Takeaway: Histories taught in bodywork courses need to consult professional historians to become broader and provide context and understanding, not just fact files.

When you’re studyingto become a manual therapist or looking for courses to keep your skills sharp, history probably isn’t high on your list of priorities. Curricula, especially in osteopathic, chiropractic, and physical therapy training, sometimes include a couple hours on the history of the foundation of the profession early in the syllabus. Similar potted histories are encountered in massage therapy classes. Yet, there seem to be precious few uses for anything other than bullet-point history summaries in any health-care clinic. But is that really the case? This article explores the role of histories in bodywork education, considers the recently revived interest in aspects of the history of manual therapy professions, and investigates its hefty relevance to the integrative health professions.

Which History?

There are three main types of histories written about bodywork professions. First, traditional narratives of origins, which comprise broader versions of those summarized in curricula. These tell the foundation story, generally praise the founder of a profession relatively uncritically, and outline how the technique or modality developed, was passed on from the founders to their students, and, from there, evolved into schools. These often begin with narratives of ancient, traditional, and pre-modern healing practices, occasionally highlighting their antiquity as a kind of “proof” of their efficacy and safety. In other cases, they trace the foundation of some of these approaches (largely in the 19th century) through their founding fathers (or mothers), their development through the work of individual practitioners held up as leading lights, and brief notes on their evolution into fully fledged professions—often in the face of establishment opposition. Some critics call these hagiographies, which means “biographies of saints,” reflecting the uncritical spirit in which they are often taught and discussed. 
Common examples found in various bodywork communities might include features on A. T. Still, founder of osteopathy; Ida P. Rolf, who developed structural integration; D. D. Palmer, the father of chiropractic; or James Cyriax, known as the father of orthopedic medicine who exercised a strong influence on physical therapy. They include biographical anecdotes that are largely cherry-picked for their wisdom and experience, numerous quotes with little context, and dates and events surrounding the evolution of their particular method or school. They do not follow a structured or academic method of historiography (from the Greek historia, meaning “story” or “history” and graphein, which means “to write” or to have the skills to research and write a history). 
The second type are called internalist histories. The best of these manage to avoid the narrative freedom of the first type and focus more closely on the development of a technique or practice. They might explain the way a particular practitioner drew upon several influences to develop, for example, Muscle Energy or Neuromuscular Technique, and then outline the contributions of various later practitioners who took these further. Versions of such brief, internalist histories often highlight details such as early archaeological and ancient references to particular medical practices (Hippocrates always gets a look in, though context is rarely provided); if speaking of the modern period, the immediate actions and interactions of the founders and developers of such methods in direct relation to their practice. These are most commonly used in bodywork textbooks and curricula.¹ Like the first type, internalist histories are often written by practitioners and authors who are not trained historians, but experienced physicians or practitioners who have gathered the key points of the narrative. Some are written by physicians with training in sociology or history, but the prevalent model of narrating the histories remains largely internalist; i.e., it trims the matrix in which the events occurred. Many of them tend to filter out the more embarrassing elements of a profession’s history, termed “skeletons in the closet” by the history panel of the International Consortium of Manual Therapies inaugural conference in May 2022, which, to its credit, highlighted the need to open these “closets” to understand the origins of key issues troubling relevant professions.²
Examples of such skeletons may include association with mystical beliefs such as Mesmerism, contemporary connotations associated with “woo” practices of any sort, or the use of massage therapy as a cover for human trafficking and sex work—a practice that has plagued the profession’s reputation ever since. A lesser known, but equally significant, skeleton is that massage was classified as medicine by the American Medical Association in the early 20th century, and this legal designation was then used to arrest and shut down naturopathic practitioners at a time when the conflict between biomedicine and naturopathic practice was at its most vicious.³ A systematic exploration of the factors surrounding this designation and its impact would provide significant insight into current unresolved problems in the profession.
The third type of histories are known as academic histories. These are in-depth investigations of the evolution of methods or whole professions in relation to broader social change, some of which are academic, while others are written in a livelier style closer to investigative journalism. Researching and writing them requires training and specific skills in historiographical methods. They are especially valuable because they are authoritative, reliable if done properly, and unlike the first two types, look at the broader (holistic) context of how, and crucially, why the topic of investigation (a method or profession, for example) developed as it did, as well as its implications. Although these are the most correct and useful types of histories, they are also the rarest when it comes to health-care education, and are generally found in specialized publications within the discipline of the history of medicine. 

