Until I encountered Jacob Lieberman I thought there was only one area of my body to which I was uneasy about allowing strangers access. In fact there are two.
Lieberman is a registered osteopath and psychotherapist with an interest in psychosomatic disorders. What makes him unusual is that he has made the manipulation of the larynx his field of study. In the world of acting and singing he is well known as a man with a very particular skill, treating a part of the throat which few hands, if any, ever touch.
Lieberman became fascinated by osteopathy while working as a management executive in his home country of Israel. Having developed a serious neck problem when painting his house, he was "clicked" back into place by a chiropractor.
"That click changed my life, literally and metaphorically," he says. "I threw up everything, my job, my home, my car, and came to Britain to study osteopathy." But the limitations of dealing purely with the physical body without reference to the psychosomatic aspects of the complaint soon became clear, and he enrolled on a course of psychotherapy at the Tavistock clinic in London.
Most people arriving for a meeting with Lieberman are taken aback, as I was, by the fact that much of his initial consultation consists of inquiry into the person's lifestyle and history. It is more akin to a psychotherapy session than a manipulation; throughout his questioning his manner is considered, his tone studious, almost academic. "The larynx is inextricably linked to the psychological state of the person," he says. "We all use phrases such as 'a stiff upper lip' or 'a lump in the throat' to describe physical manifestations of emotional states - thus, by dealing merely with the symptoms of voice loss without investigating its emotional cause is less likely to prove beneficial in the long run."
In fact, Lieberman will not even attempt physical manipulation unless he has gained an understanding of the person's emotional state beforehand. "Often the vocal folds themselves may give no physical indication of strain or overuse. Only by working with the body, but also studying the mind, is it possible to unlock the fundamental underlying problem."
Lieberman admits that this is an area where there has been little or no application of physical therapy before. The larynx is a largely ignored, almost forgotten part of the body. It is a complex mechanism made of collections of cartilage (muscles, ligaments and joints) suspended in the throat; in young people it is springy and flexible, with age the texture becomes harder and more unyielding. In all cases it is a delicate area to manipulate.
"Its original function was as a shield to provide protection for the airways," he explains. "Virtually any animal of prey which attacks another will go for the throat." He points out that the use of vocal folds for highly organised speech came at a much later stage of evolution.
The moment Lieberman first places his hands on the voice box is a curious sensation and he is careful to alert patients to possible reaction. In my case, I was convulsed with a bout of unstoppable adolescent giggling, but I was aware, even while laughing, that it is no mere tickling sensation; I also experienced an intense physiological relief.
Lieberman remains unfazed by such responses: "One's personal reaction is very informative. Some people laugh, many cry profusely, while others feel overwhelmingly tired and deflated. Some can't even bear the sensation of a scarf around their throat." After a few moments he asks me to swallow. What he refers to as "the quality of the swallowing" is, he believes, itself, determined by psychological states. "The action causes you to tighten muscles which creates a combined movement; the larynx moves slightly backwards and then upwards and forwards from its resting place, after which it relaxes again. At this point it is possible to push it sideways and move your fingers gently behind it." It sounds worse than it feels, the pressure of his fingers is not uncomfortable.
Many of his clients work in the performing arts and their voices have broken down, often for no immediately identifiable reason. "I had a cold four months ago and now this," they lament. For businessmen, actors and even professional singers, the voice has been artificially maintained on constant adrenaline, often for weeks on end. Often problems only occur when they have a break or a holiday and the excessive adrenaline is no longer required. Worse still, the fact of losing the voice provokes further stress, and Lieberman believes that at this point people quickly develop what he calls "survival techniques" which only compound the problems. "Deprived of confidence in the ability of your voice to manage, you fail to support it, or even to breathe properly. It becomes a vicious spiral."
Lieberman also believes that the performers' lifestyle is a strain: "Performing each evening and eating late at night leads to poor digestion and disrupted sleep patterns. When one is young, the rate of recovery is faster than the damage process, but as one gets older the situation is reversed."
The pressure experienced by workers in call centres, dealing with complaints and anxieties by phone day after day, is another area in which he believes there is a strong connection between vocal and physical illness.
At the end of the manipulation I am advised to rise from the chair slowly. As I do so, the full effect of Lieberman's expertise becomes apparent. I feel what seems like a pint of warm oil gliding down my throat. Something has been released, both physically and emotionally, which has been trapped there a very long time.