I head underground. I choose the cleanest seat available; one slightly removed from the other people. I sit.
I feel an incredible warmth surge up the back of my thighs. It follows a path all the way up to the level of my shoulder blades. It is pleasant. I push into it.
I feel both feet firmly planted into the ground, even through the thick layer of rubber that makes up the bottoms of my boots. I can choose to which foot I put more of my weight. And I can choose to which part of each foot I put my weight. This is apparent in the amount of resistance the floor gives back to me. It feels good to have choices. It feels good to find an unexpected playmate in the ground beneath me.
I am aware of an airy space around my calves and knees and then pressure into the backs of my thighs, accompanying the heat.
I place my hands on the tops of my thighs and experience their shape and density. I am aware that I am not just touching pant material; that I am not just contacting human flesh. There is something else. I sense another layer. Between my hands and my thighs there is an energy. I feel it.
Like hovering above a Ouija board for the first time, I am transported back to one of my elementary school sleepovers: a room full of young girls, nervous and giddy with anticipation, all trying to psych each other out, but all secretly eager for the magic; for the goosebumps; for the unknown to reveal itself.
If I hold my hands there long enough (just feeling; just sensing), my hands completely disappear. The lack of movement prevents any proprioceptive information from entering my brain. I no longer experience my hands as separate from my legs, or from the air around them.
What I am left with is pure sensation, warmth, a feeling of oneness, a loss of the concrete converted into some mysterious realm where everything seems to float together: atoms intermingling.
With eyes closed, my entire body disappears into the surrounding environment; I feel light; free.
Yet, even during this momentary spiritual experience, I am still aware of the sounds: the rumbling, the rattling, the screeching; metal over metal, propelling me forward; the sounds that prevent me from disappearing completely.
I am aware of the other people. They are not near me, but I can sense their approximate distance with accuracy. I am aware that the relatively small woman, sitting a few seats down to my left, just got up to leave. I am aware that her spot was replaced by a large, clumsily walking man. Maybe he has a limp? A slight handicap? He drops his body weight without control, and the vibration streams through my body.
I can also sense the people who are not moving; who are sitting quietly, eyes closed, just like me. Perhaps I am picking up on their heat? Their electromagnetic fields? Their emotions? Their intentions? Who’s to know?
As much as I want to dive out of my physical body into this savory, delicious feeling of ethereal bliss, the constant oscillation of acceleration and breaking keeps me grounded here in the moment; grounded in my feet; grounded in the weight change that encourages the floor to play with me.
Oh, and the smells! How did I forget the smells?
Olfaction: the quickest sense to reach my cerebral cortex; my conscious awareness. The smells had hit first, before I had even chosen my seat. They already offered me all the information I require. What did they tell me?
Well, that this is a dirty place; it smells subtly of human excrement. They told me that nothing will kill me in the immediate, but that I certainly should not get too comfortable; this is no place for a picnic. In fact, it would be best to keep my mouth closed and filter everything through my nasal apparatus. There is little oxygen down here; poor ventilation, but survivable. Humans have experienced far worse.
Ah, the smell. In any other place it would be revolting, but here, it is part of the daily routine; part of the banal quotidian experience; harmless. This is why my brain has chosen to filter out the signals coming in from my olfactory nerves, making the most repugnant odors simply blend into the background; barely detectable.
All the while I am on this sensory journey, my body (below my level of awareness) is keeping my heart beating at a steady and appropriate rate, my blood pressure regulated, my breath involuntary; finding oxygen automatically even without any sign of green plant life down here. My metabolism is constant; cells taking in glucose and producing ATP. My brain is processing memories, processing emotions, absorbing new information. My lymph is slowly moving, detoxifying a highly toxified urban system.
What even is lymph? Thank goodness my body knows! I can’t imagine using my conscious mind to manage a system I don’t even understand.
I hear a woman’s scrambled voice; half-machine/half-human. She is speaking words barely coherent, but I am able to decipher “59th Street”. This is my stop. The daydream immediately vanishes; the reverie crowded out by preparatory thoughts: Did I leave clean sheets on the table? How long will it take the table to heat up? Do I have time for a cup of tea before my client arrives? What approach am I going to use to balance her pelvis with her cranium today?
