Unbounded Faith

By Stephen Paulus, DO

When I treat people in my office utilizing Osteopathic Manipulation, I rarely ask them how they feel physically during or at the end of an office visit. I am not interested in the immediate effects of an Osteopathy Treatment. Very early in my Osteopathic training, I understood that I was not doing the work of healing. I instinctually appreciated that some innate process within the patient does the work of healing. I learned from the wisdom of Andrew Taylor Still that, “The Osteopath who succeeds best does so because he looks to Nature for knowledge and obeys her teachings.”1 He also emphatically declared that, “Nature has no apology to offer. It does the work . . . .”2 I realized, as a young and naïve Osteopath, that if I did not trust Nature to do the work of healing, then the therapeutic results were inferior. If I placed my attention, and intention, with intellectual capacities and an ego based need to do something, then I could only access a purely mechanical and insufficient material based method of treatment. In this limited perspective, founded upon a lack of trust in Nature, I had no feeling for a patient’s true necessity. Sometimes I would “collide” with what was needed by a patient, but most of the time I only “scratched at the surface” of cause (the source of disease) by addressing the treatment of effects (or symptoms).

A. T. Still said, “Has not nature’s God been thoughtful enough to place in man all the elements and principles that the word “remedy” means?”3 He also emphasized the importance for us to, “. . . have unbounded faith that Nature’s chemistry is the doctor and the only one on whom we depend for relief.”4 [italics added for emphasis] We can summarize this essential Osteopathic principle by stating that, Nature does the work of an Osteopathic Treatment. Nature provides all the “remedies” that perform healing. Historically, most schools of healing make some reference to the recuperative powers of Nature.

It was Hippocrates, the father of western medicine, who taught that Nature is the healer of all disease. He formulated the maxim, vis medicatix naturae ; which means, “the healing power of nature.” Since the time of Hippocrates, many healing traditions have utilized this essential commandment. Dr. Still, like many before him and like many after, made this “law of nature” a part of the foundation of Osteopathy.

If we as Osteopaths combine any treatment approach (i.e., biomechanical or non-mechanical) in conjunction with an unbounded faith in the innate remedies provided by Nature, then the therapeutic process 5 has the greatest potential to be remedial and/or uniquely successful for that individual. If only a biomechanical treatment approach is used, in exclusion of an absolute respect for the inborn abilities of Nature to do the actual healing, then there is less of an opportunity for a therapeutic process to be generated and the patient’s true necessity is considerably less likely to be addressed. Carl P. McConnell, DO (one of Dr. Still’s earliest and most adept students) once said, “After all has been said, after all theories have been spun, no matter by what school, the very kernel of the healing art is simply what can you or I do to assist Nature.” 6 As Osteopaths, we don’t force or instigate Nature to do the work of healing; we assist Nature in order that she may do her job unrestrained. It is not external force, volitional intent, or the intellectual power applied by the operator (the Osteopath offering a hands-on treatment) that does the healing. The therapeutic process is a direct consequence of the intelligence manifested in Nature and is not an effect of blindly applying mechanical principles from outside the patient.

When we trust Nature and all the natural remedies found within our patients, we don’t need to ask how someone physically feels during or after a treatment. In fact, the simple act of asking how a patient feels demonstrates a basic lack of trust in Nature on the part of the operator. Rollin Becker, DO once said, “All the corrections in any form of treatment always take place after you do the work. Nothing ever happens while you’re there at the time you give a treatment.”7 This statement is totally congruent with A. T. Still’s teachings and demonstrates that Becker was an Osteopath who had “unbounded faith.” I would add a qualifier to his definitive statement. When he said, “Nothing ever happens while you’re there at the time you give a treatment,” I think he meant that nothing of great and lasting therapeutic benefit happens. Of course we observe tissue texture changes, alterations of inherent motility, improvements in gross mobility, valuable changes in local and overall vitality, an active engagement in the Health, 8 and the earliest phases of a therapeutic process. But we do not observe, at the time of a treatment, the complete intricate, moment-to-moment transformations that are involved with true healing.

