Issue link: https://www.massageandbodyworkdigital.com/i/1476304
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 77 histories are often written by practitioners and authors who are not trained historians, but experienced physicians or practitioners who have gathered the key points of the narrative. Some are written by physicians with training in sociology or history, but the prevalent model of narrating the histories remains largely internalist; i.e., it trims the matrix in which the events occurred. Many of them tend to filter out the more embarrassing elements of a profession's history, termed "skeletons in the closet" by the history panel of the International Consortium of Manual Therapies inaugural conference in May 2022, which, to its credit, highlighted the need to open these "closets" to understand the origins of key issues troubling relevant professions. 2 Examples of such skeletons may include association with mystical beliefs such as Mesmerism, contemporary connotations associated with "woo" practices of any sort, or the use of massage therapy as a cover for human trafficking and sex work—a practice that has plagued the profession's reputation ever since. A lesser known, but equally significant, skeleton is that massage was classified as medicine by the American Medical Association in the early 20th century, and this legal designation was then used to arrest and shut down naturopathic practitioners at a time when the conflict between biomedicine and naturopathic practice was at its most vicious. 3 A systematic exploration of the factors surrounding this designation and its impact would provide significant insight into current unresolved problems in the profession. The third type of histories are known as academic histories. These are in- depth investigations of the evolution of methods or whole professions in relation to broader social change, some of which are academic, while others are written in a livelier style closer to investigative journalism. Researching and writing them requires training and specific skills in historiographical methods. They are especially valuable because they are authoritative, reliable if done properly, and unlike the first two types, look at the broader (holistic) context of how, and crucially, why the topic of investigation (a method or profession, for example) developed as it did, as well as its implications. Although these are the most correct and useful types of histories, they are also the rarest when it comes to health-care education, and are generally found in specialized publications within the discipline of the history of medicine. WHY IS IT SO COMPLICATED (AND WHY DOES IT MATTER)? In the 19th century, Canadian doctor William Osler, considered to be the father of modern medical practice, established a perspective that the history of medicine is a source of models to be used as guidance based on the "wisdom" of the great physicians of the past, but stripped to the bare bones, focused only on the medical practices or concepts that were immediately relevant to the topic at hand. This approach to medical history became the foundation for the internalist histories described earlier. In contrast, the academic historians building the actual discipline of history (a discipline built and shaped over two millennia), argued that history is an ongoing process of inquiry. Health care is a practice that derives from human experience, is practiced within society, and is constantly being shaped by social values, beliefs, and necessities. So, an academic history of medicine is a holistic exploration of all the factors impacting our understanding of health, disease, patient narratives, and the roles of physicians in society. If we imagine a historical narrative as the story of a single person, the biopsychosocial approach properly applied is a great analogy for the academic approach to history: It will look at phenomena, data, and the sequence of events, but it will also examine and interpret them in terms of values, belief systems, and the broader social and economic environment. This allows the practitioner to understand and build trust with their patient; it allows the historian—and the reader of an academic history—to build a full picture of how the multiple factors have led to a given situation. In contrast, an internalist history is similar to a specialist examining only the physical system or model they are familiar with, like a patient consulting an orthopedic surgeon for a soft-tissue injury, only to be told they need surgery—because that is the protocol the specialist has learned to follow. Sometimes they do indeed need surgery; however, unless the broader context is considered, including the potential benefits of less invasive methods, the patient will not be offered options, nor will their psychosocial needs be met. These two perspectives on histories have clashed since Osler's time, and while Oslerian histories continue to dominate health-care education, many historians of medicine and science argue that the focus on internalist histories dismisses and discards the well-established, crucial skill set that holistic academic histories bring to clinical practice. 4 Where internalist histories provide information, academic histories bring understanding as well as fresh skills. HOW HISTORY ENRICHES THE CLINICAL ENCOUNTER When we take a client's history, we are in effect trying to piece together a story that will help us get to the root of a problem, TAKEAWAY: Histories taught in bodywork courses need to consult professional historians to become broader and provide context and understanding, not just fact files.