Massage is Sensational

Brain OrgasmA recent article in The Atlantic about a phenomenon called ASMR (autonomous sensory meridian response) reminded me of how little we celebrate the purely sensational nature of massage.

ASMR is a subjective sensory experience that typically includes highly pleasurable tingling in the head triggered by external audio or visual stimuli such as whispering, tapping or watching certain videos. Possibly because someone early on began referring to this sensation as a “brain orgasm,” the ASMR meme went viral with articles appearing on Slate, Time, and Huffington Post as well as numerous podcasts and radio programs. YouTube already lists nearly 2 million videos on the subject.

I had two reactions when I first read about ASMR. The first was, “What’s the fuss about? Every time I get a massage, I tingle all over, including in my head and brain.” My second thought was, “How come massage doesn’t have 2 million videos on how good massage feels?”

Professional massage exists on a social acceptability spectrum that can be summarized into four major categories: Sexual, sensual, wellness, and therapy. For the past 30 years the goal of the mainstream massage industry has been to highlight the latter two categories while downplaying the first two in an attempt to create as much distance as possible between massage and any hint of prostitution.

In the process, the fact that, first and foremost, massage feels good has gotten lost. That is unfortunate because, as science is now discovering, feeling good is probably one of the best things that we can do for our ongoing health and well being.

Learning how to stimulate a parasympathetic (relaxation) response, as massage does quickly and so effectively, is crucial to the daily health and renewal of virtually every physiological system in our bodies, not to mention the maintenance of a healthy psycho-social balance.

“Massage is not just pampering,” popular magazine headlines try to convince us. I say, what’s wrong with pampering if it boosts the immune system, lowers blood pressure, reduces stress hormones, increases oxytocin and heightens heart rate variability, a marker of parasympathetic response? A simple, caring massage is also an unconditional validation of my existence that nurtures both internal and external empathy. What’s not to like?

All massage is sensational. It makes us feel more and it makes us feel better. What a gift is the massage that banishes the numbness with which we armor our bodies and our spirits. Let us celebrate the sensational essence of massage and start making those videos.

Viewing Massage Through a Holonic Lens

One of the critical topics in the massage community is how to define and label what we do. How we define massage influences how we market our services, how we regulate them and how we educate new people coming into our profession.

Like the classic tale of the blind men trying to describe an elephant, how we define massage, to a great extent, depends on where we are standing. Massage is a very big elephant with many facets. So, when we talk about massage, at the least, we need to talk about where we are standing so we can also frame the limits of each perspective and how it relates to every other perspective.

Since 1998, I have been a student of integral theory, which presumes that every perspective is true but partial. The integral approach thus allows for an infinite number of perspectives while, at the same time, providing a framework that allows us to carefully examine and map, in this case, all dimensions of massage.

This article is the first in a series that will analyze massage from a wide range of perspectives using the integral framework. Each analysis will define a lens through which to consider the rich tapestry of massage. The first lens I will use is called the holonic perspective.

The holonic lens defines that every aspect of existence is at once both a whole and a part—a “holon.” Writer/philosopher Arthur Koestler coined the term holon in 1967 and called the hierarchical ordering of any sequence of whole/parts a holarchy.

For example, a human holon is composed of many organ parts. Each organ holon is composed of cells; each cell is composed of molecules; molecules are composed of atoms; atoms of particles and so on. This article is a holarchy starting with letters that make words that make sentences that make paragraphs that make the article.

Each fundamental holon can stand on its own but, when combined with other holons, more complex, more significant holons emerge. That is to say, a holon is not merely the sum of its parts. Each holon transcends and includes the previous structures. While a cell is composed of molecules, it also transcends cells to form a higher functioning, more complex structure.

This concept is imbedded in the origins of the Holistic Health movement that emerged in the 1970s. That movement was a reaction to the reductionism dominant in the specialization of mainstream medicine for most of the 20th century that treated only parts of people, not the whole person. Indeed, one of the reasons I was drawn to massage and bodywork forty years ago was the fact that its resurgence was driven by people committed to a holistic understanding of the body/mind.

There are many holarchies we can study in massage. I will give two examples in this article, one that looks at the physical, objective exterior of massage and one that considers an interior, subjective perspective. In future articles other holonic analyses will emerge.

A Massage Exterior

A complete professional massage holon is composed of a series of sequences or protocols applied to various parts of the body. Which sequences are selected (location) and how much time we spend on each part and in what order (choreography) has a lot to do with how we define any particular massage.

