In "Modern Medical Yoga: Struggling with a History of Magic, Alchemy, and Sex," Joseph Alter traces the development of modern yoga and its particular identity crisis, which he characterizes as "a degree of profound ambivalence if not explicit contradiction between a secularised, 'sanitised' scientific ideal of medicalised practice, and the 'other history' of sex, magic, and alchemy" (119). Similarly, in "Medical Mimesis: Healing Signs of a Cosmopolitan 'Quack,'"Jean Langford calls our attention to another sometimes illusory distinction between true and false medicine. Langford is specifically interested in the role of imitation or mimicry in the constitution and legitimation of the healer's identity. She writes, "simulation is integral to medical practice, troubling the binary of truth and falsehood that is a foundation of scientific knowledge" (24). Langford concerns herself primarily with the case of Dr. Mistry, an Indian Ayurvedic doctor who confounds the established categories of legitimate doctor and "quack" with his inconsistent and unintelligible mimicry of both the respected Ayurvedic doctor and the folk healer. Finally, Tom O'Dell explores the sense of magic that permeates the promotional literature and experience of patrons of two Swedish spas in "Meditation, Magic and Spiritual Regeneration: Spas and the Mass Production of Serenity." All of these texts take as their subject "the tension between pragmatic rationalism and esoteric magic" that exists in the modern discourse of alternative (that is, non-biomedical) healing therapies (Alter, 119).
At the risk of being ego-centric, I would like to situate myself in my role as a licensed massage practitioner (LMP) at the center of these contested ideas of legitimacy/quackery and scientific objectivity/magical subjectivity. Just as an angsty Roger Daltry asks “who are you?” I wish to ask “who am I?” to the Western medical establishment, the consumer patient, and myself. Am I a legitimate clinician? Am I a “quack” with no real, respectable credentials like Dr. Mistry? Or am I something else entirely?
I have been practicing massage in Seattle for the past three plus years. Washington is a fairly progressive state in terms of massage regulation, which is to say that it has some of the highest educational requirements, and massage therapists[1] enjoy more respect from the public and medical profession alike than in many other states. In fact, LMPs are licensed as health care providers, and legislation makes it possible for many people to use their medical insurance to receive massage treatment, which is a definitive source of institutionalized legitimacy. Over the course of my career I have maintained a private practice as well as working as an independent contractor in a massage clinic located within a larger integrated health clinic boasting MDs, naturopaths, acupuncturists, physical therapists, psychotherapists, and chiropractors. For the past year I have worked exclusively in this clinical setting seeing clients[2] with various injuries, chronic pain, and other medical conditions.
The first two pictures above are intended to be exaggerations and perhaps even a little offensive in the way that they imitate and conflate certain signs. They might be said to illustrate precisely the “mimetic excess” that Langford discusses with regard to Dr. Mistry (30). He is difficult to classify as legitimate doctor or "quack" because he is performing his identity in a way that exceeds either referent. In the first picture I embody the stereotypical biomedical clinician most easily identified by the white coat and surgical mask. My glasses serve to further refine my vision and bring into focus the body on the table. This privileging of vision over other sensory systems (notably touch in the case of my work as exemplified by the barrier of the gloves) is what Deborah Gordon calls the “visual metaphor” (32). She writes, “Vision fosters the sense of separation between subject and object, particularly when compared to touch, and supports a physicalist interpretation of the elements of reality as things-in-themselves” (32). Further objectification is provided by my client’s quite literally dehumanizing mask. Like the monkeys and other animals poked and prodded in laboratories, my client is merely meat on the table.
In the second picture, I embody the West’s conception of a “quack” complete with a trusty magic wand. My olfactory organ has been transformed into a duck bill, and my hair scarf, silver hoop earrings, and dress recall an exoticized vision of the shaman or traditional healer in a developing country. That my pasty skin tone belies my cultural inauthenticity can simply be added to the list of my transgressions. “New age” candles and crystals also figure prominently, and the client’s look of bliss and transcendence is testimony to the fact that magic and perhaps even a bit of alchemy is indeed being performed. All these elements (the clothing and props) function in much the same way as Dr. Mistry’s photo albums and certificates, magically lending me the appearance of legitimacy while at the same time closeting more substantive questions about that legitimacy.
