Massage's culture wars

June 23, 1883. THE BRITISH MEDICAL JOURNAL. THE RISKS OF "MASSAGE" By JULIUS ALTHAUS, M.D., Senior Physician to the Hospital for Epilepsy and Paralysis, Regent's Park.

Julius Althaus (1883-1900) was a German-born neurologist, medical educator, and science writer, who practiced in London until his death, and who was very influential in contemporary understanding of epilepsy, paralysis, and other neurological conditions.

"MASSAGE," which has for a long time been the Cinderella of therapeutics, has recently seen a considerable change in its fortunes, and become as thoroughly fashionable as mesmerism and homeopathy have been at previous periods in the history of medicine.

What exactly is he saying about massage here?

What is he saying about homeopathy?

Mesmerism (also called animal magnetism) is a vitalistic concept developed by the 17th-century Austrian physician Franz Mesmer.

Firstly, animal magnetism as a general vital universal principle: animal magnetism is for Mesmer a principle that touches both man and the universe at all levels: psychological, human and cosmological. For Mesmer, animal magnetism is mainly a theory to describe the entanglement between man and universe. Mesmer's theory is based on the concept of something through which everything in the universe is interconnected. It is something before matter. Lacking other terms, he called it a "universal fluid".[5] For him this subtle fluid or energy, source of life and health, fill the cosmos and moves in it. This fluid is also the basis of the cosmos as it is the basis of which matter is constituted. This fluid is also a sort of energy or life force.[6] When this fluid circulates, living beings are healthy. When it is blocked we experience sickness. This theory is largely inspired by ancient doctrines and Renaissance concepts. Scholars such as Meheust say that it would be interesting to compare it with the Chinese concept of Chi, or "vital energy".

Secondly, animal magnetism as a system of cure: Animal magnetism is defined by Mesmer in an even more restricted sense. For him, it is the capability present in all men, (but mostly developed in those working as magnetists), to use the vital fluid or life force for therapeutical purposes. According to this theory, the magnetizer is able to direct his vital fluid toward the sick person, and heal him. This second definition was often adopted even by those magnetists who did not accept the preceding larger theory. For example [B]aron DuPotet says:

"the fluid is not a substance that can be weighted, measured, condensed, it is a vital force (Du Potet)[7]"

The "Weir-Mitchell treatment" more especially, which has been found very useful in some obstinate forms of hysteria, is now being indiscriminately applied to all sorts of cases of cerebral and spinal disease of which loss of power forms a conspicuous symptom ; and it is therefore time that we should say, "Hands off!" lest a procedure which does good in a limited class of cases should suffer by the excessive praises of injudicious partisans, and eventually be thrown aside altogether.

http://en.wikipedia.org/wiki/Rest_cure#History

As a treatment, bed rest is mentioned in the earliest medical writings. The rest cure, or bed rest cure, was a 19th century treatment for many mental disorders, particularly hysteria. "Taking to bed" and becoming an "invalid" for an indefinite period of time was a culturally accepted response to some of the adversities of life. In addition to bed rest, patients were secluded from all family contact in order to reduce dependence on others. The only person that bed rest patients were allowed to see was the nurse who massaged, bathed, and clothed them. Patients were also not allowed to use their hands at all. In some extreme cases electrotherapy was prescribed. The food the patient was served usually consisted of fatty dairy products in order to revitalize the body with new energy. This cure as well as its name were created by doctor Silas Weir Mitchell, and it was almost always prescribed to women, many of whom were suffering from depression; especially postpartum depression. It was not effective and caused many to go insane or die. In the middle of the 20th century, bed rest was still a standard treatment for markedly high blood pressure. It is still used in cases of carditis secondary to rheumatic fever. Its popularity and perceived efficacy have varied greatly over the centuries.
Indications

Bed rest is commonly prescribed in the following cases.

    For sufferers of acute pain in the spine or joints; for example, in the case of backache the unloading of the corresponding spinal segment decreases the intradiscal pressure, and it would bring relief in cases such as compression of spinal nerve. The prescribed duration of bed rest vary and opinions differ.[2]
    Bed rest is prescribed for some maternal or fetal complications of pregnancy, such as preterm labor, high blood pressure, incompetent cervix, or fetal growth problems. In the past it was a general prescription during any kind of pregnancy, now deprecated.[3]
    Women pregnant with twins or higher-order multiples are at higher risk for preterm labor, preeclampsia (toxemia), and other pregnancy complications, thus bed rest is common in these cases. About 50% of women pregnant with twins will be on some form of bed rest for at least part of their pregnancy. Recent studies have shown that routine bed rest in twin pregnancies (bed rest in the absence of complications) does not improve outcomes; however, bed rest is almost always prescribed for women carrying triplets or more.
    Heart diseases
    Bed rest is an important measure in the cases of chorea. In the mild cases it may suffice for treatment.[4]
    Acute gout, as early ambulation may precipitate a recurrence.[5]