Why Is It So Complicated (And Why Does It Matter)?

In the 19th century, Canadian doctor William Osler, considered to be the father of modern medical practice, established a perspective that the history of medicine is a source of models to be used as guidance based on the “wisdom” of the great physicians of the past, but stripped to the bare bones, focused only on the medical practices or concepts that were immediately relevant to the topic at hand. This approach to medical history became the foundation for the internalist histories described earlier. 
In contrast, the academic historians building the actual discipline of history (a discipline built and shaped over two millennia), argued that history is an ongoing process of inquiry. Health care is a practice that derives from human experience, is practiced within society, and is constantly being shaped by social values, beliefs, and necessities. So, an academic history of medicine is a holistic exploration of all the factors impacting our understanding of health, disease, patient narratives, and the roles of physicians in society.
If we imagine a historical narrative as the story of a single person, the biopsychosocial approach properly applied is a great analogy for the academic approach to history: It will look at phenomena, data, and the sequence of events, but it will also examine and interpret them in terms of values, belief systems, and the broader social and economic environment. This allows the practitioner to understand and build trust with their patient; it allows the historian—and the reader of an academic history—to build a full picture of how the multiple factors have led to a given situation. In contrast, an internalist history is similar to a specialist examining only the physical system or model they are familiar with, like a patient consulting an orthopedic surgeon for a soft-tissue injury, only to be told they need surgery—because that is the protocol the specialist has learned to follow. Sometimes they do indeed need surgery; however, unless the broader context is considered, including the potential benefits of less invasive methods, the patient will not be offered options, nor will their psychosocial needs be met.
These two perspectives on histories have clashed since Osler’s time, and while Oslerian histories continue to dominate health-care education, many historians of medicine and science argue that the focus on internalist histories dismisses and discards the well-established, crucial skill set that holistic academic histories bring to clinical practice.⁴ Where internalist histories provide information, academic histories bring understanding as well as fresh skills.

How History Enriches the Clinical Encounter

When we take a client’s history, we are in effect trying to piece together a story that will help us get to the root of a problem, and to discover the factors contributing to and maintaining dysfunction. We’re also, ideally, looking for clues as to the psychosocial profile and environment of the client to better understand their expectations, what they are likely to respond to, and where to begin addressing their complaint. And we should be discussing realistic outcomes with that client to begin building a treatment plan. However, those realistic outcomes can only be presented once we have a clear and holistic view of the client within their full context. 

