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Dopamine and Desperation

This past weekend, I attended a seminar on how to write a bestseller. Unsurprisingly, the focus of the event was mostly upon publicity and marketing. (If nuanced insights and a scintillating prose style were all that were required to sell books…well, I can dream.)

One of the speakers had a lot of energy. At first, I thought he was caricaturing the manic marketing guy; he was talking so fast, and in such a high-pitched voice, that a punchline seemed imminent. But he kept it up. For an hour. By the end of the hour, I was horribly certain that if producing a bestselling book requires a person to become a compulsively Tweeting, twitching shell of a human being, I will die in obscurity.

That ‘bestselling author’, however, will die of a nervous breakdown some forty years before I do.

Recently, I read Susan Cain’s new book, Quiet: The Power of Introverts in a World that Won’t Stop Talking. This book is a bestseller for a good reason. It’s piled with non-obvious insights about the way people’s nervous systems differ from one another, and the implications for the way they function in work and society.

One insight which floored me is that introverts and extraverts have substantially different patterns of ‘reward’ in their brains. An extravert gets a huge hit of dopamine whenever they win something–a sporting event, a game of blackjack, the top 10 list on the New York Times Book Review. Their decision-making habits can often be skewed by this; they may be blind to serious risks they’re undertaking in pursuit of this reward. She uses, as an example, a man who gambled away $700,000 of his $1m retirement fund, in the continuing certainty that GM stock was going to rally dramatically–in 2007.

Introverts, on the other hand, get small hits of dopamine all the time–chopping vegetables with the sun streaming through the kitchen window, listening to a favorite piece of music, hugging their child. What they don’t get is a whopping dopamine wallop when their team wins the Super Bowl. It’s nice, they’re pleased, but it’s really no big deal. They’re motivated by risk-avoidance rather than reward, which means that there should be more introverts in charge of the financial system than there are.

This explains a lot.

I’ve always thought of myself as ‘ambitious,’ but there are many things I am not willing to sacrifice to ambition. Everyday quality of life is one of those things. I’ve often been baffled by people who seem unable to take a break. It appears that their ‘pursuit of fame, fortune and hot sex’ switches are turned on all the time, to the exclusion of enjoying the humble pleasures of Now. Sure, fame and fortune would be nice, but not at the expense of coffee breaks!

Because desperation isn’t healthy. When I’m working on a client, or writing an essay, or studying my Rolfing textbook, I can’t afford to be thinking about how I’m going to Tweet about the right celebrity to get more followers to sell more books to make it to the New York Times bestseller list to raise my fees to become a multimillionaire. That’s not what this work is about. What makes my work special is the details–the right environment, the right timing, the right words, the right silences.

For some truly wise advice on how to fill your life with something more valuable than celebrity Tweets:

How to Find Your Purpose and Do What You Love

“Prestige is especially dangerous to the ambitious. If you want to make ambitious people waste their time on errands, the way to do it is to bait the hook with prestige. That’s the recipe for getting people to give talks, write forewords, serve on committees, be department heads, and so on. It might be a good rule simply to avoid any prestigious task. If it didn’t suck, they wouldn’t have had to make it prestigious.”

The Myth of the Chemical Imbalance

by Sujatha Ramakrishna, M.D.

It’s been over a decade now since the pharmaceutical industry started exposing the American public to advertisements such as this one:

In that time I’ve encountered many patients who simply state, “I have a chemical imbalance,” when I ask them what brings them into the office. They don’t want to discuss their symptoms, or the details of their lives. They see a commercial on TV, decide that the description fits, and make an appointment so they can get some medication. Admittedly, these are some very effective advertising campaigns.

Thanks to the miracles of corporate marketing, we now have millions of people in the United States who are convinced that psychiatrists have deciphered the inner workings of the human mind to such an extent that we can add a little serotonin or norepinephrine to a depressed patient’s brain, and presto! Everything will be working smoothly again in no time at all.

