Saturday, June 26, 2010

Tom's, Saturday Morning

Facebook ad for T-shirts featuring the Buddha Shakyamuni: “Are you proud of being a Buddhist?”



I'm a Buddhist because my life is a mess and I have difficulty coping with the simplest ordinary problems and I'm a complete wimp about emotional suffering and my loving-kindness fits comfortably on a microscope slide, along with my generosity and my courage. I think I'll pass on the T-shirt.

Coffee traces the side of my tongue, warmth flowers in my throat, my soft palate resonates like drum skin. Oh, first cup of coffee! Earth hath nothing to show more sweet.

Except you.

Glimpsed through the window in the kitchen door, and through the pass-through: the Mexicans in the kitchen, wearing moustaches and kitchen-whites. I remember how my clothes would stink of the kitchen after a shift: a rancid combination of fry-grease, onions, and vegetable blood.

But I loved it, working in restaurant kitchens. No past and no tomorrow. Like playing a video game, except you got paid.

Waitress: “I have that book.”

Self: “This one?” I turn it over so she can see the title. Elizabeth Bishop: The Complete Poems, 1927-1979.

Waitress: “Uh huh. My brother and I were up on the phone last night till three, reading each other poems from it.”

Thursday, June 24, 2010

How I Fixed my Severe Ankle Pain (or Maybe it just Went Away.)

So evening before last I became aware that my ankle was hurting. A lot. I’d just come home from doing a massage. So far as I knew I hadn’t done a thing to it, though I had set my table unusually low, and hence been doing a fair amount of my work kneeling. Dropping to a kneeling position puts the ankle rapidly into extreme flexion; it wouldn’t be that surprising if I’d hurt myself, either by over-flexing the ankle or by the eccentric contraction of the calf muscles.

But the pain surprised me, because it was superficial and localized. Right on the point of the lateral malleolus, what civilians might call “the bump on the outside of the ankle.” As if I’d whacked it on something. Maybe I had whacked it on something, but you’d think I’d remember whacking it that hard. Man, it hurt.

So it was like trigger point pain in that it appeared rather mysteriously, without what Paul Ingraham (of so accurately calls “an Oh Shit moment” – a moment when you know you’ve been injured. But it was unlike trigger point pain in being very localized, and tender to the slightest touch.

Okay, well, this is my area of expertise, right? Physician, heal thyself. So I did the obvious sweep, carefully stripping the peroneals (along the outside of the lower leg.) Wow. That might be a trigger point, in the peroneus tertius. Reproduced the referred pain. Or did it? Well, maybe not. Hard to tell. Do I even have a peroneus tertius? Some people don’t. Maybe that’s the peroneus brevis. All this time studying anatomy, and mine in particular, and I’m not even sure which muscles I have.

Well, look it up. Oh! Yeah. I should definitely check the soleus (deep calf muscle, under the bulgy ones).

Whoa! Hurts like hell. Work on that sucker, for sure.

Okay. Does that feel better?

Well, I don’t know. It might. Is this really trigger point pain at all? Maybe I actually tore something in the ankle. Sometimes you get too clever, in this business. Sometimes the pain is exactly what it seems like, exactly where you feel it. Or maybe I really did whack it. No sign of bruising, though.

So sleep on it. Next day – yesterday – the pain was still impressive – in fact now it felt very like a sprain, and I felt it throughout the joint; I had a pronounced limp — and the point of the ankle just as tender. I worked the points several times.

Today the pain almost gone. I rode my bike to work quite happily. Almost certain not to have been ligament pain, then – they don’t get better that quick. And surely if I’d whacked it, I’d have seen a bruise? So I think I fixed it. With that trigger point on the peroneus tertius, unless it’s the peroneus brevis. Or the soleus one. I can still get a ghost of the pain if I flex my ankle all the way.

My point here is how very vague and provisional all your conclusions are, as you’re working on pain. If I had a different personality type, I might be trumpeting to the world how magnificently I just treated my ankle. And I’d rail against physical therapists, who would have told me to stretch (disastrous!) and train up (even worse!) the peroneal and soleus muscles, and physicians, who would have told me maybe I have bursitis or tendonitis or arthritis, and given me drugs to poison my liver.