For example, foot reflexology, chair massage, Indian head massage, sports massage, remedial massage, and full-body Swedish or acupressure massage each select their locations and arrange their choreography very differently.

Each holonic sequence in a massage is a composition of various techniques that can be categorized into dozens of variations on compression, friction, stroking, holding, kneading, lifting, movement and mobilization, percussion, and vibration. These techniques and sequences, combined with a clearly defined intention and/or theoretical framework and/or worldview is what defines a particular massage modality.

Finally, every technique holon is composed of touch. Professional massage is a physical connection to and through the skin of the recipient. Most of the time this is done by the hands of the practitioner but can also include the intermediary of massage tools manipulated by the practitioner.

So, to summarize this analysis of massage we could say that fundamental to all massage is touch. But the particular kind of touch in a massage is not casual, accidental or spontaneous. Rather it is the trained touch of definable techniques. These techniques, in turn, compose the sequences that, informed by specific intentions, create what we call a massage.

A Massage Interior

One subjective (interior) analysis of another holarchy inherent to massage might point to the fact that every massage is fundamentally a relationship holon.

While there are many kinds of relationships (e.g. mathematical, organizational, mechanical), in massage the relationship is interpersonal, i.e. between two people.

Within the universe of all possible interpersonal relationships, massage is not a parental relationship or a friendship, but I would suggest it falls in the category of service relationships.

The kind of service that we provide, as noted in the first section, is fundamentally touch which, by definition, means that this service is one that requires physical intimacy.

So, we could summarize this point of view by saying that massage is subjectively experienced as an intimate, interpersonal, service relationship.

Practical Value

These two holarchies point to the internal and external constructions of a massage. Understanding that fundamentally massage is objectively about touch and subjectively about intimacy is critical to the health and growth of our profession. While these should be our primary areas of expertise, by and large, both of these aspects have been increasingly relegated to the shadows of our profession.

With the transformation of “massage” into “massage therapy” we have left behind the philosophical roots of the holistic health tradition.

Consequently an ever-increasing number of students are allowed to graduate from massage programs without knowing how to give and receive touch nor deal with the intimacy inherent in a touch relationship.

The latest striking example of touch-denying in our profession comes from the two surveys currently circulating in the industry—the FSMTB Job Task Analysis Survey and the companion Entry Level Analysis Project. Both are part of the attempt to define entry-level skills for our profession. Between the two, the word “touch” appears exactly one time. Of course the term “intimacy” does not appear at all.

Our refusal as a profession to embrace touch and the intimacy it represents by sterilizing it under the guise of massage therapy is clearly leading us down an unnecessarily self-limiting path. [See the related article Moving from Acceptability to Accessibility.] Our virtual culture is increasingly debilitated by the lack of authentic human validation and connection. We hold an answer literally in the palm of our hands. Let’s give people what they crave.

Haptics: The Science of Touch

Last week I saw a commercial for the new Cadillac XTS that featured an innovative touch technology called the Safety Alert Seat. The system sends vibrating pulses to drivers through the seat cushion if they drift out of their lane without a turn signal activated or if there is threat from the front or rear, such as when backing blind out of a parking space.

“It’s akin to someone tapping on your shoulder in a crowd to get your attention,” said, General Motors Active Safety Technical Fellow Raymond Kiefer. “Using the tactile sense to communicate crash threat direction provides an effective and intuitive way to cut through the clutter of visual and auditory sensory information that drivers routinely experience.”

Cool!

Chart comparing Massage to Haptic research

Number of annual peer-reviewed research papers.
Source: EBSCOhost

This technology had been developed in a field of touch research that I have been following for the past 15 years called “haptics,” derived from the Greek word meaning “pertaining to the sense of touch.” Thus, if you are studying touch, you are studying haptics.

Since the only thing that all 100+ modalities of massage and bodywork have in common is that they are all based on touch, it would seem only natural that the massage industry would have a close association with the folks doing haptic research. Unfortunately, that is not the case. Even the recently published groundbreaking textbook on massage therapy research (Massage Therapy: Integrating Research and Practice) makes no mention of haptic research.

As noted in the accompanying chart, annual research in massage has actually leveled off in the past five years while annual haptic research surpassed massage research ten years ago and continues to grow steadily each year.

Who is doing haptics research?