If only our work was as simple as poking a dipstick into someone’s head, like a mechanic checking the oil in a car, and pouring a little dopamine in there if we find that they are a quart or two on the low side.

The truth is that doctors don’t really know how antidepressant medications work. We know that they alter the amounts of certain neurotransmitters in the synapses, and we know that they have positive clinical effects, but the exact mechanism of the process remains a mystery. Another rarely discussed fact is that the resulting improvements in mood are neither guaranteed nor permanent. Many patients experience no benefit at all from antidepressants, and even ones who do achieve satisfactory results report that the effects wear off after they have taken them for a few years.

Since psychiatrists are specialists, primary care doctors often refer patients to us after they have prescribed several different psychotropic drugs for them with minimal success, and much of what we do involves adjusting their medication regimen in an attempt to help them achieve remission. Unfortunately, I’ve had many people complain to me that they are tired of being “treated like a guinea pig,” because previous doctors have repeatedly switched them from one drug to another, as if they were conducting experiments on them to find out what worked.

The suffering that these patients endure during their frequent relapses illustrates the problem with believing in myths. In most of these cases, searching for the right mix of medications is a pointless endeavor, because describing their issues as a “chemical imbalance” is a horrible oversimplification. The human brain is not a piece of machinery. It can’t be manipulated and adjusted by a physician according to standardized specifications, as if it were the engine of a car. The biology of psychology is a much more subtle and intricate process than that. When human beings use their nervous systems in certain ways, it causes some neuronal connections to strengthen, while others are weakened. As an analogy, think of how people learn to play sports. The first time that someone throws a football, kicks a soccer ball, or swings a baseball bat, he or she might not be so great. With many repetitions, the neural pathways in the brain and body which are responsible for these acts of coordination become stronger, and the person’s performance improves.

While emotions and moods are different from motor activities, they are nevertheless functions of the nervous system, and the same principles apply. Being happy makes it more likely that a person will be happy in the future, because those neural pathways become strengthened over time. Unfortunately, sad people also tend to continue to be sad, and if the downward spiral progresses it eventually leads to clinical depression. It is theorized that the long-term administration of psychotropic medications somehow alters these pathways, and that those structural changes, rather than the the initial chemical changes, are what result in the relief of psychiatric symptoms. This is why it generally takes several weeks for the medications to start working when they are first prescribed. It’s also theorized that these drugs wear off after a certain period of time because the brain eventually reverts back to its original state, through a process resembling homeostasis.

More permanent changes in the brain can be achieved through other forms of treatment, such as psychotherapy. This is why mental health practitioners rarely, if ever, prescribe drugs as the only form of therapy for patients with active symptoms. Drugs can provide patients with a boost in mood, enabling them to work on the issues in their lives which resulted in their depression in the first place, but unless the underlying problems are addressed they will come up again when the medication effect wears off. A good counselor provides an objective voice, as opposed to a depressed patient’s inner voice of doom, and can help a patient come up with realistic ways to change his/her outlook or behavior that will eventually result in positive and long-lasting changes in his/her brain structure. Changing oneself for the better is commonly known as “personal growth” or “maturity,” and it is not achieved through ingesting chemicals. As with riding a bike, it takes time and practice, and once you learn you never forget.

There are many valid reasons that people want their symptoms to be managed with “meds only.” These include no time for therapy, no insurance coverage, and no interest in sharing their innermost thoughts and feelings with a therapist. However, if patients take psychotropic medications but opt out of other parts of their prescribed treatment plan, they rarely if ever achieve a full recovery. This is something that is left out of the drug-company advertisements, but it’s something that anyone who has ever taken antidepressants needs to know.

Big Healthcare and Cheesecake

I always get a little giddy when a new article by Atul Gawande appears. The latest, in which he compares the quality control and cost efficiency at the Cheesecake Factory with that of Big Healthcare, does not disappoint:

The neurologist, after giving her a two-minute exam, suggested tests that had already been done and wrote a prescription that he admitted was of doubtful benefit. Luz’s family seemed to encounter this kind of disorganization, imprecision, and waste wherever his mother went for help.