But, being who I am, I’m acutely aware of the fact that I just don’t know. Maybe stretching and exercising it would have been just the thing – maybe they would have fixed it a day earlier. Maybe there was never a muscular problem at all: maybe I bruised my ankle and it just never showed up on the skin. Maybe I irritated a ligament but it got better quick, and ibuprofen would have spared me even yesterday’s pain. Nobody will ever know. Did my trigger point work fix my ankle? Was Napoleon poisoned on Elba? Did human beings wipe out the Neanderthals? I don’t know. Neither do you.

I do know that since learning that most of this sort of pain is muscular, and heals up really quickly if you know what to do, I’m much less intimidated by it. Pain drops on me out of the blue, as it does on anyone my age, but I meet it aggressively, with a bristling arsenal of methods and ideas. I have confidence I can make it go away. I have heat, I have contract-release methods, I have trigger point, I have visualizations, I have deep breathing, I have mobilizations, I have stretches, I have meditation, I have drugs. By God, something I throw at this pain is going to faze it.

And I have by now a history of recovering from chronic disabling pain, and helping other people recover from it. The back pain I had in my thirties, the debilitating knee pain Martha used to have – these things can go away, completely, as if they had never been. The model I used to have of the human body, as a machine made of delicate irreplaceable parts that wear out, one by one, has been replaced by that of an organic system that is so tough and vigorously alive that it even reproduces kinks and snags like trigger points, infinite loops (to drop into programming jargon) that sometimes you have to break forcibly to keep them from running forever.

The less you know, the scarier pain is. I used live in a very murky world of fear. What if my pain was a damaged nerve? Would that mean I would never get better? What if a disk slipped in my back and severed my spinal cord? What if this or that joint was just wearing out, cartilage disintegrating, connective tissue separating, never ever to heal? Seriously, I used to think all those outlandish things virtually any time I had back or neck or joint pain. It didn’t even have to be severe pain.

Sure, all these things are theoretically possible. They’re just all quite unusual, whereas trigger point pain is dead common. It was as if every time I had a cough I imagined I had tuberculosis. It is a possible explanation, no denying it; but it’s more likely to be a cold.

Tuesday, June 22, 2010

Lost at Sea

On bad days I think we are swimmers
in the wide sea: clutching, pulling under,
each thinking to find a life raft in another.

On good days I think the same, only
I'm not so sure we know what's underneath.

I remember taking a deep breath of the water --
all rippling shadows, the lungs filling
with dark green light, my mouth full of something
stronger, deeper, older than air.

At first I thought the diamondback pattern
was a trick of subaqueous light along my skin.

But my lengthening tail, unrolling in the push and pull,
glittered just the same, each flickering scale
winking at the next, and we twined as we sank
in the slowly burning jewelry of our flesh.

Don't wait up for us. We're not coming back.

Monday, June 21, 2010


Burn and heft and balance surefootedness and grace
An overflow of talents and still she hides her face.

Friday, June 18, 2010

Sotto Voce

What it comes to I guess is a sense that something is very close, yet escaping. And that the everyday misery of life is in the balance.

That I could – what? Translate the Buddha into touch therapy?

My mind darts at once in two opposite directions – one, that this is the same stupid arrogance that culminates in the AMA, and two, that sense in the Vajrayana that a skillful tap can shatter a glass slab that otherwise will take a thousand years to grind through. And people do report these breakthroughs.

Are they telling the truth?

Well, probably not. It's mostly impossible to tell the truth, especially about breaking free.

But still, telling the stories. Telling the stories is crucial. Not because the stories have not yet been told – to yourself. They have. But because they have not yet been externalized. Before they have been told to someone else, or to paper, or to a recorder, their power is absolute. Because you don't know them as stories, you know them as The Truth. The only way to escape the tyranny of your stories is to tell them.

For a year I worked on Z's shoulder and got nowhere. He gets surgery, and the whole complex of trigger points and pain dissolves. Now, I don't believe in this surgery; I don't believe the pain was mechanical. But Z believed in it. He believed there was a family curse, a malformed shoulder, and surgery would fix it. Perhaps he was right. But I suspect that if the surgeon had simply closed the skin incision without doing another thing, the results would have been the same. No one will ever know. No controls on this experiment.

And now? Now the shoulder pain has been replaced by an equally mysterious and equally debilitating “sciatica,” and I can't say I'm surprised. I'm just watching this pain develop. Trying to treat it, of course, but it's eerie to me how it has exactly replaced the shoulder pain, in the narrative of his life – all the fears about the shoulder have transferred to the “sciatic” with ridiculous ease. This one, like that, is a harbinger of a hundred deadly diseases and conditions – it's diabetes, it's nerve degeneration, it's who knows what. And it will only get worse. And, like the shoulder, it has blossomed into a whole network of mutually reinforcing trigger points and pain. Spookiest of all is that he no longer remembers the shoulder pain. “Remember how debilitating that was, how you thought it would never go away, how it dominated your life?” He looks at me as if I was making it all up. “The shoulder? That was never much of a problem,” says the look.

