Barrett L.
Dorko, P.T.
The location: a dusty back road in Kansas. The characters: A young farm girl named Dorothy Gale and her beloved dog, Toto. The year: 1900.
Dorothy
has run away from the only home she has ever known. She did this in a desperate
attempt to keep her dog from being taken away. She�s unsure of what will
happen next, where she�ll stay that night, or how they�ll eat.
She
comes around a bend in the road and sees a wagon in the middle of a small camp.
There�s a fire and she hears a man humming an odd tune with no discernable
melody. On the side of the wagon is an ornate sign. It reads, �Professor
Marvel-Psychic-Acclaimed by the Crowned Heads of Europe.�
Dorothy
enters the camp�
I have been a member of the physical therapy profession for
nearly thirty years. During that time I�ve watched the nature of healthcare
change in a number of ways. Of greatest interest to me is the movement from a
modernist to a postmodernist view of physical reality (see What Went Wrong:
Postmodern Thought and Physical Therapy Practice at http://barrettdorko.com).
Many feel that this has resulted in a movement toward the acceptance of
supposedly therapeutic practices that are not supported by any rational theory.
Predictably, their proponents advocate a reliance on �intuition,�
�positive energy,� �ancient knowledge,� and other similar entreaties to
faith and belief. The technique proposed is typically claimed to require many
years (and many expensive continuing education courses) to perfect and the deep
model of its theoretical construct (when one is offered) is compiled from
obscure, esoteric and questionable �research� well out of the medical
mainstream. Not surprisingly, the nontraditional nature of the technique and
theory are proposed to be a positive aspect of the therapy, considering the
�corrupt, close-minded, and prejudicial� nature of modernist science.
Given that physical therapists are college graduates, and
assuming that physical therapy programs do, at least to some extent, teach the
principles of modern scientific inquiry (heck, high schools do this), you
wouldn�t expect the profession to easily accept any sort of care that
contained all the attributes listed above. You would expect resistance from the
academic community, written commentaries from the profession�s theorists and
clinicians regarding the dangerous nature of using any modality of care that
could not possibly do what it proposed to do, and, eventually, a dissipation of
the modality�s popularity over time. This has been a recurrent cycle of
response, witnessed during my career at least, and I never anticipated that
anything else would happen when techniques without reasonable theory appeared. I
was wrong.
Dorothy
first sees Professor Marvel as he exits his wagon. He has an appearance of
rumpled comfort. Dressed semi-formally; his demeanor is benign and mildly
befuddled. Seemingly surprised to see the girl, he doesn�t object when Toto
steals the hot dog he�d been roasting and generously relinquishes it with a
small joke and a chuckle. Clearly, Dorothy does not represent any sort of threat
to Marvel. As we shall see, to him, she is instead, an opportunity.
I was wrong about a certain form of irrational therapy
because I had not taken into account three things; the neediness of many in the
profession, the influence of postmodern thought in our culture, and the power of
charisma. All of these have combined to perpetuate a method and theory of
management that makes no real scientific sense and is, arguably, quite
dangerous.
Think
of Dorothy. Alone, hungry, still upset at nearly losing her dog, and, probably
feeling guilty about worrying her family, she finds in Marvel a comfort and
wisdom that she desperately wishes she herself had. He �cold reads� her.
That is to say he speaks to her in a fashion that leads her to believe he knows
all about her, though he is simply using his observational skills and his
knowledge of human nature. He�s not particularly good at this (he guesses
she�s traveling in disguise at first) but he finally hits upon the fact that
she�s running away from home and that those there neither understand nor
appreciate her. Dorothy is amazed. This old trick of the psychic�s craft
easily fools so vulnerable and innocent a young girl.
Physical therapy can be a frustrating and difficult way to
make a living, especially when the therapist is asked to solve problems that are
poorly understood and notorious for their persistently painful nature.