“It is unbelievable to me that they would not manage this better,” Luz said. I asked him what he would do if he were the manager of a neurology unit or a cardiology clinic. “I don’t know anything about medicine,” he said. But when I pressed he thought for a moment, and said, “This is pretty obvious. I’m sure you already do it. But I’d study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute.”

This is not at all the normal way of doing things in medicine.

I’d strongly recommend that you go read the whole thing. There are so many things to discuss that it’s hard for me to pick one. But in answer to the biggest and most obvious question–why aren’t best practices standardized in modern healthcare?–I offer this theory: Because doctors, by and large, are smart and ambitious people. And smart, ambitious people vigorously resist rule by committee.

That is not at all what Gawande or the Cheesecake Factory are suggesting. But in order for best practices to be evaluated and implemented within a large, complex system, communication has to be far more nuanced and, ironically, less hierarchical than has ever been the case in human history. One of the more fascinating parts of the article is his description of a successful interaction between a remote monitoring facility and a suspicious doctor:

Half an hour later, Hayes called Mr. Karlage’s nurse again. She hadn’t received the orders. For all the millions of dollars of technology spent on the I.C.U. command center, this is where the plug meets the socket. The fundamental question in medicine is: Who is in charge? With the opening of the command center, Steward was trying to change the answer—it gave the remote doctors the authority to issue orders as well. The idea was that they could help when a unit doctor got too busy and fell behind, and that’s what Hayes chose to believe had happened. He entered the orders into the computer. In a conflict, however, the on-site physician has the final say. So Hayes texted the St. Anne’s doctor, informing him of the changes and asking if he’d let him know if he disagreed.

Hayes received no reply. No “thanks” or “got it” or “O.K.” After midnight, though, the unit doctor pressed the video call button and his face flashed onto Hayes’s screen. Hayes braced for a confrontation. Instead, the doctor said, “So I’ve got this other patient and I wanted to get your opinion.”

Hayes suppressed a smile. “Sure,” he said.

When he signed off, he seemed ready to high-five someone. “He called us,” he marvelled. The command center was gaining credibility.

Notice: this is not an authoritarian system. This is negotiation by persuasion, using facts, mutual respect, and good manners.

Woo hoo.

What to Do When You Can’t DO Anything

As many of you know, my brother-in-law, Leif, is currently battling a rare form of cancer called mantle cell lymphoma. He’s young, formidably strong and has one of the healthiest lifestyles of anyone I know. We went up to Maine to visit him last week.

Rain

It’s impossible to describe what it’s like to watch someone you love go through a terrible experience. As far too many of us already know, cancer treatment is not only brutal, but chronic; it just goes on and on. Coping with chronic is qualitatively different from coping with a crisis, like getting hit by a bus; getting hit by a bus has a narrative arc that you can move through. Getting cancer is like setting up house in the middle of a freeway.

Most of us, of course, want to be able to walk into a crisis and fix it. Feeling helpless in the face of suffering is thus one of the most difficult states of mind we endure. So what can we do about that? Here are a few suggestions.

•  Never underestimate the healing value of mundane service. Wash dishes, clean floors, do laundry, run errands, cook a healthy meal. These tasks are particularly helpful by virtue of the fact that they are infinitely renewable, and can be done without thinking too hard.

• Just be around. Send notes, send gifts, make phone calls. They’re appreciated.

• Don’t say, “If there’s anything I can do, give me a call!” Instead say, “Would it be helpful if I brought a meal, did laundry?” People under stress are often too overwhelmed to be proactive in asking for help. Use your common sense, double-check, and listen to the answers.