Adverse effects
Further information: Lying_(position)#Long-term risks

Prolonged bed rest has long been known to have deleterious physiological effects, such as muscle atrophy and other forms of deconditioning such as arterial constriction.[6] Besides lack of physical exercise it was shown that another important factor is that the hydrostatic pressure (caused by gravity) acts anomalously, resulting in altered distribution of body fluids. Even physical exercise in bed fails to address certain adverse effects.[7]

It is also a major cause of thrombosis,[8] mainly by reducing blood flow in the legs.[9]

For details on the potential effects associated with bed rest see Potential Complications of Immobility [10]



http://en.wikipedia.org/wiki/Silas_Weir_Mitchell

Silas Weir Mitchell
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This article is about the physician/writer. For the actor, see Silas Weir Mitchell (actor).
Silas Weir Mitchell

Silas Weir Mitchell (February 15, 1829 – January 4, 1914) was an American physician and writer. the physician who discovered causalgia.
Contents

    1 Biography
        1.1 Influence on Freud
    2 Art patron
    3 Honors and recognition
    4 Terms
    5 Publications
    6 References
    7 Further Reading
    8 External links
    9 Source

Biography

He was son of a physician, John Kearsley Mitchell (1798–1858), and was born in Philadelphia, Pennsylvania.

He studied at the University of Pennsylvania in that city, and received the degree of M.D. at Jefferson Medical College in 1850. During the Civil War he had charge of nervous injuries and maladies at Turners Lane Hospital, Philadelphia, and at the close of the war became a specialist in neurology. In this field Weir Mitchell's name became prominently associated with his introduction of the rest cure, subsequently taken up by the medical world, for nervous diseases, particularly neurasthenia and hysteria.[1] The treatment consisted primarily in isolation, confinement to bed, dieting, electrotherapy and massage; and was popularly know as 'Dr Diet and Dr Quiet'.[2] His medical texts include Injuries of Nerves and Their Consequences (1872) and Fat and Blood (1877). Mitchell's disease (erythromelalgia) is named after him. He also coined the term Phantom Limb during his study of an amputee. [3]

In 1863 he wrote a clever short story, combining physiological and psychological problems, entitled "The Case of George Dedlow", in the Atlantic Monthly. Thenceforward, Mitchell, as a writer, divided his attention between professional and literary pursuits. In the former field, he produced monographs on rattlesnake venom, on intellectual hygiene, on injuries to the nerves, on neurasthenia, on nervous diseases of women, on the effects of gunshot wounds upon the nervous system, and on the relations between nurse, physician, and patient; while in the latter, he wrote juvenile stories, several volumes of respectable verse, and prose fiction of varying merit, which, however, gave him a leading place among the American authors of the close of the 19th century. His historical novels, Hugh Wynne, Free Quaker (1897), The Adventures of François (1898) and The Red City (1909), take high rank in this branch of fiction.

He was Charlotte Perkins Gilman's doctor and his use of a rest cure on her provided the idea for "The Yellow Wallpaper", a short story in which the narrator is driven insane by her rest cure.

His treatment was also used on Virginia Woolf, who wrote a savage satire of it: "you invoke proportion; order rest in bed; rest in solitude; silence and rest; rest without friends, without books, without messages; six months rest; until a man who went in weighing seven stone six comes out weighing twelve".[4]

http://en.wikipedia.org/wiki/Silas_Weir_Mitchell#Terms

Weir Mitchell treatment — a method of treating neurasthenia, hysteria, etc., by absolute rest in bed, frequent and abundant feeding, and the systematic use of massage and electricity.

Professor Busch of Berlin, who has written the most recent and sensible treatise on massage and gymnastics (in vol. ii, part 2, of von Ziemssen's Handbuch der Allgemeinen Therapie [Handbook of General Therapy], Leipzig, 1882), recommends these proceedings chiefly for the treatment of deformities, and of muscular pain. Amongst nervous affections which have thus been treated, he mentions scriveners' palsy, stammering, some forms of hysteria, and muscular paralysis or paresis after poliomyelitis; without, however, saying much in favour of this treatment in the latter conditions. It is well known that at various times epilepsy, idiocy, and some forms of insanity, have been treated by massage and gymnastics; but, fortunately, we now hear very little of such therapeutical aberrations.

scriveners' palsy

stammering

some forms of hysteria

muscular paralysis or paresis after poliomyelitis

epilepsy

idiocy

some forms of insanity

It appears to me that diseases of the brain and spinal cord must, on account of the anatomical situation of, these organs, be inaccessible to the influence of massage, which can only be applicable to more superficial parts of the body. Apart from this, however, it is important to consider that many of the most important: diseases of these organs are of an inflammatory or irritant character, either primarily or secondarily; and this should make it self-evident that massage should not be used for their treatment, even if the suffering parts could be reached by it. I will here only allude to many forms of cerebral paralysis from haemorrhage, embolism, and thrombosis, which are followed by sclerosjng myelitis of the pyramidal strands ; and most forms of primary lateral, posterior, or insular sclerosis of the spinal cord.

