At the Still Point of the Turning World

The Art and Philosophy of Osteopathy

Robert Lever

• Verlag: Handspring Publishing Limited
• Jahr: 2013
• ISBN:
  9781909141414
• Auflage: 1
• Thema: Medicine
• Thema: Alternative & Complementary Medicine

The healing arts involve a complex range of skills which each practitioner draws together in a unique way. These skills, attitudes and perspectives complement the scientific basis underpinning each discipline to create the wisdom and artistry of any therapeutic approach.

The practice of osteopathy is no exception. It involves a growing field of scientific knowledge in physics and biology that couples with an extraordinary range of human qualities to give the work depth, as well as relevance, and which can be tailored to the individual patient holistically and with compassion.

At the Still Point of the Turning World examines and explores both the art and the science of osteopathy through the eyes and approach of a devoted teacher and practitioner. The true value of holism, vitalism and osteopathic principles are discussed as part of the approach that each practitioner brings to the patient/practitioner relationship.

Part 1

Principles

Chapter 1

Osteopathy: an overview

Healing, Papa would tell me, is not a science, but the intuitive art of wooing Nature.

(W H Auden: The Art of Healing)

In our professional role, we as osteopaths spend a lot of time helping patients find answers: ‘answers’ to help with pain and other symptoms, ailments or complaints. Sometimes this is purely palliative, sometimes part of a quest for better health. Sometimes it’s a way of addressing deeper struggles or attempts to find meaning and reasons for things. This may help patients find ways of controlling their problems, if not their destiny! Meanwhile, the search for meaning and control is, perhaps, the driving force behind most if not all of our endeavours in the context of what it is to be human, but the drive towards ‘structural balance and integrity’ and everything that this enables, is what dominates osteopathic thinking. And what is truly remarkable is just what this does enable and the potential for change that it can afford on so many levels of human function and experience. I sincerely hope that this book goes some way towards showing why this is possible, why it happens in daily practice, and something of the process by which we can help it to make it happen.

Background

Osteopathy, or osteopathic medicine as it is sometimes called, is one of many windows on the wider world of meaning whether its purpose is focused on the relief of pain, a pathway to improved health, a means of coping or finding a sense of direction or purpose, that precious quest without end, or simply on helping people live more comfortably ‘inside their own skins’. And as such, osteopathy is one form of ‘interpretation’, one of many approaches that dedicates itself to making things better. However, it has managed to acquire a number of stereotypical misconceptions over the years about what it is and what it purports to do and when it ‘states’ its potential honestly, it is often viewed as pretentious, over-ambitious or even arrogant. One of the reasons for this is that its methods and its theoretical basis are viewed against the backdrop of a highly developed medical sophistication and technology that are of a very different cultural flavour. Osteopathy and mainstream medicine may well have approximately similar goals – healing – but they are conceptually as different as painting and music. When osteopathy was conceived, it was both a reaction, almost a revolution, and an alternative. But above all, it was a new way of seeing; a way of conceptualising health and disease that called for a new way of treating patients. Indeed, its methods were dedicated to the ‘location’, enhancement and expression of health in the patient more than the confrontation of disease per se.

Misconceptions

Let’s look at misconceptions about osteopathy first and then at its evolution over its 150 years’ history. Sit next to a perfect stranger at that sometimes grim phenomenon known as the dinner party and naturally enough and pretty soon the subject of one’s occupation will arise. All of us in the profession will have heard one of the stock responses: ‘what’s that?’ (although this is becoming rarer in the last 30 years); or ‘oh that’s bones isn’t it?’; or, ‘oh that’s backs’; or the ‘tabloid-oriented’ might gleefully recall Stephen Ward – ‘society osteopath’– and the notorious ‘Profumo scandal’ of the 1960s, imagining us to have equally colourful if not scandalous lives; or perhaps someone will launch into a description of back-related pain that invites on-the-spot consultation. One colleague would circumvent the tedium of such conversations, bringing them to an abrupt close with the words, ‘Actually, I sell spoons’! Well, given that things like that don’t happen without a reason, why is it that members of the public have so little idea about osteopathic medicine unless, that is, they have personally experienced osteopathy at its broadest and best? Why has Andrew Taylor Still’s vision been so poorly understood and interpreted?