• Meditate. Here is Ken Wilber:

…Foremost among these practices is the one known as tonglen, which means “taking and sending.” The practice is as follows:

In meditation, picture or visualize someone you know and love who is going through much suffering–an illness, a loss, depression, pain, anxiety, fear. As you breathe in, imagine all of that person’s suffering–in the form of dark, black, smokelike, tarlike, thick, and heavy clouds–entering your nostrils and traveling down into your heart. Hold that suffering in your heart. Then, on the outbreath, take all of your peace, freedom, health, goodness, and virtue, and send it out to the person in the form of healing, liberating light. Imagine that they take it all in, and feel completely free, released, and happy. Do that for several breaths. Then imagine the town that person is in, and, on the inbreath, take in all of the suffering of that town, and send back all of your health and happiness to everyone in it. Then do that for the entire, state, then the entire country, the entire planet, the universe. You are taking in all the suffering of beings everywhere and sending them back health and happiness and virtue.

When people are first introduced to this practice, their reactions are usually strong, visceral, and negative. Mine were. Take that black tar into me? Are you kidding? What if I actually get sick? This is insane, dangerous! When Kalu first gave us these tonglen instructions, a woman stood up in the audience of about one hundred people and said what virtually everybody there was thinking:

“But what if I am doing this with someone who is really sick, and I start to get that sickness myself?”

Without hesitating Kalu said, “You should think, Oh good! It’s working!”

A strange thing begins to happen when one practices tonglen for any length of time. First of all, nobody actually gets sick. Rather, you find that you stop recoiling in the face of suffering, both yours and others’. You stop running from pain, and instead find that you can begin to transform it by simply being willing to take it into yourself and then release it. The real changes start to happen in you, by the simple willingness to get your ego-protecting tendencies out of the way.

–Ken Wilber, ‘Grace and Grit,’ 247-49

This doesn’t have to be a big dogmatic deal. You don’t have to let anyone know you’re doing it. It’s a practice that may help you to be more present, less anxious, and less visibly freaked out. Lots of us want to ‘be strong’ for our loved ones, but what does that mean? Stoicism? False cheer? Pretending nothing’s wrong?

Tonglen meditation can help you stop ‘doing’ and move into ‘being,’ which is where authentic connection lives.

The You-ness of Rolfing

Theresa Zordan is an expert Rolfer and visionary blogger from Denver, CO who graciously offered to swap guest posts with Practical Bodywork. We are pleased as punch to have her.

It may be hard to believe, but sometimes I forget about Rolfing and how helpful it can be.  It’s especially hard to believe considering I am a Rolfer.  This is what I do all day, every day.  But you see, I have this weird thing in my brain about Rolfing: I think it can help just about everything, for just about everyone.  Except me.

Someone tells me how their knee’s been bothering them; I think to myself, “I can help with that.”  Someone tells me how they feel out of whack and off kilter; I think to myself, “I can help with that.”  Someone tells me how they get headaches a few times a week; I think to myself, “I can help with that.”  Someone’s freaking out about work and their house and their boyfriend; I think to myself, “I can help with that.”  Then, I break my toe, sprain my shoulder, get emotionally wrapped up into a giant-multi-colored-extra-knotted ball of string and I think to myself, “Whatever am I going to do?!?  Who could possibly help me with this!?!”

And so, last week, I found myself with said broken toe (my first broken bone!), and sprained shoulder (thanks for nothing, yoga), and emotional ball of knots and I finally (finally!!!) remembered that Rolfing might be able to help me.  So, I called up my bud, Dave Sheldon, a Rolfer in Boulder, and asked if he could fit me in.  He said yes and I walked into his office with a laundry list of complaints.  It was one of those sessions (do you do this?) where you go in, planning to mention just those two or three things that are really bothering you, and by the time you’re five minutes into the session you’ve listed 23 things instead.  “AND my roommate’s dog is driving me crazy!  AND my sister’s coming to visit next week and it’s stressing me out!  AND my sacrum feels all wonky!  AND I’ve been wearing flip-flops for two weeks now and I’m sick of it, but I can’t wear any other shoes without my toe hurting and I can’t exactly walk into the bank barefoot, can I?”  And so on, and so forth.

