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 79 developments. A client with a bad back does not arrive in a vacuum; nor did any of the bodywork professions develop in a vacuum. So, it makes little sense to teach the story of their development as a neat, linear sequence, as is usually the case in internalist histories. Whether you are asking questions about the limitations of your scope of practice, wondering why there are so many bewildering modalities available, why attitudes and language are used as they are, why osteopathy is practiced differently in the US, UK, France, Germany, Italy, and Australia, or why remedial massage and myotherapy in Australia correspond to advanced levels of clearly regulated therapeutic massage, 6 holistic context will offer the answers. Internalist histories will not; they will offer bite-size answers that remain superficial rather than providing understanding. Understanding full histories also allows the recovery of neglected topics, which should be a priority given the current shift toward holistic thinking evident in biomedical education, where the holistic wheel has been practically reinvented over a century after it originally came under fire from early biomedical authorities. 7 All too often, we see marketing material and strongly worded debates about "outdated practices," calling for a shift to some new model or modality. These calls to action are invariably simplistic, and they count on a lack of critical thinking to attract followers. They usually rest on an ideological framework known as presentism—an attitude that we are always progressing toward something better, and that anything past an undefined sell-by date is to be discarded. Yet, this is an error of logic that is often misapplied either through a lack of critical ability, or for commercial gain or self- serving image management. Engaging in the process of inquiry embedded in historical learning forces us to develop the skills needed to evaluate the fuller picture, develop higher reasoning skills, and by extension, to appreciate principles of uncertainty we will repeatedly encounter clinically. This process encourages both humility and skepticism, but in an informed and systematic way. Adapted academic historical training is being built into biomedical curricula for these reasons, and it is an equally valuable tool for manual therapy, as these developments have already demonstrated. 8 HISTORIES AND PROFESSIONAL IDENTITY The version of a profession's history that is taught in basic training plays an important role in establishing professional identity. It also governs the language used to talk about a given profession. It is the basis for using allopathic medicine rather than biomedicine as a general term understood in opposition to holistic medicine, consciously or unconsciously creating a tension between the two. In some cases, this goes as far as framing the self- perception of "holistic" practitioners as part of a proud, countercultural heritage. Regular readers of this column will be aware that I have frequently highlighted the shift toward whole-person health care evolving in biomedicine, and the reality of this tension has been changing for some time. Several sociological studies of the relationship between complementary and alternative medicine (CA M)—the term used in the studies, but the same applies to "integrative" or "functional" medicine— and biomedicine have long established that almost one in two biomedical clinicians (48 percent) and medical students (91 percent) want to discuss CA M with their patients, but feel inadequately educated to do so, pointing to a gap in baseline or continuing education as the cause. Even though the potential for CA M values to improve the effectiveness and patient satisfaction of conventional medicine is well established in biomedicine, time-starved electives and divisive, practice-based debate have been identified as key hindrances to progress. 9 It is in the full histories—and the full sociological studies—that the answers will be found, and this is where interdisciplinary collaboration with humanities specialists is crucial. Current efforts to formulate a common nomenclature, better definitions of manual therapy practices, and a collation of the existing evidence have acknowledged the importance of histories, but so far remain focused on internalist ones. Such efforts are doomed to struggle until the lens is widened to include the expertise that provides contextual insight—because if the wider context is not considered, there is no way to work out how the current situation developed, and our understanding will remain fragmented, resting on anecdotes or event-specific details, instead of understanding the complex matrix of contingencies (things that depend on other things happening or not happening), which impacts the ways health-care practices develop. WHAT ABOUT THE SKELETONS? In a previous column, I outlined the deep roots of many holistic practices in mystical and esoteric thought, in an article ultimately talking about fascia research. 10 A large part of that article focused on the social, cultural, and ideological framework in which holistic thought came to be sidelined, how it survived, and was eventually structured and professionalized. Though shorter and more reader-friendly than a true academic piece, that was an example of academic history in which I aimed to highlight where manual therapy debates were hitting a wall; how good ideas become dogma, and dogma turns into bad ideas, which then damage professions, as I have also argued in previous columns. 11 Acknowledging all the skeletons, good and bad, allows us to SOMATIC RESE ARCH