May 30, 2011

How to get a Bad Massage

There's a lot more to getting a bad massage than just finding the wrong therapist! For those who don't want to enjoy the experience, I've assembled a few hints on how to have a lousy time on a massage table. It's easy if you know how.

1) Arrive late. This is a simple but effective technique. Make your therapist rush, or worry about whether he'll be able to finish in time for his next appointment! This is especially effective for first appointments, when you have to squeeze in the paperwork anyway. (Though some therapists may spoil this by budgeting extra time for it.)

2) Start off uncomfortable. Arrive chilled, if possible. Be sure not to go to the bathroom before your appointment.

3) Undress to your level of discomfort. It's actually harder than you might think, to make the undressing uncomfortable. Your therapist is going to tell you to undress as much as you want and get under the covers, and then he'll leave the room, and give you all the time in the world. But you can still make it uncomfortable, by imagining that that you're supposed to take off all your clothes, if you'd rather not, or by imagining that you're not supposed to, if you rather would. The sad truth of the matter is that your therapist doesn't give a damn, and he'll keep you modestly covered up with the sheets whatever you do. Five minutes after the massage he won't remember whether you had your undies on or not. So it's up to you to be sure and do what's uncomfortable for you.

4) If you forgot to arrive uncomfortable, it's not too late. You can still get uncomfortable. After 20 minutes, you might find your bladder full, and then rather than saying so, and hopping off the table wrapped in the blankets to nip out for a quick pee, you can just tough it out. Or maybe your nose will fill with mucus, with your face down in that face-cradle. Then all you have to do is not ask for a kleenex, and try to sniff it up, or surreptitiously wipe your nose on the sheets. You'd be amazed how much discomfort and distraction you can leverage out of a simple thing like that! Of course, if you ask your therapist for a kleenex to blow your nose he'll be happy to hand you one, and take the kleenex afterwards and toss it away – he does it a dozen times a day – and you'll get barely any discomfort out of it all. So don't speak up! -- Or you might get too cold, or too hot, or the face cradle might be scratchy: the opportunities are endless. The secret to maximizing your discomfort is not letting your therapist know about it.

5) If you've got an injury, or some part of your body that you don't want your therapist to touch -- for any reason -- don't tell him! Just tense up every time he approaches it. (He's not going to uncover or touch your breasts or genitals anyway: but that doesn't mean you can't worry about that, too.)

6) Likewise, if the pressure he's using is too light or too heavy, be sure to keep mum about it.

7) If not speaking up is too difficult, there's always the opposite approach. Micromanage the massage! Indulge in your anxiety that he might not hit the right spots, before he's even gotten to that area of your body, and direct him to them with vague but plentiful instructions. This will throw off his rhythm, at the same time ensuring that you don't sink into any unwanted state of relaxation. If you keep busy peppering him with directions, your risk of really enjoying anything is small. (Be careful not to confuse this with asking him to do more, if he's leaving an area and it feels unfinished – that's the sort of thing that puts you at risk for a good massage.)

8) Be sure to make a mental inventory of everything you dislike about your body, and imagine that he's revolted by it all. It's unfortunately true that most massage therapists really like bodies, of all shapes and sizes, and they have spent years seeing what people really look like under their clothes. He probably thinks you're gorgeous. But what's to keep you from imagining he doesn't? Be creative!

9) Rush to get off the table. It's important to imagine that your therapist needs you to get out pronto, and to scramble hastily to get dressed. (If you followed instruction #1, and arrived late, this will be a bit easier, but it's certainly not necessary.) Whatever you do, don't spend five minutes looking dreamily at the ceiling and feeling content! Something like that can leave you feeling relaxed and happy for days.

