Mind, Matter and motion

Tradition and Innovation in Osteopathy

Robert Lever

• Publisher: Handspring Publishing Limited
• Year: 2020
• ISBN:
  9781912085880
• Edition: 1
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

This book is an adventurous foray into the subtle aspects of osteopathic diagnosis and treatment, the 'energetic' dimension in relation to the Lesion, the patient/practitioner exchange and touch; the clinical 'art' and the alchemy of practice. The role of visualisation and intention; the mind/matter dichotomy; the evolving view of osteopathy in relation to its proud legacy, and its often troubled place within the medical world. The vital balance between tradition and innovation and the enduring importance of our fundamental principles. Much of this book is relevant to other healthcare practices and might have appeal for other health professionals who also share some interest in osteopathy.

Chapter 1

Prologue

Scientific views end in awe and mystery, lost at the edge in uncertainty, but they appear to be so deep and so impressive that the theory that it is all arranged as a stage for God to watch man’s struggle for good and evil seems inadequate.

– Richard Feynman (Lecture ‘The meaning of it all: Thoughts of a citizen-scientist’, 1963)

It is part of the human condition to inquire. We are desperate to know ‘how’, ‘why’, and ‘when’ about almost everything. Why are we here? What do things mean? How do we make things happen? How do we stop things happening? How do we make things better and, if that doesn’t work, how do we work out why? Sometimes, our impotence becomes unbearable so that, when faced with the imponderable and the impossible, we respond in various ways: we might muster an attitude of awe and acceptance, appearing humble and serene, or we might create wonderful myths, stories, and symbols in an attempt to bridge ignorance and certainty and in order to live more comfortably in relationship with nature and the planet we inhabit. As author Karen Armstrong says, ‘Human beings have always been myth-makers’ (2005), and our great archetypes lend color, depth, and meaning to our human plight. This strategy works well for many. Others, on the other hand, exploit it, promoting dogma and creating cults and divisive attitudes or beliefs. The struggle to deal with our ignorance has often divided us over the ages.

But, of course, there is another way of living with uncertainty: cutting-edge science sits on the cusp of the known and the unknown, extrapolating from the assumptions based on current knowledge the potential that the rarest gifted minds can imagine. And, at this threshold, those minds create understanding out of mystery. In fact, they make mystery real.

Whether revising the Ptolemaic notion of Earth’s place in the Solar System, reinterpreting the nature of space/time and gravity in relation to relativity theory, exploring the nature of reality based on quantum theory, tussling with the principles of ‘vitalism’ versus ‘mechanism’ or the cosmological conundrum of the origins of our universe, we are driven by the need to find clarity in the face of these tantalizing challenges.

Similar challenges face biologists as they roll back the layers of knowledge to uncover the workings of living organisms with greater accuracy, refining knowledge of anatomy, physiology, and pathology, and discovering more about how things work and what sustains life. They explore and reveal the dynamic properties of the body’s structures and chemicals, along with its genes, proteins, connective tissues, and highly significant fluid and water content. From this writer’s vantage point as an osteopath, the privilege of being able to import knowledge borrowed from great men and women of science has enriched our own discipline immeasurably. Many of our theories and concepts have been enlivened by the imported revelations proffered by the biosciences. Paralleling this, the creative artistic fields have also loaned us insights into our own artistry and skills. Refinements of technique and the psychology behind them afford the translation of an intention based on analysis and reason into a biologically useful event.