The question is really a far deeper one and not only involves the problem that any society or culture has with the integration of new ideas but also the resistance to embrace new perspectives. When Dr Still established osteopathy in the 1870s, he was already a practising physician and for reasons known to many in the profession (see below), he propounded the concept of osteopathy as an alternative, not as an extension of conventional medical practice. Now as much as we need and teach medical science in its conventional guise and integrate it into the whole matter of patient care, the true practice of osteopathy has to sidestep conventional methods, almost completely, to base its diagnostic and therapeutic practice on a very different paradigm.

It has been said that if a new idea involves too many logical steps to integrate it into the established canon of knowledge, it will remain on the sidelines where it will be consigned to ‘cranky’ unorthodoxy at best and oblivion at worst. Alfred Pischinger (1899–1982), for example, who pioneered research into the significance of the extracellular matrix and its role in disease causation made such a valuable contribution to a truer understanding of disease, yet his work was too radical to be absorbed into the mainstream and has been largely ignored or forgotten. Comparatively recently it has been resuscitated as its relevance is being realized, more particularly within those disciplines that focus on the predisposition to disease rather than the confrontation of it. But we’ll look at this more a little later.

Meanwhile, the culture of scepticism daily rejects so-called ‘alternative’ approaches, blind to their complexity, seeing them as transgressions of what is anyway an incomplete and sometimes erroneous ‘orthodox’ medical concept whose adherents remain convinced of its infallibility. Add to this the weight of the establishment/mainstream credo, and the integration of alternative principles can become a forlorn hope with as much promise of meaningful dialogue as an acrimonious divorce. I often think that the articulate and intelligent critics of alternative methods might sometimes temper their certainty with a willingness to look outside their beautifully crafted conceptual boxes. To be genuinely and constructively discriminating is to ‘let go’ of certainty, to allow knowledge to point the way towards the unknown, rather than merely to underscore the already proven.

PARADIGMS

In his classic text The Structure of Scientific Revolutions (1962) on the crisis essential to the ‘paradigm shift’, a phrase he coined, Thomas Kuhn elucidates for all time the way that major advances in science and knowledge ‘happen’ rather than ‘evolve’. The happening may well require an evolution of thought but it is when the creative leap occurs that innovation is truly born. This might be the result of inspiration, intuition, divine intervention or sheer genius or the overlapping of all these, but it occurs rather than develops, often as a by-product of the methodical search for something else. What is virtually inevitable is the way that innovation is resisted, feared and rejected, though what I’m afraid sometimes ‘oils the wheels’ of acceptance, might be political or commercial expediency. (Clearly, in this respect, no one had much to gain from the integration of osteopathy into health care, at least not for a while!)

What is worse for osteopathy is that as a profession, it has reacted to ostracism by bargaining with the establishment and attempting to dress itself in ‘respectable’ clothes, even believing that it should conform to the conventional model to gain acceptance. Sadly, this has created a schism in the profession but more strangely, it has as a trend ignored the fact that medical science is itself changing all the time while some in our own profession cling to worn-out models! Some of the newer models have evolved from contemporary physics and this has provided some of the most exciting underpinnings of the osteopathic method that we have known. The problem is that these innovations in science are truly challenging and their proponents have similar problems of acceptance amongst many of their peers. But here, it has to be said and said loudly, that if ‘new’ knowledge simply exaggerated and elaborated what we knew already, nothing much would have changed in the history of civilisation.

Likewise, if musicians and artists had never offended established opinions and tastes (which many of the great ones did), their art would have died from stultification. Allowing for the vagaries of fashion, many have broken new ground to drive their art forward, celebration only gradually replacing vilification and derision. Look, for example, at the public reaction to Manet, Turner, Van Gogh, Scriabin and Stravinsky. Time would have to pass before their influence and pivotal place in the evolution of their artistic fields would be appreciated, respected and acclaimed. The breaking of new ground, so vital for progress, inevitably entails the radical restructuring of the ‘established,’ whose minions and devotees are profoundly threatened and outraged by change.