May 27, 2011

Divagation on "Energy"

Wikipedia quotes Feynman:

There is a fact, or if you wish, a law, governing all natural phenomena that are known to date. There is no known exception to this law—it is exact so far as we know. The law is called the conservation of energy. It states that there is a certain quantity, which we call energy, that does not change in manifold changes which nature undergoes. That is a most abstract idea, because it is a mathematical principle; it says that there is a numerical quantity which does not change when something happens. It is not a description of a mechanism, or anything concrete; it is just a strange fact that we can calculate some number and when we finish watching nature go through her tricks and calculate the number again, it is the same.
—The Feynman Lectures on Physics

“Energy,” you might say, is the most boring of all things, in physics at least: it is the name of a quantity, and what's more, the name of a quantity that doesn't even change. There is nothing qualitative or concrete about it: it is, as Feynman says, inexorably mathematical and abstract.

It's a made-up word of pseudo-Greek origin, and I should admit that I have a prejudice against such words. There was a respectable reason for importing Latin scientific terminology into English. Latin was, for many centuries, the common learned language of the Western world. If you were going to learn just one foreign language, Latin was what you learned, and if you were going to write about something of international significance, you wrote in Latin and used Latin terms. The Polish Copernicus, The Italian Galileo, and the English Newton all wrote their books in Latin – and could all have read each other's writing with ease. The loss of this common language is one of the great intellectual disasters of our time. But that's all by the way. My point is, there was a good reason to use Latin terms: everybody who was interested in science knew what they meant, and they meant the same thing from Cracow to Pisa to Cambridge. But there's only ever been one reason to import Greek terms in the post-classical West, and that's to show off. You use Latin if you want to be understood: you use Greek if you want to impress. And often to people who actually know Greek, it's not very impressive: the Greek words get hauled into ludicrously wrong contexts, get fitted up with Latin plurals, and generally look, to someone with linguistic sensitivities, like wizards trying to dress as muggles.

One of them was a very old wizard who was wearing a long flowery nightgown. The other was clearly a Ministry wizard; he was holding out a pair of pinstriped trousers and almost crying with exasperation.

"Just put them on, Archie, there's a good chap. You can't walk around like that, the Muggle at the gate's already getting suspicious-"

"I bought this in a Muggle shop," said the old wizard stubbornly. "Muggles wear them."

"Muggle women wear them, Archie, not the men, they wear these," said the Ministry wizard, and he brandished the pinstriped trousers.

"I'm not putting them on," said old Archie in indignation. "I like a healthy breeze 'round my privates, thanks."
-- J.K. Rowling, Harry Potter and the Goblet of Fire

Well, somebody around the beginning of the 19th Century dug ἐνέργεια out of a Greek dictionary, much as Archie dug his nightgown out of a muggle shop, and we all need to pretend that it's a real word now: not because anyone is very sure what it means, but precisely because they're not. It's all very highfalutin and authoritative, but as Feynman, with his gift for isolating essentials, pointed out – it's a name for the strange fact that you can run certain calculations over at the conclusion of a change and get the same answer you got before it. It's not a description of change, or of the operations of cause and effect, or of force: in fact it's very nearly the opposite, and its co-option into English to mean things such as “vigor” or “transfer of force” is particularly inept.

Of course, that's just the way language goes: there's no use in objecting to the process, and I wouldn't even if there was. I'm just explaining my visceral response to the word: it strikes me, before we even get to bodywork, as bogus and posturing.

Don't get me wrong. It is a real word, thought not a common one, in classical Greek: it means something like "action" or "operation." But in the New Testament, where our English borrower no doubt found it, it is, as Strong says, "used only of superhuman power, whether of God or of the Devil." In other words, the English word "energy" has been trying to have it both ways ever since it was born: parading as a technical term, but deriving its energy (so to speak) from being associated with superhuman powers.

May 25, 2011

Energy in Bodywork

On Facebook recently, there was a discussion of the notion that one ought to sleep oriented north-south, to align oneself with the Earth's magnetic fields. Someone asked if there was any evidence for this, or if it was just woo, and a lively discussion ensued. I always know when I'm overstressed because I get drawn into arguments about this sort of thing, as if it mattered. I don't care if people sleep north-south – what skin is it off my nose?

