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Linus Geisler: Doctor and patient - a partnership through dialogue   © Pharma Verlag Frankfurt
Body language - an excursion
Eyes and eye contact
The body does not lie.
J. Fast
Body language - an excursion
Body language forms a major part of non-verbal communication. Watzlawick's observation that "people can't not communicate" also applies to body language. J. Fast talks about the obligation of communication presented by body language: "A person can refrain from talking, but he cannot prevent his body from communication by body language. He has to say something with his body, whether or not it is true - but it is impossible for him to say nothing." For example analysis of video recordings has shown that practically everybody speaks with their hands and almost nobody is able to desist from moving their hands or fingers longer than 15 seconds while speaking (S. Molcho). If body language is consciously suppressed, in order to prevent communication with the body, the behaviour appears unnatural or forced. A typical example is the mimic rigidity and unnatural posturing of the mannequin in Haute Couture as she attempts not to transmit any emotional signal. Another example is the accentuated static technique of role-playing as exemplified by Sean Connery and others in the James Bond films (J. Fast).

In the same way that there is a drive to articulate with the body movements, it is not possible to avoid noticing body signals. Some people are able to interpret body signals intuitively and correctly. For many however body language is a foreign language the basic principles of which have to be learnt in order to recognize non-verbal messages. It must be pointed out here that there is a basic danger in the interpretation of body language. Birdwhistell, who did most of the basic work in kinesics, urgently warns that: "There is no position or movement of the body that has any unique significance." He points out that the interpretation of the kinesic can only be correct when it is consistent with the total behaviour pattern of a person. Birdwhistell: "We will never know the full significance of what a person says from the spoken word alone. But we will also never know the full meaning of an expression of body language. If we only take notice of the words in a conversation it is probable that we will get as incorrect an impression, as we would if we were to only take notice of body language."

Although body language is at the basis of all languages, it was not investigated until relatively recently, and then in America. Kinesics as part of the psychology of expression is still controversial because it is not completely accessible to scientific scrutiny. It was developed by the philosopher and psychologist Philipp Lersch (1893-1969). The term expression is a general term which includes body language, emotional expression and vocal expression. Vocal expression is made up by an inseparable intertwining of verbal and non-verbal communication: voice and speech together form a "tandem" (Ploog).

Verbal information can be clearly underlined and magnified by body language. Gesticulation can "colour" the meaning of what is said, exerting a particular weight. However body language can also reduce the power of the words and diminish their significance. Finally body language can be used to express something that cannot be expressed in words, either because the speaker has not got the necessary vocabulary, or because the information is itself very difficult to put into words. This applies to the attempt to make descriptions of physical suffering clear. A typical example if that of the so-called Levine sign. Here the patient with angina pectoris "describes" the pressurizing nature of the ischaemic pain whilst laying the tightly clenched fist at the lower end of the sternum. Using the index finger for the description of cardiac discomfort is however typical for functional cardiac disturbances, which are usually localized as pricking or the shape of a point on the left side of the chest.

Ethical differences should be taken into account when interpreting body language. Major misunderstandings can arise if they are not. For example Russian soldiers invading Bulgaria were very surprised to find that the Bulgarians reacted to every order that they gave by shaking their heads. It was only later that they learnt Bulgarians mean "yes" when they shake the head.

The following interpretation of body language is based mainly on the work of J. Fast and S. Molcho.
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Eyes and eye contact
The eyes are the most important of all of the parts of the body involved in transmitting information. They can convey the most subtle nuances. Acceptance of another person always takes place with eye contact. The "empty regard" makes the other anonymous or reduces the other to a "non-person". Usually eye contact takes place at the start of every discussion, and depending upon what is said and on the setting, is followed by further short eye contacts. There is a further "ritual glance" at the end of a sentence. This eye contact lasts between 2 and 4 seconds in the Western world in cases where the people do not know each other. Depending on the situation, this can be much longer or much shorter if the two trust each other. Not using eye-contact may be pathological, as the genetically-determined ritual glance which acknowledges the other as a person is no longer available (a typical example is the husband who answers the wife while he is reading the paper, but does not raise his eyes).

