By Aviva Lori
Translated from the Hebrew edition of Ha’aretz – 2006
The atmosphere was magical. Marilyn Monroe was fascinating: “I wanna be loved by you,” she sang, and people took off their shoes, stepped onto the mattresses one after the other and were soon swaying with the music. One song followed another, bossa nova and jazz, and the dancers were told to move to the rhythm, back and forth, to move their hands and feet and relax their muscles. “Do stupid things,” said the emcee, “go wild.”
If not for the mattresses, you might have thought this was a course in ballroom dancing. But when the dancers left the floor for a moment to wipe away perspiration or drink some water, a metamorphosis took place: They became disabled. Their legs barely moved, their facial expressions froze, their hands – mainly their hands – trembled uncontrollably.
There is nothing like the workshop for Parkinson’s patients at Alex Kerten’s studio in Kibbutz Glil Yam to reveal one of the undeciphered secrets of Parkinson’s disease.The existence of chaos and discipline existing side by side… Muscular chaos on the one hand, and an ability to control the body on the other. Chaos and discipline that exist side by side, or in opposition, in one body, in an inexplicable physical combination. When the patients move onto the padded dance floor, the trembling stops, as with a magic wand. When they leave it, the magic disappears.
Thirty years ago, Kerten, 63, a master of martial arts and former musician, began to study the connection between breathing, heartbeat and movement, and developed a therapeutic method called Gyro–Kinetics. Over the years he has used the method mainly on people suffering from Parkinson’s, a disease that is incurable, but “manageable.” Between 60 and 80 Parkinson’s patients, aged 57 to 68, the vast majority of them men, come to him weekly in groups for dancing and martial arts classes, and report on? a physical and emotional renewal that they don’t achieve by any other means.
What is a man, whose expertise is music and martial arts, doing treating Parkinson’s patients?
“The medical establishment is naturally suspicious,” says Prof. Ruth Djaldetti, a senior physician in the department of neurology at the Beilinson campus of the Rabin Medical Center in Petah Tikva, and director of the clinic for Parkinson’s and movement disabilities. “These things always cost a lot of money and there’s a fear that charlatans will [charge for] something unnecessary. But if it’s not too expensive and it helps, I recommend it. I’m always in favor of physical activity of all kinds. Some of it also makes the patients feel good, releases endorphins. There are already new research studies that have examined the subject specifically and it turns out that among those who are active, there is motor improvement. Personally I’m very much in favor of Gyro–Kinetics. In the hospital I see patients who are helped a great deal by it.”
One of the participants in Kerten’s workshop is the director of a department at Hadassah University Medical Center in Jerusalem and is himself a Parkinson’s patient. He identified himself only partially. “There is a lot of conservatism among doctors and quite a bit of arrogance,” he says. “Today there is a dominant sect in medicine that favors anything that has been scientifically proven – all the rest is inconsequential. But what Alex is doing with dance has already appeared in the international literature and in other treatment centers in Germany and especially in the United States. The top Parkinson’s specialists in Israel recommend it highly. They are aware of the fact that what creates dopamine in the most natural way is walking an hour a day or what Alex is doing.”
One of the scientific studies on the subject was carried out four years ago by Kerten himself and Dr. Marietta Anca, director of the clinic for movement disabilities at the Wolfson Medical Center in Holon. “It was a pilot that we did with 16 patients, at different stages of the disease, over three months,” says Dr. Anca. “We examined every patient before and after Gyro–Kinetics therapy twice a week for an hour and a half. We wanted to see the immediate and cumulative effect, and which parameters improved. It turned out that the therapy is very effective immediately. Parkinson’s patients function on medications every few hours, the way a car operates on fuel. When the effect of the medicine ends, you have to take a pill. In the work we did there were instances when people didn’t have to take a pill after the therapy.”
How can that be explained scientifically?
“There are studies on the fact that peripheral activation of the limbs causes a positive stimulus to the brain that arouses the cells in that region, and they in turn send pulses back to the limbs. That is how they explain the effectiveness of physiotherapy in paralysis. The same thing happens in Parkinson’s. That’s why people who engage in activity need less medicine. What is unique about Alex is that his method is very complex and broadly activates all the parts of the body. Long, wide, round and short movements lead to various levels of muscle contraction. If you add the music to that, the process becomes very complex, activates two stimuli simultaneously, each of which is effective in itself. It combines musical activity and movement at the same time, and it helps Parkinson’s patients to reorganize their walking strategies.”
And over the long term?
“There is definitely a positive cumulative effect. Alex has a patient who for seven years has refused to take medicine, and every day she does the exercises and has managed to this day to avoid medical treatment.”
