Not in Kansas Anymore

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.

 

Notes 

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.