As I stand up and walk off the train, my sympathetic nervous system kicks on ever so slightly. My heart rate increases, as does my respiration. I try to beat the slowest movers through the turnstyle and up the stairs. My eyes scan my surroundings, hyper-aware of all the stimuli and constantly helping my legs strategize the quickest, most unpopulated route. I make it to my office unscathed, adrenaline pumping.
Now to recenter before I put my hands on my client. I consciously walk myself through the steps: Breathe. Activate your diaphragm. Let your belly expand. Know that you will soon return to equilibrium and be able to give your full attention to the needs of the people who come to see you today.
I smile and let out a small chuckle. I feel blessed for this awareness of what is happening under my skin. If I had to name this movie, I would call it “The Ultimate Human Experience”, in 4D, complete with full sensory simulation.
The above journey only lasted about 15 minutes, and barely scratched the surface of the incredible inner-workings of the human body. As I have heard Joshua Rosenthal, the founder of the Institute for Integrative Nutrition, say many times, the body is an amazing bio-computer. It continuously keeps our hearts beating, our lungs working, our cells functioning, our brains thinking, our senses perceiving, our muscles moving and on, and on, and on. Can we please take a moment to celebrate the countless things that go right with our bodies every day?
This leads to a really interesting series of questions: What causes things to go wrong? What does it mean to be sick? Why do some people heal and some perish? And what does it even mean to heal?
My Personal Postulate
What does it mean to heal? Lately, I hear a lot of people refer to the etymology of this word as coming from the Old English “to make whole”. I really appreciate this concept of healing as making someone more complete. What a beautifully poetic way to describe someone’s health: complete.
In describing healing this way, I find it to be distinctly different than curing. To cure someone is to alleviate or manage that person’s symptoms. Curing is about making a condition livable by treating its superficial manifestations, rather than its root cause.
Healing is about understanding the root causes of an affliction, acknowledging them, working through them and reintegrating all the pieces as to feel complete; not merely symptom-less. True healing will take more than medication; it will require a prescription of individualized nutrition and movement; it may need a dash of spirituality; it will take forgiveness, compassion, self-acceptance and self-love.
What do all of these prescriptive elements have in common? They all act to harmonize the physical, emotional and spiritual bodies; they function to establish an internal terrain in which healing is even possible. If you do not have fertile, nutrient-rich soil, you cannot grow good health; these elements are your nutrients; your fertilizers.
Is this to say that anyone who eats well, exercises, partakes in a religious practice, has supportive relationships, a dream career and balanced emotional health will never get sick? Or that he/she will be able to overcome any illness? No, but the chances of recovery and recuperation are far greater when the human psyche, human heart and human body are in sync, keeping the stress response from becoming overactive.
The stress response (and the deleterious effects of excessive amounts of cortisol flooding the system for prolonged periods of time) is a big topic in the discussion of mind-body medicine and the body’s ability to heal. The takeaway point is that the body has the ability to heal itself by itself, if given the proper conditions in which to do so.
You can read more about the stress response and ways to minimize its activation here:
What are the proper conditions?
I have already named several, but here is a good working short list:
- 7-9 hours of sleep, at least 5 days per week
- A predominantly plant-based diet (4-5 servings of fruits & veggies per day, at the very minimum)
- At least 30 minutes of physical exercise per day (can include walking)
- A social network of peers with the same health values as you
- A healthy emotional body (not holding onto anger, regret, resentment, grief, etc.)
- A healthy psyche (a belief in your own health/that you have the ability to heal)
- A regular spiritual, meditative or faith-based practice
- A sense of purpose (WHY do you want to be healthy in the first place? How will you use that health to better serve your community and the world?)
When you feel great, you’re able to move through your days with joy and ease, creating and nurturing supportive relationships and a career you love. When you do not feel great, you can utilize that already developed and fortified internal terrain to help you find your equilibrium again.
