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(regardless of whether they are ready to hear it) through a subject-object dynamic in which the patient remains largely a subject, and not an equal partner in the clinical encounter. The true revolution in the rapidly growing subdiscipline of narrative-based medicine (NBM), however, is to reeducate physicians to see their patients not in terms of their pathology, bad habits, lay or "pop" understandings of disease, or assumed ignorance. Instead, they are perceived as whole individuals whose lived experience and whose own narratives of illness will point the way to both assessment and treatment. WHAT IS NARRATIVE' BASED MEDICINE? Narrative-based medicine (NBM) emerged to counter the problem that "scientifically competent medicine alone cannot help a patient grapple with the loss of health or find meaning in suffering." 3 In the NBM framework, disease, dysfunction, and pain are to be seen first and foremost as a narrative inextricable from the person's life, rather than as a list of codes, difficult names, protocols to be followed, or corrections to be shared. This is the true definition of person-centered care. By no means does this mean that therapists and physicians will not use their expertise or take the necessary steps in the face of red flags, and it is unlikely that NBM can be extensively applied in the context of the emergency room. Nevertheless, in all other health-care contexts, NBM is a game changer in terms of the renewed dynamic between clinician and patient. As noted by Trisha Greenhalgh, GP, DPhil (an international authority on applying and implementing evidence- based medicine), on the value of narrative medicine as early as 1999, NBM "may provide a way of mediating between the very different worlds of patients and health professionals. Whether . . . performed well or badly, [it] is likely to have as much influence on the outcome of the illness from the patient's point of view as the more scientific and technical aspects of diagnosis or treatment." 4 From this perspective, NBM is critical to truly ethical practice. With mediation as its goal, NBM has been quietly gaining ground since the turn of this century. Founded by internal medicine specialist Rita Charon, MD, PhD, at Columbia University and taken up by biomedical specialists worldwide, more and more medical curricula are beginning to incorporate training in NBM's methods and applications, with nascent international centers also emerging. The goal is to refocus the way medicine is being practiced through the development of an applicable holistic diagnostic framework that is based on patient narratives of their condition, with particular attention paid to the body- mind connection. Clearly this is examined in parallel with any required biomedical assessments, but rather than "telling," "educating," or "directing" the patient, it is the patient and their articulated needs that guide the process. IS NBM REVOLUTIONIZING MEDIATION? Practitioners of integrative health will be quick to observe that they have been using this holistic approach for well over a century—indeed, there are many commonalities with the principles of osteopathy in particular. 5 So, where is the revolution? It lies in the fact that all of this is happening at the heart of biomedical science, yet the news does not seem to have reached the manual therapy professions quite as broadly. Some osteopathic schools are catching up, but not as rapidly as one might have expected. 6 There are readers who will be quick to cite the biopsychosocial approach—this is not a reinvention of that particular wheel. 44 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 1 Rather than seeing the patient as someone to be educated and corrected, thus imposing on them a receptive role that is on unequal footing with the practitioner, NBM reverses this relationship and puts the person-centered focus into tangible practice using hands-on, practical methods. This relationship change does require the development of certain skills, but no more than is usually needed for satisfying continuing education requirements. Importantly, NBM does not challenge biomedicine or EBM (it does itself rest on substantive evidence). 7 On the contrary, it seeks to instill holistic and humanistic assessment and treatment at the heart of primary health care. In such a climate of change, there is tremendous potential for building proper bridges with integrative and allied health professions with far more solid foundations than in the past. Such developments may also make it possible to solve the impasse that some MTs find themselves dealing with in relation to "hands-on" or "hands-off" in their efforts to adhere to EBM guidelines, because in some cases, it will come down to what is appropriate, not just based on the literature but based on the patient. HISTORY OF THE MEDICAL REVOLUTION In order to understand the revolution that is taking place in the biomedical disciplines, let's back up a little and take a look at where this all started. Cartesian Dualism The roots of modern science stem from a philosophical position known as Cartesian Dualism. In the early 1600s, French philosopher René Descartes aimed to establish a way of discovering absolute truth and "a single, unified science" 8