Then, the funniest (and at the same time the most natural) thing happened.  I got on the table and closed my eyes, and Dave started working.  All of a sudden, it felt like all these layers were falling away from me.  Like I’d been wearing a suit made out of 23 layers of tissue paper.  So light that I hadn’t thought to take it off, but enough that it was affecting the way I looked and that rustling noise was really getting to me.  And one by one, Dave gently cut each layer away, and let it fall to the ground.  Some layers were wrapped tightly around my foot, keeping it stable, but I didn’t need those anymore.  Some of them were wrapped all around my shoulder, all the way down to my wrist and around my ribs and spine.  I didn’t need those anymore either.  Most of them were wrapped around my heart, or my solar plexus, or my throat, or my head, getting me caught up in unnecessary worry and fear and distress.  I didn’t need a single one of those tissue paper layers.

And I realized there, on the table, why it was that I fell in love with Rolfing in the first place.  Dave wasn’t taking away anything that I needed, or anything that was inherently me.  And he wasn’t adding anything to me, either.  He was simply uncovering the real me, and giving me permission for that to be enough.  I didn’t need any of this tissue paper to make me stable or pretty or to cover anything up.  I was perfectly me, without all that other stuff.  He was reminding my shoulder and my toe that they already knew how to recover from an injury quickly and with ease.  He was reminding me that worry and fear were good intuitive signals to listen to, but there was no reason to walk around spinning in them all day.  And the greatest part was that he did all that without saying a word.  He worked with the physical tissues and the energetic patterns and gently unwound them until there I was, just the way I should be.  And when I came from that centered, more-me sort of place, I realized, my sister and I had shared a house (and usually a bedroom) for 16 1/2 years.  We could probably figure out 3 days just fine.  Oh, and my sacrum felt better, too.

It was funny.  When I walked into his office, I didn’t feel like someone other than myself.  But when I walked out…the change was drastic and clear.  I’d walked in like a papier-mâché doll of myself and walked out as me.  And that right there is some good shit, yo.

Theresa Zordan, Rolfer extraordinaire

 

So How The Hell Do We Do That???

As some of my wise friends point out, changing the face of healthcare is a quixotic proposition. It’s all very well to saythat your doctor should be prescribing more massage than painkillers, that insurance should cover it, and that everyone should be insured.

But as we all know, our broken healthcare system makes far more money by selling drugs and high-intervention treatments to sick people than by investing in low-intervention therapies that keep them well. Too many people have their livelihoods bound up in the status quo. It’s not just difficult to get a man to understand something, when his salary depends upon his not understanding it; it may well be impossibleUpton Sinclair was an optimist.

So where do we start?

This is funny. Ha. Ha.First of all, like the global economy, our healthcare system is grossly overbalanced. Premiums are rising faster than our ability to pay for insurance, high rates of unemployment mean that more and more people are getting pushed out of employer-funded healthcare, and an aging population is using up more and more healthcare resources. Those who still have jobs and insurance are able to remain in denial, but the system as it stands is unsustainable.

buckyfuller

Second, our society is changing in some fundamental ways. Communication is infinitely easier, faster and more varied than at any time in history. There are a lot of smart, underemployed people with time on their hands, and highly sophisticated communications devices in those hands.

As the healthcare system slowly collapses under its own weight, there’s a lot more motive and opportunity for alternative practitioners to set up shop, and for desperate and disillusioned clients to try them. Due to the lack of a cohesive, non-exploitive alternative system (Massage Envy: even the name is bad karma), alternative healthcare practitioners have to be entrepreneurs, if they want to earn a decent living. And good entrepreneurs know that you live or die by the number and quality of your relationships.