Once you have inner comfort (especially when combined with a strong sense of purpose), the external environment almost becomes irrelevant; you have created a foundation that has the ability to support healing on all levels.
The Extreme End of the Spectrum – Blue Zones
In speaking about disease and healing, we might as well bring longevity (the absence of disease) into the discussion.
While particular choices around food, exercise, community activity and career are (and should remain) bio-individualized, there are some key factors that are consistent among pockets of extreme longevity around the world.
Dan Buettner is famous for, what he has dubbed, the Blue Zones. He found 5 areas around the world where the collective population is overwhelmingly made up of centenarians; totally healthy, able-bodied, cognitively-strong, physically active and community-involved centenarians.
Back in 2012, he wrote this great piece for the New York Times, entitled “The Island Where People Forget to Die”. It was about a Greek man, born on the island of Ikaria, who in his early 30s settled in the United States, and over the next 30 years, raised a family.
In his mid-60s, with a lung cancer diagnosis and nine months left to live, he and his wife moved back to his native island. Without any chemotherapy or medical intervention (beyond the care of his family and childhood friends), he not only had a complete recovery, but he went on to live an abundant 3 ½ more decades.
Keys to Longevity
In doing his research, Dan Buettner found that among these extraordinary populations, while there were variances in geography and cultural tradition, there were some key factors that were well represented in each enclave:
- Predominantly Plant-Based Diet – While vegetarianism is not essential, all of these populations consume animal protein sparingly (if at all) throughout the week, or save it for very special occasions. Also, food is mostly locally grown and harvested, making seasonality a key feature in the nutrition profile.
- Exercise – Every day, these individuals are swimming, walking, lifting weights, riding bikes, gardening, climbing hills and even spear-fishing well into their 90s and beyond.
- Social Network – The people in these communities unabashedly know everyone’s business; some of them have been friends for over 90 years. There is a tight social network that is supportive and helps to alleviate the daily worries of life. Loneliness is not an option among these groups.
In addition, many of these communities have some weekly faith-based activity that not only gives them a reason to congregate, but also enhances their spirituality as a group.
- Purpose – Health is not a goal. The answer to the question “Why do you want to be healthy?” is a goal. Each and every individual in these groups has a strong reason to get up in the morning. They are still contributing substantially to the community and thriving because of it.
- Rest – In most of these areas, the general pace seems to be slower; there is not a constant rush nor a tight schedule to keep. People have a strong circadian rhythm, symbiotic with nature. They also rest when they need to, taking naps in the middle of the day and consistently getting a good night’s sleep.
There is a lot of research on the effects of loneliness, and it can not be stressed enough how detrimental the lack of a supportive, community structure is to human health; we are social animals. It is even said that over time, the cumulative effect of loneliness is worse for your health than smoking cigarettes.
Part of creating a healthy internal terrain that supports healing, is to surround yourself with people you love, and who love you in return. Healthy habits are just as contagious as unhealthy ones, so when you choose friends who share your values on health, you are doing yourself (and them) a great service.
As Relates to the Therapeutic Relationship
As a manual therapist, I am intrigued by the human hand’s potential to have a healing effect. How does this work? And why are the results so inconsistent?
There are therapists and healers who have had remarkable success with hundreds (if not thousands) of patients, but they definitely have not healed everyone they’ve put their hands on.
Likewise, there are patients with the exact same diagnoses (sometimes with a terminal prognosis), yet some go into complete remission while others fade away. What determines who survives and who does not? By what mechanism is this healing (or lack thereof) happening?
I have studied countless modalities of bodywork, with countless teachers. I have made anatomy and physiology a life’s work. I have touched hundreds of human bodies of all different ages, sizes and ethnicities. I have had great success with certain patients and certain health profiles, but I have also been ineffectual in certain cases.
At points in my career, I have perhaps been too convinced of one or another theory and its purported effectiveness. I express this in a slightly disparaging way, for as I advance in my career, I now understand that an overly myopic therapist can be a deterrent to a patient’s ability to heal.