Complaints of pain for which there is no clear-cut pathologic origin form a
large percentage of the nominal diagnoses seen by thousands of therapists each
day. If the therapist finds him or herself in a situation that affords them
little opportunity to customize programs of care, or (as is increasingly common)
they are not given any time to actually touch patients in any meaningful way,
this frustration may certainly grow. Some would characterize this as a situation
in which the therapeutic instincts of the practitioner have been rendered
irrelevant. I think it�s fair to describe these instincts as those attributes
of observational, manual and diagnostic skill that are acquired as the end
result of study, experience and time. �Therapeutic intuition� in this
context is the final result of understanding the effect of processes that cannot
be seen but have their effect nonetheless. It is not some sort of magically
derived guess based entirely upon our �feeling.� Its accuracy grows over
time as long as we study.
When therapists are not allowed to uniquely employ their
knowledge and manual skill, it is as if some authority has threatened to take
away their instinct, their animal nature, the part of their world only they are
fully familiar with and can nurture. If you�ll forgive me a slight bit of very
amateur psychoanalysis here, they feel much the same as Dorothy did when Elmira
Gultch took away her dog. Coincidentally, it was the sheriff�s order that
permitted this. I�ve gotten orders from physicians and insurance carriers that
had much the same effect on me.
Therapists in such straits often feel like running away
from home. They may quite understandably wander away from their familiar haunts
and go searching for a place where they will be understood and appreciated. They
long for adventure and excitement, for the kind of passionate embrace of
clinical life that they once knew or imagined could be possible. This is
perfectly natural. They should be warned however that there is always somebody
waiting for them just down the road, and this person is not what they appear to
be.
Enamored
of Marvel�s presence and obvious skill, Dorothy proposes that she and Toto
travel with him �to meet the crowned heads of Europe� as is advertised on
his wagon. Marvel�s demeanor changes a bit. He is momentarily taken aback by
this turn of events, but quickly recovers sufficiently to suggest that he
consult his crystal. He never does anything without consulting his crystal, he
says, and they enter his wagon. Here he asks Dorothy to close her eyes,
ostensibly �to be more in touch with the infinite.� His reason for doing
this is immediately clear when he uses this opportunity to search through her
tiny basket. He removes a photograph, examines it, and then places it beneath
him on the chair. He tells Dorothy to open her eyes, and then he begins to lie.
Having
seen the photo without her knowledge, Marvel now has the opportunity to �hot
read� his guest. This refers to the use of knowledge about someone when they
are certain you couldn�t know it. This knowledge is acquired surreptitiously
either by chance or design. You know Marvel�s method. He tells her he sees
Auntie Em in front of their home (both in the photo) and that she is stricken
with grief, having been abandoned by someone she has selflessly cared for. This
mixture of hot and cold reading is wonderfully done, revealing Marvel�s true
skill at the psychic�s craft. He plays Dorothy�s emotions like a violin, and
she stands to leave for home.
Feigning
surprise, Marvel stands with her, careful to hold the photo from her view, and
he lets her go directly into the storm, and, ultimately, to Oz.
What I�ve just described is precisely as it happens in
the movie. Despite that, when you ask people whether Marvel was a good guy or
bad guy, the vast majority say without hesitation, �good guy.� They remember
his delightfully benign and generous manner. They point out that he convinced
Dorothy that she should go home, and, to them, he seemed wise and genuinely
concerned. It�s amazing. I never met anyone who knew that he stole the
photograph. They swear he returned it to the basket, nice guy that he obviously
was. He didn�t. Please remember that Dorothy left home forever (as far as she
knew), and she took with her only those things that she could not bear to leave
behind. To Dorothy, this photograph is truly a treasure, and stealing it is a
terrible act. Marvel could have easily returned it to her basket, but that�s
not the way he operates.
You may be wondering where I�m going with all of this,
but I�m sure there are more than a few of my regular readers know exactly what
I�m referring to when I speak of a modality of care without a rational
theoretical basis; John Barnes Myofascial Release (MFR).