To illustrate this tension between the clinician and the quack as I experience it more concretely, I would like to share two very different experiences of working with clients whom I saw for the first time (back to back on the same day incidentally) this past week. The first client is recovering from recent surgery to repair a foot that was run over by a large piece of machinery. The goal of the massage in this case was to mechanically break up adhesive scar tissue in the foot and release fascial (connective tissue) restrictions in the foot and lower leg. The
client and I did not talk much before the session. I had reviewed his chart and asked him to clarify a few things and then left the room to
let him get comfortable on the table. This session required me to utilize my knowledge of anatomy (see picture at left) and my palpation and manual therapy skills in a fairly straightforward and unemotional way. Interestingly, the client wanted to chat for most of the session. He was clearly not there for any relaxation of stress-reduction purposes, though often these clients are similarly inclined to talk, perhaps finding the emptiness of silence uncomfortable[3]. While I am not categorically opposed to talking during massage, I do think it is worth noting that this kind of mental activity can limit our engagement with our bodies. In literature related to treating trauma the separation of the mind’s activity from the temporal corporeal experience is called dissociation. This can occur just as easily without any talking at all, of course. When I checked in a few times about how the work felt, the client informed me that he was a “warrior.” That is, the actual perceived sensation of my contact was irrelevant since he could use the power of his cerebral cortex to override its potential discomfort. The transaction in this session was nice and clean. I was the “expert,” and I used my knowledge and skills to do something to the body on my table. How different was this encounter than that of a patient visiting his or her doctor besides the obvious point that I spent much more time overall with the client?
The second client I saw is also recovering from surgery. However, she underwent a more invasive procedure that left her with significant sensory and motor impairment. She has done extensive physical and occupational therapy, in addition to massage. She noted having felt at times that her body did not belong to her but also having come to the more recent realization that her body was healing despite her
mind’s inability to comprehend precisely how. In contrast to the first client, this client and I spent almost half of the allotted session time talking before she ever got on the table. Listening to her concerns and feelings was just as important in my mind as treating her complaints. Whereas with the first client I used privileged anatomical knowledge and mechanical force to effect change, with this client I employed a totally different modality: biodynamic craniosacral therapy. This technique was developed by osteopaths in the beginning of the 20th century, and I completed a ten-month advanced certification in it in January 2008. It involves gentle, non-invasive hand positions on various areas of the body (notably along the bones of the cranium and spine though it encompasses the tissues, membranes, and fluids of the whole body) and is based on the belief that the body possesses fundamental wisdom and the ability to heal itself: an inherent treatment plan. My intention in this session was to help support the client’s nervous system, providing her with more resources to bring to her healing process. I did not add anything to her system; I merely facilitated what her body told me it wanted. In this sense, I ceded authority to her body itself. The pictures and text at left are drawn from a book about craniosacral therapy. In them you can see diagrams of the “primary respiratory system.” This describes a system based on embryological anatomical development and physiological function (see the second picture detailing the circulation of cerebrospinal fluid) whereby the vital life force (“The Breath of Life”) is distributed throughout the body. It was precisely this system with which I worked. The client offered feedback describing the physical and energetic shifts and relaxation she felt in her body as a result of the work. One might ask whether her sense of the work’s
efficacy came, like that of the patrons of the spas O’Dell cites, from “both a will to believe and an actual belief” (32).
Indeed, you can find ample sources on the web that decry craniosacral therapy as “quackery,” but I believe fiercely in its solid foundations and efficacy (and, hence, find it distasteful to lend any citational credence to them here). But my resistance to cite them is instructive in itself. As Kirmayer writes, “mind body dualism is so basic to Western culture that holistic or psychosomatic medical approaches are assimilated to it rather than resulting in any reform of practice” (83). My very desire to appear legitimate and substantiate the scientific basis of my work says something about the degree to which I have been steeped in Western biomedical epistemologies. The American Massage Therapy Association (my professional organization) also expends a lot of energy promoting and disseminating research that details the clinical efficacy of massage.
O’Dell writes, “as Mauss phrased it: ‘Magic, like religion, is viewed as a totality; either you believe in it all, or you do not’” (3). This begs the question: is medicine a totality? Is healing? I do not think it has to be. What I wish for is a middle path, the third picture above. Alter argues that “the tension between pragmatic rationalism and esoteric magic make yoga powerful” (119). Can this apply to massage and other alternative therapies as well? Do I have to be either a clinician or a “quack?” Can I incorporate elements of Western biomedical epistemology without sacrificing cultural and medical authenticity if I practice non-Western modalities[4]? Can I be both, and can this diversity of perspective lend power to my work rather than de-legitimize it? I certainly both believe and hope[5] so.
