There is grandeur in this view of life, with its several powers, having been originally breathed into a few forms or into one; and that, whilst this planet has gone cycling on according to the fixed law of gravity, from so simple a beginning endless forms most beautiful and most wonderful have been, and are being, evolved.
--Charles Darwin, Origin of Species, close of first edition, 1859
Source: Left: http://upload.wikimedia.org/wikipedia/commons/1/18/Charles_Darwin_by_G._Richmond.png; Right: http://upload.wikimedia.org/wikipedia/commons/a/a0/George_Richmond_-_Emma_Darwin_-_1840.jpg accessed 17 November 2012
Charles Darwin, whose biological observations led to the development of evolutionary theory, and his wife Emma loved each other very much.
Their many letters to each other over the years (preserved online in the Darwin Correspondence Project) stand as a testament to how much they thought, cared, and worried about each other.
In one letter, written around February 1839, Emma expresses her wish as a faithful believer, but at the same time, also admits to her doubts in her own hope:
The state of mind that I wish to preserve with respect to you, is to feel that while you are acting conscientiously & sincerely wishing, & trying to learn the truth, you cannot be wrong; but there are some reasons that force themselves upon me & prevent my being always able to give myself this comfort.
--Darwin Correspondence Project, Darwin, Emma to Darwin, Charles [c. Feb 1839] accessed 17 November 2012
She wants to feel secure that, if she (or he, or anyone) is really trying diligently and sincerely to learn what is true, that that effort guarantees that she cannot possibly be mistaken about what she is learning. The reason she is so concerned about this is that she was devoutly religious, and she knew that Charles had doubts about religion.
To be impossible to be wrong, through sheer effort and sincerity, is a lovely wish--and yet, in the same sentence, she admits to her beloved husband that even she herself cannot always keep up that belief.
She was right to be concerned about that issue--the history of science at that time in England contains many examples of geologists, paleontologists, biologists, and other scientists who set out on a journey to find evidence in the material physical natural world that proved the stories in the Bible to be literally true.
For example, if the story of Noah's Ark and the Flood were literally true, you would find evidence of it in the layers of rock in that part of the world. The scientists who set out to find it discovered that that evidence is not there, but other evidence, showing that other things happened, is indeed there.
The scientists who set out to demonstrate that the earth is literally only a bit more than 6000 years old demonstrated instead that they would have to reject all the other multiple sources of repeatable, verifiable evidence that showed the earth to be much older than that.
Darwin himself demonstrated that--rather than the Genesis creation story that species were created one time in their present and unchanging form--species actually change over time to better adapt to the environments they find themselves in.
When the evidence these scientists found contradicted what they wanted it to say about the literal truth of the Bible, they faced a test of their own moral character in deciding what to do next about that fact:
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They could ignore the evidence, pretend the discovery never happened, and never face the meanings of the contradictions between the evidence and what they believed, or
Source: http://thinkingmomsrevolution.com/wp-content/uploads/2012/06/fingers-in-ears.jpg accessed 17 November 2012
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They could double-down on their belief, holding on even tighter to it while rejecting the reality of the material physical evidence, or
Source: http://www.examiner.com/images/blog/wysiwyg/image/bad_poker.jpg accessed 17 November 2012
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They could accept the reality of the material physical evidence, revising their beliefs as needed to resolve the contradictions between the beliefs and the evidence.
Source: http://2.bp.blogspot.com/-LSEZYAmp3P0/UEKl9Td19sI/AAAAAAAACKE/m0nhbygv1nU/s1600/alone.jpg accessed 17 November 2012
Some of the most solid scientific knowledge that we rely on every day came from people who had the courage to face the implications for their beliefs that the evidence presented them, and the integrity to not turn away from or deny the contradictions, but rather to engage with them.
To take a more contemporary example of that same spirit, this quotation from Julie Onofrio is, for me, the essence of the courageous engagement that we so urgently need to participate in if we really want to become a profession:
Having an open forum and getting some help in analyzing research is really needed in our profession. Yes, I have to say it disturbs me when the researchers say things like traditional modalities don't work--it's like a slap in the face to all who are doing energy work, or reiki, or Rolfing, and having results and success. It's very hard not to take it personally, but also to set emotions aside and remain in communication. But that is why I support it. I want to learn more and to support the profession in understanding research.
This willingness to remain engaged, even when it's difficult because it contradicts what we've been taught, is nothing short of admirable. Julie is showing the courage of facing difficult dilemmas that evidence presents us about how massage actually works, and she is actively engaging with that process, and in that, she is going the extra mile.
Like Emma and Charles Darwin, most MTs are good, decent, caring, and loving people, who want to understand the truth.
If just wanting it sincerely, and working hard at it, were enough by themselves to avoid error, most of us would be there already.
Sadly, in this material physical universe, those good intentions are not sufficient to help us to be correct.
The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) is an independent non-profit organization that offers national certification in massage and bodywork.
