Sunday, December 11, 2011

Expanded response to Ravensara

I read your response to my blog to my advanced students this weekend and they were impressed.  I used it as an example for how to develop an opposing statement and/or engage discussion.  I told them that what I did not realize is that this discussion may end up being an example of how a conversation of this type can evolve. Later  Laura Allen posted on Face book

Laura wrote: "Two ladies I admire--Sandy Fritz and Ravensara Travillian--can disagree and be gracious about it. That is the hallmark of civil argument and it would serve certain people to take a lesson in it.”.

 So I posted the blog to see if this important topic would be discussed and thanks to you it is and additionally an example ( at least to Laura  ) of a civil argument.   Later, one of my students emailed me a quote from Einstein about energy and physic and mysticism. I checked it out and identified that maybe Einstein may not have made the statement but I did find this one.

Even though the realms of religion and science in themselves are clearly marked off from each other, nevertheless there exist between the two strong reciprocal relationships and dependencies.
Albert Einstein - "Science, Philosophy and Religion, A Symposium" (1941)

I made the statement  ---I think it is the mystical factor when in reality there is no mystery at all.

Ravensara replied:  Here, I respectfully disagree.

The arguments linking thermodynamic energy to the energy healing concept all, universally, without exception, require a mystical leap of faith to make that connection. …..That metaphysical leap of faith contains the mystery associated with the energy healing concept, which some of us are happy to accept without questioning, and which others of us have a large problem with. The energy healing concept cannot be directly connected to thermodynamic energy without that leap of faith, which is what makes this issue so irreconcilable.

MY REPLY: Yes Ravensara- your right. I did exactly this without realizing it. My intention was to point out the line between evidence and opinion yet I still confused the two.  You write --Here is where Fritz takes the metaphysical leap of faith I mentioned earlier:

I think the big question is if humans can purposefully direct their energy fields. Here is what I suggest- approach each client with the energy of compassion, respect and intent to help using solid massage application.

RAVENSARA points out: In the first sentence, she is speaking of objectively-detectable electrical activity at the subcellular level. In the second sentence, she is speaking of complex and sophisticated emotions and cognition that are not objectively detectable.

By juxtaposing the sentences, she is claiming that they are the same thing, but she is not doing the work to connect the dots to demonstrate that they are, indeed, the same thing.  She is, implicitly, asking us to take the same leap of faith to consider the two phenomena (subcellular ionic activity and complex emotions/cognition) to be equivalent to each other.

MY REPLY: Yes Ravensara you caught me. I did not intend to do this but on review, I did. This is a clear example of why "Experts" should be challenged and I am glad you did.

My point better clarified is this- as a massage therapist be mindful of your intentions, presence and influence and represent massage methods clearly without confusion. There is good evidence for benefits of massage and there is indication that one of the mechanisms of benefit may be the interaction of the therapeutic relationship which would fall into the psychosocial model. Christopher Moyer has pointed this out.

 Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004;130:3–18. doi: 10.1037/0033-2909.130.1.3.[PubMed] [

‘Later Ravensara writes - The important question is, what is the significance of those electrical impulses? Is it nothing more than white noise, generated by millions of independent interactions at the subcellular level, or is it a top-down, coherent entity that has an independent existence and properties of its own? 

MY RESPONSE:  This is clear concise and brilliantly stated Ravensara. I wish I would have said it that way.   The aspect yet to be understood within the realm of scientific evidence is---- can the energy of the body function as top-down, coherent entity that has an independent existence and properties of its own that can be use purposefully to influence a physiological process in another.

What constitutes quality evidence?  I copy and pasted this from

Levels of Evidence

Level I:
Systematic reviews, meta-analyses, randomized controlled trials
Level II:
Two groups, non-randomized studies (e.g., cohort, case-control)
Level III:
One group, non-randomized (e.g., before and after, pretest and posttest)
Level IV:
Descriptive studies that include analysis of outcomes (single subject design, case series)
Level V:
Case reports and expert opinion that include narrative literature reviews and consensus statements

Adapted from “Evidence-Based Medicine: What It Is and What It Isn’t,” by D. L. Sackett, W. M. Rosenberg, J. A. Muir Gray, R. B. Haynes, & W. S. Richardson, 1996, British Medical Journal, 312, pp. 71–72. Copyright © 1996 by the British Medical Association. Adapted with permission

I point out level V evidence.  Case reports and expert opinion that include narrative literature reviews and consensus statements.

