In order to resolve any health issue there are two relationships of importance to consider (1,2);
- The relationship between the tissues/anatomy/pathology causing symptoms and the symptoms themselves
- The relationship (issues) between everything else going on in a person’s life (I.e. ‘What else’ is going on behind the scenes) and the tissues/anatomy/pathology causing the symptoms.
The first relationship focuses on identifying the immediate cause of symptoms and may often be emphasised during traditional medical education and practice. In this author’s experience, this relationship tends to be so over focused upon that we have in todays day and age a situation which focuses almost exclusively on symptoms (particularly pain) that practitioners try everything they can to alleviate the symptoms (treating involved body tissues or applying relevant first aid, etc) and therefore getting patients immediately out of trouble. The trouble with this approach is that although symptoms may be abated (often temporarily) and emergency situations averted (and which is always extremely important – to preserve life in particular), this approach offers little relief for patients with chronic health issues.
With chronic or complicated health issues such an approach falls short. Why is this so?
A little reflection will outline why? A symptom cannot exist without a cause but – this immediate cause may have numerous other predisposing causes (i.e. relationship imbalances in other elements of a person’s life) impacting upon it (mentally, emotionally, physically, socially, nutritionally etc) – and thus is not necessarily the originating cause for its distress. There may be, in fact, numerous other factors/components all inter-related and collectively placing stress (of many possible kinds; compressive, congestive, tensile, etc) on the symptomatic anatomy; interacting upon it in interconnected and potentially complex ways to effect symptomatic tissues or otherwise interfere with (and thus slow) recovery. This makes each case very individual and unique because – although symptoms in one person may be similar to that of another person, the underlying contributing relationship imbalances elsewhere may, in fact, be very different. These other factors comprise the “what else” and are catered for in the second relationship point mentioned above. In order to identify these a holistic assessment is necessary.
Furthermore, a symptomatic (stressed, overloaded, depressed, etc) structure may not actually be dysfunctional but may actually be coping with its stress quite adequately to a point, until it has had enough and breaks down; at which point it may need “emergency – first aid’ type care. This can be likened to a person being constantly barraged at work or home with so much psychological abuse that one day he breaks down and lets loose, physically attacking everyone nearby at the moment he ‘looses’ it so to speak. He has now become symptomatic and will probably end up in Jail for it (which is first aid management at best) while the psychological abusers remain free (playing the roles of ‘completely’ innocent victims) and unnoticed (assuming they survive the retaliatory physical abuse) to wreak their havoc on some other poor soul in their work or home environment until they are truly recognised and dealt with effectively. By dealing with the symptom alone (i.e. throwing the person in jail) everyone else is happy and able to function once again but, in reality, the real causes underneath apparent events have not yet been addressed at all. This is the case with any chronic or complicated issue. The real perpetrators often remain hidden “within”; unnoticed, unrecognised and thus there is no real long-term improvement in health and well-being; nothing has really been dealt with regarding the “real” underlying causes. Even dealing with pain or symptoms alone (prior to the person breaking down and lashing out) would be like noticing the poor fellow is manifesting stress (anxiety, depression) etc and performing some alleviating/pacifying treatment; comforting him, soothing him, sympathising with him etc – to the point where he settles down and doesn’t manifest his symptoms anymore. Now he is comforted – no longer in immediate distress so everyone else (i.e. the practitioner administering the symptomatic remedy and friends/colleagues etc) can go on for a bit longer maintaining the illusion that everything is ok – at least until the real perpetrators, psychologically abusing the symptomatic effect (i.e. the unconscious real victim) tip him to breaking point once again. Using this analogy, we can see that dealing with symptoms alone will actually prolong the problem long term because, by alleviating immediate distress (i.e. pain, for example), a patient (and practitioner for that matter) can maintain the illusion that everything is alright and carry on with life oblivious of the fact that underlying predisposing causes (i.e. relationship imbalances elsewhere) are still there ready to re-emerge once again when conditions are ripe.
With this in mind it is readily apparent that if we only assess for immediate symptomatic causes then we may be missing vital information which may be needed in order to see the bigger picture and adjust management accordingly to address it. How are the real culprits going to be caught (and hopefully then re-educated and re-habilitated so it doesn’t happen again to someone else) if these other ‘potential’ relationship imbalances are not assessed for and then, if present, included into a suitable management plan.