It is only charitable to assume that the advocates of massage, who recommend their favourite procedure in such and similar cases, are somewhat at sea with regard to the pathology and diagnosis of diseases of the nervous system.

That which may be good for developing and strengthening healthy muscles, or muscles which have been enfeebled by disuse or certain local morbid conditions, etc., is not for that reason suitable for the treatment of muscular paralysis owing to central disease. In most cases of lateral and insular sclerosis, which are, unfortunately, now much treated with massage and exercises, rest is indicated rather than active exertion; and overstraining of the enfeebled muscles acts prejudicially on the state of the nervous centres. I have recently seen quite a number of instances in which the central disease had been rendered palpably worse by procedures of this kind ; and, in a case of cerebral paralysis which was some time ago under my care, the patient had, after four such sittings, been seized with collapse, which nearly carried him off.

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:

1. 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
    
2. 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
    
3. 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.

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.

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.

Seth Godin writes, on the natural human tendency to deny facts we don't like:

The problem with Orwellian talking heads, agitprop, faux news and Ballmer-like posturing is that they take away a foundation for a genuine movement to occur, because once we start denying facts, it's difficult to know when to stop.

Still, it's understandable--when reality seems overwhelming, the temptation to deny that reality, and avoid the pain of dealing with it, can be very strong. Barrett Dorko also has an excellent take on that phenomenon and this article, over at SomaSimple.

We've got a lot of massive problems in massage--for example, at the same time that we have the chance for a place at the healthcare professional table under Obamacare, and that we say we want to be taken seriously as professional members of the healthcare team, our major credentialing organizations grant recognition to courses that take money for teaching claims like "body cells carry emotional memory", "craniosacral therapy moves skull bones", and "all past traumas are stored in the fascia".

Anyone who had a decent education in anatomy should be able to debunk those claims after the first day of the first class.

Yet our major professional organizations visibly sanction the teaching of claims like these and grant CE credit for them, at the same time we say we want to be real healthcare professionals.

Our walk doesn't match our talk, and the problem's not going to go away just because we refuse to face it.

If we refuse to face it and discuss it in a civil and professional way in an attempt to reach solutions, history's going to make us eat the decisions that others make for us about these problems.

And if we claim we want to incorporate the latest neuroscience findings into massage as a healthcare profession, and we start that process off by being Neurophysiology 101 denialists, how, exactly, is that supposed to work?

No one's denying the fact that this shift to accepting facts and material physical reality is going to cause a great deal of disruption and moral distress. The world has entirely shifted out from under us, and the old social contract that we were comfortably used to just does not work any more.

That fact is going to cause an unforeseeable amount of pain and distress, and we need to be extra kind to each other as a result.

But denying reality is not a sustainable choice anymore, and the only real question is whether we'll make the change in time to make use of these new opportunities, or whether our process will make us too late to accept the invitation, and we'll totally miss out.

Godin provides an aspirational ideal to assist in that process:

Transformational leaders don't start by denying the world around them. Instead, they describe a future they'd like to create instead.

We can't change the larger universal material physical reality that confronts us. What we can change is how we react to it, and that reaction--what we commit to--will sow the seeds for the future we want to create.

Source: "13 Plus Myths of Massage Therapy", by Lee Kalpin RMT http://www.massagetherapypros.ca/wp-content/uploads/2012/03/Myths-of-Massage-Therapy.jpg accessed 3 October 2012

Or, as the Buddha famously put it: Life means that suffering exists.

An important question is what do you do about that suffering? We all are confronted with that question, because no one escapes suffering as a part of life.

You can't change that fact, but you can choose what you do in response to that fact.

Some ways of reacting to suffering in life are constructive--others, not so much. You can choose to blame others, or to "kill the messenger". Lots of people make that very choice.

But if you choose that path, and you find it is not making you any happier, at least there are other alternatives you can change to.

Kat Mayerovitch has a blog post up about relations with biomedical healthcare practitioners--mainly physicians--at Miracles, Medicine, and Manners.

Take a moment to go read the whole post--it's definitely worth it.

One of the best things about it is that she doesn't just recommend what not to do; she also suggests ways to proceed more constructively--to build bridges, not to burn them.

She provides practical suggestions for starting to work together with physicians in a client-centered way. She also provides a well-deserved shout-out to Laura Allen and the Massage Therapy Foundation for creating Working with Physicians: a Massage Therapist's Guide, and making it available on an open-access basis as an e-Book for free download.

You don't have to approve of every single thing about the modern American healthcare system to find and work with sympathetic allies in it toward goals that you share.

It won't change the basic nature of modern reality, but finding and working with supportive allies and companions along the way can definitely make a big dent in the suffering.

Source: http://upload.wikimedia.org/wikipedia/commons/4/42/FlameDance.jpg accessed 28 August 2012

cheers, to Kat, Laura, and the Massage Therapy Foundation!