Of course it's silly. How does one “align” a non-magnetized thing like a human body with the earth's magnetic fields in the first place? Who says the magnetic poles of the human body are in the head and the feet, and how do they propose to prove it? Has anyone ever noticed that these planetary magnetic fields curve? And can anyone come up with a plausible – let alone verifiable – way in which the incredibly weak influence of the Earth's electromagnetic fields would have any influence on my well-being? Of all the forces acting on me daily, I can think of few less likely candidates than those fields. My laptop, not to mention my next door neighbor's refrigerator-magnets, are blasting those fields all to hell anyway, as far as local influence goes.

But of course it's not really about the facts: it hardly ever is. The emotional investment is actually in much different things. For me it's the question of: do you believe things because they're tidy and convenient and comfy, or because they're true? I wrote in that thread: “this has 'woo' written all over it.” Not just because it strung together a whole series of absurdities and indefensible assumptions, but, much more tellingly, because it arrived at an improbably tidy conclusion: one should sleep oriented, out of all conceivable choices – “right side up.” North is up, and your head is up, so your head should go to the north. It's the childlike insistence on neatness, on the world obediently lining up with our ideas about it, that irks me. It makes me want to insist on these people moving the foot of their beds six inches away from the adjoining north-south wall, if in Maine, or three inches away in the other direction, if in Texas, to account for the magnetic declination. If you invite science to your party, you're going to have to let it play with your toys.

And on the other side, the emotional investment is in not letting schoolbook-learning quash the questing spirit, not letting your native language – which is one of correspondences, microcosms and macrocosms, the language of poetry, in short – be taken away. The people who are doing polarity therapy may be exploring something terribly important, something that has far more to do with people's well-being than correcting for magnetic declination will ever be. And there is a horrible real-world component here which most scientific people I know poo-poo or just refuse to entertain at all. The question is whether people who can't do math or memorize tables or learn Latin nomenclature get to participate. The people who are all gung-ho on a more rigorous science-based training for massage therapists often seem not to get this. There are people who can't do that stuff, and some of them are marvelously gifted bodyworkers. If you raise the academic bar on these people you really are going to cut them off from work they love, and are good at. Possibly even their vocation, the only work they would ever be really good at.

In any case, and more fundamentally, every one has to take their own journey, and will, whether we like it or not. It's one thing for us to tell people: you're not qualified to make medical recommendations based on your own outlandish misunderstanding of electromagnetics. It's another to tell them, your spiritual explorations and emotional discoveries are invalid. We must say the first, and we must not say the second. The fact that we know that Reiki practitioners are talking nonsense when they talk about “working with someone's energy,” as if they were electricians doing a bit of rewiring, doesn't mean we know anything about what happens in a Reiki session that is a decisive turning point in someone's emotional life.

What will make this easier, all round, is if people who don't really understand science stop trying to pretend they do, and stop mixing up their own terminology with scientific terminology. Don't call the damn stuff “energy.” Call it “chi.” Or make up a new word for it. Don't drag in magnetism and electricity. These are things with precise definitions. They can be measured accurately. They behave predictably. You're only going to make yourself look silly, and aid in your own disempowerment, if you try to make them fit with your meridians or sen lines or polarities.

And if you are going to work with the dream world, bear in mind what any genuine shaman will tell you: the crossing is arduous, and the translation is difficult. It's easy to think you know what things in the dream world will mean in this one, but more often than not you don't. Does it intersect with things that scientists talk about? Of course it does, but you don't know how.

To me, the bottom line – and what scientists and shamans are, ideally, in complete agreement about – is don't pretend to understand things, if you don't. Things are confusing enough already.

May 24, 2011

On the Medical Uselessness of Massage

About a year ago I posted this essay on my personal blog. I reproduce it here on request, together with the semi-retraction I wrote a couple days later, with a further observation or two at the end.