There exist as many healing modalities as there are cultures in the world; to say that one method is better than another, is highly arrogant and also terribly shortsighted. Traditional healing methods grew up out of a collective belief system of a particular people. As we saw earlier, community plays a critical role in the healing experience; so do that individual’s beliefs around health. If someone feels a cultural connection to a particular form of treatment, it has been shown that the efficacy of that treatment is more probable and that the individual’s health will very likely improve.
Mind Over Medicine
Dr. Lissa Rankin wrote a great book called, “Mind Over Medicine”, in which she tackles this very question of the body’s ability to heal. The book is filled with endless bits of intrigue on human healing and spontaneous remission, all founded in scientific research. In mentioning the power of cultural heritage and the subsequent efficacy of traditional medicine, I am reminded of a concept in her book: the doctor as the placebo, or worse, the doctor as the nocebo.
I find this a lot in my older clients; perhaps because they grew up in a time where doctors would make house calls, get to know the family dynamic and understand all aspects of their patients’ lives. My clients’ upbringing established the “modern medical doctor” as not only an authority on human health, but also as a family friend; someone to be trusted implicitly. As a result, these older clients often experience the doctor as the placebo; as the cure. They have such a strong faith in the doctor’s ability to diagnose and treat their symptoms, they often get better just knowing they have an appointment scheduled on the books.
I also see the opposite: the doctor as the nocebo. Let’s say an individual grew up in a culture where there was a local medicine man or shaman who would counsel the community through challenging times. This authority figure may have used locally grown herbs and plants to create homemade medicine; may have integrated ritualistic and spiritual components into the healing process; may have included an energetic aspect to the treatment.
This picture is something very different than what we find in a modern doctor’s office. Consequently, a person who grew up in that tradition might be very skeptical of a modern doctor’s ability to evaluate and treat.
Another possibility is that a person grew up within the framework of a modern health care system, but had some horrible past experience; either suffering him/herself, or watching a loved one fade among all the modern medical technologies.
Whether from an inherent trust in cultural tradition, or from a traumatic past experience, both of the above cases might experience a visit to the doctor as a nocebo; a psychological stressor so strong, that their health actually gets worse. This same result is also seen among people who have so much fear around a potentially dreadful diagnosis, that the fear literally makes them sicker.
Massage and Research
I have seen some really interesting research on the positive health effects of regular massage therapy sessions. However, I know that the reason there is not more great research to help back-up what most therapists seem to understand intuitively, is that it is nearly impossible to craft a gold standard, placebo controlled study on any method of bodywork.
Why? Because there are way too many factors to be taken into consideration, many of which we cannot even conceive of with our conscious minds:
- No two sessions are ever the same…ever!
- No two therapists are ever doing exactly the same work
- No two clients are ever experiencing the exact same work
- Even the same therapist and same client across multiple sessions, will every time have a slightly different experience
Besides any measurable physiological changes (e.g. lowered blood pressure) or self-reported improvements (e.g. decreased pain), I believe all manner of indescribable events happen when one human touches another; especially in a loving way with an intention to heal. Just look at how many observations I had in my 15-minute subway ride, sparked by placing my own hands on my own thighs. Those were a mere handful, and only represented what I could take in with my conscious awareness.
Clients who comes to me, entered the world with births of varying difficulty. They were each raised in different households, by different parents, in environments with an infinite number of variables. They have experienced past physical traumas and past emotional traumas; some more resilient to overcome those traumas than others. They formed varying beliefs around health and healing. Some of them may even see “pain” as a way of getting sympathy; a way of getting love. They might not be ready to heal their pain, for they have not yet found another way of getting attention.
Before they enter my treatment room, they have already formed an opinion around whether they believe I can help them or not. After some discussion, that initial opinion might change or it might remain the same. I too, upon evaluation, will form an opinion around whether I believe I can help them or not.
And then I put my hands on them. Just like when touching my own thighs on the train that day, everything might shift in an instant. They are lying down, soaking in some much needed rest, finally feeling their parasympathetic nervous system activate, finally feeling some calm, finally feeling some much needed therapeutic touch. All the past stories, belief systems, upbringings, traumas and opinions might very well fade away, and they might find that this type of bodywork helps them so much, as it allows them to find their own equilibrium.