There is no difference between the critical skills needed to explore and respond to a client history and those that will unlock important insights from the history of health-care practice. Believing the wider history of a profession is somehow irrelevant to those on the front lines of hands-on practice is as misguided as thinking your hands and intuition alone will tell you all you need to know about the client. The reasons why the immediate connection between these two types of history is frequently missed are complex, but the problem has been well studied by medical educationalists and historians working to integrate the skills and insights that history can provide for clinical practice directly into biomedical curricula.
Academic histories of medicine explain the driving forces motivating, obstructing, and providing fertile ground for historical founders of various therapeutic practices. They provide insight into how and why change occurs in practices, attitudes, and methods; how health care and society interact in the lives of individuals; and how health-care principles impact actual events.⁵ Crucially, they help us to understand what is practiced, how, and why; raise our awareness of differences in practice among locales and professions; and support us in developing the all-important critical ability to apply in clinical practice. The same thought process sheds light on the messy, slow, uncertain interpersonal exchanges that give birth to ideas, how they succeed and fail, and the many complex layers that shape such developments. A client with a bad back does not arrive in a vacuum; nor did any of the bodywork professions develop in a vacuum. So, it makes little sense to teach the story of their development as a neat, linear sequence, as is usually the case in internalist histories.
Whether you are asking questions about the limitations of your scope of practice, wondering why there are so many bewildering modalities available, why attitudes and language are used as they are, why osteopathy is practiced differently in the US, UK, France, Germany, Italy, and Australia, or why remedial massage and myotherapy in Australia correspond to advanced levels of clearly regulated therapeutic massage,⁶ holistic context will offer the answers. Internalist histories will not; they will offer bite-size answers that remain superficial rather than providing understanding.
Understanding full histories also allows the recovery of neglected topics, which should be a priority given the current shift toward holistic thinking evident in biomedical education, where the holistic wheel has been practically reinvented over a century after it originally came under fire from early biomedical authorities.⁷ All too often, we see marketing material and strongly worded debates about “outdated practices,” calling for a shift to some new model or modality. These calls to action are invariably simplistic, and they count on a lack of critical thinking to attract followers. They usually rest on an ideological framework known as presentism—an attitude that we are always progressing toward something better, and that anything past an undefined sell-by date is to be discarded. Yet, this is an error of logic that is often misapplied either through a lack of critical ability, or for commercial gain or self-serving image management. 
Engaging in the process of inquiry embedded in historical learning forces us to develop the skills needed to evaluate the fuller picture, develop higher reasoning skills, and by extension, to appreciate principles of uncertainty we will repeatedly encounter clinically. This process encourages both humility and skepticism, but in an informed and systematic way. Adapted academic historical training is being built into biomedical curricula for these reasons, and it is an equally valuable tool for manual therapy, as these developments have already demonstrated.⁸

Histories and Professional Identity

The version of a profession’s history that is taught in basic training plays an important role in establishing professional identity. It also governs the language used to talk about a given profession. It is the basis for using allopathic medicine rather than biomedicine as a general term understood in opposition to holistic medicine, consciously or unconsciously creating a tension between the two. In some cases, this goes as far as framing the self-perception of “holistic” practitioners as part of a proud, countercultural heritage. 
Regular readers of this column will be aware that I have frequently highlighted the shift toward whole-person health care evolving in biomedicine, and the reality of this tension has been changing for some time. Several sociological studies of the relationship between complementary and alternative medicine (CAM)—the term used in the studies, but the same applies to “integrative” or “functional” medicine—and biomedicine have long established that almost one in two biomedical clinicians (48 percent) and medical students (91 percent) want to discuss CAM with their patients, but feel inadequately educated to do so, pointing to a gap in baseline or continuing education as the cause. Even though the potential for CAM values to improve the effectiveness and patient satisfaction of conventional medicine is well established in biomedicine, time-starved electives and divisive, practice-based debate have been identified as key hindrances to progress.⁹ It is in the full histories—and the full sociological studies—that the answers will be found, and this is where interdisciplinary collaboration with humanities specialists is crucial. 
Current efforts to formulate a common nomenclature, better definitions of manual therapy practices, and a collation of the existing evidence have acknowledged the importance of histories, but so far remain focused on internalist ones. Such efforts are doomed to struggle until the lens is widened to include the expertise that provides contextual insight—because if the wider context is not considered, there is no way to work out how the current situation developed, and our understanding will remain fragmented, resting on anecdotes or event-specific details, instead of understanding the complex matrix of contingencies (things that depend on other things happening or not happening), which impacts the ways health-care practices develop.

What About the Skeletons?

In a previous column, I outlined the deep roots of many holistic practices in mystical and esoteric thought, in an article ultimately talking about fascia research.¹⁰ A large part of that article focused on the social, cultural, and ideological framework in which holistic thought came to be sidelined, how it survived, and was eventually structured and professionalized. Though shorter and more reader-friendly than a true academic piece, that was an example of academic history in which I aimed to highlight where manual therapy debates were hitting a wall; how good ideas become dogma, and dogma turns into bad ideas, which then damage professions, as I have also argued in previous columns.¹¹ Acknowledging all the skeletons, good and bad, allows us to learn from these errors of the past. Jumping on bandwagons while locking them in the closet will ensure we repeat the errors.