ANDREW TAYLOR STILL

Still himself was a man of vision who bequeathed a view of clinical therapeutics based on the ‘structure/function’ concept: the notion that in living organisms, structure and function are interdependent. For 140 years the practice of osteopathy has been based on a model and a very effective one at that. Some of the ingredients of this model have been spurious, needing revision in the light of the revelations of science, but, strangely, this has not altered what we’ve done very much. The practice of osteopathy at its best is a holistic ‘top-down’ system, its strength residing in its holistic vision and the pursuit of ‘coherence’ in the body. Its methods are sound even though the nature of its rationales may have evolved. Much of this has revolved around a matter of interpretation, Still’s words tending to render our methods acceptable in the materialistic and mechanistically inclined culture that prevailed at the turn of the nineteenth and twentieth centuries. When its language insinuates the amorphous, the spiritual, or the numinous, osteopathy courts controversy and sometimes rejection, a position that has unfortunately changed little during its 140-year history. However, what has changed is the wealth of extraordinary revelations in physics and biology that are beginning to give scientific language to some of our less tangible ideas and methods. And it is some of these that I want to explore in the pages that follow. For the twentieth century during which osteopathy developed was an age of ‘mechanism’ and materialism like no other. As such, it was sandwiched between an era that was more dependent on philosophy, faith, and myth and their relationship with science, and our present time with its technology that, with its extraordinary counterintuitive ‘nanosphere’, shifts our focus toward the unimaginable. This is resonant with the great teachings of the East whose wisdom and tradition reach out toward the unfathomable worlds of consciousness and the ineffable.

For us, in osteopathy, much of this links with certain central themes: the nature of holistic function and information-transfer within and between organisms; the ‘coherent’ nature of health both intrinsically and in terms of the relationship between living organisms and their environment; the nature of ‘touch’ in a therapeutic sense; and the role of conscious (subjective) participation in the clinical situation.

Some of these issues have become illuminated by contemporary research. At the same time, they prompt reaffirmation of traditional wisdom and ideas that have been summarily eclipsed by the obsession with mechanism and the materialistic paradigm, a somewhat blinkered view of experience for all its success as a practical analytical vision of reality. Many traditional ideas that are being resuscitated in the modern era were supplanted or rejected for two main reasons: first, the technology was not available to support them to a level that satisfied the scientific scrutiny of the time; second, the culture moved away from the notion of subtle energy (including the electromagnetic basis of biological function) toward a more tangible and demonstrable science of classically based physics and the chemistry of cell function.

But scientific scrutiny can, of course, express the propensity to complement the inspirational and deductive ingredients of new thinking and new ideas. And, as has often been said, for new ideas to be new, they will start by offending many who cling a little too tightly to the safety of established fact. But such is the nature of progress: our certainties carry ‘sell-by dates’, and we should be ready, when appropriate, to challenge them. Sutherland posed a challenge when he elaborated the vital ingredient within the fluidic component of the living organism. Just as Still before had posed another with the assertion of the osteopathic principle and the significance of the fascia to health and physiology. It was largely ignored and rejected. But more than 100 years later, science is beginning to ‘rediscover’ the complex role of connective tissue and fascia. Myth has become reality!

REALITY VERSUS EXPERIENCE

The relationship between ‘reality’ and experience has obsessed philosophers for thousands of years, since Socrates and Plato, through the centuries of philosophy (with Locke, Hume, and Kant, for example), and penetrating the world of modern science, the physics of Newton, of relativity following Einstein, and the counterintuitive revelations of quantum mechanics.

Contemporary ‘reality’

Strangely and paradoxically, our mundane twenty-first-century world has delivered an extraordinary and unpredicted blow to these profound attempts to pin reality down in the form of two extraordinary contemporary phenomena, both enabled by technology and social media: the contrivance known as ‘virtual reality’, and modern myth-making known as ‘fake news’ that challenges our grasp on reality via the assertion that anything is ‘real’ if anyone says it is: the product of a culture of narcissism that places reality in the realm of the ‘self’ while at times alienating it from collective interest and experience. Having fanatically sought the basis of reality so assiduously, we now have every reason to be cynical of it!

The challenge of defining reality has then resulted in diverse strategies: the elaboration of classical myth and spirituality, the assertion of fact based on empiricism and demonstrable experience (via the senses), and the creation of a somewhat solipsistic version of reality driven by personal needs and self-interest.