Why do feel I this way? Well, consider this quote from his
book: "The medical, dental, and therapy professions have been based on
Newtonian physics, which is 300 years old and was proved to be totally
inadequate over 50 years ago by Einstein, physicist Niels Bohr, and Max Planck,
the father of quantum physics. Yet the very foundation of our scientific
training is based on this inadequate information. When the model is created on
an inaccurate assumption, many other assumptions will also be incorrect, leading
us to misunderstand how our bodies function in vivo. Too many health
professionals have become captivated by the obvious, the symptom, paying no
attention to the possible cause, fascial restrictions. How could we have missed
something so fundamental?"
Newtonian physics inadequate? In a word, this statement is
absurd. Newtonian physics works in the macroscopic world we occupy and
experience with a precision and predictability that is literally beyond the
comprehension of any but those well trained in the discipline. Barnes proposes
that what he refers to as �quantum mechanics� (I put it in quotations
because it is not evident to me that he understands what the term actually
means) allows us to exist in a way that permits astounding changes to occur in
anatomy, psychology and physiology instantaneously, even if the impetus to do so
is merely the thought of another a vast distance away. In short, Barnes says the
research demonstrating that connective tissue changes in accordance with the
laws of Newtonian physics can be ignored. I guess he says this in order to
explain the changes seen with gentle pressure while maintaining that the fascia
is the organ primarily involved in illness and change. He�s stuck with a piece
of anatomy that can�t account for the symptoms he hears and doesn�t explain
the changes that occur with care, so he evokes the generally unknown and
misunderstood world of quantum mechanics. His students seem to go along quite
willingly. What�s amazing to me is not just that Barnes says this (and it is
well documented), but that I�ve not read much in opposition to it. I�ve
personally written a few things about such thinking (see The Quantum Scam and No
More Mister Nice Guy Part II at http://barrettdorko.com). Although these essays
have been widely distributed on the Internet, I�ve never heard one word of
defense from Barnes or his people. There are so many, I can�t believe several
haven�t read this. Why is there no response? Is it because they can�t think
of one?
Barnes has a theory of fascial distortion, adherence and
permanent elongation that not only confuses me; it strikes me as completely
implausible. If it were true, our connective tissue structure would be so easily
deformed by the slightest prolonged pressure that it would acquire the shape of
just about anything it leaned upon. I, for instance, would be shaped mainly like
my recliner. I�m not.
I see that over the years the MFR community has begun to rely less and less on
this theory of fascial change and use instead the wild assertions of �energy
medicine� to explain any and all phenomena surrounding the application of
their technique. This makes even less sense. I�ve criticized this theory and
practice repetitively for years, and I�ve never heard any sort of defense
beyond anecdotal evidence and testimonials of experiential learning. To me, this
is pathetic.
Finally, and perhaps most importantly, there is this quote
from Barnes first book: "Recent evidence and my experience have
demonstrated that embedded in our structure, particularly the fascial system,
lie memories of past events or trauma. These stored emotions can produce lessons
in literal or symbolic form from which the patient can discover blocks that may
have been hindering his or her improvement. ...It appears that not only the
myofascial element, but also every cell of the body has a consciousness that
stores memories and emotions...It has been demonstrated over and over that when
a fascial barrier is engaged or when the person reaches a significant position
during myofascial unwinding, the tissue releases and a memory or emotion
surfaces. This electrophysical event produces a positive change and improvement
in the patient. Myofascial release and myofascial unwinding are not linear but
result in a whole-body effect, capable of producing a wide variety of physical,
emotional, and mental changes�I have discovered that when we quiet our minds
and bodies, our proprioceptive senses act like a mirror image, detecting the
subtle motions occurring in patients' bodies. This activity allows us to
discover fascial restrictions,
feel when they release, and feel the motion that will take the patients' bodies
into the three-dimensional position necessary for structural release or for
bringing disassociated memories to a conscious level�The link between
mind-body awareness and healing is the concept of state-dependent memory,
learning and behavior (also called deja vu)...I would like to expand this theory
to include position-dependent memory, learning, and behavior, with the
structural position being the missing component in the state-dependent theory.
