One of massage's biggest culture wars at present arises out of the dispute between monistic and dualisticphilosophies. It has implications for how we practice with clients, and how we teach our students in our schools.
Although we're experiencing this culture war every day in our own field, this argument is centuries-old and is not limited to massage. Throughout human history, great minds have tried--and failed--to resolve it. I don't expect us to resolve it anytime soon, but we do need to resolve whether those of us on opposite sides of the philosophical divide can work together, or whether it divides us irreconcilably.
The argument goes back much further in history, but in the early 1800s, advances in the relatively new science of chemistry caused a seismic shift in the evolving field of medicine. As Siddhartha Mukherjee describes the experiment that shattered previous thought on dualism in health and medicine:
Early interactions between synthetic chemistry and medicine had largely been disappointing. Gideon Harvey, a seventeenth-century physician, had once called chemists the "most impudent, ignorant, flatulent, fleshy, and vainly boasting sort of mankind." The mutual scorn and animosity between the two disciplines had persisted. In 1849, August Hofmann, William Perkin's teacher at the Royal College, gloomily acknowledged the chasm between medicine and chemistry: "None of these compounds have, as yet, found their way into any of the appliances of life. We have not been able to use them...for curing disease."
But even Hofmann knew that the boundary between the synthetic world and the natural world was inevitably collapsing. In 1828, a Berlin scientist named Friedrich Wöhler had sparked a metaphysical storm in science by building ammonium cyanate, a plain, inorganicsalt, and creating urea, a chemical typically produced by the kidneys.
--Siddhartha Mukherjee, The Emperor of All Maladies: A Biography of Cancer, Scribner 2010, p. 83.
This drawing shows a molecule of ammonium cyanate, a compound that doesn't come from living things. It's made up of:
- 2 nitrogen atoms, shown in blue;
- 4 hydrogen atoms, shown in gray (since this is a 2-D drawing of a 3-D molecule, one of the hydrogens is hidden behind a nitrogen, but it really is there, even though we can't see it in this arrangement);
- 1 carbon atom, shown in black; and
- 1 oxygen atom, shown in red.
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Source: modified from http://upload.wikimedia.org/wikipedia/commons/8/8c/Wohler_synthesis.gif accessed 27 June 2012
Urea, a kind of waste product produced by the kidneys in many different species of living things, forms molecules that are made up of:
- 2 nitrogen atoms, shown in blue;
- 4 hydrogen atoms, shown in gray;
- 1 carbon atom, shown in black; and
- 1 oxygen atom, shown in red.
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Source: modified from http://upload.wikimedia.org/wikipedia/commons/8/8c/Wohler_synthesis.gif accessed 27 June 2012
These two very different substances, one found in living organisms and one not found in them at all, have exactly the same atoms in exactly the same amounts. The only difference is the arrangement of those atoms in 3D space.
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Source: http://upload.wikimedia.org/wikipedia/commons/8/8c/Wohler_synthesis.gif accessed 27 June 2012
The Wöhler experiment--seemingly trivial--had enormous implications. Urea was a "natural" chemical, while its precursor was an inorganic salt. That a chemical produced by natural organisms could be derived so easily in a flask threatened to overturn the entire conception of living organisms: for centuries, the chemistry of living organisms was thought to be imbued with some mystical property, a vital essence that could not be duplicated in a laboratory--a theory called vitalism. Wöhler's experiment demolished vitalism. Organic and inorganic chemicals, he proved, were interchangeable. Biology was chemistry: perhaps even a human body was no different from a bag of busily reacting chemicals--a beaker with arms, legs, eyes, brain, and soul.
With vitalism dead, the extension of this logic to medicine was inevitable. If the chemicals of life could be synthesized in a laboratory, could they work on living systems? If biology and chemistry were so interchangeable, could a molecule concocted in a flask affect the inner workings of a biological organism?
--Siddhartha Mukherjee, The Emperor of All Maladies: A Biography of Cancer, Scribner 2010, p. 83.
In one way, Mukherjee is right--this experiment showed that the vitalistic claim that a distinction based on vital essence existed between living organisms and non-living things had no basis in material physical reality. By "dead", he means that its foundation was shown to be false, and that there was therefore no basis to continue to use it as a basis for explanations in medicine or science. His usage refers to the "referent" part of the Semantic Triangle--no referent means no vitalism.
But in another sense, he's prematurely pronouncing it dead. There are still many people who believe in vitalism and dualism, not only in their own personal belief systems, but also by bringing dualistic concepts such as "spirit" and "energy healing" into the therapeutic encounter. The fact that there is no material physical referent in support of the idea does not prevent them from operating in the "concept" and "terms" part of the Semantic Triangle.
Whoever wrote the Wikipedia article on vitalism correctly observed that vitalism didn't disappear just because of that one experiment:
The concept of vitalism in chemistry can be traced back to Jöns Jakob Berzelius who suggested that in the division of organic and inorganic that a mysterious vital force exists in organic compounds.