I am not too concerned here with writing a history of osteopathy; others have tackled this task admirably, many within the profession will be fairly familiar with it and others of my readers might have only marginal interest in it. However there are certain aspects that seem to engage people. One is the misconception that osteopathy is derived from eastern culture; a view that many of our patients have voiced. Many eastern philosophical and spiritual ideas have certainly influenced some aspects of practice for several – though certainly not all – practitioners. However, osteopathy was born in the United States, in Missouri; delivered into the world by a physician, Andrew Taylor Still, who was born in Virginia and whose father was a Methodist minister in a predominantly farming community. Various cultural influences might well have shaped Still’s ideas since his time living and working with the Shwanee Indians in the 1850s, but osteopathy was an American import.

STILL AND ORIGINS

There can be very little doubt that Dr Still saw his version of medicine as a radical alternative to the medicine of the day. Many patients and their families come to us now for the same reason, as an alternative to the mainstream. Still’s reasons were very personal. He had lost three children from spinal meningitis and this experience filtered through his almost obsessive musings on the body, on what we would now call functional anatomy, and on the natural order of things. Still was a highly spiritual man though he probably had little time for formal religion, and his spiritual sense expanded his philosophical approach to the human condition that led to the assertion of a vitalistic principle that expressed the potential for health and repair in the body, provided that certain conditions were met, a dynamic propensity that he called ‘biogen’. This potential was based on the principle of unity of function (integration), the biochemical mechanism of self-regulation, and the prime requisite of healthy physical and mechanical ‘adjustment.’ The idea that the balanced complex integration of the body structure – most importantly including the fascia – being intimately related to health, healing and self-repair was born. So was an approach to manual treatment that was designed to enhance it, and Still called it ‘osteopathy.’

Now, however complex the art of this work may be and however hard it is to acquire the necessary skills of diagnosis, palpation and technique, this notion can sometimes appear banal in the face of the medical sophistication that we are so used to in the orthodox arena. But it was ever thus. Still’s ideas were ground-breaking, and although he had derived some of his ideas from pioneers in other fields, it was his inspiration to bring them together in the form of a medical discipline or system, to advocate an almost passionate interest in anatomy and to assert the relationship between ‘structure’ and ‘function’ that was to form the basis for the system that has been practised for 150 years. The orthodoxy of Still’s time simply couldn’t wear it and frankly, many would say they haven’t really worn it since! However, we’re still here and though many in the profession have felt the squeeze of disapproval from the medical establishment and have sought a more comfortable place within it, involving a significant compromise of principle, there are others who see Still’s truths as vividly as ever, whose practice is based on them and who continue to explore available developments in science that validate the work and Still’s gift.

Some inside the profession will be disappointed by my reluctance to have osteopathy conform theoretically or methodologically to conventional medical discipline. Such conformity – for either politically expedient reasons or through the bowing under the weight of medicine’s undisputed achievements – would be disingenuous. Osteopathy has always been a different discipline with strengths that are its raisons d’être. Without them, and by compromising to become an ‘add-on’ to the structural end of medicine, we would gradually lose our role and cease to be, with our unique voice. Some would say such a danger is closer than we think. Furthermore, the ambiguous relationship between osteopathy and the mainstream has taken many different forms in different parts of the world. In some countries, it is illegal; in others it is permitted but only if practised by medical doctors; in many, it exists as an independently regulated profession, as in the UK; and somewhat paradoxically, in the USA, the birthplace of osteopathy, it has undergone a political ‘mutation’, in which it has donned the guise, training and discipline of the allopathic profession leaving a tiny minority who have continued ‘on the path’.

When Theresa Cisler edited and produced the compilation of impassioned writings of one of osteopathy’s elder statesmen, Bob Fulford, under the title Are We On The Path? (2003), it posed the very real challenge to the profession that, in many respects, we weren’t. The struggle that the profession has experienced with this ‘true’ relationship wit...