Healing Ritual

The first principle is that you must not fool yourself -- and you are the easiest person to fool.  --Richard Feynman

I began this series of posts by listing some ways people think of massage:

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.

Now we're headed for deep water. But this is why I get massage -- which I do, regularly -- and why I've made massage my life work. Massage can take you places. (It can do this both for the person on the table, and for the person doing the work: this is one of the less-discussed job benefits of doing massage.) 

It's easy to make this story stupid. It's easy to come up with engaging, anti-scientific stories about what's going on, replete with auras and crystals and and "energies" that instruments can't detect; which obey cosmological rules (that can be cherry-picked, because they come from long ago and far away, and no one can force their less likable variants on you). Browse a sample of massage therapists' websites and you'll find some very silly ones: some people are very transparently fooling themselves. When I tell people what I do for a living, a fair number of them evince a certain wariness, and I can tell they're waiting for the wack-a-doodle to surface. I can't blame them.

But in fact massage can deliver benefits that I would call "spiritual." If you're allergic to the word, feel free to use some other. What I mean is that it loosens the anxiety, and sense of constraint, of an overbearing ego. It reminds me that I am, in fact, just a small person who is part of a large world. It reminds me that my own obsessions, concerns, and worries are mental projections, not realities, and that even if they became realities they would not be all that important. My mind becomes spacious, and the world becomes radiant. All my senses (vision in particular) become sharper. Images become clearer.

It is an effect much like that of meditation. And like meditation, it is not invariably pleasant. It can make me feel raw, unskinned, vulnerable. There are reasons why we spend most of our conscious time pursuing distraction. Sometimes we would really much prefer not to "be here now." But we lose more than we gain by chasing distraction. 

This spacious mind is more open and more credulous than is usual, which is probably one reason why we massage therapists tend to be viewed as wacky or flaky: we often are. It's easy, especially if you haven't cultivated meditative discipline, to seize on some of the more vivid visualizations and fantasies, or some of the more appealing stories, and decide that they are real. But you don't have to do this. You can take them for what they are: ground for thought. "Intimations," as Wordsworth would say. You've opened the door to a multitude of images and ideas. That's good. Leave the door open, so they can leave just as easily: that's even better.

I recently read Michael Pollan's book on psychedelics, How to Change Your Mind. He has a chapter on neuroscience, with some intriguing hypotheses about states in which the brain becomes less organized -- the traffic controls are relaxed, and parts of the brain talk with other parts that they don't usually communicate with. I was struck at once by the similarity with how I experience massage, and I noticed particularly the phenomenon he calls the afterglow, an apparently common day-after effect, from psychedelics, of heightened vividness in perception, which is also a massage effect I've wondered about before. He cites scientist Robin Carhart-Harris, who speculates that when the brain becomes too good at being a prediction-machine it veers into anxiety and depression, and begins filtering out too much of "irrelevant" perception (for instance, perceptions of beauty): psychedelic experiences can counter that tendency. Maybe massage can too, by the same mechanism: throttling back the activity of the so-called "Default Mode Network," which is (possibly) the cerebral cortex's traffic-controller.  

I view such neuroscience hypotheses with a lot of skepticism: we still just don't know much about how the brain works, or what brain imaging really has to tell us about it. But it's a way of thinking about what we're doing, when we're doing massage, that doesn't require postulates that are demonstrably false. In this business, that's a step forward.

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.

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.

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.

That Email I Always Write

A friend of mine "threw her back out" a week or two ago and emailed me for advice. I realized as I answered her that I seem to write this email a couple times a year, so I thought: "I'll edit this lightly and post it." 

I asked a few questions to see if it was likely to be a serious injury or a degenerative condition: it wasn't. No numbness, no functional impairment beyond the pain. "What she'd done to it" was crouch down to load the dishwasher. So I wrote:

Yeah, this is a pretty typical onset.

First thing to know: this is very common and it is very likely to resolve of itself within a week or two, regardless of what you do. It is more like a headache or a cold than like a degenerative condition. And it's more common at your age [parent-of-toddler age] than it is at mine [sixty]. 

Second thing to know: disks do not "slip." Spines are not fragile. They are incredibly tough structures that it generally takes enormous forces to injure. In the absence of obvious trauma what you've likely got is a pain problem, not a back problem. Which can be totally as debilitating in the short term, for sure, but it's important to think about these things accurately.

The reason it's important is that when your unconscious brain is deciding whether to throw the panic pain switch, it consults your opinion on how serious this injury is. It does this without you ever being conscious of it. The first thing you know is an explosion of pain. But back there behind the conscious mind, your unconscious mind is flipping through the files on "back pain" and deciding whether to escalate the twinge to the whole pain explosion. If it finds a bunch of old info about fragile backs and slipping disks and degenerative conditions, it's VERY likely to throw that switch.

And as you know excruciatingly well, you do NOT want it to throw that switch.

I used to have this back pain a lot, mostly before I worked at the Foundation. The worst episode, I missed about ten days of work. I had to crawl to the bathroom. I get it, believe me. The pain is totally disabling when it's bad.

So the general rules: stress makes an episode more likely. Lack of sleep makes it more likely. Lack of exercise makes it more likely. (Of course, what this pain does is 1) stress you out, 2) make it hard to sleep, 3) make it impossible to exercise. Catch-22. I hate it.)

You don't want to get the switch thrown again, but you want to move as much as you can without setting it off. Right now you mostly just wait and let it calm down. If you have a tub -- and can get into it in your present state -- a hot bath can work miracles.