Let's be honest. I am in no doubt as to the therapeutic value of massage, but most of it is more spiritual or psychological than medical. The medical benefits solemnly listed by massage therapists are real enough, but they're mostly trivial. Yes, an hour of massage relieves stress and lowers blood pressure -- but not more than a ten-minute nap. It improves the circulation of blood and lymph -- but not more than a stroll around the block. It triggers an endorphin release – but not more than eating a bar of chocolate. It relieves muscle tension -- but not more than a hot bath. All these effects are real and measurable; they're just not very important, medically speaking, and they are not – quite obviously to me – why people really get massage. People get massage because they ache for the touch, for the physical communication, for the sensation of being physically cared for, physically attended to, physically heard. We dress it up as a medical intervention because that makes it respectable. It's justifiable to spend money on it, if it's medical. But it's no more medical really than a momma cat licking her kittens' tummies. Perhaps that does aid the kitten's digestion, but you and I and every cat knows that's not really the point.

The point is that we must love and be loved; we must touch and be touched. It's fundamental to our well-being. My favorite massage myth is that it “releases toxins.” This has been studied, and there's not a shred of evidence for it, but the myth marches on regardless, because it feels right. It feels like you're getting rid of something poisonous when you get a good massage, when you give your body over to someone and they treat it with interest and love and respect. But the poison isn't metabolic waste: the poison is the anxiety of loneliness, the ache for acceptance, the doubt whether we really belong to the tribe. Those are the toxins massage flushes from the system.

(Okay. An exception, here, is trigger point, which has serious therapeutic value for relieving chronic myofascial pain – what's commonly perceived as joint pain. But the most common “dosages” of massage – one hour once a month, or one hour once a week – are all but useless for trigger point, which typically needs ten minutes three or four times a day to be effective. I do trigger point on myself all the time, and so should you: but save your money. See a good trigger point therapist once or twice, get them to teach you how to work the points causing your pain, and do it yourself till the points resolve. That would be my advice, for all but the gnarliest and most entrenched trigger point systems.)

The thing about the psychological benefit of massage is that it falls roughly under the rubric of placebo treatment, and from what we know about placebo, the more ritual and mystery surrounding it, and the more sense of its preciousness, the better it works. If I could talk a good line about releasing toxins or balancing energy, my massage would be more therapeutic. And if I charged more for it, it would be more effective. There's a serious case to be made for the therapeutic value of driveling, especially if you believe in the nonsense yourself. But I can't do it.

I can say this, in recompense: the love I feel for my clients is intense, and quite as real as any other kind of love. I'll stumble upon pockets of grief, I'll open up veins of lifelong loneliness, that will stagger me. Doing massage is no more soothing, ordinarily, than participating in a meditation retreat is relaxing. On the contrary, like a meditation retreat, it's most often, for me, a wild roller-coaster ride of emotions, waves of joy and sadness in quick succession, glimpses of rare colors and strange countries. The connection can be downright unnerving. You need either a thick skin or a certain amount of contemplative stability to ride it out. The end result may be – usually is – a profound sense of gratitude and well being: but it doesn't come cheap.

I suspect that if you studied people with a life history of getting regular massage, you'd find longevity benefits similar to – and as difficult to analyze as – those of marriage. But a study definitively establishing cause would be, under present funding conditions, prohibitively expensive. After all, people who get regular massage tend to be prosperous, tend to look after themselves, tend to be willing to expend resources on their own well-being, tend to be comfortable with touch and hence likely to be in healthy love relationships: you'd need to randomize your clientele, and track them over years, to avoid all that skew and get real results. A study like that is not going to happen while Big Pharma rules the medical roost.

The trouble is that if we keep making claims for short term medical effectiveness that we can't actually back up, sooner or later we're going to be discredited. Massage could go into another eclipse like that of the middle 20th Century, when it almost disappeared in America as a respectable profession. I'd hate to see that happen, because I do think we help people, profoundly and lastingly, and I do think we are the keepers of a traditional lore – of several traditional lores – that ought to be preserved. But I don't think we can compete with Big Pharma on its own ground of quick fixes and magical pain relief, and I don't think we should try.

