Being and Doing

What is it that we actually “do” during an Osteopathic Treatment? Do we fix, renovate, or repair our patients? Is the “doing” part of an Osteopathic Treatment the removal of somatic dysfunctions? Does Osteopathic Treatment exclusively involve the alleviation of biomechanical imbalances? Is an Osteopathic treatment only a process involved with “doing something,” or is there more? These are all Osteopathic existential questions. These questions force us, as philosophers and clinicians, to more clearly express our actions as well as our apparent inactions.

What patients commonly call the treatment part of Osteopathic Manipulation is the aspect where a biomechanical dysfunction is addressed. They find intellectual comfort, and understanding, in having a mechanical problem corrected. It is easier for us to explain, verbally, the biomechanical processes that contribute to a particular problem, disease, or injury. It is more challenging, to put into plain words, the non-mechanical aspects of an Osteopathic Treatment.

Healing does not occur at an intellectual level. Also, healing will still occur even if we do not have the words to describe it, or an organized system of descriptive terminology. The forces preceding and following the generation of a therapeutic process occur, primarily, outside of our mental awareness. Intellectual explanations, can be helpful to our patients, but they do not generate a therapeutic process. In fact, the intellect often gets in the way of true healing.

An Osteopathic Treatment is an intricate interaction between two living beings—the doctor and the patient. The ultimate goal of an Osteopathic Treatment is to engage the Natural World found within our patients and assist their innate abilities to heal.

Sometimes the “doing” part of an Osteopathic Treatment involves the fixing of biomechanical dysfunctions on a gross anatomic level so that, for example, obstructions to nerve action, blood flow, or venous and lymphatic return are removed. The removal of a physical obstruction then allows for better function, a return to normal anatomy, and the efficient distribution of nerve action and fluid dynamics.

On other occasions, the “doing” part of an Osteopathic Treatment involves applying biomechanical principles on a micro-anatomic level, as in the intricate geometric orientation of Cranial Osteopathy.

There is a category or stage of Osteopathic Treatment that involves engaging biologic phenomena that have no agreed upon name among Osteopaths or other health care professionals. There is a form of “doing” where the Osteopath apparently does nothing. Rollin Becker, DO was fond of rephrasing a common adage and stating to his students: “Don’t just do something, sit there.”

There are stages of a complete Osteopathic Treatment, and there are entire treatment sessions, that are devoted to “being” rather than “doing.” Being with a patient, or considering in an expansive way (without the intention of fixing) can be, and is, highly therapeutic.

One of my favorite stories regarding Dr. Still was related by his friend and student Arthur Hildreth, DO in his book: The Lengthening Shadow of Dr. Andrew Taylor Still. Dr. Hildreth, one of the great early Osteopathic pioneers recounted:

Another interesting incident which Dr. Charlie related to me was the case of a young man who had injured his knee. This boy came from a family in Kirksville who were great friends of Dr. Still. At a time when Dr. Still was out of town, this young man who was working with an adz in a cooper shop, through some misstroke, dropped his tool and it struck his knee, resulting in a deep cut. A nearby doctor was called and examined the boy. He said that the accident had resulted in the escape of joint fluid from the knee. Very soon afterwards, the limb became inflamed, blood poisoning set in and three of the local doctors were called in consultation. They decided that the limb would have to be amputated. The mother of the boy would not consent to the amputation until Dr. Still returned home. Two of the physicians insisted that the limb should come off immediately and not later than the next day or the boy’s life would be lost. The third man of the three, Dr. F. A. Gore, one of the finest men I have ever known and one who was a personal friend of Dr. Still, said to the other doctors, in the presence of the mother, that he was in favor of waiting, that Dr. Still had secured some very marvelous results in the past and he himself would like Dr. Still to see this patient before the operation was performed.

Dr. Still unexpectedly returned to town that evening, and, even before hearing of the case, while out in the east end of Kirksville where the boy’s people lived, he called upon them and was surprised to learn of the son’s condition. The mother, describing this visit to Dr. Charlie, said that he went into the room, looked at the boy and examined his knee for a few minutes. Then he sat down in a chair by the side of the bed, put his feet up on another chair, and pulled his hat down over his eyes. He sat there so long in contemplation that the family became alarmed, and they were afraid he was not going to do anything. Evidently having satisfied himself as to procedure, he arose and went to work. He manipulated the thigh and the pelvic bone on that side, gently rotating the thigh, and stretching the limb a little, thus causing relaxation of the contracted and inflamed tissues around the knee. Then he went away. By morning the swelling had materially decreased and by afternoon, when the doctors who had advised amputation came, they found there was absolutely no necessity for an operation.

What was the “something” that Dr. Still did? Was the treatment the procedure of manipulating the thigh and pelvic bone while rotating the thigh and stretching the limb thus “causing a relaxation of the contracted and inflamed tissues around the knee”, as Dr. Hildreth interpreted? Or was the treatment, the time Dr. Still spent in the chair with his hat pulled down over his eyes? In other words, was the “doing” part in reality the “being” with this patient?

I would like to offer a different interpretation of this case history than the one presented by Dr. Hildreth. I would suggest that, following his hands-on examination, the time spent by Dr. Still “in contemplation” was one of his methods of connecting with a patient. He was synchronizing his healing rhythm with the forces of self-healing in the patient. He was “being with” the patient before “doing something” mechanical. In this case, Dr. Still initiated and deepened his connection with the patient by contemplation, if you will, rather than via touch or palpation. Every true physician knows that healing begins when the doctor enters the examination room. We don’t need to touch the patient to initiate a connection or achieve synchronization. We can initiate this deep and abiding relationship, i.e. “being with” with our patients, by having a hands-on contact or by including them within the healing field of our attention without actual physical contact.

There is a category of Osteopathic Treatment where the remedial action has nothing to do with fixing something that is broken or in dysfunction. An entire Osteopathic Treatment session may be devoted to synchronizing with the patient’s forces of self-healing, or what Dr. Still called, “the attributes of Life.” Or, an entire Osteopathic Treatment session may be devoted exclusively engaging the living texture of the Health in a patient. These categories of treatment involve having a hands-on connection while being extremely patient and having no intention to repair a dysfunction. With seriously ill patients, or with the chronically unwell, the first few office visits may be devoted exclusively to what Dr. Hildreth called, being “in contemplation” before initiating a procedure to fix something.

Ultimately, once a familiarity is achieved with a patient, the process of contemplation, synchronization, or engagement of the Health in a patient becomes rapid and seamless with the examination and the “doing something” parts. In the real world of patient care, we never divide an Osteopathic Treatment into parts. “Being with,” examining, and “doing something” encompass a wholistic Osteopathic Treatment.

We don’t just “do something,” and, I would argue, we don’t just “sit there.” As Osteopaths we must “be with” first and, then, “do something.” To “do” without “being” is to practice incomplete Osteopathy. If we choose to practice in alignment with the teachings of Dr. Still, we must combine “being” and “doing” to help usher our patients to harmony and health.

I would rephrase Dr. Becker’s adage to read: “Don’t just do something, be there.”

Steve Paulus, DO