SO – WHAT IS A PRACTITIONERS AND A PATIENTS ROLE IN HEALING?
To successfully rehabilitate a person with any health issue (especially if chronic) requires two things:
|Practitioners Responsibility in Healing||Patients Responsibility in Healing|
|ASSESSMENT: To assess for; Identify and understand what is happening behind the scenes and how it relates to the presenting complaint.This requires both;
1) Holistic Assessment for “what else” is going on (i.e. the relationship imbalances – spiritually, mentally, emotionally, energetically, physically, environmentally, nutritionally, socially, including the effects of past traumas on the present situation etc) setting up the anatomy causing symptoms, contributing to their stress and or otherwise hindering their recovery. They do this by identifying primary areas of A.R.T (asymmetry, Range/Quality of motion abnormality, and tissue texture change – as real dysfunctions have all three of these factors) (1). Remember – Primary problems are not about pain or range but more about feel and function.
2) Regional/medical or other assessment to identify the tissues/pathology causing symptoms.
Once involved patterns of dysfunction are identified from assessment – Holistic management requires;
A) It is a practitioner’s choice (dependent on education, comfort, and experience) how much of these identified patterns (components and their relationships) can be included into treatment (through their individual approach to treatment – being mindful of involved patterns and their links to symptomatic structures as well as inner health for overall balance) – and/or
B) to refer out to complimentary health practitioners to support (in conjunction) or treat/manage those components or relationships outside their scope/comfort level of practice.
NOTE: the extent of holistic assessment and management depends on how much of the whole person (i.e. the included anatomy and physiology and their inter-relationships) is included in each individual practitioner’s concept of holism and what they are comfortable exploring, assessing and treating.
The GOAL of treatment is to restore optimal balance to the whole person to facilitate self-healing and to provide a stable base for rehabilitation.
|Once Identifying ‘primary;’ causes/contributing factors (relationships etc) are identified (by a practitioner able to recognise these) – Patients need to;1) Learn about health (what it is and means, etc) and be willing to look within, develop the awareness (mindfulness) of both the health and the underlying problem patterns and work with their inner health (and self-healing mechanisms as well as appropriate practitioner support) to work through any issues that come up through the healing process.
2) Remember that perfection (health) drives imperfection (dis-ease) to the surface and so trauma patterns may come up (to be recognised, allowed, released and dealt with) and things may get difficult (even worse in some cases) for a while as things improve; as new healthy skills/patterns and habits have to be learned to replace bad (destructive) ones. This requires EFFORT and AWARENESS
3) Become Health conscious rather than disease focused. i.e. focus on Inner FUNCTION (quality of movement), ease, health, flow, texture-feeling and well-being – NOT PAIN/symptoms (which indicate effects only). Basically, ENERGY FOLLOWS THOUGHT – so build in more of what you want rather than focus on what you don’t want (negatives). Notice the negatives but don’t feed them, then allow them to transmute back into health (YES – you can learn to do this)
4) To be patient and perseverant as it takes time to build in healthy habit patterns and practice them
Therefore, in addition to good HOLISTIC and Regional treatment patients need also Self-healing and Self-awareness education.
GOAL – for patients and practitioners alike to support each other and work together for the overall health, well-being and self-development of clients.
If these requirements are met by both patient and practitioner then there is a good probability that long term health benefits will be gained (karma and life purpose of the client permitting). At least there should be no excuses for no improvement whatsoever. If the correct building blocks are in place a patient should have no reason not to become more healthy and aware.
A focus on symptoms alone, in this authors experience, will never resolve complicated and chronic health issues because what is actually going on is individualised for each patient and thus needs an individualised program to manage. The relationship between symptoms and immediate causative anatomy may be the same but the predisposing life patterns, traumas and relationship issues may be very different for each case (1).
CURRENT TRENDS AND EDUCATION (in relation to chronic health):
As a practitioner I have noticed nowadays that there is a growing interest in fitness and rehabilitation, psychology, kinesiology, movement patterns etc. Why is this potentially effective? Possibly because it helps clients to become more self-empowered to take responsibility for their own health and take steps to learn how to use our vehicles (bodies, mind, etc) in a healthier way. Is short – its deals a little more with some of the “what else”.