My interest in treating the sciatica dwindles. It will go away or it won't, but as long as this story holds sway, I have the horrible feeling that Z will never be free of pain. What we really have to do is break the story.

The next time I see him, I will ask, when was the last time you were without pain? What was that like? Can you see it in your mind's eye, feel it in your mind's body? It's a longshot, but I have to try something. I want to back up to before the pain, and then see if I can elicit the story of how the pain came, and why it stays.

But maybe I already know. Always, always, there's the unhappiness with work, the unhappiness with love. This life is killing you, Z. There must be more to life, you keep saying. There is. But I don't know how to help you find it.

Well, sure, I could recommend meditation. People know I meditate, they even sort of fish for me to advise them to meditate. I don't, because I know what they'd do. They'd sit once, for five minutes. Or maybe twice. They'd find their mind full of jumpy obsessive thoughts. Then they'd conclude that they can't meditate.

Or else they'd sort of doze and fantasize and they'd love it and advertise themselves as the next thing to enlightened. Christ.

I do think that meditation is probably the single best way to change your life. But it's horribly difficult and usually it takes months, or years, before you start seeing the differences. What American is going to sit still (so to speak) for that?

I hate it when I see meditation advertised as a solution to stress. Well, yes, sort of. Meditate seriously and you'll realize that everything you know is wrong and that you have to change your life, and get out of your marriage, and quit your job, and scrape a living as a woodcarver, or as a mendicant monk. And when you've done all those (extremely stressful) things, yes, your stress levels will probably drop a notch. But the idea that you can beat stress just by adding meditation to your life is stupid. No. At first it's yet another stress, trying to find that much time, and it's hard as hell. And when meditation does lower stress, it does it by violently upending your life. Don't try it. It's not safe.

Though really, you know, that's nonsense too. Jon Kabat-Zinn got some good results with meditation for chronic pain. So it can be done. I just can't provide that kind of framework for it.

A band of brightness behind the trees: muffled gray sky above. Birds shift places on a distant telephone wire, like one of those old bead puzzles. If they get it just right, the sky will unlock, and we'll all go fluttering up to the Sun. They say it's still up there somewhere.

Thursday, June 17, 2010

Not Part of the Castle

Some people, it seems to me, crave touch much more than others, and they must go through life assessing over and over: what must I be, what must I do, and what must I give up, in order to be touched lovingly?

For many victims of abuse, touch has meant becoming someone's secret, entering a world of duplicity, of being – simultaneously – admitted into the secret world of someone's desires, and being cut off from the plain daylight world where things are as they appear. They become someone else's dirty little secret. They are simultaneously granted a special privilege, and reduced to someone else's intense but degrading gratification: they're the rag the abuser comes on, and hides under the bed.

For many others, touch comes only at two times: in response to injury, in a context of pain – doctors and dentists touch you – or in a love relationship, in the extraordinarily complicated context of sexual interaction. It often cannot be experienced outside of pain, or outside of sexual need and sexual performance – typically, for the touch-deprived, matters of intense but unmentionable anxiety.

In either case, massage is, in varying proportions, liberating, disturbing, and unsatisfying. Liberating because you find you can have touch without paying excessive costs in self-respect. Disturbing because it is still associated with shame or pain or sexual desire. Unsatisfying because it floats in a no man's land between categories. Does your massage therapist love you? Yes. No. If they do, why don't they hurt you or shame you or make love with you? If they don't, why are they touching you at all? What does it mean?

Well, the truth of the matter has nothing to do with the brisk, cheerful medical image massage organizations would like us to project. We get into the business because we have our own issues with touch. We have always known we're a little different. Our boundaries are more elastic than most people's. Bodies aren't icky to us. The idea of touching strangers is more pleasant than alarming. We have always had a heightened awareness of the tactile, the impulse to touch things to understand them. We have an inexhaustible curiosity about the body: it's an object of intense interest to us.

I've been struck by how many massage therapists are twilight dwellers, neither this nor that. We have – some people will be unhappy with me for saying this, but it's true – we have a lot in common with prostitutes: we live daily with physical realities that for most people are only phantoms, shadows of meaning, images of desire or shame. We are grounded in the real world. We know what people's bodies are really like, under those clothes. We know how they like to be touched. That makes us marginal in society: indispensable but not quite respectable. That's okay with us. We don't care much about all that.