Vitalism played a pivotal role in the history of chemistry since it gave rise to the basic distinction between organic and inorganic substances, following Aristotle's distinction between the mineral kingdom and the animal and vegetative kingdoms. The basic premise was that organic materials differed from inorganic materials fundamentally; accordingly, vitalist chemists predicted that organic materials could not be synthesized from inorganic components. However, as chemical techniques advanced, Friedrich Wöhler synthesised urea from inorganic components in 1828.
Further discoveries continued to marginalise need for a "vital force" explanation as more and more life processes came to be described in chemical or physical terms. However, contemporary accounts do not support the common belief that vitalism died when Wöhler made urea. This Wöhler Myth, as historian of science Peter J. Ramberg called it, originated from a popular history of chemistry published in 1931, which, "ignoring all pretense of historical accuracy, turned Wöhler into a crusader who made attempt after attempt to synthesize a natural product that would refute vitalism and lift the veil of ignorance, until 'one afternoon the miracle happened'". However, in 1845, Adolph Kolbe succeeded in making acetic acid from inorganic compounds, and in the 1850s, Marcellin Berthelot repeated this feat for numerous organic compounds. In retrospect, Wöhler's work was the beginning of the end of Berzelius's vitalist hypothesis, but only in retrospect, as Ramberg had shown.
In fact, some of the greatest scientific minds of the time continued to investigate the possibility of vital properties. Louis Pasteur, shortly after his famous rebuttal of spontaneous generation, performed several experiments that he felt supported the vital concepts of life. According to Bechtel, Pasteur "fitted fermentation into a more general programme describing special reactions that only occur in living organisms. These are irreducibly vital phenomena." In 1858, Pasteur showed that fermentation only occurs when living cells are present and, that fermentation only occurs in the absence of oxygen; he was thus led to describe fermentation as 'life without air'. Rejecting the claims of Berzelius, Liebig, Traube and others that fermentation resulted from chemical agents or catalysts within cells, he concluded that fermentation was a "vital action".
but he/she ends the chemistry section rather abruptly with Pasteur, rather than following through continuously to the present. This, too, is premature--vitalistic thought persists to this day. The developments in chemistry and other sciences that--among people who are familiar with the subject--convinced them that vitalism is no longer a compelling alternative explanation.
I think this overlooks a great number of people who aspire to be healthcare professionals, but who have not had access to an in-depth scientific and biomedical ethics education.
The issue of vitalism/dualism in MT is a huge issue for us. To continue to insist on vitalistic mechanisms as explanations is an obstacle to integration with other members of the healthcare team in fields that have long ago accepted the scientific consensus that--as a source of explanation in the lab and in the clinic--vitalism is dead.
And it directly contradicts established consensus of what belongs in an MT body of knowledge. As we've seen, vitalism contradicts chemistry and pharmacology.
Yet MTs are expected to know basic principles of pharmacology in order to practice.
The Massage Therapy Body of Knowledge (MTBoK) calls for the following required knowledge:
Pharmacology
- General classification and types of drugs, herbs, supplements, their effects and their side effects.
- Massage therapy considerations and potential responses to general classes of drugs, herbs and supplements.
- Use of authoritative, medically accepted drug reference to look up drugs, their effects and their side effects.
--MTBoK, p. 18
while the Massage and Bodywork Licensing Examination (MBLEX) states the following expectations:
PATHOLOGY, CONTRAINDICATIONS, AREAS OF CAUTION, SPECIAL POPULATIONS (13%)
...E. Classes of medications
--Massage and Bodywork Licensing Examination Candidate Handbook, Content Outline, p. 15
and the National Certification Exam in Therapeutic Massage and Bodywork/National Certification Exam in Therapeutic Massage lists the following topics:
III. Pathology (13%)
...
L. Drug interactions with massage/bodywork
1. medications (e.g., prescription; over-thecounter)
2. recreational drugs (e.g., tobacco; alcohol)
3. herbs
4. natural supplements--NCETMB/NCETM Candidate Handbook, pp. 21, 23
and yet, at the same time, they require vitalistic concepts on the very same test--concepts that directly contradict the science on which these learning expectations are based.
This puts our students in an impossible position for learning, when one set of expectations directly contradicts another, as well as putting the teachers and schools in the position of being required to teach mutually contradictory information, and to assess students on how well they perform the impossible task of integrating that knowledge.
We need to figure out what this means to us as a community and as a developing profession. As Mukherjee observes, the metaphysical boundary collapsed a century and a half ago, but not all of us have quite gotten word of the collapse yet.
We need to address, at the very least (there may be even more issues that I have overlooked here):
- how do we balance ethical standards and best practices in the client's interests in the therapeutic encounter with the practitioner's freedom of conscience?
- how do we--schools, teachers, mentors--provide an education to our MT students that prepares them to build bridges to integration with other members of the biomedical healthcare team?
- what do we do about the sunk costs in the previous unsustainable path, and the tremendous investment that it will require for us to practice as an integrated healthcare profession?
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Source: The 7 November 1940 collapse of the Tacoma Narrows suspension bridge, http://upload.wikimedia.org/wikipedia/en/5/5c/TacomaNarrowsBridgeCollapse_in_color.jpg accessed 27 June 2012