Because of these factors, there’s a lot more scope for new healthcare paradigms gaining influence and visibility through lateral connections, like network marketing, rather than the top-down corporate capitalism model, which requires huge investments up front.

Therefore, Bucky Fuller’s ‘better model’ is building itself as we speak. As people lose their insurance, or see their premiums rise, they’re forced to take responsibility for their own health. As network marketing reaches more and more people, they will be savvier about how they choose a practitioner, and what healing modalities work for them.

At the same time, Big Healthcare is trying to save costs by cutting payments to practitioners. Mainstream healthcare practitioners will have less and less incentive to hitch their wagons to a system which is giving them less and less, and more incentive to look around for another model.

And there it will be. People like Atul Gawande are out there backing up their common sense advice with research and documentation. Practitioners who collaborate, develop skills and market effectively will have a wider range of influence over cultural thinking about healthcare. And people getting screwed by an insane system will have both the motive and means (through relentless communcation) for demanding change.

Any questions?

Vision for the Future of Healthcare

‘Winter and Spring,’ stained glass by Judith Schaecter, 30″ x 38″, judithschaecter.com

Wouldn’t it be amazing if:

• You could go to your doctor with severe pain, and she would write you a prescription for a course of massage therapy and other bodywork, which not only blissed you out, but solved your problem without the nasty side effects of drugs?

• Your massage therapist could refer you to the top specialist in the area for whatever issue you had, from varicose veins to systemic nerve pain?

• Hospitals felt like wellness centers, complete with fountains, lovely smells, spa-like decor, fresh organic meals, your favorite media on tap, natural light, and a virtual dearth of harsh fluorescent lighting, scary sounds, sinister smells, andsimilarities to an Argentinian torture chamber?

• Wellness centers were jam-packed with practitioners who not only knew how to work miracles, but knew when to send you to someone else for the best possible treatment?

• You’d be hard put to tell the difference between a doctor’s office waiting room and the atrium of a high-level resort spa?

• Insurance covered all of this, and everybody?

Impossible, you say? Crazy? Hubristic to the max?

Yes, possibly.

But this is the vision for Practical Bodywork that gets me out of bed every day. In my mind, I see that atrium, with the fountain, and stained glass by Judith Schaecter set into the walls. I see my favorite clients pouring in and receiving all the love and joy they’ve come to expect. I see practitioners who like and respect one another, working together to create the best health outcomes for every client. I see everybody earning a living wage with health insurance.

During the last year I’ve been taking a crash course in business development–marketing, networking, accounting, and management–a DIY MBA, if you will. I’m surprised to note that I’m loving it. The business world has, seemingly, greater scope for idealism than the art world ever did–more leverage, more autonomy, more community engagement, and more practical influence. Also more money.

Practical Bodywork is still at the very beginning of this journey. We’re moving along at a pace that may not set the world on fire, but won’t kill us, either. We’re beginning the search for office space, which will one day hold that fountain and fabulous art, as well as many other amazing health care practitioners. We’ve got a bookkeeper and an editor, a project development advisor and a business coach, and may qualify for a loan sooner than we thought we could.

We have also, on a joyful, visionary whim, applied for a small business grant. You can help us qualify. Just go here, search for Practical Bodywork in Philadelphia, and vote. No donations required. Love!

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You Cannot Control Your Posture

Do you hear that? You’re not responsible for sitting up straight:

You do not have conscious control over your postural muscles. Your postural muscles are controlled by a part of your sub-conscious system. If you had conscious control over your posture you would be unable to do anything else. For example, while you are reading this, you probably aren’t consciously thinking about holding your head off your chest, or keeping your body from collapsing to the ground.  The reason is… you don’t have to. Your nervous system does the job of maintaining your posture naturally – without you even thinking about it.

