May 18, 2019

Treatment

"massage is... a medical intervention, treating musculoskeletal ills, as a chiropractor does."

My skepticism about massage as a medical intervention is well-known, even notorious, in some circles. No need to go over that again here. 

Medicine is where the money is, of course. The deepest pockets we're ever likely to dip into are those of insurance companies. And it's where at least one brand of dignity is: some of us long to be thought of as health care professionals. 

For years I "took insurance," as we say. I duly submitted my treatment plans and carefully documented my results, and sent them off to insurance companies, which paid me faithfully. Insurance companies are quite easy to work with, when you're a provider, which surprised me: they were as anxious as I was to make things go smoothly, and were always helpful on the phone. Nothing Kafkaesque about it: quite different from the consumer experience.

But I always disliked it, and finally I decided I was done. I stopped "taking insurance." I simply didn't believe that the medical model fit what I was doing. I was scrupulously honest, but I couldn't shake the sense that we were all making it up. I didn't believe what I was doing was very like setting a broken bone, at all. Sure pain levels would reduce, "trigger points" would evaporate and stiffness would ease. Clients were happy, and the checks were coming in. If everybody was happy, what was the problem?

Well, the problem was that I didn't believe in it. Oh, I believed in massage -- I've always believed in massage. But in spite of the fact that both my clients and the insurance companies believed that my medical interventions worked -- I didn't, particularly. I'm sure an enterprising researcher could have found significant medical effects from my massages, but I think those would be side-effects, reductions in pain that did not have much to do with my manipulations of muscle and tendon and fascia. They had to with touching and attention and loving-kindness; or with setting sail and leaving the world behind for a bit.

The trouble with thinking of massage as a medical treatment is that we herd it into being done the way medical treatments are done: and I'm not sure we want to do that. Or rather, I'm very sure I don't want to do that. Medical treatments are assigned by highly educated, certified professionals. They are standardized and given out in measured doses on a strict timetable. There are protocols to ensure that nobody innovates or improvises. The typical setting is a hospital or a clinic, with blazing lights and loudspeaker paging and images on a muted television screen writhing in the background. I work in hospitals when I have to, when my clients are sick or dying, but I never do it very happily. 

So much of real connection happens off the clock. Idle chat as I'm packing up to go. I never schedule massages back to back, if I can help it. I never rush. I'm determined to live a sane and human life, and that means taking time. If I finally discover what the client needed in the last five minutes of the session, the session magically becomes ten minutes longer, so I can address it. Or if the client wants to pack it all into fifty minutes, because they're all fired up about their work, that can happen too. The medical world is never off the clock. I don't want to work that way; I don't want to live that way.

When I think of what I would like massage to be like, typically -- I think of something far different. I would like massage to be something that most people do, and most people receive. I would like it to be thoroughly amateur. I would like dual roles to sprout like dandelions. I would like it to be at home, in cozy light, according to no clock and in no set dosages. I would like it to be part of ordinary daily life. I would like people who could not possibly pass the exams to get a massage license to be doing it. Our fellow primates spend hours a day grooming each other. In the modern world we have lost that habit: and we pay a price in isolation and alienation.

If that came to pass, of course, I'd be out of work. Who'd pay for massage, if it was always to hand (so to speak) and free? But still, it's what I wish would happen. Even if it meant that I had to go out and get a real job.

April 4, 2019

Rubdown

Viewed in one light, I said, massage is a business, selling a personal service, as a hairdresser does. When I think of it in this light, I always think of John Wayne calling peremptorily for his rubdown:




That's a long time ago, and a lot of water under the cultural bridge, but it still illustrates a lot the massage that actually happens in the world. We like to talk about massage as medical treatment or as cosmic connection, but much of it is just "where's my rubdown?"

There's a directness and lack of pretension to it. I have a few clients who think of it this way, and I like working with them. I relax them, soften things up, work out the kinks a bit, and I'm on my way. I have a client who just had his 95th birthday, who listens to Glen Miller during the session -- the music of his youth, as I might listen to Crosby Stills & Nash -- and at the end he'll say, "that felt good!" and we're done. In chatty mood, we might discuss single-payer insurance (I'm fur it, he's agin it) or rent control (we both take a dim view of it.) I'm not expected to fix anything or deliver any insight.

I have younger clients who treat it the same way. One professional woman who works at her laptop the whole time I'm setting up, hops on to the table for her 90 minute massage, hops back off, and is back at work again before I'm all packed up. We exchange a few pleasant words about her last business trip, maybe, but my job is to deliver the rubdown. It's an uncomplicated, straightforward service relationship. If massage was my first career, rather than my third, it might rankle a bit -- being the help -- but I'm long past all that. I don't mind being a servant, as long as I'm treated well. It's comfortable. Soothing.

The text for my ethics class in massage school, made much of the the care massage therapists must take with the power imbalance of the therapeutic relationship: we were the experts, the authorities, and our timid clients would believe anything we said and follow any instructions we gave. Well, yeah, sometimes. Sometimes not.

March 30, 2019

Handwritten Massage

Tracy Walton, one of the most thoughtful people who writes about massage, considered a passage she wrote twenty years ago, and pondered whether she could still endorse it:


Handwritten Massage

She decided she could, that she did. But in mulling it over, and thinking about what massage as a business and a medical intervention has become, she wonders: is this what we wanted? Is this really what we were trying to create?

Reading Tracy's post made me wonder something more immediate and more personal: how well have I kept my own practice aligned with what I am trying to do in the world? How hard have I even tried? And have I ever really thought it out? The anxiety of "can I actually make this work?" and the day to day business of getting a practice off the ground have carried me along -- in my case, for twelve years. The work itself is absorbing and joyful. My practice is a personal and practical success. But what am I succeeding at?

I wanted to be my own master, choose my own hours, make my own rules: and my life has been much happier and calmer since I achieved that. I also wanted a life that encouraged -- demanded -- a daily cultivation of compassion. I wanted, in Tracy's words, "to build a bridge that may heal us both." Have I done that? Well, in some ways.

This is where the larger context of massage as business, massage as medical intervention, comes into play. I don't actually get to set my own rules (nobody does.) Whatever I do, I'm working with my clients' expectations, and I'm working within the laws and customs governing massage here in my corner of the world. By local expectation, law, and custom, massage is a business, selling a personal service, as a hairdresser does; and it's a medical intervention, treating musculoskeletal ills, as a chiropractor does. And then (not by law, but by alternative custom) it's sometimes a third thing: a healing ritual, addressing spiritual ills, as a shaman does. In any given day I might have clients who think of a massage primarily as any or all of these. I'm an affable man and I try to deliver what's expected. But what do I think it is? What do I want it to be? I'm going to think about that for a while. I don't have a simple answer.