors for all the “action” in the rehab arena. These women do not wear flour sacks. The “scrubs” like uniforms they wear are so configured as to display their lavish and erotic anatomies for the delectation of the men, and maybe in some instances for each other. The constant focus of a physical therapist in “scrubs” is a magnificent and erotically stimulating posterior. Watching any one of them cross the room to fetch this or that piece of equipment is like watching two cats fighting in a gunny sack. And if you are there on Friday, they are dressed underneath these “scrubs” for their Friday night entertainment. As they are treating other patients, I can see them in the mirror. Something tells me they know I am watching and that they are deliberately doing things to drive me out of my mind. One particularly lovely young woman, tall and everything else a man might wish, often will do some ballet move that I am certain she knows makes every man in the room practically drop to his knees in a state of erotic collapse. One Friday she showed up wearing a thong beneath her “scrubs” and I would gladly have died that moment for the pure erotic voyage that transpired in my mind’s eye when she picked up something from a low bench.

          As things progress, very small amounts of weight are added to legs and arms to provide progressive resistance. To keep the patient’s attitude properly manipulated, the therapist switches to telling him how strong he is getting and how much better he looks now that he is “weight training”. Telling a man in any normal situation that lifting something the equivalent of a bottle of scotch represents weight training would never be credible. Telling him that while the imbecile is standing in front of a mirror with a young woman beside him brings instant belief and pride.

          There is a rehab technique in which the therapist slowly counts repetitions into the old fool’s ear and occasionally says something like “hold it there for five seconds”. In his mind he imagines they are copulating and she is counting her increments to climax, not even realizing in her erotic burgeonings that she is counting numbers, and that “hold it there for five seconds” is the announcement of her orgasm. She knows this, and since she does this with every patient, the likelihood of her ever becoming aroused with him is about the same as that of a prostitute with some street John. The reason this is so easy to use as a therapeutic technique is that the therapist probably has the cooperation of his wife faking orgasms at home that he never realizes are only devices to get him off sooner. This may not specifically apply to Muldoon, of course, as he is certain that no orgasm is ever faked at his house and he isn’t married. There is a universally held belief among men that only married women fake orgasms.

          Another gambit in this make the old fart think he is doing well campaign is for the therapist to pretend she is dealing with difficult problems in some mundane context or other and ask him questions about how to solve them. This is called “make him think he is brilliant”, and he immediately becomes the man of her hour in his own mind, further cementing their bond and adding another dimension to his delusions about her. By the third week of therapy he is her slave forever or until his insurance runs out, whichever comes first. The delusion becomes so intense that, when he gets home and his significant other asks him how his therapy went today, he instinctively tries to sort out what happened there to avoid saying anything that might reveal to her that he is there “cheating” on her. “Oh, it was rather difficult today. Louise is working me like a rented mule”.

          By the end of the course of rehab therapy there is a very significant matter of disengagement. The old fool will feel dumped as though he is no longer in “a relationship”. It is so extreme that they come back “just to say hello” from time to time, like some old boy friend who can’t let it go and move on. When he shows up for “hello” it is customary for the personnel to comment positively about how well he “seems to be” doing, a deliberate putting off technique. Most of the time this works after a visit or two, as on these visits his therapist/lover is engaged with some other old fool and he is forced to accept that she has moved on as he must force himself to do. If he is lucky he will be injured or otherwise fucked up again in the near future and can return to renew the relationship and fantasies. They never do catch on, despite the obvious repetitious therapeutic techniques, that this is not really a renewal of some wildly erotic intense personal relationship.

          Men are engineered to be the victims of anything to which a woman might wish them to be exposed. Men are essentially so stupid as to believe that they have power and are/should be in charge. While a man can and often will blow someone’s head off, and can play football in the NFL, when it comes to the real levers of control and authority, men are nothing compared to women. The most famous father of psychiatry was stupid enough to posit that women were jealous of men and showed what he called “penis envy”. Penis envy is about the dumbest thing anyone has ever said about the relationship between men and women. As the naked little girl said to the naked little boy who asked her “I bet you wish you had one of these”, “My mommy told me that if I have one of these, I can have all of those I might ever want.” Is it any wonder that women find men so terribly easy to fool? When you have them by the genitalia, their hearts and minds will follow.