This conundrum is interesting to those of us who celebrate the role of the subjective in the clinical arena and osteopathic medical practice in particular. Contemporary medical science has, of course, challenged it, striving to reduce or eliminate the subjective from clinical assessment, virtually stifling the art of diagnosis in favour of a ‘digital’ box-ticking approach. But, for osteopaths, this is uncomfortable and, as I’ve been at pains to point out in previous writings, it ignores two essential facts: first, the individuated nature of patients’ clinical presentations and, second, the interactive nature of our therapeutic skill (in both diagnosis and treatment).

OSTEOPATHY: ART AND SCIENCE

To speak of osteopathy as an art as well as a science has almost become a cliché. But dwelling on this briefly reveals something even more interesting, something with relevance way beyond osteopathy. It is the fact that somewhere enfolded in consciousness, the ‘art’ and the ‘science’ converge. If consciousness virtually creates our realities, we enter the strange world of contemporary physics that invokes the power of mentation and intention as prime ingredients of our physical participatory world. For osteopaths, this notion can be particularly tantalizing while it is especially pertinent. This is because our interactive dialogue with the patient has always to be balanced by discretion and clinical judgment.

The ‘lesion’, for example, while conspicuous and anomalous, is that part of the patient’s struggling wholeness that we ‘edit’ and define, to be seen in our chosen terms, enshrined within our special discipline with its perspective and its language. In the language of quantum physics, it is the process of observation, of ‘measurement’, of definition that de-contextualises the part, removing it from the seamless unity of the integrated whole, an ineffable wholeness that is a complex abstraction: the ‘quantum wave’ in physics terms. And it is the phenomenon of consciousness, of unceasing observation and perpetual awareness, that reduces the world and our existence into analyzable parts. This fact is the fuel of reductionist science and our culture of materialism. But the remarkable benefits and insights derived from this faculty of meticulous scrutiny are equaled by the imponderable, awe-inspiring nature of wholeness, whether in our cosmos, in complex systems, or in living organisms. And it is here that we reach out for and celebrate an orientation based on holism and systems theory. In contrast to reductionism, these permit a meaningful relationship with things whose ingredients are inevitably imperfectly grasped or defined. We derive useful knowledge about such things through the observation or perception of relationships between ingredients that can be identified or defined. This permits us to move beyond an understanding of things to the experience of them; at which point, it is then up to the individual to decide which is ‘truer’.

This interplay between the subjective and the objective remains pivotal in our culture and our participation in it. But, for osteopathy, it poses a challenge that is both real and perplexing. The analytical process in the safe practice of osteopathic medicine morphs into a diagnostic and therapeutic resonance that is more remarkable than we can know to reveal ‘energetic’ qualities in the operator’s skills that mirror those in the complex workings of mind and body themselves and of the connective tissue matrix in particular. We’ll explore some of these qualities in the pages that follow, including the extraordinary nature of touch, the bioelectric watery nature of communication (and health) in living tissue, an expanded view of holism, and the sheer prescience of the osteopathic concept.

References

Armstrong K (2005) A short history of myth, Edinburgh: Canongate Books Ltd.

Feynman R (1988) What do you care what other people think? London: Norton & Co.

Chapter 2

The enduring truths defining osteopathy

All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

– attributed to Arthur Schopenhauer (c. 1818)

Through its struggle to be understood, osteopathy has had a problematic tussle with its identity. What, if anything, defines osteopathy and makes it different?

More than ever, the range of therapeutic disciplines, many of them ‘handson’, is vast. Many have far-ranging clinical and ‘medical’ pretensions incorporating varying levels of medical science and skill. But the question remains: what distinguishes osteopathy from all other disciplines that share the notion that patients can be treated and assisted clinically through the manual treatment of ‘structure’ (or the patient’s structural anatomy)?