In Mediterranean and Arab countries eye contact lasts much longer, but is very brief in Asians, whereas Africans do not look at the person who is speaking at all, or only make eye contact at the very end of the discussion. The length and intensity of regard can imply that there is a territorial battle occurring; he who drops his gaze first has lost. Observation can markedly influence the course of the conversation, and also markedly disturb it. Strong fixation, which has the objective of forcing the other to concentrate on what is said, usually has the opposite effect, as the other cannot listen any more. It is especially important that the discussion partner in a heated discussion is given the opportunity to avert his gaze. On the other hand, if there is too long a time between eye contacts, this too can endanger a conversation. The information transfer will then be weighted more to one side, as the person receiving it has already "retreated". This particularly applies to conversations which are unpleasant or distressing for one partner; as he can not run away with his legs, he takes the next option which is to at least do this with his eyes.
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Pressing the lips together implies disagreement and signals that the person does not wish to speak. Lowering the corner of the mouth should express disparagement or ignorance.
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The hands are second only to the eyes in importance as an instrument of body language. The close relationship between brain and hand ("thought and deed") plays a major role. It is known that the thumb and forefinger alone take up ten times as much cerebral cortex as one foot. Particular significance has been attributed to each individual finger.

The thumb is regarded as the dominant finger, and is also the strongest as regards motor function. Caesar used the outstretched thumb to seal the fate of gladiators, either to live or die. "Thumbs up" means "Okay, you can fly" in aeronautics. If the thumb is protected and hidden by other fingers, this can be an expression of anxiety and a desire to hide.

The index finger is the most sensitive. S. Molcho refers to it as the "most knowledgeable" of all. The index finger teaches, but, when pointing, threatens. Those who use the outstretched index finger sometimes create unpleasant feelings in those they are talking to. People who have been brought up differently use substitutes such as ball-point pens, pipes or glasses held between thumb and index finger to make their point.

The middle finger is regarded as the finger for "self-actualization", while the ring-finger is that of feeling. It is not able to move easily without the middle finger, and has a passive role. The little finger is occasionally regarded as the "society" finger, and extending it was previously a sign of eliteness.

The way the hand is held expresses significance. When the hand is open, the palm is offered, and this is twice as sensitive as the back of the hand. Whoever offers the open, sensitive face of the hand, is offering trust, is conciliatory and charitable. The gesture of freely giving and taking is symbolized by the open hand (iconography of religious painting, the blessing, intercession and offering). The open hand signals that the other is respected, and is, at the same time, an offer of a symmetrical, mutual relationship. The opposite occurs with the gesture of the covered palm, when the sensitive palm is underneath and the back of the hand is turned upwards. The person hides his sensitive side from the world around him. People who continually direct the back of the hand to their conversation partner, protect themselves either because they are uncertain or because they would like to hide something; they are very often difficult business partners.

Tendencies to conceal can be signaled by hands which are held on the table, the arms of the chair, the thighs or under the table. Discussion which are run with the use of the outstretched finger usually take place from a dominant position. A fist indicates aggression or a readiness to fight, although this often is in contrast to the comprehensive and apparently receptive words being uttered. Somebody who pushes open hands away from himself, indicates that he wants to be rid of something. S. Molcho refers to a historical example of this. During the Vietnam war, President Nixon held a television interview, in which he attempted to calm the young protesters with major promises. Whilst he was saying "I promise you, you will get everything you want!" he visibly pushed his hands forwards.

The left hand is mostly referred to as that of feeling and the right hand as that of action. Movement of both hands accentuate the significance of open or closed hands. If for example the arm is supported at the elbow, and the fist laid in the other hand, this symbolizes the construction of an internal protective wall. Pressing the palms together and interlocking the fingers to form a palisade signifies defensiveness. Holding the hands together in the shape of a pyramid can signify weighing of mutual interests and readiness to agree. Rubbing the hands can have various meanings such as coming to the point, satisfaction, or gloating over the misfortune of another. Folding the hands together with raised thumbs is a symbol of dominance.

Finally touching the body with the hands can also express a meaning; the hand that flies to the mouth probably blocks a hasty statement. The hand that rubs the nape of the neck can be an expression of an unpleasant situation. Pulling the tip of the nose can accompany painful or incorrect statements. If the head is supported by thumb and index finger at the root of the nose, tiredness or exhaustion can be signaled. It may be that an attempt to continue concentrating is signaled if the ear lobe is taken between the thumb and index finger.

Body positioning, sitting and leg movements have been discussed in the chapter on the correct seating position link.

Even though interpretation of body language is illuminating, it must be reemphasized that body language may have more than one meaning and a passably reliable interpretation can only be made in the context of other non-verbal expressions, and what is said. The likelihood of significance is increased if two body language statements are judged to be confirmatory. It is therefore important to remember that: "Nonverbal statements have to be checked verbally" (R.H. Ruhleder). 

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Linus Geisler: Doctor and patient - a partnership through dialogue
© Pharma Verlag Frankfurt/Germany, 1991
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