Education, Professional Scope, and Transferable Skills

I am an academic historian (and communication specialist) by training, and I have never professed to be anything else. In my research, I have specialized in understanding how intellectual histories impact real life and developments in society. These tell the complicated stories of how ideas become actions and explore the tangled web (a lot like fascia) that leads to their evolution and success or failure in a very obvious biotensegrity structure, where any one distortion would lead to a whole parallel timeline. That is what we historians look at. 
Despite my long observation of clinical practice as Leon Chaitow’s interpreter and assistant, as well as through sociological research, if I were to begin seeing patients tomorrow, I would be arrested for breaking the law, and rightly so. Yet, when a lifelong clinician—even one with a PhD—writes an internalist history, it is considered gospel. Many are excellent teachers and clinicians, but they possess neither the training nor the expertise to widen that lens from informing to providing understanding, as is seen time and again in internalist histories. This can only be understood once the value of the broader holistic context—that tangled web—is recognized. When thought leaders and bodywork faculty repeat these and the more subjective narratives without at least acknowledging that there is more to the story, the issues highlighted here go unchallenged. 
This is not my own argument; rather, it is one of the central problems identified by medical historians seeking to develop interdisciplinary curricula in undergraduate medical training, as it is this very conflict between histories and lack of specialist input that has hindered their development.¹² It is only recently that these issues have been acknowledged, and tools have evolved to address them. Those seeking to tackle these problems in the context of integrative health professions would do well to draw what they can from such models, and it is in the full histories that they will find the resources to do so. 

Examples of the Types of Histories 

The classification of histories should not be taken as a criticism of authors in any of the categories. Each type of history serves a different purpose, and each is valuable. This article does not aim to disrespect the work of any author. The aim here is to provide a guide for nonspecialists to be able to recognize these different types, and to develop their awareness of the value of broader contextual histories that adhere to scholarly standards and look at the evolution of health care holistically. The titles listed below are indicative only.

Narratives

Narratives are characterized by a close biographical focus, often told from an openly stated subjective perspective, and often written by experienced clinicians without historical training. Think of it as a selfie with filter applied.
• Zachary Comeaux, Robert Fulford D.O. and the Philosopher Physician (Seattle, Eastland, 2002).
• Iva Lloyd, The History of Naturopathic Medicine: A Canadian Perspective (Toronto: MCArthur & Co., 2009).
• Phil Young, ed., Pranotherapy, The Origins of Polarity Therapy, and European Neuromuscular Technique: Pioneers of Manual Medicine Vol. I (London: Masterworks International Publishing, 2011). 

Internalist Histories

Internalist histories are written largely objectively, with accurate but narrowly focused sequences of events relating directly to the topic without considering the broader social, cultural, and political context. This may be pointed to and reported as brief factual information, but not analyzed or explored in any depth. Authors may well be both professional clinicians and trained historians, but they have selected a characteristically tight focus that does not allow for depth regarding anything but the immediate topic. Think of it as a well-lit family photo with just enough background to provide scale, but little else.
• Susan E. Cayleff, Nature’s Path: A History of Naturopathic Healing in America (Baltimore, MD: Johns Hopkins University Press, 2016).
• Norman Gevitz, The DOs: Osteopathic Medicine in America (Baltimore/London: Johns Hopkins University Press, 2004).
• Friedhelm Kirchfeld et al., Nature Doctors: Pioneers in Naturopathic Medicine (Oregon: Buckeye Naturopathic Press, 1994).

Academic Histories 

The focus of academic histories is much broader than in internalist histories, and clear efforts are made to understand the social and cultural matrix in which developments occurred. Sides are deliberately not taken, and objectivity is maintained. The priority is to understand the complex interaction of attitudes and events. Think of it as a wide-angle photo, clearly showing both scale, lighting, and interrelationships between the subject and its environment.
• Adele E. Clarke et al., ed., Biomedicalization, Technoscience, Health, and Illness in the U.S. (Durham, London: Duke University Press, 2010).
• Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry, 2nd ed. (Basic Books, 2017).
• James C. Whorton, Nature Cures: The History of Alternative Medicine in America (Oxford University Press, 2002).