Studies have shown that during periods of trauma people make indelible imprints
of experiences that have high levels of emotional content. The body can hold
information below the conscious level, as a protective mechanism, so that
memories tend to become dissociated or amnesic. This is called memory
dissociation, or reversible amnesia. The memories are state or position
dependent and can therefore be retrieved when the person is in a particular
state or position. This information is not available in the normal conscious
state, and the body's protective mechanisms keep us away from the positions that
our mind-body awareness construes as painful or traumatic. It has been
demonstrated consistently that when a myofascial release technique takes the
tissue to a significant position, or when myofascial unwinding allows a body
part to assume a significant position three-dimensionally in space, the tissue
not only changes and improves, but also memories, associated emotional states
and belief systems arise to the conscious level...This release of the tissue,
emotions, and hidden information creates an environment for change that is both
consistent and effective."
When I read this I can�t help but shake my head. Not only does it display a massive misunderstanding of the nature
of memory, but also stacks upon that a completely unsubstantiated �theory� of �position-dependent� memory. There is
no explanation of how this is supposed to work or why such a massive emotional problem with movement into any
number of positions doesn�t afflict virtually everybody with regularity. How is it that I�ve never seen it? Why don�t we
see it every time we take our patients through a full range of motion? But Barnes says he�s demonstrated it
�consistently.� It seems obvious to me that there�s something aside from simply acquiring certain positions going on
here (see the work of Elizabeth Loftus below). I must say I especially like his emphasis on the �three dimensional�
position. This very helpfully distinguishes it from the two-dimensional positions that I suppose other techniques
produce. (I'm being sarcastic here)
But there is a larger and even more troubling issue here. For the past 15 years the phenomenon known as
False Memory Syndrome has been carefully documented and studied. Without question, this circumstance of
a specific form of psychotherapy has proven to be both tragic and dangerous for all involved. For anyone interested in
the consequences of requesting or fully expecting the patient to suddenly �remember� or �recover� past experiences
of trauma or abuse, I�d recommend the web site of Elizabeth Loftus <http://faculty.washington.edu/eloftus/>
the most highly regarded authority on the nature of memory. Whatever anyone may say about this controversial
situation, the fact remains that many therapists have been successfully prosecuted for doing precisely
what Barnes suggests be done. I mean they�ve lost their licenses to practice and now owe their patients
a great deal of money. This fact is not in dispute. (See notes)
(Author's note 6/8/05 Anyone who supposes that this practice at Barnes' clinics is a thing of the past should visit Go to http://mfrjourney.blogspot.com/ This blog by a patient in Sedona was written within the past few weeks. A prolonged discussion concerning what she's reported here has taken place on
<http://rehabedge.com> in "The News From Cuyahoga Falls" in the entry "Cross Country 22-The Culture Comes Through")
It is the �unwinding� taught by Barnes that most
directly addresses the issue of (supposedly) repressed memory. Through their MFR
Chat Line <http://vll.com/lists.html>
his students encourage others rather new to the process not to be discouraged
when this seems to only make people worse. For example, one recently wrote about
his patient�s response and asked for help: ��when they went home some
of them had some emotional release and some could not sleep for a few days. Some
complained about increase in their pain level. I had warned them about some
changes they might feel emotionally and physically. Now they are apprehensive
about unwinding treatment and are scared about the releases they might have and
they say that they do not want to f eel upset. I do not know if I am doing
anything wrong or not. I also feel guilty thinking that I am hurting them since
their pain level has increased. Most of my patients are under a lot of emotional
stress. Should I insist on continuation of unwinding treatment every time they
come for therapy? Please help me.�
The next day this request was answered: �The unwinding
process only brings out what is already present inside themselves. In my
experience, PWF (people with fibromyalgia) are full of repressed/suppressed
emotional issues. Most PWF will heal only when they start dealing with their
issues. Should you insist that they participate in unwinding? No. Not everyone
is ready to deal with their demons now. I would lovingly plead with them to hang
on a little longer and see what possibilities unfold. By the time PWF are
officially given their label, they have suffered for years without much hope or
relief. Another avenue is to ask them to seek professional psychological help.