So why does part of the medical establishment reject his methods?
“Doctors are a very conservative group. Especially doctors from the previous generation, who were unwilling to accept innovative methods of therapy. I found out about it from patients who came to me and told me, and when I saw that they had improved I went to Alex to see what it was. Afterward I looked at the literature and found explanations for all these things. We doctors are always looking for scientific proof, and after more than 20 years I can tell you, with great regret, that all the medical statistics are a bunch of nonsense. When I studied medicine, one of the professors told us: ‘There are no diseases, there are only patients.’ Statistics are good the moment you have to introduce medicines into the health basket and the market, and not when you’re treating human beings.”
Instead of grating cheese
According to the statistics, between one and two percent of the population will contract Parkinson’s after the age of 50 – in other words, they will suffer from a serious chronic shortage of dopamine in the brain. Most of them will be men; for every two men with Parkinson’s there is one woman. No one knows exactly what causes the disease and it is impossible to predict who will contract it. The average age of diagnosis is 58, although there are patients aged 30 to 40 who hide their disease as long as they can. They keep their trembling hands in their pockets and try to avoid the harsh social image of the disease that results from its overt motor symptoms: tremors, stiffness and a slow gait. It is generally assumed that the incubation period is about five years, during which there is no early sign heralding its approach.
“In genetic studies, they have found that it is more common among Ashkenazim [Jews of Eastern European origin],” says Daniel Neuman, chair of the Israel Parkinson Association, which has about 1,100 members (out of 20,000–30,000 patients in Israel). “One of the signs of approaching Parkinson’s is damage to the sense of smell, which takes place long before the outbreak of the disease,” he says.
The medicines existing on the market neutralize the symptoms, calming the tremors, but do not solve the problem. After several years the body may become accustomed to the medication and react in an unpredictable manner. Parkinson’s patients call it the on/off situation: There are hours when they feel balanced, but at other times movements become uncontrolled.
“One of the problems of Parkinson’s patients is that they shut themselves up at home,” says Neuman. “The shortage of dopamine in the brain causes depression and arouses a fear of public exposure, accompanied by a fear of bumping into people and falling. You don’t die from the disease, you die from a fall. The previous chairman of the association, for example, got out of the car, fell and died a few months later from the blow to his head. Moreover, as the disease progresses, they begin to speak slowly and quietly, and then they can’t be heard.Most of them give up and stop going out.”
Here Kerten enters the picture with his Gyro–Kinetics technique, developed on the basis of his knowledge of martial arts and the intense concentration and physical control they demand. Kerten tried to teach Parkinson’s patients these abilities. While they are dancing in his workshops, the patients learn to translate the external beat into an inner voice that gives them orders to lift their hands and feet in coordination, a voice that ostensibly bypasses the cells that have deteriorated.
“When you place a metronome in the pocket of a Parkinson’s patient, it helps him walk,” says Neuman, a retired computer engineer. “Alex plays music with different beats, and that does a similar job.” Prof. Djaldetti says that the rhythmic activity stimulates mechanisms in the brain that manage to bypass the cells that have atrophied. “It links up to routes that for healthy people are natural and automatic. For Parkinson’s patients the physical activity activates them indirectly.”
Robert Rubin, a 57–year–old attorney from San Francisco, married with three daughters, was diagnosed with Parkinson’s five years ago. He began taking medication and hoped that would be the end of it, “but I quickly understood I was deceiving myself,” he says in a telephone conversation, “that I was not initiating anything but was dependent only on drugs. I have always been very active and athletic and very competitive, I have a high level of self discipline, I’m used to fighting and winning tough cases, and here I was suddenly totally passive. I did acupuncture, massage, but nothing really helped. Then I met Alex.”
Three years ago, Rubin visited Israel and a chance meeting brought him to Kerten’s studio and to dance therapy. After that he visited Kerten twice more, each time for an intensive week of therapy. He says that he has tremors in his hands and problems of balance, and that Kerten’s therapy helps him mainly psychologically. “He said I have to play the role of a healthy person as much as possible. He imitated my movements and I understood that my face was expressionless. Now I have a large mirror in the office and I make faces in front of it. I try to find ways of conveying to my brain what my brain does not do by itself. Until then, when I walked my legs became entangled and my hands hung frozen on both sides of my body.
“Anyone who doesn’t have Parkinson’s doesn’t think about the steps he takes in the street or about how his hands are raised during walking. Now, thanks to Alex, when I walk I think all the time about how to place my feet on the ground and how to raise my hands in coordination. If I don’t think, I step on myself. It’s a Zen technique, to be here and now. To live the moment. I walk to the office less, but I still work as usual and appear in court. I’m open to the disease in a personal way, less in a professional way; I don’t want people to think that my abilities have been affected.”