To me, massage is an insurrection, a revolt against a touch culture that I believe is essentially a culture of abuse. A culture that says, oh, you can have touch all right – if you play by master's rules. If you agree to be ashamed of wanting it, and to cover up whatever master wants you to cover up. The reason I don't cross sexual boundaries in massage, why I am an absolutist about that, has nothing to do with being respectable or with catering to massage organizations' ambitions for professional status. Who cares about that? It's because I'm damned if I'll let my practice become one more turret in the abusive castle. You pay the printed price for this loving touch, and nothing more. There's no secret clause. There's no shame. You don't have to qualify, by being pretty or petite or docile. There's nothing you have to play along with.

And personally? What do I get from it? I get what I've always wanted: to get under the mask of society, to touch people in the way I've always wanted to but never been allowed to, to communicate with my skin instead of with clumsy, misleading, irrelevant talk. The sense of intimacy, of being loved and accepted, runs both ways, believe me. There's a reason why massage therapy consistently rates as one of the happiest, most fulfilling occupations. You'll never get rich doing massage. You'll never have prestige. But you'll get to touch people, which is what you wanted in the first place.

Tuesday, June 15, 2010


Now, all my life I've wondered this. Why, when the solstice comes in late June, is the hottest part of the summer (in the Northern Hemisphere) late August? Sure, things take a while to warm up. But two months?

Just finished my first read of Daniel Moerman's Meaning, Medicine and the 'Placebo Effect'. First, because I knew within a few pages that I'll be reading it several times. I'm not ready to talk about it yet, but I'm starting to identify my ambition: it's to learn to mobilize (invoke? organize? release?) healing processes in the way that Shamanic rituals or Western surgical rituals do, without their deceptions and inflictions of injury.

It may be impossible: for the stories to be compelling they may have to be false, and for the rituals to be effective they may have to be genuinely risky. I don't know.

(For the obdurately mechanistic: I imagine that surgery sometimes works exactly as advertised. But I want someone to explain why sham surgery is also sometimes so effective, in the rare cases in which it's been allowed to take place; and if you are not going to allow “placebo” surgery you have to expect your results to be looked at skeptically by anyone with a genuine respect for science.)

Monday, June 14, 2010

Sunday, June 13, 2010


Breathe in shapes, twisting forms:
breathe out dim blankets, swirled sheets.
Breathe in the anxiety of troubled days;
breathe out new jobs, the list of
things to do and to learn.

Here, for a moment, we are at the fulcrum,
at the tilting of the world: the old joy rustles
and patters on ahead, and we follow
with a deliberate step. We
are not so easily fooled now.

The shoulders swing free
like folded wings,
the spine sways this way and that
in the wind: gently curved, tough
as an old tree root. We will live forever.

The water trickles in the creek
carrying iron, copper, zinc;
blues and rusty reds. Drink it
And you will turn into a kingfisher,
quick and bright, vanishing as seen.

Listen. You've been told a pack of lies
by people who want you to be afraid.
Turn them carefully, finally, one by one,
and let them dissolve in the mineral
flesh. Ten thousand lives are open to you.

Death will come richly bedizened,
full of joy, and bow before you.
He will take you to be queen of a circus
new to town. You will hook
the trapeze bar with a casual elbow,

Your breasts not quite shrugging free
of their admiring sequins, and then you will fly
through an air thick with the scent of
animals who trust you, who adore you,
to platforms made strong with the sweat

of generations of nimble feet.
Your strength will astonish no one in
that gasping crowd more than yourself.
Death will applaud so hard his mask will split,
and you will glimpse his beautiful face beneath

the skull, the face of a boy, almost.
Up in the shadows of the Top – they
tell this to nobody – is where the mountain
gorillas have found their final refuge.
You vanish from the lights

And they pull you into their warm,
musky, grateful embrace: high, high
up, there is unknown foliage, there is
fruit to eat, and babies
who ride their mothers with wondering eyes.

Friday, June 11, 2010

Massage Certification

I have, to put it mildly, mixed feelings about the certification and licensing of massage therapists. Oregon is middling strict for American states, requiring 500 hours of education, and passage of both a national written exam and a practical exam administered by a state board. But in some parts of Europe a four year degree program is required: it's a profession on par with (and largely overlapping with) physical therapy. Some American states, on the other hand, don't regulate massage at all. Canadian provinces vary, but they usually require much more than American states.