Curiously, this is a question that is even being posed within the profession. Why should this be so? I strongly suspect that it derives from the feeling – misguided perhaps – that we have still to ‘prove’ osteopathy to the satisfaction of those within mainstream medicine. Meanwhile, many in the profession claim, quite rightly, that other disciplines such as physiotherapy have espoused some of the principles that we once considered to be the exclusive domain of osteopathy. This may be true, but it does not rob osteopathy of its claims to its traditional wisdom, a wisdom that others may have come to share.

It is my view that osteopathy has always rested on a body of theory and knowledge, even if that knowledge has evolved. Many osteopaths themselves have been critical that some of our precepts have been unsubstantiated or inadequate; but this is so in all of medicine and science. Where osteopathy has been lacking is in the now fashionable and obligatory requirement of objective ‘evidence’, ideally supported by randomised controlled trials. These involve research protocols that are difficult to apply when individual variability (in both patients’ presentations and practitioners’ methods) is so enshrined in our approach. What is more, it is difficult to describe the implications of a holistic ‘top–down’ concept in terms that belong to a reductive ‘bottom–up’ culture.

Broadly speaking, osteopathy has much in common with other manual medical disciplines. If ‘structure’ and ‘function’ are fundamentally interrelated, then this notion, and its potential for patient benefit, obtain whatever the approach. It is salutary to look at both the notions developed by some of the great thinkers over the years whose contributions inadvertently contributed to what became the osteopathic concept and also to consider some of the distinguishing features of osteopathy itself that give it its distinct flavour. So much has been contributed to our expanded view of osteopathy from so many intellectual quarters, for example, philosophy, physiology, physics, and biology, along with the constant interpretation and re-interpretation of ideas that were expressed by our own great thinkers like Andrew Taylor Still, William Sutherland, John Martin Littlejohn, Dain Tasker, Louisa Burns, Viola Frymann, John Wernham, Edward Hall, Rollin Becker, Bob Fulford, Bill Johnston, Willis Haycock, Charles Bowles, Harold Hoover, Herb Miller, Anne Wales, Thomas Dummer, Fred Mitchell, and many more. In developing and contributing their ideas, these people have enriched osteopathy while emphasizing different aspects of the concept. As we know, this has meant differing ‘flavours’ within osteopathic practice that we have characterised with various labels such as ‘Structural’, ‘Cranial’, ‘Functional Technique’, ‘Specific Adjusting Technique’ and ‘Muscle Energy Technique’, Contrary to the assertions and prejudices of some, these methods share the fundamentals of the osteopathic concept while sometimes interpreting and applying them in contrasting ways. (It is not so much the technique that is important but the thought process behind it that gives it its efficacy and its potency.)

A CONTINUUM OF KNOWLEDGE

As Littlejohn himself stated, all knowledge exists on a continuum of knowledge that has come before and that will develop into the future. Osteopathy is based not on ‘new’ knowledge as such, but on an innovative way of assembling existing knowledge into a conceptual approach. For example, developments in the understanding of tissue function, the science of phy...

Table of contents

• Cover
• Reviews
• Title Page
• Copyright
• Contents
• Foreword
• Author’s note
• Preface
• Chapter 1: Prologue
• Chapter 2: The enduring truths defining osteopathy
• Chapter 3: From ether to consciousness: the energetics of the lesion
• Chapter 4: ‘Reality’, uncertainty and alchemy in practice
• Chapter 5: Osteopaths’ ‘structure and function’: what are they really? A matrix of function
• Chapter 6: Mind: intention, visualisation and projection; the clinical art
• Chapter 7: Coherence is all: patterns and holograms and broadening the concept of holism
• Chapter 8: The ‘osteopathic lesion’, then and now
• Chapter 9: ‘Psychosomatic’: are psyche and soma so different? Returning the mind to the body where it ‘resides’
• Chapter 10: ‘Hearing’ the patient, brokering health
• Chapter 11: Square pegs in round holes: the folly of misguided scrutiny
• Chapter 12: Survival: a bold future … ?
• Bibliography
• Index