How does it affect your family life?
“When we eat pasta, the girls ask me to grate the cheese for them. And when there are earthquakes sometimes my youngest daughter asks me to stop moving the table.”
One, one hundred, one thousand
Kerten’s parents met in Israel, in the Haganah (the pre–State paramilitary force). His mother, Bella, immigrated from Poland, and his father, Egon Kerten, a well–known musicologist, immigrated to Israel from Prague in 1940 on the deck of the illegal immigrant ship Patria, and was miraculously saved from drowning. (The ship was accidentally blown up by the Haganah and 267 passengers drowned.) He has taught generations of musicians in Israel, was among the founders of the Israel Radio orchestra, established the Israel Chamber Ensemble with Gary Bertini and afterward was invited by the Turkish government to turn Radio Istanbul into Radio Europe. Alex, who was born in Tel Aviv, was six years old at the time; the family went to Turkey for a year and stayed for eight.
In Istanbul Kerten studied at a British school. In addition to English, Turkish and French he studied two other things in Turkey: boxing and music – music with his father and boxing in the street. “The school made me very tough,” he says. “It was an international school with the children of diplomats, but they called me ‘dirty Jew, cowardly Jew.’ There were a few other Israelis there, and we all got organized and I started my boxing club. There wasn’t a day when I didn’t get into a fight.”
When they returned to Israel his father went back to Israel Radio. Kerten studied for a year in a school in Tel Aviv – and says he achieved his reputation thanks to his boxing ability – and then switched to the British school in Jaffa, where instead of boxing he was able to develop his music. He was a guitarist and eventually participated in plays, various performances, and in the Zadikov Choir, a very successful choir for adults and children whose members were Bulgarian Jews from Jaffa. When his father retired from the Israel Radio orchestra, Alex replaced him. He began his military service in the Combat EngineersCorps and ended up in the Israel Defense Forces orchestra. In the reserves, almost until the age of 50, he was in charge of the reserve ensemble of the orchestra and had the privilege of accompanying the Hagashash Hahiver entertainment troupe, singer Chava Alberstein and Harry Belafonte.
After his discharge he turned to his second love, martial arts. “Apparently I had a subconscious spirit of adventure, after the Holocaust, in order to prove that I was a strong Israeli, not afraid of death.” He traveled all over the Far East – Japan, Hong Kong, Thailand – and sustained many tough blows and injuries. “It suited me. I believe in the brain, but at the time I was not yet aware that the dominant element in martial arts is that with it you can control your body, as well as pain and fear. In Japan I had a friend, Doron Navon, who is still there, and I trained there with the greatest masters. On the way, I was very seriously injured in Thailand; I was hit in the knee while practicing Tahi box.”
He underwent two operations at Sheba Medical Center in Tel Hashomer, and the prognosis was that he would not be able to return to athletic activity. “My leg was totally straight, and I couldn’t bend it.” But he refused to accept the decision and examined other possibilities. “I decided that I would rehabilitate myself,” he recalls. “I climbed mountains, went skiing, but nothing happened. I was told that there was perhaps one person who could save my leg, a man named Gad Skornik, the Israeli judo champion. I went to him. He grabbed my leg and said, ‘You know that I’ve always loved you with all my heart,’ pulled at me with all his strength and broke my knee. I fainted, but then it healed and the cartilage was built up. I joined Gadi, began to train and we worked together for 20 years. I became one of his leading teachers; it was my religion. We developed kempo jitsu, which is now the IDF method. We trained the members of the department and the Shin Bet security services.”
Over time, he stopped playing instruments, but did not abandon music. “When I worked in martial arts I always worked with music. At some stage I began to research the influence of jazz rhythm on the heartbeat and pulse, and at the same time I treated people with movement disabilities. Almost everyone who works in the martial arts treats people. I treated problems of concentration, breathing and posture, and at a certain point people with Parkinson’s began to come. One, two, 10, 100, 1,000. It happened on its own and I discovered that I had a very broad knowledge of the disease. Like an artist who knows how to paint things that he feels, or a pianist who feels the music, in the same way I feel the person just by looking at him. I know how to diagnose his breathing rate. At first I had a lot of question for doctors and physiotherapists, who were not so understanding.”