And here's the semi-retraction:

Okay, Not Useless

I promise you, if I ever undertake seriously to argue that massage has no medical value, my paper will have footnotes and close argumentation and takedowns of several studies, and it will be longer than 500 words. I promise also that I will try to refrain from tweaking people with inflammatory and outrageous titles, although that will be a harder promise to keep. It's been part of my rhetorical strategy so long that it persists even when the ideology which formed it (essentially, that dull people are improved by being poked) has long since withered away. Habits die hard. I was given Strunk & White at a tender age, and encouraged to think that forcefulness was the prime virtue -- what all writing should aspire to all the time. I now have a middle-aged respect for accuracy and caveat, even when dull; but I still find myself fluttering the cape sometimes.

And anyway, I would never want to make that argument: it's untrue. When my essay was linked to for a group of people who work hard to do medical massage (and justify its use), they were understandably miffed. It was a nice lesson for me in how contexts can shift, on the internets. I can ordinarily assume that my audience here knows that I'm passionate about massage, that my much of my practice is what is called “relaxation massage,” rather than treatment-oriented massage (though I'm doing much more treatment nowadays.) So the “medical benefits of massage” that I was poking fun at are the ones that routinely show up on the web pages of practitioners like me -- not the pain relief, lymph drainage, and trigger point, and all the techniques that shade into physical therapy, but rather the stock list that you learn in Massage I – relieves stress, promotes circulation, lowers blood pressure -- all true, all verifiable, all temporary, and all trivial.

If massage were as effective as many of its practitioners claim, it would blow other therapies out of the water in comparative studies. In fact it comes out lackluster, most of the time. If some therapists have the extraordinary success rates they claim, that only makes the general picture worse: for every therapist two sigmas out on the right, there have to be a dozen or two whose work is completely worthless, to get the kind of distributions we see. Massage came out tops in treating low back pain, in a study a while back, but that was more because the other therapies were so ineffective, than because massage worked so well.

I started reading studies of massage back before I was in massage school, but I gave up pretty soon. What I saw then was mostly very small studies with inadequate controls documenting that massage could have a significant effect on this, that or the next thing. Which, if you're not a science person, might sound impressive. But “significant” doesn't mean “important,” in statistics: it just means “very unlikely to be a random result.” Aspirin significantly reduces low back pain, but we can be excused for not jumping up and down with delight about that fact, especially if we can't get out of bed. These studies were a start, and I'm not mocking the people who did them, who had next to no resources. They established that there's something to study, that the idea of treating various conditions with massage is not absurd. But they didn't take us much further than that.

I know. I have anecdotal evidence too. I have clients who swear that I fixed their necks, backs, hips, knees. I am confident that I've reduced a lot of pain. I even have people I think I really rehabilitated, got back on their feet again. Someone who couldn't go up and downstairs, who now runs up and down like a goat. Another who couldn't hold a pencil, whom I enabled to write again. Someone who thought it was only my work that allowed her still to stand upright, at the end of her pregnancy. That feels good, and I like believing in it, but I can hardly be classed as an unbiased observer. A scientific person has to ask: how many people were just going to get better anyway? Eighty percent of my appointments are with clients who think I'm terrific, but how much of that is because the people who didn't get any relief just didn't come back? How much of it is just because of the rapport and affection that any loving touch conveys? I like to think – be real, I do think – I'm a good therapist. I study and I think and I pay attention. If something doesn't seem to be working, I try something else. But I don't think the comparative studies are lying, and I don't think the majority of massage therapists are incompetent.

Having said that much – and possibly gotten myself in trouble again – I will also say: we don't know a damn thing. The study of massage is in its infancy. Chronic myofascial pain is very mysterious, and much of what we thought we knew about it is being daily disproven.