The main social function of certification is to give those of us who succeed in it license to treat those who don't as inferior, and I'm never sure whether that is not the main function of it, pure and simple. Human beings ache, they ache for status, to be “dress'd in a little brief authority.” I find this aspect of certification loathsome. I hate it and I don't want any part of it.

I'm not sure training makes much difference, or if it makes more difference than experience. If we knew how to study the effectiveness of massage at all (I'm not sure we do) it would not be a hard thing to study. Remember that study, a generation back, that found there was not much difference in outcomes of talk therapy, that the benefits conferred by talking to an ivy-league trained psychiatrist and by talking to any sympathetic listener were about the same? It caused a bit of a stir at the time, but it seems to have been nicely papered over, and the certification mills for mental health practitioners grind on.

I personally know of two people who were excluded from doing massage by the certification process. One was a young woman with truly magic hands, the greatest gift for massage that I've ever encountered. She also could not read very well, and had a crippling anxiety about taking exams: she failed them, one after one. Scratch one massage therapist. The other gave a very good strong massage, but had real problems with authority: didn't get on with “the man.” He got into a dispute with the school administration about his fees, and refused to pay what they said he owed. No diploma, no license. Scratch another massage therapist. On the basis of what I personally know, this process, which delivered up several licensed massage therapists who were mediocre and a couple who were downright bad, excluded two of the best.

On the other hand, I attended a talk given by someone on the state board, and according to her they failed a number of people on the practical exam who were truly dangerous, e.g. trying to make joints move in ways they weren't meant to. Those seem like good people to exclude. I wasn't in school with anyone like that, so I don't know how common they are. Another thing the board does is monitor advertising and complaints, and take away the licenses of people who sexualize their massage. You can have pretty good confidence that a licensed massage therapist in Oregon a) won't hurt you and b) won't grope you. This is a good thing. There are states where you just don't know. Someone advertising massage could be pretty much anyone.

Another effect of certification is that it excludes people from casually taking up practice. You have to want to be a massage therapist, put in some time and some resources, to get licensed. It's hard for me to judge how many people this discourages whom we want to discourage. Certainly some.

But massage is something that can be done well, even brilliantly, by people incapable of book-learning. It seems like a shame to cut them off from it. I've learned lots from books and from studying anatomy, but that's the kind of learner I am. I haven't learned to do much that a person with sensitive hands couldn't learn to do by experience and example -- by, basically, apprenticeship. I trade massage with an LMT who claims to know nothing of trigger point. In fact she does excellent trigger point work: she's gifted at finding them with her fingers and working them out. She doesn't know, as I do, that pain in the deltoids is often referred from trigger points in the teres major. But if she finds the trigger points in the teres major anyway, is that such a big deal? Someone who knows the patterns of referred pain can miss the trigger points anyway if they don't have sensitive hands. (Trigger points are surprisingly localized: a miss of an eighth of an inch can be as good as a mile.) Book learning is neither necessary nor sufficient. I don't want to denigrate it, but it's just one method of learning your way around the body.

So I end up being a very grudging supporter of certification. I'm glad to exclude sexual predators and dangerously incompetent therapists. And there's a modicum of pathology you have to learn somehow, so you can recognize, say, melanoma or scabies when you see it. But I wish we had alternate paths to certification.

Books and classrooms and exams have come to dominate our conception of what education is, to the exclusion of many other valid kinds. Skilled manual labor traditionally has been a matter of master and apprentice. Certainly the most valuable training I got in massage school was not in the classes per se – much of the book-learning I got in them, to tell the truth, I have subsequently had to unlearn – but from those moments after the end of class, when two or three avid students were still trying to get the hang of something and the teacher stayed on, demonstrating, taking turns, experimenting. I think a year spent getting massages from masters, and trying to replicate them in small, supervised groups might produce better therapists than the current education: I've learned a lot from books, but I've learned even more by watching massage, or getting massage, from people who really know what they're doing.

Wednesday, June 09, 2010

Crowfall and Catlight

Say a crow lurches into the air
from high in the maple tree;
skids, corners, falls down invisible stairs,
and drops the last yard softly to the eaves --
catlike, stealthy, perfectly controlled. Is the fall
or the landing the act?

I gather you in my arms when the light begins,
and hold you through the whole storm.
Am I trying to keep you or to give you away?
You make unearthly sounds, and so do I;
when the thunder comes
the old gods shift beneath us.

