May 18, 2019


"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.

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