Independence and Interdependence

In unpublished notes written by A. T. Still in the early 20th century he referred to the Osteopathic profession as a “Brotherhood of Independent Thinkers.”¹ Osteopathy was founded by a radical individualist who was an explorer and philosopher. He did not invent Osteopathy, he discovered these eternal principles of Nature. Most importantly, Dr. Still created a teachable system of health care by founding the first Osteopathic school and setting up the structure for Osteopathic professional organizations to come into being.

It has been said that bringing Osteopaths together is like “herding cats.” Our profession was founded by a self-reliant individual who was a free spirit. Dr. Still not only encouraged integrative and independent thinking, he demanded it. Functionally, Osteopathy was established in the late 19th century as an alternative to allopathic medicine. DOs were thought of as being eccentric and were forced to operate outside of mainstream medicine. Because we were seen as outsiders and eccentrics we were attacked by our allopathic brethren for most of the 20th century.

It was the constant barrage of harassment from the allopathic profession that forced the independent minded DOs to band together for professional survival. We were linked primarily through survival mechanisms not just by a common philosophy. As a profession we created a separate medical school structure, a distinct post-graduate education system of internships and residencies, and an independent hospital network of Osteopathic institutions. For decades, DOs were not allowed to practice in allopathic hospitals, join allopathic professional organizations, or participate in government sponsored programs for physicians. We were discriminated against and segregated from the greater medical community in the United States.

Segregation and discrimination bound all DOs into a cohesive unit, even in the presence of personal or Osteopathic professional disagreement. Philosophic differences between DOs became practically inconsequential when faced with the foreboding of attempted legal and financial destruction by the local and national allopathic organizations.

During the past 20 years, barriers between DOs and MDs have been functionally eliminated. DOs are fully integrated into the allopathic system. We are no longer segregated. We are rarely discriminated against, as long as we practice in alignment with allopathic principles. DOs and MDs are full partners in the health care industry in the United States.

Once DOs became integrated and were no longer under attack, it was not necessary to maintain systems of Osteopathic professional cooperation. The diverse individuals within the Osteopathic community became a professional centrifugal force -- proceeding in a direction away from their source. Being under attack for nearly 100 years held the Osteopathic profession together. Being integrated dissipated our cohesion.

If we were once bonded by survival mechanisms and a common philosophy, what happens when survival mechanisms are no longer needed? Once those DOs who did not utilize the Osteopathic principles and manipulation saw themselves as equals to MDs, they also envisioned themselves as being separate from DOs who practiced Osteopathy in alignment with Dr. Still. Most of our DO brothers and sisters have now allied themselves with allopathy and have quietly placed Osteopathically oriented DOs on the outside of the health care system in the United States.

Because the Osteopathically oriented DOs are small in number, they have no real political power within local and national allopathic or Osteopathic societies. There is a new insidious style of discrimination that is directed at the Osteopathically oriented DOs and it is perpetuated by both MDs and the majority allopathically oriented DOs. Because this new form of intolerance is insidious, there has not been a comprehensive professional outrage or sense of injustice that motivates cohesive political actions.

Are Osteopathically oriented DOs only linked by independent thinking and a common philosophy? Unfortunately independent thinking usually overrules our shared philosophy and the practice of Osteopathic Manipulation. Widespread independent thinking by itself can be divisive to professional organizations. Our national Osteopathic medical societies contain a very small percentage of Osteopathic physicians who regularly utilize Osteopathic principles and manipulation. The independent minded DOs have failed to generate enough cohesiveness or power to have significant influence on national Osteopathic policies. National Osteopathic policies are more often than not aligned with allopathic medical values.

Dr. Still, however, referred to the Osteopathic profession not just as a group of independent thinkers but as a “brotherhood.” Brotherhood is a feeling of fellowship and compassion for all people. It is an organization or a whole body of persons engaged in a common purpose or in a particular profession. A brotherhood is an organized system of interdependence.

Independent thinkers usually separated themselves and are generally not aligned with groups. However, Dr. Still asked that we not only become independent thinkers but also brothers and sisters. We agree to be different and we grant permission for diversity. Osteopathically oriented DOs are bound by a common purpose and potentially by our fellowship. And most of all, we agree upon the principles of Osteopathy as discovered by Andrew Taylor Still.

The future of Osteopathically oriented DOs depends upon cooperation among diverse individuals. It depends upon independent thought and interdependent action. I believe that our future requires a model of cooperation based upon the celebration of inclusion, democracy, and member participation in organizations that promote Osteopathic principles and the practice of manipulative medicine. The essential philosophy of Osteopathy is based upon cooperation, which is holistic. Cooperation is also based upon solidarity and harmony. Our future requires that we engage in fellowship and cooperation as the binding elements in our Osteopathic professional organizations. We don’t need to artificially utilize survival mechanisms to bind us. In fact, to use survival mechanisms as a professional linkage device is dysfunctional and based upon a disease model.

True Osteopathy is model based upon health not disease. It is based upon this teaching of Dr. Still: “To find health is the object of the doctor. Anyone can find disease.”² DOs who practice Osteopathic philosophy and manipulation every day with every patient have an alternative pathway to professional holism. We can foster societies of interdependence based upon sharing a common Osteopathic philosophy and having a respect for diversity. We can base our fellowship upon health rather than the lesion of survival mechanisms. And, we can recognize the need for Osteopathic independence and the creativity that arises from our distinctiveness. Finally, our success depends upon engaging our interdependence and admitting that what connects us is more important that what makes us unique.

Copyright (c) 2005 Steve Paulus, DO, MS

¹ Still National Osteopathic Museum, unpublished writings of A. T. Still, ATS Box 2, Brotherhood of Independent Thinkers

² Still, A. T. Philosophy of Osteopathy (1899, reprint, American Academy of Osteopathy, Colorado Springs, Colorado, 1977), p. 28