Attention vs. Intention

Is there a difference between attention and intention in the context of an Osteopathic Treatment? In colloquial usage, these two words often overlap improperly. When the specificity of semantics meets the careless use of language, then confusion creates ineffectiveness. From an Osteopathic perspective, these two words are distinct and their appropriate use is essential to conveying Osteopathic philosophy.

Intent is vectorial and directional. It is a determination to do a specific thing or act in a particular manner. It has a purpose and an endpoint. It has an objective, goal, or an aim. Proper intent, when employed in a clinical setting, is essential to help create a healing environment.

Attention is expansive and at best non-focal. It involves being careful, giving heed, taking notice, being thoughtful or courteous, and being observant. It involves a readiness, or openness, to respond to stimuli or information. In an Osteopathic context, attention is much more than concentration or mental focus. However, during the intricacies of a healing exchange between doctor and patient, mental applications intersect readily with instinctive impulses.

The surface expression of Osteopathy is directional and focused, i.e. the biomechanical applications of Osteopathic philosophy. The deeper manifestations of an Osteopathic Treatment are rarely discussed. However, the unsaid or the unnamed, is more important than the labeled or codified objects in a human being.

Intention, in any context, means having a plan. Attention, in an Osteopathic context, is a perceptual field involving care and observation. Intent, when used inappropriately, can do harm by invading and distorting a patient’s natural process of healing. At the worst, not paying attention, is an act of ignorance and is not invasive.

What is the goal of an Osteopathic Treatment? For many Osteopaths, the obvious goal is to fix a somatic dysfunction. For others, the aim is to free the patient from pain. Some target relaxation as the product of an Osteopathic Treatment. For the naïve, the goal of an Osteopathic Treatment is to cure.

G. D. Hulett, DO profoundly stated in 1915 that, “Cure is the prerogative of the organism.” If we enter the setting of an Osteopathic Treatment having the intent to cure, the act becomes an ill-fated attempt to defy the patient’s innate regulatory mechanisms based upon the laws of Nature. If we impose the will of the doctor upon the biology of a patient we have in reality invaded their system. By invading a patients innate process of healing with the objective of curing we externally manipulate the tempo of individual healing and interpose our design upon the unique needs of our patient. Cure is not the prerogative of the Osteopath! Cure always has been, and always will be, the prerogative of the patient’s instinctive healing processes.

The goal of an Osteopathic Treatment is not to induce relaxation. Relaxation, by itself is rarely therapeutically advancing. Neuromuscular relaxation is a limited and superficial aspect of an Osteopathic Treatment. 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.

Any experienced Osteopath knows that removing pain is not an effective objective in an Osteopathic Treatment. Dr. Still referred to the treatment of pain or the therapies addressing symptoms as, “engine wiping.” For him, cure was the prerogative of the Master Mechanic. He implored us to find the cause of disease and not treat the effects. Pain is an effect. Dr. Still once said, “I want it understood that I look upon the treating of effects as being unwarranted as it would be for the fireman of a city to fight the smoke and pay no attention to the cause that produces it.” By agreeing with Dr. Still, I am not implying that any clinician should ignore pain. We should take in the specifics of pain and assess it at face value. Pain is a signal. Pain is not a disease.

For many Osteopaths, the removal of structural disorders constitutes the most effective treatment, and therefore qualifies as an adequate goal. Addressing structural disorders that alter function has been the mainstay in the public expression of the Osteopathic profession for over 100 years. Treating structural disorders, by itself, is not the true goal of an Osteopathic Treatment, it is only a method of access.

The sincere goal of an Osteopathic Treatment is to help the patient engage his or her own natural therapeutic process. We help a patient implement what they already possess. We don’t achieve this intent by trying to cure, induce relaxation, or remove pain. We use the good will of our intention to help our patients enhance their unique therapeutic processes and combined this with the enduring expansiveness of our attention. If our goal is to help a patient fully access and activate his or her own natural abilities to heal, then we as clinicians will not be burdened with the overwhelming responsibility to cure or fix. True healing transcends cure.

I believe that the inappropriate application of intent can be harmful to a patient. At best, our intentions ought to stay out of the way of the patient’s therapeutic process. I believe that, in many ways, ones attention is more important than ones intention. In an Osteopathic context, attention is usually based upon awareness without focusing. The foundation of attention is patience and being receptive. If we are attentive to a patient’s necessity, and leave the manipulations of our intentions out of the picture, I believe we serve at the highest levels.

We must have some quality of intention in order to work as healers. However, if our intention is to fix, heal, or renovate we burden ourselves as Osteopaths and our attention can become diverted from our true work. As Osteopaths, we don’t fix people. We don’t rebuild faulty structure. We use the context of Osteopathy and the work of our hands to help create the greatest opportunity for healing to occur. We help people find their individual healing rather than dictate what we think they need.

Our intention during an Osteopathic Treatment is to get out of the way of our patient’s healing. Our intention is to assist our patients in expanding their therapeutic process. Our intention is to individualize each treatment based upon the unique needs of each individual.

There is a difference between attention and intention. We must implement a model for intention that is sincere and founded upon humility. At the same time, we must allow for a model of attention that is flexible and adaptive to a patient’s individual needs. Our attention and intention must agree with the needs of our patients rather than the will of the Osteopath.

Steve Paulus, DO