Regardless of this natural ability, we are taught to think or be mindful about our posture. We are told to hold our heads up, have our shoulders pulled down and back, and our abs pulled in tight. But since we do not have conscious control over our postural muscles, the act of consciously engaging our muscles to provide postural support activates the mobile muscles that we do have conscious control over. Over time, these movement muscles become neurologically trained to function as stabilizing postural muscles. This is not what they were designed to do. As our movement muscles are re-programed to provide postural stability, they become less efficient at providing movement. All this happens and our postural muscles remain inept. The result is the significant loss of range of motion which will lead to dysfunction, pain and injury…

This is something I’ve been telling a lot of my clients, lately. They come in and guiltily confess that they ‘have bad posture,’ and this is why they hurt. But adding to the stress of modern life by heaping on a large portion of personal guilt isn’t helping anything. Your body arrives at certain postures because of the demands your environment places on it, not by your conscious will. If you hurt because of ‘bad posture,’ you need a little help to realign your fascia. Forcing yourself into a ‘better position’ only makes matters worse.

On a related note–I had twelve years of ballet training in my formative years. About 25 years later I had a trial session with a network chiropractor, who encourages the nervous system to balance itself by targeted, gentle stimulation of the spinal cord. After the session I noticed that my hips spontaneously rolled inward, so that they were parallel, rather than chronically ‘turned out’ in correct ballet posture. All of that training, all of those years ago, was still overriding my body’s natural (and efficient) positioning.

Read the whole article.

The Smoking Gun

widely-reported study finally traces the mechanism by which massage therapy reduces pain and promotes healing:

They found that massage reduced the production of compounds called cytokines, which play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside cells that convert glucose into the energy essential for cell function and repair. “The bottom line is that there appears to be a suppression of pathways in inflammation and an increase in mitochondrial biogenesis,” helping the muscle adapt to the demands of increased exercise, said the senior author, Dr. Mark A. Tarnopolsky.

When you reflect on the fact that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen not only retard healing, but have been linked to severe gastrointestinal disorders, renal problems, heart attack, stroke, erectile dysfuntion, and other side effects including death, your cost-benefit analysis may be altered. It may be cheaper in the short term to pop a pill for pain relief, but getting regular massage could save a bundle on long-term health care.

Why I Am A Bodyworker

Talk about stumbling upon a gift.

At the age of four, during a performance of The Nutcracker, it was revealed to me that I was destined to be a Famous Ballerina. I pursued this vocation with focused determination until the age of seventeen, when I acknowledged that no girl with flat feet and limited hip flexion would ever make Principal Dancer with the NYCB, and quit cold turkey. At least I could finally wear bangs.

Ballet being dead to me, my next career was Famous Painter. With equal seriousness of purpose I obtained a couple of art degrees, and mastered the art of living on almost nothing. To pay my rent I found myself working as the Information Lady at the San Francisco Public Library.

Several years into my tenure, a few things hijacked my attention. First, several of my friends started having crippling health problems that only got worse when treated by mainstream health care practitioners. An ex-boyfriend ended up on disability for repetitive stress injury in both hands. A college friend developed intermittent pelvic pain and paralysis that landed her in a wheelchair, while doctors accused her of ‘trying to get attention’ and administered needless catheters without anesthesia in order to ‘teach her a lesson.’

At the same time, I found that I loved answering people’s health questions. I would get so wrapped up in researching a problem that I’d go through a department of reference manuals. Here again, I encountered people who were as traumatized from their interaction with western medicine as they were from the illness itself.

I once spoke with a caller who had been to her doctor for a disfiguring skin condition, and wanted me to 1) look up the condition to find out if she was going to die, and 2) look up her prescription to find out whether it had any hideous side effects. She sounded terrified.

After a few minutes of research (Google hadn’t been invented yet), I informed her that she wasn’t going to die, and that the problem might take awhile to go away but was neither degenerative nor permanent. Her relief was tearful and extravagant. I then asked her whether she’d been under stress. “My father died,” she replied.