God, think what we could find out if we had the kind of money that gets spent researching drugs! Everything remains to be discovered. There may come a time when we can confidently tell someone with chronic back pain, “I'll have you on your feet again in a week, and after that you'll never need to come see me again.”

We are not there now, and claiming that we are only makes us look ridiculous. We want solutions that a workaday, non-brilliant, not particularly gifted therapist can execute and get reliable outcomes. The traditional lores are not going to get us there, not on their own, although they are full of hints. We need science. We need to understand how it really works. We need results that are verifiable and repeatable.

In the meantime, I'll do my best to help with the pain presented to me. But I don't have the confidence in the value of that part of my practice that I have in the supposedly vaguer, touchy-feely, cloth-mom-for-the-rhesus part of it. People need to be touched with love and understanding, and I know how to do it. The bottom is not going to drop out of that market if Methylene Blue turns out to fix discogenic back pain, or if someone builds a cool nerve-feedback acupuncture machine that fixes pseudosciatica every time. All that will do is take away one of the pretexts people have been depending on to get the touch they need. They'll find another.

So, a year later, I find this is still pretty much where I come down. I have more experience of helping people recover from auto accidents, now, and those benefits seem to me pretty clear: trauma of that sort doesn't just cause new injuries, it re-activates old, latent trigger points, and after a few days it's often old injuries are causing more pain and distress than the new ones. Massage can do a lot to put them right. It's a prime instance of medically useful massage, and the results are impressive enough to convince even me.

There are things I wouldn't say now. I've come to dislike the phrase "Big Pharma," with its hints of conspiracy and collusion: I wouldn't use it now. But I have become even more skeptical of many therapies, over the past year, than I was when I wrote this: I still think that many massage therapists routinely make claims they can't back up. In this we aren't, maybe, all that different from other health care providers. But we have other traditions and other ground to stand on: we don't have to present ourselves as an alternative to opiates, disc surgery, or chelation. We could say we're doing some else, something worth doing for its own sake.

May 9, 2011


I pull down the blanket, then the sheet, and tuck it around the hips. It's love, pure and simple; the same love you feel when you zip up your child's jacket against the cold of winter.

Here, in the complicated space between the scapulae and spine, are rage and disappointment. I lay my thumbs in the precise center of the lower triangles of the scapulae; and there is the agony of pride. I move my fingers to the striations of the deltoids. This is a gentler woe, the long soft lamentation of vanity.

I read, with my fingers, how tightly the skin adheres. That tells me at once: how afraid is this person? An anxious skin clutches tight to what's underneath.

And then here, in the bunched muscles that rise from shoulder to neck, is the love of God: I hold there, and I can feel it coursing, weak or strong, under my fingertips.

A perfect body is not a perfect person. We live in a time too prone to conflate health and goodness. As a therapist I may want those muscles to let go. But don't mistake a lolling head for virtue.

Gently the head relaxes into my hands. Here, in two thimble spaces under the skull, is the whole story of grief. This is where the shadow of everything lost lingers on, like snow in the northward hollow at the foot of a tree. Listen, there, with one finger in each space, and they will tell you about lovers lost, children quarreled with, a favorite watch gone missing after a harrowing weekend. It's all there.

Follow the narrative, written in a turning scrawl between the ribs. The coda of the diaphragm. Cover the back, visit the glutes, and move on.

There are hidden clauses, reservations, and footnotes in the flesh of the inner thigh, just above the knees: the residue of old, poisonous stories, never believed but never forgotten.

And so to the feet, where it is all recapitulated, written small. At last the thumbs go of their own accord to the space under the balls of the feet, and there it is again, the grief met in the hollows under the skull. Just hold. It needn't always be stroking and kneading and pushing. In my end is my beginning.

Never mind: they won't see it if my eyes fill with tears. Cover the feet. Like tucking a child into bed.

"Thank you," I murmur. And then, "take your time." And I leave the room, careful not to look back as I close the door.