During an Osteopathic Treatment, I never specifically ask someone how they physically feel with respect to the tangible treatment process. For example, I won’t ask a patient: “Does your shoulder feel better?” or “How does your knee feel now?” or “Do you still have the headache?” However, I sometimes will ask a patient how they are feeling generally, from an emotional perspective, especially if I sense that something is moving within their psyche. I may wish to gain an overall gestalt of their situation that requires asking them open-ended questions. I may ask someone how they are physically feeling, particularly if they appear uncomfortable on the treatment table. They may need to change position due to excessive pain or discomfort. This category of inquiry is not leading, as in the question, “Does your shoulder feel better?” and is not oriented to superficial changes in symptoms, e.g., “How does your knee feel now?” Nor do I offer leading statements like, “Your headache is better now” or “You will be cured of that sinus infection after this treatment.” My personal goal is not to have the patient project upon me the power of healing by using personal charisma. I prefer that a patient accepts the mysteries of healing and learns to engage their own natural healer within.

I tell my patients that the therapeutic effects of an Osteopathic Treatment may not fully reveal themselves for days or even weeks. Using this type of Osteopathic Treatment, it is normal for the healing forces to unfold over time. I could give a treatment that would make people temporarily feel better and more relaxed ‑‑ but it will not last because I have placed my intention upon relaxation. I tell them that I am not doing the work of healing; I am only helping them engage their own natural healing remedies that have somehow become blocked or unavailable. I reveal to them that I completely trust in their innate abilities to heal. I derive an unusual satisfaction when a patient returns several weeks later telling me how they have significantly improved or are “cured” and they do not identify me as the source of healing. They might say, “I have no idea why I’m better.” They might give credit to a recent change in diet, or starting a new exercise program, or beginning a meditation class, or stopping a harmful activity, etc. I prefer that a patient not assign me the credit for making them well. The moment a patient gives me credit for success in treatment I divert their attention to the inherent potent natural healing tendencies within their own body and psyche. I am delighted when they can’t place the source of healing, then I know they won’t become dependent upon me to provide an outwardly directed treatment. Eventually, I hope they too will begin to have unbounded faith in the ability of their inherent Nature to do the work of healing.

A. T. Still also emphasized that, “To find health is the object of the doctor. Anyone can find disease.”9 And according to Dr. Still, “Health is Nature.”10 I believe that he actively engaged the Health, the perceivable quality of Nature, during every Osteopathic Treatment. When we honor this approach, we can’t first identify with lesions but we must source our attention to what is healthy. The Osteopathic approach is simple. We must first direct the fulcrum of our attention to the Health and have the ultimate goal to restore harmony by having unbounded faith in Nature. Only after we have engaged what is healthy in the patient’s system, then and only then, are we ready to identify obstructions to healing and remove them with a specific Osteopathic Treatment. The Osteopath must assist Nature by removing the impediments to Health and healing. Dr. Still said that, “Harmony only dwells where obstructions do not exist.”11 He also said that, “disease is only too much dirt in the wheels of life [and] we must see that Nature takes this method [Osteopathy] to work out the dirt.”12

At no point did Dr. Still tell us that Osteopathy is a system of relaxation. The goal of an Osteopathic Treatment is not to induce relaxation. Relaxation, by itself, is rarely therapeutically advancing. By asking a patient how they physically feel during or after a treatment, we are depending upon the superficial abilities of relaxation and are not relying on the potent therapeutic powers of Nature. If we are depending on neuromuscular relaxation to perform the task of treatment, it means we don’t have unbounded faith in Nature style='font-size:11.0pt;font-family:Symbol'>¾ style='font-size: 11.0pt;font-family:"Calisto MT"'>we only have limited superficial skills in relaxation techniques. Relaxation, by itself, is pleasing, supportive, and useful. It may be a nice side effect of an Osteopathic Treatment, but it is not, and never has been, our goal.