Those who spoke in Kerten’s favor were the patients themselves.Hanna Cohen Aharonov, 69, from Jerusalem, contracted Parkinson’s when she was 57. Since then she has been taking medications, engages in various kinds of physical activity – walking, swimming, Feldenkrais exercises – and now Gyro–Kinetics as well. “My son is involved in music,” she says. “He heard about Alex through a friend and tried to convince me to go there. I told him that I do so many things, but he urged me to go just for the diagnosis. I went and I was impressed. It really spoke to me both psychologically and physically.”
She feels the effect in simple everyday activities. “At first I couldn’t get up from the chair quickly, when there was a phone call for example, and Alex taught me how to do it. I don’t want to take so many pills because they have side effects, so at night I don’t take medicine and it would take me 15 minutes to get out of bed. Alex taught me how to get out of bed. These are little things, but they make life easier. Since then I’ve been attending a group in Yad Sarah in Jerusalem taught by a student of his. It’s amazing sometimes that I can’t walk, it’s hard for me to move, yet when I hear music I can dance to the rhythm.”
Healthy with Parkinson’s
Kerten speaks through his belly. He has a round one, somewhat bigger than usual in teachers of movement and physical activity, but he caresses it with great affection and explains its existence – aside from his love for croissants – as ideological. “All our philosophy is constructed around the round belly, as the center of intelligence and information. In the East they say: ‘You’re very intelligent, you have a round belly.'”
If the connection between the belly and the brain is responsible for physical and emotional balance in general, this is even more true in Parkinson’s, when the body loses its synchronization.
“When there is no connection between the heartbeat and the brain waves, breathing and pulse, the entire body loses its synchronization. I know how to get them synchronized, to a situation where the breathing, the brain waves, the pulse and the movement begin to come together,” says Kerten.
He works slowly. Before he brings patients into the dance group, he prepares them for several months with passive methods, massage and touch on the treatment table. “I teach them how to breathe. To stop thinking. Not to hear and not to see, but to listen to the music. We practice rhythm. Afterward, I teach them how to conduct an orchestra. To use facial expressions. And only then do they join the group. At first they improvise with their feet and hands and finally with their entire body, and suddenly the difficult things become easy. It’s easy for them to walk. If they can walk to the theater without falling along the way, or sit in a cafe and talk to other people, that’s already a tremendous success.”
What’s the key word or phrase?
“‘I can do it.‘ To live the present and not worry about the future. You learn to take responsibility for your body, because the disease is not that of your wife or your children. You are responsible for it and for your life. It’s like religion: There are no miracles; there’s hard work. You have to work out at least twice a day, morning and evening. There are people who believe in drugs, who say ‘It’s convenient for me not to do anything.’ I don’t suit them. I suit those who believe that you don’t have to be a professional Parkinson’s sufferer, but rather a healthy person with Parkinson’s.”
A British couple, Estelle and Laurie Philips, she a psychologist and he a psychotherapist, live in southwest England. The two heard about Kerten from Robert Rubin and came to Israel two months ago for 10 days of dance therapy. Estelle has been suffering from Parkinson’s for six years. “It was a complicated process,” says Laurie in a phone conversation, “because her movements were restricted and she had a problem with balance. In a sense, the therapy was perfect for us because we danced a lot before she fell ill.”
What did you find in Kerten that you hadn’t been familiar with previously?
“It’s entirely different from what we experienced in the past, and we’ve been through a lot over the years. I searched the entire Internet, I looked everywhere, and nothing has been as effective as this. I can say that he has a much better understanding of Parkinson’s than anyone else. Most research is about chemical treatments and much less about what he does. It’s not only effective for my wife but for our relationship as well, because since she fell ill I have become her caregiver, which I had never been before, and now I can separate myself from her and live my life. And she has received more self confidence and become less dependent on me. Even her desire to leave the house and do things has improved. It’s true that you have to work out every day, and that’s what she does. Now we’re trying to organize a group of Parkinson’s patients that will bring Alex here.”
Four men in spotless judo outfits were rolling on the mattress to the strains of jazz music. Kerten sat in his deejay’s cubicle giving instructions. They looked skilled – yellow and red belts – touched each other with the corners of their uniforms, put down their feet, pulled each other’s hands from above and tried to get an ippon.
“I must say something to people from the medical world who have no awareness,” said Dr. A. of Tel Aviv, a 64–year–old psychiatrist, at the end of the session. “I didn’t get a recommendation from the neurologist who treats me to come here. But I’m a doctor, I understand psychophysiology and I know how the physiological systems in the body are constructed. We work here on coordination and that is definitely anti–Parkinson’s. I don’t know if I’ve undergone a change for the better, but there’s no change for the worse, and that’s quite an achievement.”