Overstepping the bounds of a proper Information Lady, I expressed my condolences, diagnosed her rash as somaticized grief, and prescribed brown rice, broccoli, long walks and the company of friends. (I had just been reading Andrew Weil.) She pardoned my youthful condescension and hung up the phone a happier woman.

So, I wondered, why didn’t her doctor do that? Surely common sense and compassion are a prerequisite for obtaining an M.D.?

(Idealistic? Me?)

Over time, I found that alternative healthcare really floated my boat. The Bay Area offered a smorgasboard of available disciplines to sample: Ayurveda! Chi healing! Hypnotherapy! Acupuncture! Shiatsu! Raw food veganism! Thai massage! Registered nursing!

After breathlessly exploring these options, common sense prevailed (sort of), and I decided that massage therapy was my most practical starting point–popular, portable, and somewhat clinical. I enrolled in a program at the National Holistic Institute in Emeryville, CA, almost on a whim.

I didn’t expect to be good at it. I’m not sure what I expected. Mainly I was terrified that my WASP-ish upbringing would make it impossible for me to touch people. I thought of it as making a heroic attempt to balance my own shortcomings, before moving into a career more suited to my temperament.

Almost from the first day, however, I’d put my hands on a client or colleague and they’d remark, “Wow, what are you doing?”

“Nothing,” I’d reply. Literally, nothing. After a few years of dating a Buddhist monk, I’d gotten into the practice of Zen meditation, and when I put my hands on people I reflexively emptied my mind.

“There’s heat, coming from your hands,” people informed me. Wow. Cool.

What I came to realize was that I already had a background of kinesthetic understanding that was ripe to be used. Years of dance, yoga and meditation had given me a vast repository of wisdom that I didn’t know I possessed. I didn’t think of it as valuable, perhaps because our culture doesn’t often recognize it as wisdom. We might admire the grace of a dancer, or the speed and precision of a star athlete, but we don’t necessarily think of such skills as having ‘practical’ applications beyond their entertainment value.

But as any musician knows, there is a world of difference between pressing a button and singing a note. It’s not enough to know your anatomy, and push on the right muscle with the right clinical objective. To perform effective bodywork, you have to have calculus in your hands and rhythm in your brain. You must be able to inhabit your client’s body as if it were your own, while maintaining a conscious boundary and therapeutic objective. This may be termed ‘empathy’ or ‘intuition,’  but the mystical implications of these words mask the fact that massage is just physics. Physics may be understood with the mind, but it is manifested by the body.

The word ‘healer’ is so obnoxiously overused in New Age circles that I tend to avoid it. It’s not possible to march in and ‘heal’ anyone; that was made clear to me in every book I read, no matter how whacky, before I discovered it in practice. ‘Healing’ is a natural, organic process that thrums along by itself, with or without interference from us. So to call myself a ‘healer’ seems presumptuous and flaky.

But the root of the word ‘heal’ also means ‘to make whole,’ and seeing problems in relationship to a whole is something that Western medicine doesn’t always do so well. The scientific method has given us miraculous drugs and virtuoso surgical procedures, but these are often applied without balance, discrimination or boundaries. They are almost always used to banish symptoms, rather than to solve core problems.

And creative problem-solving is my favorite exercise. Pain is the manifestation of a problem, and healing the pain could lead anywhere. That’s what makes my work interesting–not the rigid application of a set of techniques to an unresisting body.

So perhaps what I am is a ‘balancer.’ I listen. I ask questions. I do research. I offer creative solutions to overarching problems. I give you a nudge here, a pull there, and often you feel better. Balance enables joy.

Stephanie Lee Jackson is a licensed massage therapist, founder and owner of Practical Bodywork in Philadelphia. She received her massage therapy certification at the National Holistic Institute in Emeryville, CA, and her second-level Reiki attunement from Uma Schaef.

Stephanie is also a fine artist, with a career spanning twenty years. She is best known as the art blogger and provocateur, Pretty Lady; her portfolio and writings may be found at stephart.com.