There is also seems to me to be a strong emphasis for pain education and management, which informs people how pain comes to be and that it can be felt on remote sites to the original cause; as well as chronic pain patterns and how they can become fixed (facilitated) and difficult to resolve with out education and multi modality management. To me is still mainly focusing mostly on pain and education about pain rather than on building inner health and about finding and treating the “what else” behind the scenes. My research on holism in Osteopathic practitioners and personal experience in other health therapies seems to indicates that education (and research) has a strong biomedical emphasis to the point where the holistic philosophical elements may be lost, omitted or not developed to an integrated level of understanding (1,2). The emphasis seems to be reductionist, mainly focused on the part with symptoms rather than the person with the problem. Thus – if symptoms have become a dominant focus, is it any wonder many practitioners are likewise focusing on symptoms (and fancy techniques designed to alleviate symptoms). Participants in my research all indicated that they all treat some of the “what else” or they would get no long-term results (1,2), suggesting that if one only treated symptoms it would not get good results. In modern day education and practice it seems a holistic assessment for, and treatment of, the “what else” seems to be missing (or if conceptually grasped is not fully practically understood to its full significance). If practitioners are finding that with chronic health issues, symptomatic treatment alone is not working – then it stands to reason those that care about their clients will look for other options to help – thus the interest in pain management and exercise rehabilitation. Both focus on the education and self-care/responsibility of clients; an important aspect but – treatment of underlying patterns of dysfunction (i.e. the “what else”) I feel remains a difficulty/challenge for many practitioners and is not necessarily being done, either at all (due to symptomatic focus) or if attempted, not with conscious awareness of how to read the body for clues to these dysfunction patterns or with a realisation of the significance of these patterns of dysfunction (once found). How do we find the underlying patterns, identify them, make sense of them and then include them into treatment? (Note: The answers to these questions all lie in my educational materials). I feel if this were done and done well – patients would not only have to live with and manage chronic pain (for their whole life sometimes), they may actually be able to lift themselves out of it. I feel even confident enough with this methodology make a prediction that if the circumstances in the above table were met by both patient and practitioner then at least 7/10 clients with persistent chronic pain would get significant improvement (and not necessarily in a great deal of time for some – although time is usually needed, initially especially, as issues can come up prior to them clearing away). But studies need to be done here to prove if this hypothesis is indeed verifiable. However – before this occurs at all – education needs to include the holistic model (and to integrate it consciously with the biomedical model) and practitioners trained in its use such that they can use it consistently, with awareness and with success (which ultimately is picked up in the bodies tissues as improved health, vitality, function and balance in the integrated whole being).
As a final thought:
For patients seeking health care options: The above chart may be a useful way of assessing which health care providers may be most supportive of patients on your journey for greater health. Are your practitioners addressing only the symptomatic parts or are they also investigating for and including the “what else”? Are you learning how to be more aware, mindful and health conscious? And are you being encouraged to take the necessary steps to work through emerging issues (without running away from them) and improve your health. These and similar questions may help guide your search and find the best practitioners in any field most able to meet your health needs.
For practitioners: We can ask ourselves; do we just assess and treat symptoms? Or are we also searching for the “what else” and to what extent? Are we assessing the whole – for predisposing patterns, causes, etc or only the part with symptoms? Can we identify important primary clues from assessment? Do we look for all three of ART (which I have talked about in other articles) or only tight, asymmetrical or painful tissues (with no awareness of their health or if they are even functioning correctly – despite being symptomatic)? Can we make sense of all the information and express the entire pattern – cause to effect? And are we treating patterns or parts? These and similar questions might be very revealing. Basically – The more holistic one’s assessment is, the more potential components and relationship imbalances can be recognised and included in the overall management plan and the better we are able to most recognise what to do about it and what other health practitioners are most suitable to best support the individual needs of the client.
In all of the above discussion I have hopefully given readers much food for thought.
Best wishes, Paul Turner.
- Turner PWD, Holroyd E. Holism in Osteopathy – Bridging the gap between concept and practice: A grounded theory study. International Journal of Osteopathic Medicine. 2016 12//;22:40-51.
- Turner P. Holism in [Osteopathic] Health Care, RMIT Health Sciences, Melbourne, Australia. [Unpublished Thesis]. In press 2014.