And in a day or two you should have a friend come over and do some gentle massage work on it :-) Your big job right now is to convince your back that it's okay, that nothing overwhelming is going to be demanded of it, that it actually still can move and all will be well. Which it will.

Hugs--

Dale

I realize that I could capitalize on back pain by saying I could fix it. But really I don't see massage doing a lot for it, and especially not in the acute phase -- that is, in the first day or two. After that, yes, massage helps the nervous system settle down. Even better is massage before it happens in the first place. Nonspecific back pain, like a lot of stress-related conditions, is a lot easier to prevent than it is to treat.

Just Relaxation Massage

I took a three day Shiatsu workshop, a couple weeks ago -- great fun, I learned lots. (And forgive me: no, I still don't believe in energetic meridians. More about that anon, maybe.) I ate lunch with some other participants, the first day, and when asked about my practice, I said, "Oh, I do in-home massage. I've been doing it ten years, now. I love it." And then the demon of self-deprecation got hold of me, as he will, and I added, "Just relaxation massage."

That's the way we massage therapists often talk about it, among ourselves. Just relaxation massage. The lowest common denominator. Swedish; spa massage; fluff n buff. The stuff anyone can do.

But I've resolved to stop talking that way. The thing we call "relaxation" isn't trivial, and it isn't easy to do well. In fact I think it's the most important part of massage, and probably the active ingredient in most of our successful "treatments." It's what I personally get massage for. But it's hard to talk about clearly. It's an experience that does not lend itself to words.

I wrote recently to one of my own massage therapists: Thanks so much! That was a transcendent massage. Changed the quality of the sunlight coming through the leaves.

It didn't fix me. No particular issues were addressed. I'm still the same sorry messed up mortal I was before: working at a desk all day will still make my neck stiff, and dealing with obnoxious people will still annoy me, and I will still want to eat more than I should at the end of a long day.

So what's it for? What's the point?

The point is going to another place, where the quality of the sunlight is different, where everything is clear and luminous and spacious, and nothing needs to be done. We don't stay there. And an hour afterwards maybe it won't make any obvious difference in our lives. But really forgetting that other place is there -- that would be a catastrophe: that would set us up to be dislocated and uprooted in hundred different ways. We need to go back periodically, to be reminded: it's still there.

Six Things To Know Before We Start

1. Timing. The time we set is when I arrive, not when the massage starts. It takes me about ten minutes to set up. If it's our first appointment, you'll fill out a one-page intake form and we'll talk about what you're looking for and what I'll do. You can ask me questions and give me instructions. (You can ask me questions or give me instructions any time, of course -- please do! -- but this is time formally set aside for it.) The massage itself typically lasts about 90 minutes. Then it takes me another ten minutes to pack up and get out. This adds up to about two hours, for the first time, maybe fifteen or twenty minutes less, after that. It's a big chunk of time. If you're picturing me showing up at the door at 7:00 and being out the door at 8:00, then we need to plan for that, and you need to be okay with having just 45 minutes on the table.

2. You are not my host. Different relationship. You don't have to keep me entertained. You don't have to offer me coffee. If you feel like chatting, that's great; but you don't have to. I have clients who barely acknowledge me when I come in and set up: they keep working right up until I say "ready!" Then I go wash my hands while they get on the table.

The house doesn't need to be tidy. There can be dishes in the sink. Your four-year-old can wander in and out of the room, looking for his airplane.

I have one regular client just says "good night" and goes to bed, when I'm done: I lock up and drop their key back in through the mail slot. I've had a couple clients who have their own massage tables, so they can stay on the table when I leave. Some people like a hug and a chat and when I show up and when I go; some people prefer me to just appear and vanish. I'm happiest when people are doing what they're comfortable with. I'll follow your lead: I like the variety.

3. Undressing and getting on the table. When I'm all set up, I leave the room and wash my hands while you get undressed, get on the table, and get under the sheets and blanket. Some people like to already be in a robe when I get there. Doesn't matter to me, just as it doesn't matter how much you undress.

4. Music. I don't bring music, so if you want music, you'll need to set it up. The stuff people like to play runs from Enya to Tchaikovsky. The Beach Boys, 1940s swing, technopop, Navajo flute -- I like everything. But be aware that the tempo of the music will influence the tempo of your massage! The William Tell Overture gets you different bodywork than Arvo Pärt.

5. Your pets and I will get along fine. Dogs generally like massage to be going on. They seem to understand it right away: oh, this is chill time! They often curl up under the table, or nearby, and fall asleep. Cats are inquisitive, and need to check out my massage duffle, and sometimes get a little impatient that all this petting is going on and none of it involves them. Occasionally bold ones may jump up on the table, and I'll gently set them back down on the floor. I only recall one that insisted on jumping back up and staying there: I just worked around him.

6. Tweakability. The main value-added with in-home massage, besides that you get to stay home? -- it's that it's infinitely tweakable. You decide how long. You decide on the music, if you want any, and how loud it will be. You decide on the the lighting. You decide on the warmth of the room. (I bring a table-warmer, sort of like an electric blanket under the sheets: but you decide whether I turn on high, or at all.) I bring a stack of pillows for some people: some people like more than just a bolster under their knees. Make yourself comfortable, and ask for what you want! That's the whole idea. Some people have special oils they want me to use. I'm delighted to take the time and effort to make it comfortable: if I didn't like that sort of thing, I'd be working in an office.