This national certification functions as a path to initial licensure (sometimes the only path) for MTs in some states.
The Board has undertaken a major revamp of policies and procedures, one which is causing a great deal of disruption among nationally certified MTs and continuing education providers.
Its CEO, Mike Williams, states that the purpose and effects of this change are
streamlined online processes, enhanced communications, and improved programs that elevate the profession and better serve the public.
--NCBTMB front page accessed 17 November 2012
Some of those changes may well have that effect--I am not personally nationally certified, and I have not yet examined the changes in depth as other MTs and bloggers such as Laura Allen have.
But in the FAQ about the new procedures for approving continuing education providers, there is--for me--an absolute deal-killer.
Q: Will NCBTMB continue to accept alternative courses like energy work, aromatherapy, animal massage, etc?
A: Yes. Massage therapy is part of the holistic profession as are several other modalities and techniques. NCB will continue to accept modalities and techniques that can be legally practiced by a massage therapist without another healthcare provider, (i.e., DC, MD, PT) present. As long as the technique or modality can be shown to be embedded in the lineage of massage, it will be accepted. This means that if the core information of the technique or modality can be referenced as a derivative of another technique or modality that is within the massage therapy scope of practice it will be accepted.
--NCBTMB Approved Providers FAQ accessed 17 November 2012
The argument over the relationship between massage and "energy work" is nothing new.
In the early 1990s, when I was in massage school, the NCBTMB was developing the first national certification exam--the National Certification Examination for Therapeutic Massage and Bodywork (NCETMB). Eventually, as a result of consumer pressure, they were forced to offer an energy-free alternative, the National Certification Examination for Therapeutic Massage and Bodywork (NCETM), for those MTs who did not want to be coerced into an anti-evidential belief system as the price of their professional training and licensure.
Although the argument is nothing new, there was a fresh opportunity to do something innovative here among the other disruptive changes--but NCBTMB did not take that opportunity.
Instead, they opted to permit teaching any information (which includes misinformation and malinformation) as approved continuing education, as long that that can be shown to be "embedded in the lineage of massage". Considering the long history of "massage myths", documented by Laura Allen (here and here), Lee Kalpin, Paul Ingraham, and many others, it is clear that just because an idea has been embedded in massage, even for a very long time, that does not mean the idea is correct.
NCBTMB had an opportunity to stand up for the principle that, in the therapeutic encounter, a professional should provide only validated warranted (justified or justifiable) high-quality information to the client.
They did not take the opportunity to stand up for that principle, and as a result of that decision, I cannot participate in their new process. I will not go on to apply for national certification as a practitioner, nor will I become an approved continuing education provider under those standards.
I regret those facts, as I consider them massive missed opportunities. But I cannot do it, because our first principles on these matters are so far apart as to be irreconcilable.
Don't misunderstand me here--I am positive that the NCBTMB members are well-intentioned, and that they wanted to do the right thing. I genuinely believe that they were attempting to have the best of both worlds for the benefit of all massage stakeholders, and to not hurt anyone's feelings.
I respect them as the kind, caring, motivated, passionate people that they clearly are.
If that, by itself, were enough to be right, as Emma Darwin wished, we would not have to have this very serious and difficult discussion.
But evidence doesn't work like that--you can't pick and choose which evidence you accept, and which you reject. Either you accept all the evidence, and you go courageously wherever those implications take you, or you just don't accept the evidence.
If they are going to accept massage's traditional explanation of "energy work"--no matter how many times that explanation has been shown by the evidence to be mythical--as validated approved continuing education with their official imprimatur, then they are not preparing MTs who are taught that explanation for modern translational science. Holding on to old ideas even after they have been disproven is an active obstacle to understanding these new developments.
The environment of massage is exhibiting selection pressures toward a type of massage that is integrated with validated high-quality information, and that prepares MTs for understanding advances in neuroscience, cognitive science, endocrinology, and pain science, and translating that understanding into clinical practices that are client-centered and effective.
As a direct response of those pressures, biopsychosocial massage is breaking off from the main lineage of massage to provide a new massage lineage that is fully consistent with those principles.
Source: Darwin's first documented sketch of an evolutionary tree, around 1837, from his notebooks http://www.sciencebuzz.org/sites/default/files/images/myers_darwin_tree.png accessed 17 November 2012
You can consider this the official birth announcement of a new lineage of massage.
Biopsychosocial massage (BPSM) is massage understood and practiced in a biopsychosocial model. It understands massage, health, wellness, and illness, and the knowledge bases underpinning those concepts in an evidence-based, natural (meaning, not supernatural), organic way that draws on what we know about biology and other natural sciences, psychology, sociocultural aspects of being human, and the emergent effects that arise from interactions among these various factors.