Or nothing might happen. Or they might feel worse. Or they might think the session was a big waste of time. Ha!
But is that result because of me, the therapist? Because of them, the clients? Because of the particular type of bodywork? Because of their beliefs around healing? Or their potential resistance to the healing process?
There are far too many things happening when one human touches another (not to mention all the things that happened leading up to that moment of contact) to ever be able to calculate the therapeutic exchange in a meaningful way, as to satisfy the scientific researcher. But does that even matter?
What are Therapists Doing?
One of my colleagues and I recently discovered an article that was highly critical of thixotropy; the property by which a substance will become less viscous with applied heat or physical pressure. As myofascial release therapists, we apply the concept of thixotropy to the colloidal matrix that is human connective tissue, and theorize it as one of the primary mechanisms by which myofascial release works.
Even though this principle is one of the foundations of my work, I have no problem at all with the criticism. Originally this concept was extrapolated from research on the properties of connective tissue, and adopted by myofascial therapists as a way of explaining the work that we do and its effectiveness.
As we have already seen, the research of massage is tricky at best. If as therapists, we turn to research in order to validate the work we do, adopt a potential theory to explain efficacy and then realize that the available research is not actually a good fit, does any of that change the efficacy of the massage modality? We were getting results long before the research ever began.
My colleague seemed concerned that this criticism might undermine our work as fascial therapists, and started to questions what is actually happening when we touch our clients. We have both studied multiple modalities of bodywork, so in referencing her studies of Neuromuscular Therapy she asked, “isn’t it quite possible that what we’re doing is facilitating neuromuscular reeducation, rather than manipulating the connective tissue matrix?”
I might add isn’t it possible that we are also balancing out the energy meridians, as our work sometimes resembles Shiatsu and other acupressure-based methods? Or isn’t is possible that we are doing Reiki (working more on the energetic body), as myofascial therapists tend to engage the tissue in sustained holds of substantial duration? When we engage patients to actively move while we are working on specific areas of soft tissue, is that not highly similar to Active Release Therapy?
The answer to all these questions is a resounding YES!
Not only is it probable that we are utilizing all of the above-mentioned methods at once, we are almost definitely also doing a number of other things we never even considered; concepts we would not be able to show in a scientific way. There is so much cross-over among various manual therapies, it would seem impossible to not use multiple mechanisms at once.
A Healer’s Existential Crisis
The question of what we are actually doing as healers, has also been weighing on my mind (hence this blog post). In all honesty, the more I study, and the more I understand, the less I have any idea what I am actually doing.
It seems like a horribly stupid admission for a therapist to commit to writing, but it is obvious to me that understanding therapeutic concepts theoretically, does not allow you to better comprehend the mechanism by which healing happens.
As I have expressed multiple times now, there are countless things that occur when one human puts their hands on another; and that list of countless things will be totally different for each person, based on the concept of bio-individuality. For my part, I no longer need to know exactly why or how my work is effective; I just need to know that the person I am touching feels better after than they did before.
I am increasingly questioning of the therapist who is overly dogmatic about his/her preferred methodology. For decades, I have studied with many teachers in a somewhat reductionistic manner; dissecting the human body from their particular viewpoints. Now, in putting all the pieces back together to take in the whole picture, I realize that the technique is almost irrelevant.
I now believe that regardless of your chosen modality, there are some crucial keys to an effective therapeutic relationship:
- human connection
- established trust between two people
- an ability to listen to and see the entire picture (not just the current symptoms)
- beliefs around health & healing (from the therapist’s perspective and the client’s perspective)
This understanding has also allowed me to remove my ego from the therapy room. All my knowledge, continued studying and practice are meaningless if all my client needs in order to heal, is a safe place in which to be heard.
Healing is not some tangible gift that a therapist gets to hand to a patient. It is not even some abstract concept that the therapist transfers over. All the healing happens within you! The therapist is simply a guide, helping you to better understand your own body and navigate your own healing. The human body is not a structure; it is a process. Healing is simply a component of that process.