The important point here is get someone who is open for change, not someone who
will help them live more comfortably with their condition. The therapist's
job is to introduce Chaos, purposely and with great compassion. People in
chronic pain are stuck-physically, emotionally, mentally, and spiritually.�
I emphasized the part about introducing �chaos,� which,
I gather, is the term Barnes uses to explain any worsening of the patient�s
physical or emotional life after a session of MFR. And I should point out that a
massage therapist offered this advice, though I�ve seen no objection from any
of the physical therapists on the listserv. In fact, over the course of several
months, I�ve never seen anybody object to anything posted to the list. This
includes descriptions of astral projection, teleportation and clairvoyance.
Let me quote the editor of the APTA Journal, Jules
Rothstein, in a recent discussion about what constitutes evidence in
evidence-based practice: "...at best, we have an argument that a treatment
makes sense, that is, a case for `biological plausibility.' This is not evidence
of effectiveness, and it proves nothing other than the treatment is derived from
an idea." (Physical Therapy Vol. 80 No. 1 Jan. 2000) He goes on to say that
others might not find the idea "reasonable.�
There is virtually nothing reasonable or biologically
plausible about the theory of Barnes MFR. Not only that, its practice appears to
be potentially dangerous for patient and therapist alike.
You may ask, �Why, if this is true, does the practice of
MFR remain so popular and continue to thrive as an educational option for so
many people involved in the direct manual care of patients in pain?�
I think the answer lies in the story of Marvel and
Dorothy, and that�s why I spent so much time at the beginning of this essay
examining and commenting upon it. It seems clear to me who the players
represent, how they feel, what their motivations certainly are.
I make no apology for the opinion expressed here, and I feel it is time for others in our profession to express their own.
The �MFR Chat� listserv exemplifies what is taught and believed by those who have attended Barnes� courses. I read one recently that displays an attitude common to those who�ve been asking others to behave during �unwinding� in the fashion suggested:
When we do this MFR work, whoever touches us and
whomever we touch has the capability to KNOW everything there is to know about
us, the rawest stuff.
There are no longer secrets. I think that might be
one reason there is such a growing bond among us. It's all laid out there
bared to the barest.
In Recovered Memories of Child Sexual Abuse:
Psychological, Social and Legal Perspectives on a Contemporary Mental Health
Controversy (Charles C. Thomas 1998) Anita Lipton documents the legal
ramifications of the �repressed memory� movement. Those who claim to have
been falsely accused of illegal conduct because a therapist encouraged their
client to �remember� trauma they may have repressed have brought over 150
lawsuits against the therapist involved. In a number of these suits, large
monetary awards have been given the plaintiffs and the therapists have lost
their licenses to practice. Specific information about these cases and others
can also be found on <http://www.memoryandreality.org/>.
However anyone might feel about the controversy surrounding
repressed memories of trauma, it is a fact that qualified psychotherapists have
gotten into trouble (to say the least) when delving into this. Statistical
analysis in the aforementioned book indicates that the use of this type of
�therapy� has all but disappeared in that community for obvious reasons.
Teaching totally unqualified (in terms of psychological training) physical or
massage therapists that the revelation of �repressed� memories is common,
therapeutic, necessary for �healing� or progression in therapy is a terrible
idea. Not telling them what is known about the consequences of this type of
dialogue with patients is unforgivable.