Quiet places between spatters of rain
when the window no longer flinches;
light, soft light, not quite the sun,
works up from the soil,
pauses in the stillness to lick its fur,
gazes curious at the frightened world.

Sunday, June 06, 2010

Mary Oliver, Halfway Through

I'm nearly done with Oliver's New and Selected Poems, Volume One. For me, it's a lot of lyric poetry to read at once. I was impressed, and a little horrified, when Dave Bonta undertook to read and review a poetry book every day this April. A little like someone vowing to eat three cheesecakes at a sitting. But I've gone along reading probably five to fifteen poems per day without bursting my poetry stomach.

I've started memorizing my favorite poem so far, “Some Herons,” but I'm finding it heavy going, with no rhyme and no regular meter to help me. And it makes me a little sad: even if I succeed in nailing this poem, I'll never have much of Oliver in my head, as I have Shakespeare or Blake. She'll always be in her books, indistinct and out of focus unless I have the text in my hands. I don't much miss those tricks of the poetic trade, otherwise, and I understand why modern poets feel that the extra ornamentation is not worth the cost, or even that it's just too frilly and fussy. But to me the consummation of love affairs with poets has always been memorizing their work. With Oliver, with most of the moderns, it's just not going to happen, not much.

Oh, she irritates me occasionally. I get tired of her consternation that animals prey on each other, and also of the “animals are so innocent and egoless and I wish I was like them!” poem, which appears in a variety of forms. The animals I know best -- dogs, cats, and crows -- are not at all free from ego, worry, or social anxiety. I've seen them get their dignity offended, try to impress their peers, harbor resentment. But I'm not surprised that Oliver romanticizes them this way, because if she has a weakness, it's that she stands on her dignity and innocence. She's not willing to do much clowning, and when she does confess, she confesses to things such as not giving as much money to a beggar as maybe she should have. C'mon, Mary. Do you never eat too much ice cream, covet pretty undies, watch trash television? Maybe not: but taking on the sins and absurdities of your people is actually part of the job description of a poet. It's not a part she does very well.

But. Her sense of beauty is intense. The herons' swamp:

The water
was the kind of dark silk

that has silver lines
shot through it
when it is touched by the wind

or is splashed upward
in a small, quick flower
by the life beneath it.

And even if she's unwilling to clown, she's by no means humorless. The first heron in the swamp is

an old Chinese poet,
hunched in the white gown of his wings

And the second to arrive is a “a blue preacher”:

The preacher
made his difficult landing,
his skirts up around his knees

If you know herons, their solemnity and stiffness, their odd combination of grace and gawkiness, you have to laugh at this accuracy. Oliver's eye is perfect. She misses nothing, glosses nothing over.

She's most famous, I guess, for her sententious poems, such as “Some Questions You Might Ask,” in which she fails to understand why only human beings are supposed to have souls -- the face of the moose is as sad / as the face of Jesus, she says, and why should I have it and not the anteater / who loves her children? I like those, but the ones I've enjoyed most have been pure description, or ones where the lesson, if any, is oblique – say “Rice,” in which she implores the reader, for reasons obscure but to me compelling, to go far away from the white tablecloth and lift a handful of wet mud; or “Crows”:

wherever you arrive
they'll be there first,

glossy and rowdy
and indistinguishable.
The deep muscle of the world.

Of course, I have twenty more years of her poetry to read, and I will not be surprised if she surprises me. But I'm not sure if I'm going to go straight on to that, or hop over to another poet for a bit. Probably hop. Maybe Elizabeth Bishop is next?

Friday, June 04, 2010

What They Said

It's a sorry excuse, one said, but I can't stop my heart from opening
and I can't keep my legs from opening and that's just how it is.
And one said the morning light is so bright white on the wall that I can't see
what I was building in the night, a white thread from a black,
good work from bad, but I just keep building with each little death
like coral. We must build and we must fuck and I hope we aren't
breaking the world to bits because it is a fragile place but
we come from it and we return to it
and we come in it and come out of it.
And one wondered why the serpent wanted Eve to eat,
and decided that the smooth globe was too much for him
he needed someone to bite through the peel so his little mouth
could nibble at the flesh. And one said the sky opens too wide
like a broken backed book, so much sky that your heart arches
to try to hold it all and it's a sorry excuse but
love is like that, don't you think?