In 1908, A. T. Still said in his autobiography that by utilizing Osteopathy, “Seventy-five percent of all cases benefited [and] fifty percent [were] cured.”13 That means, in his hands, that one out of every four patients demonstrated no significant improvement or was not helped at all with the use of Osteopathy. As practicing clinicians, we all accept that we cannot help every person who comes to our office for Osteopathic care and treatment. If our clinical outcomes are the same as Dr. Still’s, and our goal is to cure, then we are all doomed to a lack of cure 50% of the time! However, if our aspiration is to reorient the patient toward Health and harmony, then we are freed from the distorted human obsession to cure. If we orient our attention toward Nature’s ability to do the work of healing, we are also liberated from the burden of “manipulating” the system via manipulation. Dr. Still once said, “To make the sick well is not the duty of the operator, but to adjust a part or the whole of the system in order that the rivers of life may flow in and irrigate the famished fields.”14 He also said, “. . . to heal the sick is a duty that belongs to another division of Operators, and not to the hewers of timber, nor to muscles of force, but to the rivers of life only.” 15

Our responsibility as Osteopaths is not to do the healing, but to help restore harmony, to conduct body to normal (which is Health), 16 and to adjust the body by bringing either the lesioned part to the whole or the whole to the part, so that the rivers of life may flow in and irrigate the famished fields (the region of dysfunction, disease, or lesion). Then, we wait, and trust, and stay out of the way so that Nature will do the work of healing. It is the function of Nature and her rivers of life to heal! Once we, as Osteopaths, liberate ourselves of this burdensome and exhausting task of being healers, then we are free to fulfill our role, as Dr. McConnell says, “to assist Nature.” The simple act of having unbounded faith in Nature’s ability to heal is an every day, perceivable method of having the direct experience of wholism.

Why were 25% of people not helped, even in A. T. Still’s hands? Why are a certain percentage of patients not helped in our offices? This question has many potential answers. Sometimes we know the single reason for the lack of clinical benefit, and in other instances there is more than one explanation. In many situations, the exact reason is unknown. Here is a list of possible explanations for a lack of positive clinical results:

1. Osteopathy may not be the healing system that will best help the patient. They may require traditional allopathic medicine, Chinese medicine, Homeopathy, Ayruvedic medicine, or some other therapeutic approach.



2. Osteopathy may be the complementary system of healing and not the primary healing system that will help the patient. For example, the patient may need surgery plus Osteopathy to achieve their greatest therapeutic benefit.



3. There is a dysrhythmic match between the doctor and the patient. As people, they simply do not get along and are not in basic agreement.



4. The operator may be inexperienced.



5. The operator may be treating symptoms and not addressing the cause(s).



6. The operator may have a basic goal to relax the patient.



7. The operator may be reacting to what the patient is saying they want (i.e., answering to symptoms) rather than offering the patient a treatment they need, based upon necessity.



8. The Osteopath may be giving the same all-purpose, general treatment to every patient without recognizing unique individual characteristics or needs.



9. The operator may be applying series of independent Osteopathic techniques without engaging the whole patient or the integrated nature of a living being.



10. The Osteopath may be physically ill, emotionally distraught, or may be unable to concentrate for some known or unknown reason.


11. The operator is not respecting the tempo of the patient. The Osteopath may not be able to recognize what the patient needs at the exact time they need it.



12. The operator may not be adequately attuning to the patient’s unique frequency or internal rhythms.17



13. The patient’s disease/illness/dysfunction is too advanced, with too much tissue damage, for a therapeutic process to be clinically effective.



14. The patient may not want to get well.



15. The patient may have secondary gain reinforcing and maintaining their illness.



16. The patient may be gaining wisdom from their illness. There may be a learning experience that is generated through the process of being ill. If we take away the illness, the patient may lose the opportunity to have a deep and meaningful revelation.



17. The patient may be over treated by the Osteopath. They may be receiving Osteopathic Manipulation too often and the body is becoming overly dependent upon external interventions from the operator rather than innate Nature based remedies. The operator may be attempting to perform too much in one treatment session, thus reflexly shutting down the body’s ability to generate a Therapeutic process. The treatment itself may have become irritating to a patient’s system. Dr. Still once said, “many of your patients are well six months before they are discharged. They continue treatments, because they are weak, and they are weak because you keep them so by irritating the spinal cord.”18
    
    The patient may be over treated from seeing a variety of practitioners too frequently. For example, the patient may be receiving Osteopathic Treatment, Acupuncture, massage, and Chiropractic adjustments concurrently.



18. The treatment process may be working, but the unlayering process may take months or years. The patient’s problems are so deeply imbedded into their tissues and psyche that treatment over a long period of time will allow a healing transformation to unfold.