Notes

1. See, for example, Susan G. Salvo, Massage Therapy: Principles and Practice, 6th ed. (Amsterdam: Elsevier, 2020).

2. ICMT Conference, “ICMT History Panel Opening Discussion MT History Skeletons,” April 21, 2022, YouTube video, 1:06:04, https://youtu.be/6Dweji5yU5I.

3. Susan E. Cayleff, Nature’s Path: A History of Naturopathic Healing in America, (Baltimore, MD: Johns Hopkins University Press, 2016): 44.

4. Mary E. Kollmer Horton, “The Orphan Child: Humanities in Modern Medical Education,” Philosophy, Ethics, and Humanities in Medicine 14, no. 1 (2019), https://doi.org/10.1186/s13010-018-0067-y; Howard I. Kushner, “Medical Historians and the History of Medicine,” The Lancet 372, no. 9640 (2008): 710–11, https://doi.org/10.1016/S0140-6736(08)61293-3; Hedy S. Wald, Jonathan McFarland, and Irina Markovina, “Medical Humanities in Medical Education and Practice,” Medical Teacher 41, no. 5, (2019): 492–96, https://doi.org/10.1080/0142159X.2018.1497151; A. Batistatou et al., “The Introduction of Medical Humanities in the Undergraduate Curriculum of Greek Medical Schools: Challenge and Necessity,” Hippokratia 14, no. 4 (2010): 241–43.

5. Theodore Arabatzis, “Explaining Science Historically,” Isis 110, no. 2 (2019), https://doi.org/10.1086/703513.

6. Sandra Grace and Jane Graves, Textbook of Remedial Massage 2nd ed. (Amsterdam: Elsevier, 2019) 1.

7. Hasok Chang, “Who Cares About the History of Science? Notes and Records 71, no. 1 (March 20, 2017): 91–107, http://doi.org/10.1098/rsnr.2016.0042.

8. A. Batistatou et al., “The Introduction of Medical Humanities in the Undergraduate Curriculum of Greek Medical Schools: Challenge and Necessity;” Mary E. Kollmer Horton, “The Orphan Child: Humanities in Modern Medical Education.” 

9. L. Winslow and H. Shapiro, “Physicians Want Education About Complementary and Alternative Medicine to Enhance Communication With Their Patients,” Archives of Internal Medicine 162 (2002): 1176–81; R. Chaterji et al., “A Large-Sample Survey of First- and Second-Year Medical Student Attitudes Toward Complementary and Alternative Medicine in the Curriculum and In Practice,” Alternative Therapies in Health Medicine 13 (2007): 30–5; Alex Broom and Jon Adams, “The Status of CAM in Biomedical Education,” in Handbook of the Sociology of Medical Education, eds. Caragh Brosnan and Bryan S. Turner (New York: Routledge, 2009): 124.

10. Sasha Chaitow, “Intelligent Fascia,” Massage & Bodywork, November/December 2020.

11. Sasha Chaitow, “Science, Pseudoscience, and Communication Battles,” Massage & Bodywork, July/August 2020.

12. Howard I. Kushner, “Medical Historians and the History of Medicine;” Misa Mi et al., “Integration of Arts and Humanities in Medicine to Develop Well-Rounded Physicians: The Roles of Health Sciences Librarians,” Journal of the Medical Library Association 110, no. 2 (2022): 247–52, http://doi.org/10.5195/jmla.2022.1368; Jeremy Howick et al., “Do Medical Schools Teach Medical Humanities? Review of Curricula in the United States, Canada and the United Kingdom,” Journal of Evaluation in Clinical Practice 28, no. 1 (2022): 86–92, http://doi.org/10.1111/jep.13589; Kaitlin Stouffer et al., “The Role of Online Arts and Humanities in Medical Student Education: Mixed Methods Study of Feasibility and Perceived Impact of a 1-Week Online Course,” JMIR Medical Education 7, no. 3 (September 2021): e27923, http://doi.org/10.2196/27923.