June 1, 2019

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.

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.

April 4, 2019


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.