On a (more) personal note, I’d like to address one final point. Discussing the costs of medical objectivity Laurence Kirmayer suggests “it is the emotions of the physician, as much as those of the patient, that must be understood and reckoned with” (84). Similarly, writing about the spa industry, O’Dell notes “in this sense, they are not only mass producers of instant serenity, but in the eyes of their employees, they can even be understood as machines of stress production-and in this way an integrated aspect of the cultural and economic malaise that they strive to treat” (32). While I have already noted some beef I have with O’Dell, his point here is well-taken. As much as I believe we need to focus more on the veracity of the patient’s distress and emotional landscape, I think we also need to look at issues of emotional sustainability for the practitioner. Excessive objectivity may be dangerous for both patient and doctor, but excessive subjectivity and emotional identification can be equally damaging for both client and therapist. I recently took a three-month “mental health sabbatical” from massage after failing to adequately inscribe the boundary between myself and my clients and, consequently, burning out from taking on too much emotional content. Again, I invoke the middle path as the answer. We are all individual humans, but we are also inextricably linked to one another by our shared social, political, and evolutionary histories. We should recognize this simultaneous autonomy and interconnection through a health care system that respects and honors all bodies and people.
Notes
1 I tend to use the terms massage practitioner and massage therapist fairly interchangeably, though it is interesting to note the added clinical prestige of a practitioner. The word therapist could be seen to suffer from the connotation of more emotional and psychological qualities. The term O’Dell employs--”masseuse”--makes me cringe every time I hear it. For me it brings up the association of massage with sex (massage parlor, happy endings), and I would be happy if I never heard it again. It is possible that it does not have this association in Sweden, and it is also certainly true that many people may claim to use it “innocently” without realizing the social and political context within which it is embedded.
2 The conventional use of the term “client” instead of “patient,” on the other hand, reflects a less privileged position. Doctors (who have completed significantly more schooling than massage therapists) see patients.
3 I have many more thoughts on this phenomenon than space permits, but I do want to make sure to mention that I in no way view myself in my role as a human being in the modern Western world as an exception to this pattern.
4 Which I cannot say that I do, though my belief system is certainly inclusive of non-Western epistemologies.
5 Which is the will to believe.
Works Cited
Alter, Joseph S., 2005. “Modern Medical Yoga: Struggling with a History of Magic, Alchemy,
and Sex,” Asian Medicine 1(1): 119-146.
American Massage Therapy Association. “Research Citations on the Efficacy of Massage.”
http://www.amtamassage.org/pdf/rs2001_2.pdf
Gordon, Deborah R. "Tenacious Assumptions in Western Medicine," Pp 19-56 Margaret Lock
and Deborah R. Gordon, eds. Biomedicine Examined. Dordrecht, Netherlands:
Kluwer Academic Publishers, 1988.
Kern, Michael, D.O.,R.C.S.T., M.I.Cr.A., N.D. Wisdom in the Body: The Craniosacral
Approach to Essential Health. Berkeley, California: North Atlantic Books, 2005. Pp 14, 15, 42.
Kirmayer, Laurence J. "Mind and Body as Metaphors: Hidden Values in Biomedicine," Pp 57-93
Margaret Lock and Deborah R. Gordon, eds. Biomedicine Examined. Dordrecht,
Netherlands: Kluwer Academic Publishers, 1988.
Langford, Jean M., 1999. "Medical Mimesis:Healing Signs of a Cosmopolitan 'Quack'."
American Ethnologist 26(1): 24-46.
Netter, Frank H., M.D. Atlas of Human Anatomy, Third Edition. Teterboro, New Jersey:
ICON Learning Systems, LLC, 2003. Plate 510.
O’Dell, Tom. "Meditation, Magic and Spiritual Regeneration: Spas and the Mass
Production of Serenity" Orvar Lofgren and Robert Willim, eds. Magic, Culture and the
New Economy. Oxford, UK: Berg Publishers, 2005. Pp. 19-36.
The Who. "Who are You?" mp3, http://www.playlist.com/playlist/16956657163.
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