Thursday, June 03, 2010

Okay, Not Useless

I promise you, if I ever undertake seriously to argue that massage has no medical value, my paper will have footnotes and close argumentation and takedowns of several studies, and it will be longer than 500 words. I promise also that I will try to refrain from tweaking people with inflammatory and outrageous titles, although that will be a harder promise to keep. It's been part of my rhetorical strategy so long that it persists even when the ideology which formed it (essentially, that dull people are improved by being poked) has long since withered away. Habits die hard. I was given Strunk & White at a tender age, and encouraged to think that forcefulness was the prime virtue -- what all writing should aspire to all the time. I now have a middle-aged respect for accuracy and caveat, even when dull; but I still find myself fluttering the cape sometimes.

And anyway, I would never want to make that argument: it's untrue. When my essay was linked to for a group of people who work hard to do medical massage (and justify its use), they were understandably miffed. It was a nice lesson for me in how contexts can shift, on the internets. I can ordinarily assume that my audience here knows that I'm passionate about massage, that my much of my practice is what is called “relaxation massage,” rather than treatment-oriented massage (though I'm doing much more treatment nowadays.) So the “medical benefits of massage” that I was poking fun at are the ones that routinely show up on the web pages of practitioners like me -- not the pain relief, lymph drainage, and trigger point, and all the techniques that shade into physical therapy, but rather the stock list that you learn in Massage I – relieves stress, promotes circulation, lowers blood pressure -- all true, all verifiable, all temporary and trivial.

If massage were as effective as many of its practitioners claim, it would blow other therapies out of the water in comparative studies. In fact it comes out lackluster, most of the time. If some therapists have the extraordinary success rates they claim, that only makes the general picture worse: for every therapist two sigmas out on the right, there have to be a dozen or two whose work is completely worthless, to get the kind of distributions we see. Massage came out tops in treating low back pain, in a study a while back, but that was more because the other therapies were so ineffective, than because massage worked so well.

I started reading studies of massage back before I was in massage school, but I gave up pretty soon. What I saw then was mostly very small studies with inadequate controls documenting that massage could have a significant effect on this, that or the next thing. Which, if you're not a science person, might sound impressive. But “significant” doesn't mean “important,” in statistics: it just means “very unlikely to be a random result.” Aspirin significantly reduces low back pain, but we can be excused for not jumping up and down with delight about that fact, especially if we can't get out of bed. These studies were a start, and I'm not mocking the people who did them, who had next to no resources. They established that there's something to study, that the idea of treating various conditions with massage is not absurd. But they didn't take us much further than that.

I know. I have anecdotal evidence too. I have clients who swear that I fixed their necks, backs, hips, knees. I am confident that I've reduced a lot of pain. I even have people I think I really rehabilitated, got back on their feet again. Someone who couldn't go up and downstairs, who now runs up and down like a goat. Another who couldn't hold a pencil, whom I enabled to write again. Someone who thought it was only my work that allowed her still to stand upright, at the end of her pregnancy. That feels good, and I like believing in it, but I can hardly be classed as an unbiased observer. A scientific person has to ask: how many people were just going to get better anyway? Eighty percent of my appointments are with clients who think I'm terrific, but how much of that is because the people who didn't get any relief just didn't come back? How much of it is just because of the rapport and affection that any loving touch conveys? I like to think – be real, I do think – I'm a good therapist. I study and I think and I pay attention. If something doesn't seem to be working, I try something else. But I don't think the comparative studies are lying, and I don't think the majority of massage therapists are incompetent.

Having said that much – and possibly gotten myself in trouble again – I will also say: we don't know a damn thing. The study of massage is in its infancy. Chronic myofascial pain is very mysterious, and much of what we thought we knew about it is being daily disproven.

God, think what we could find out if we had the kind of money that gets spent researching drugs! Everything remains to be discovered. There may come a time when we can confidently tell someone with chronic back pain, “I'll have you on your feet again in a week, and after that you'll never need to come see me again.”

We are not there now, and claiming that we are only makes us look ridiculous. We want solutions that a workaday, non-brilliant, not particularly gifted therapist can execute and get reliable outcomes. The traditional lores are not going to get us there, not on their own, although they are full of hints. We need science. We need to understand how it really works. We need results that are verifiable and repeatable.

In the meantime, I'll do my best to help with the pain presented to me. But I don't have the confidence in the value of that part of my practice that I have in the supposedly vaguer, touchy-feely, cloth-mom-for-the-rhesus part of it. People need to be touched with love and understanding, and I know how to do it. The bottom is not going to drop out of that market if Methylene Blue turns out to fix discogenic back pain, or if someone builds a cool nerve-feedback acupuncture machine that fixes pseudosciatica every time. All that will do is take away one of the pretexts people have been depending on to get the touch they need. They'll find another.