I ask the question,”  Is there a level of evidence for energy work application based on case reports, expert opinion, narrative literature reviews and consensus statements?”

Another question I ask is “ Even if there is evidence for energy work  do these methods fit within the definition and scope for massage?”

 My opinion is that massage functions though the physiological and mechanical changes that occur when mechanical forces are applied to the body.  My opinion is that massage should be taught and explained in this way as well and researched from this perspective.  It is also my opinion that there is benefit derived from the psychosocial interactions of the therapeutic relationship. I also think that there are other methods the interface well with massage, but are not massage. Examples include hydrotherapy, thermotherapy, possibly aromatherapy, music therapy, Shiatsu and within this realm energy therapy maybe. Others methods included in this realm for me would be use of magnets, kinesio-taping, and various ointments and products that cool or warm the skin.   I think that these types of applications are adjunct or in addition to massage and should be explain as such.  Some of these methods have high levels of scientific evidence and some have none and this information should be disclosed to the client in an informed consent process..

Ravensara states concern with the following issues.
·         How do we, as practitioners, provide a safe therapeutic space for all clients, without litmus tests for belief?

MY RESPONSE:  I agree with the question and think we can within the framework of ethics and professionalism develop guidelines to help massage therapist in this area.

·         How do we, as educators, provide a safe learning space for all students, without litmus tests for belief?

MY RESPONSE: I agree with the question and think we can within the framework of ethics and professionalism and critical thinking develop curriculum guidelines to help massage educators in this area.  I have attempted to write text books with this in mind.

·         What are the commitments to principles that we, as an evolving profession, wish to make, and what are the impacts of those commitments on collaboration and communication with other potential partners on the healthcare team?  

MY RESPONSE: This is a huge issue Raven and I think the massage community continues to be immature in this area.  The massage community needs to grow up (my opinion) before this issue can be considered. It makes me sad that the profession I love remains so divided.
Raven states: There are three outcomes that I can imagine coming out of this; there may be others that I have not thought of.

1.     We come to a working arrangement with a code of ethics that practitioners of all specialties can commit to working under, one which does not require forcing any particular belief or set of beliefs on students or clients; 


2.     We agree that such a working arrangement cannot be reached, and the profession splits under mutual agreement into different areas of practice that commit to varying degrees of belief in vitalism/dualism;


3.     We do nothing, and the profession splits in an uncontrolled way along that fault line, with unpredictable fallout from that split.

                    Those reading this blog may enjoy the paper found at this link

Int J Ther Massage Bodywork. 2009; 2(2): 15–27.
Published online 2009 June 29.
PMCID: PMC3091464

Copyright © The Author(s) 2009. Published by the Massage Therapy Foundation.

Directions and Dilemmas in Massage Therapy Research: A Workshop Report from the 2009 North American Research Conference on Complementary and Integrative Medicine

Christopher A. Moyer, PhD,1 Trish Dryden, RMT, MEd,2 and Stacey Shipwright, BA, RMT2

On a final note, Ravensara commented on my sharing the picture of my granddaughter and the circumstances of my son’s death.  The compassion I felt in your response is genuine and I honor and appreciate you for it.  We all have a story with many chapters.   How we turn the pages of our life influence the quality of the journey. 

The very worst thing that could have ever happened to me did happen and because of faith, hope and love I can cry and laugh, continue to grieve yet move forward. I still struggle to forgive but I am getting there and I have been blessed. This is my life and my spirit but it is not the massage I can give nor the results the clients receive.  I am a more gentle soul because of the events and my walk through them and I think a more empathetic person which makes me a better massage therapist and educator and so we circle around the issues again.

Even though the realms of religion (spirituality) and science in themselves are clearly marked off from each other, nevertheless there exist between the two strong reciprocal relationships and dependencies.
Albert Einstein - "Science, Philosophy and Religion, A Symposium" (1941)

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