Psychosocial and cognitive approaches don't require that you become a clinical psychologist but that you have a broad concept of the influence of those factors and that you account for them in your encounters with your patients. Know the literature and be able to give management advice based on evidence. When people come to see you they want a plan. Have a plan that is defensible and that works toward their goals. Address concerns, fear avoidance, other stress, and unhelpful beliefs with compassion, understanding, empathy, and informed knowledge.
Understanding why people hurt is part of our professional responsibility and should change most everything we do on a daily basis away from traditional methods and towards methods defensible with modern science.--Jason Silvernail accessed 5 August 2011
An example of a biological factor in health could be increased cortisol in the bloodstream in response to chronic stress. The interaction of that biological factor with the increased daily stress in modern society would be an example of interactions among biological factors and sociocultural factors.
An example of a psychological factor in health could be a man who is less likely to seek professional treatment for pain than a woman is, because of his perception that stoically enduring pain is what men do in the society he grew up and lives in. The increased structural damage that can occur as a result of ignoring symptoms and delaying treatment is an example of the interactions among psychological factors and biological factors.
An example of a social factor in health could be the relative stigmatization of mental or behavioral illness, as compared to how more clearly structural conditions are regarded. This stigmatization can drive psychological conditions underground--say, for example, if someone did not get needed psychological treatment because they didn't want it to show up in their medical record. That would be an example of interactions among sociocultural factors and psychological factors.
Biopsychosocial massage is client-centered. That means that the psychological and social factors in the client's unique experience, as well as the universal biological factors we are all subject to, is the center of where we focus our attention and caring. It doesn't mean that we accept everything in someone else's experience is literally true. It does mean that we recognize that, for them it feels true, and for that reason alone, it is important in where we meet the client in the therapeutic encounter.
Biopsychosocial massage welcomes self-expression and the art of massage. It is clear, however, that sometimes our need for self-expression can come into conflict with clients' immediate healthcare needs, and--when that happens--we recognize that, in order to act as healthcare professionals, our ethical fiduciary duty is to put the clients' needs first, ahead of ours if necessary.
Biopsychosocial massage is wholistic, integrative, and evidence-based. That means that it does not draw upon supernatural explanations of mechanisms, and it builds upon foundational knowledge in the sciences to evaluate and validate the evidence for or against particular claims of effectiveness or mechanisms.
That means that we understand and practice it in a holistic, complementary, and integrative way, integrated with other domains of human knowledge and with the natural universe we find ourselves in, rather than silo'ed off in an alternative universe that denies material physical reality, and isolates us away from members of the client-centered biomedical healthcare team.
If a proposed explanation for an effect requires us, for example, to reject physics, as the explanation of "energy work" embedded in massage tradition does, then we face that contradiction head on, and we work to resolve it. If that means updating old beliefs in the light of new evidence, then that is the consequence of practicing biopsychosocial massage.
Michael Hamm is another contemporary example of courageous engagement, facing the evidence head-on and seeking to better understand. I'm paraphrasing his quote here, and I trust that he'll correct me if I've gotten it wrong. If I can find the original quote, I'll replace the paraphrase, but it was something to this effect:
I understand and accept that the traditional anatomical explanation behind craniosacral therapy doesn't hold up in light of the evidence. At the same time, I can't deny that I feel something when I am doing that work, something that I can't explain. I want to better understand what is going on when I do that work.
In the absence of clear evidence of what is exactly going on, this suspension of previous belief that has been disproven (and not yet replaced) is totally in line with the principles of BPSM. We don't have to always know everything; we just have to know what we do know, what we don't know, and how strong the evidence is behind our knowledge.
Since our encounters with clients will always run ahead of the available high-quality evidence, we don't limit ourselves only to what has been rigorously validated by studies and nothing else. We take our professional experience into account, and we actively seek to understand and incorporate the clients' preferences, whenever possible, in treatment. But in all these cases, in developing our approach to caring for the client, we remain clear on what is evidence, what is speculation, what is science, what is art, what is literal, and what is metaphor.
Understanding the material physical universe around us, and the centuries of cumulative human knowledge about that universe, give us powerful tools to draw upon. That understanding, combined with the caring that characterizes so many people who choose to go into massage as a career, is the heart of biopsychosocial massage.
Neil deGrasse Tyson sums it up almost perfectly:
I am driven by two main philosophies, know more today about the world than I knew yesterday. And lessen the suffering of others. You'd be surprised how far that gets you.
--Neil deGrasse Tyson
That quotation demonstrates the core of massage in a biopsychosocial model.
Source: http://healthskills.files.wordpress.com/2008/10/biopsychosocial.jpg accessed 7 August 2012
Over time, here at POEM, we will be following that evidence where it leads, and courageously engaging with the meanings that it shows for the practice of massage therapy. I expect intense, passionate, and fruitful discussions here over the next few years.
UPDATE, 18 November 2012, 11:01 AM PT:
Biopsychosocial massage (BPSM) by Ravensara S. Travillian is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.
Based on a work at http://poem-massage.org/content/biopsychosocial-massage-bpsm-new-lineage.
