Mechanism of Action
![](https://substackcdn.com/image/fetch/w_1456,c_limit,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F3ca91c88-82a9-4eb7-b79f-0b21f0c81368_1024x683.jpeg)
In an essay in the Oxford Handbook of Jewishness and Dance, Hadar Ahuvia situates her deconstructionist performances of the invented and stolen tradition of Israeli dance in the Hebrew word davka, itself a term rooted in Zionist attempts to duet the Israeli national project with Jewish identity. She quotes sociologist Oz Almog: “the davka spirit is one of defiance, disobedience, standing one’s ground, doing things out of spite and stubbornness.”
She says, “For the Zionist movement, like other European nationalist movements, the body was an essential site of national rehabilitation and renewal….The new Jewish body was modern, secular, and connected to native soil….The new Jewish dance was tough, upright, exuberant, energetic, buoyant, and grounded in the land of Israel.” In the performance Joy Vey, which seeks to “choreograph diasporic identity beyond Zionism”, she repeats the steps five times under different choreographic instructions. “Through my voice I reshape my internal landscape, and the shape of my body….Using the repetitive structure of the dance, I hope to bring the audience along through a psychological physical excavation.”
An Israeli dancer for much of my childhood, I found videos of her pre-pandemic performances online in early illness, when I could only exercise lying down — small unweighted, resistance-free movements meant to keep blood flowing and prevent further mobility loss —without testing my nervous system’s orthostatic dysfunction, could only listen to music in incomprehensible languages or without words at all. I had defiance yes, and spite, but I literally could not stand my ground.
Long COVID research demonstrates dysfunction in nearly every mechanism that enables the body to move and recover, from damage to the cerebellum which fine-tunes the frontal lobe’s direction, reduced extraction of oxygen into tissue, increased lactic acid and lowered anaerobic threshold, tissue infiltration of amyloid deposits in skeletal muscles, and circulating inflammatory markers in the days after. And yet, many studies and clinical guidelines insist that we are simply “exercise adverse” or have developed “lower effort preference”, that we are overestimating the risks and underestimating the benefit of movement and in doing so trick our body into failure.
The large “RECOVER” clinical trials have proposed only two interventions for what the designers consider the combined problem of exercise intolerance and fatigue — “structured pacing” and “cardiopulmonary rehab” — suggesting a poor understanding of both symptom and treatment. Patients predominantly use pacing to manage, not treat, symptoms, not as a standalone intervention; any rehab program that does not reflect this will have a high failure rate. And there is no way to meaningfully isolate “exhaustion or low energy” from the other wings of the study in either the patient population or a single patient body. A body experiencing autonomic dysfunction or immune dysregulation or the neuroinflammation of cognitive impairments will struggle to sleep well, or move comfortably.
Much of Long COVID rehab design presumes that through physical exertion we can reshape our internal landscape, that the body simply needs practice and a reminder that it is safe to move in order to realign every malfunctioning mechanism towards effective action. This is not unrelated to the logic of nation building that seeks to reshape the body politic, the idea the exercise is inherently good and good for you. Yet, I don’t know a single Long COVID patient who has successfully completed any of the multitude of online and in-person programs. Many have dropped out, due to symptom flares and worsening baseline, or seen minimal improvements.
At my worst, I could not even follow my rehab team’s instructions to dance to a single song every morning to prompt blood flow to the brain, could not sit on a recumbent bicycle to begin the CHOP protocol without fainting, could not bathe if I worked up a sweat. Our bodies cannot be rehabilitated through exercise alone without addressing underlying disease pathology, no matter how titrated and slow and personalized the program is, no matter how meticulously and ritualistically we follow the repetitive instructions. And yet, not moving is also damaging for us. Left untreated, managed only by patients’ reducing their time upright, the autonomic nervous system dysfunction that flattened me can degrade further.
When I was trying to understand why some podcasts were easier on my damaged brain than others, I interviewed Lex Rofeberg, Producer and Co-Host of the podcast Judaism Unbound. He said that repetition and retelling are built into their programming, which echos the Jewish calendar . “I repeat core phrases that I’m trying to have stick, because I’m aware that without repetition nothing happens….We have core principles, core ideas that come up in every unit, and it’s almost mantra-ish,” he says. “In many ways, that’s all Judaism is: repetition. The cycle of the Jewish year, the Torah cycle, you are meant to do it over and over again. We talk about one word or phrase or verse in a Torah portion and that only makes sense if you’re planning to return to that parshah next year. Over the course of your whole life, you build a relationship to the whole story.”
In the worst of severe illness, when my brain looped helplessly, unable to complete a coherent sentence, one of my rehab techniques was to try and recall what I’d eaten for breakfast, what colour underwear I was wearing, to practice reciting short strings of numbers or recalling a grocery list. I could not read, but I took up both listening to and reciting prayer, in what I imagine is similar to the reasons most religions have a structured daily cadence: a way to mark time ritualistically, to repeat something familiar and comforting, and shelter under external protection.
I wanted to fold myself up into a paper envelope and hand myself over to the experts to be interpreted, but there was, is, so little treatment and oversight available. In prayer, I could sit outside of myself, feet dangling off the diving board, observing the pool-on-fire that was my brain. I am not saying that God performs miracles, but that it has taken a kind of devotion and discipline to regain some function and not deteriorate further, a belief in the inconceivably complex. I had to shift perspective to the deus ex machina above the stage that was my body, treat myself like an experiment, changing variables and research design, offer myself a level of attention and curiosity unavailable outside of medical dramas.
In lieu of sufficient, personalized medical care, a friend and I have been running an informal two-person science chavruta, the traditional Talmudic study format, analyzing and discussing a shared text. The term comes from the Hebrew b'chavrusa, meaning “in partnership”. We pool knowledge, trade scientific papers, unpack pharmacology, and return again and again to the basic biology and exercise science neither of us studied in school, that our doctors and the media so often gloss over in favour of simplistic explanations, work backwards through trial data to understand the pharmacological impact on patients much less complex than we are.
Dancing is still a ways off, but I have slowly, rigorously, figured out what mechanisms of action were failing to work in a light jog or a powerlifting squat and how to treat them, regained the ability to move with a little more ease. It was never a matter of safety or trust in my capacity, or of preference, of mind over mechanics, but one of science, research, and prayer, binding the undone body together.
The Impairing Curse is a long-form, serialized experiment in personal essay, science journalism, policy analysis, and poetry. To start at the beginning and read it in order, go to the first essay or read about fainting, the aesthetics and labour of illness, or the role of patient-research. To support this project, share it online or subscribe.