Tuesday, June 01, 2010

On the Medical Uselessness of Massage

Let's be honest. I am in no doubt as to the therapeutic value of massage, but most of it is more spiritual or psychological than medical. The medical benefits solemnly listed by massage therapists are real enough, but they're mostly trivial. Yes, an hour of massage relieves stress and lowers blood pressure -- but not more than a ten-minute nap. It improves the circulation of blood and lymph -- but not more than a stroll around the block. It triggers an endorphin release – but not more than eating a bar of chocolate. It relieves muscle tension -- but not more than a hot bath. All these effects are real and measurable; they're just not very important, medically speaking, and they are not – quite obviously to me – why people really get massage. People get massage because they ache for the touch, for the physical communication, for the sensation of being physically cared for, physically attended to, physically heard. We dress it up as a medical intervention because that makes it respectable. It's justifiable to spend money on it, if it's medical. But it's no more medical really than a momma cat licking her kittens' tummies. Perhaps that does aid the kitten's digestion, but you and I and every cat knows that's not really the point.

The point is that we must love and be loved; we must touch and be touched. It's fundamental to our well-being. My favorite massage myth is that it “releases toxins.” This has been studied, and there's not a shred of evidence for it, but the myth marches on regardless, because it feels right. It feels like you're getting rid of something poisonous when you get a good massage, when you give your body over to someone and they treat it with interest and love and respect. But the poison isn't metabolic waste: the poison is the anxiety of loneliness, the ache for acceptance, the doubt whether we really belong to the tribe. Those are the toxins massage flushes from the system.

(Okay. An exception, here, is trigger point, which has serious therapeutic value for relieving chronic myofascial pain – what's commonly perceived as joint pain. But the most common “dosages” of massage – one hour once a month, or one hour once a week – are all but useless for trigger point, which typically needs ten minutes three or four times a day to be effective. I do trigger point on myself all the time, and so should you: but save your money. See a good trigger point therapist once or twice, get them to teach you how to work the points causing your pain, and do it yourself till the points resolve. That would be my advice, for all but the gnarliest and most entrenched trigger point systems.)

The thing about the pyschological benefit of massage is that it falls roughly under the rubric of placebo treatment, and from what we know about placebo, the more ritual and mystery surrounding it, and the more sense of its preciousness, the better it works. If I could talk a good line about releasing toxins or balancing energy, my massage would be more therapeutic. And if I charged more for it, it would be more effective. There's a serious case to be made for the therapeutic value of driveling, especially if you believe in the nonsense yourself. But I can't do it.

I can say this, in recompense: the love I feel for my clients is intense, and quite as real as any other kind of love. I'll stumble upon pockets of grief, I'll open up veins of lifelong loneliness, that will stagger me. Doing massage is no more soothing, ordinarily, than participating in a meditation retreat is relaxing. On the contrary, like a meditation retreat, it's most often, for me, a wild roller-coaster ride of emotions, waves of joy and sadness in quick succession, glimpses of rare colors and strange countries. The connection can be downright unnerving. You need either a thick skin or a certain amount of contemplative stability to ride it out. The end result may be – usually is – a profound sense of gratitude and well being: but it doesn't come cheap.

I suspect that if you studied people with a life history of getting regular massage, you'd find longevity benefits similar to – and as difficult to analyze as – those of marriage. But a study definitively establishing cause would be, under present funding conditions, prohibitively expensive. After all, people who get regular massage tend to be prosperous, tend to look after themselves, tend to be willing to expend resources on their own well-being, tend to be comfortable with touch and hence likely to be in healthy love relationships: you'd need to randomize your clientele, and track them over years, to avoid all that skew and get real results. A study like that is not going to happen while Big Pharma rules the medical roost.

The trouble is that if we keep making claims for short term medical effectiveness that we can't actually back up, sooner or later we're going to be discredited. Massage could go into another eclipse like that of the middle 20th Century, when it almost disappeared in America as a respectable profession. I'd hate to see that happen, because I do think we help people, profoundly and lastingly, and I do think we are the keepers of a traditional lore – of several traditional lores – that ought to be preserved. But I don't think we can compete with Big Pharma on its own ground of quick fixes and magical pain relief, and I don't think we should try.