There are scores of companies developing products based on haptics research. Many do their own research and others partner with academic institutions such as:

Disney Research is an example of a major corporation investing in touch research: Surround Haptics – Immersive Tactile Experiences

Why are they doing haptic research?

Most research in haptics has focused on extending the human ability to reach, explore, grasp, manipulate and get feedback from the world around us. Applications can be found in robotics, prosthetics, remote medicine and surgery, hazardous environments, manufacturing, communications and education.

Closer to home, the phone vibrating in your pocket and the joystick on your gaming console are both a result of haptics research.

In the future, haptics will become an essential aspect of virtual human interaction in such arenas as business meetings and classrooms. Sound waves are being studied for their ability to mimic touch making virtual handshakes within the realm of possibility.

How is this important to massage?

Since massage and haptics have never interfaced with one another, at first glance, they may not appear to have much in common. But that is definitely not the case. Here are some reasons why we should be working together.

Defining touch

One of the outcomes of haptics research has been to define the discreet constituents of touch mechanics (movement, friction control, vibration, contact force, pressure, duration) and to develop models for discriminating texture, softness, ridgidity, temperature, moisture, shape, proprioception/orientation and weight/heft.

All of these components are critical to massage and thus essential to informed massage education, practice, evolution and research.

Standardizing touch

A serious flaw in virtually all massage research to date is the lack of standardized protocols. “Subjects received ten-minutes of massage to the lower back,” is not a particularly useful sentence in a massage research paper because it is difficult, if not impossible, to duplicate.

We need to define a common vocabulary of touch far beyond effluerage, petrissage and tapotement. Iris Burman and Sandy Friedland made an attempt in their book TouchAbilities: Essential Connections, but far more refinement is required.

One of the reasons that I feel fortunate that my massage modality is Japanese acupressure is because there is a built in precision to the acupressure points, the channels they lie upon and the techniques that are used to stimulate them. I am a big fan of quality control in massage, so I also teach chair massage as one would a martial art, that is through “Katas,” highly choreographed sequences of techniques, point locations and body mechanics. The kata model is one of the few in massage that allows for high standardization of protocols.

Touch tools

As haptics has defined the parameters and functions of touch, out of necessity the field has also had to develop tools that apply and measure each aspect of touch. These tools can obviously be used by massage researchers to apply standardized touch, measure touch or used as controls in touch research.

The biology of touch

Haptics is as interested in the anatomy and neurophysiology of touch as is massage and they have the money to pay for functional MRIs. We need to be monitoring their work, sharing information and cross-fertilizing our fields.

The psychology of touch

Research into how haptic aspects affect the psychology of gaming (the thrill of driving on that racetrack), computer shopping (where you can feel the texture of the skirt you are viewing on your monitor), and mutual virtual touching continues to expand. Investigating the psychology of touch is in its infancy and the massage industry needs to be accessing research and resources wherever we can.

Massage is poor; commerce is rich

The massage industry has suffered from an inferiority complex (fighting a negative public perception) and consequent lack of imagination for decades. Because of our fear of embracing touch (see related article), we have allowed commercial interests outside of the profession to charge ahead with a touch research agenda that is almost totally off the radar of the massage industry.

The massage industry should be in the middle of all touch research, not standing on the sidelines. It is time to take off the blinders and begin dialoging and collaborating with the commercial and academic interests who are spending millions of dollars researching touch.

Let’s get in the driver’s seat, folks!

MTBOK: Missed Opportunity?

Reading the impressive 58-page paper entitled Massage Therapy Body of Knowledge (MTBOK) was both exhilarating and disappointing. Developed by a coalition of six national massage organizations, Version 1 of this effort was published in 2010 and is a landmark document for massage therapy and a must-read for everyone in the profession.

MTBOK: Missed OpportunityThe purpose of the MTBOK Project is to define the scope of practice for massage professionals and the entry-level knowledge, skills and abilities (KSA) necessary to responsibly perform massage therapy. It is intended to be a living document that is constantly modified and updated as information, understanding and perspectives change.

Unfortunately, the MTBOK effort, while commendable, is fundamentally flawed as, once again, the mainstream massage industry conflates “massage” with “massage therapy.” This is a 30-year old problem that continues to hold back our industry by presuming that all massage is massage therapy. You can read the history of how this came about and why it has been a disaster for the industry in the related articles How Massage Became Therapy and Moving from Acceptability to Accessibility.

In this article I want to use the MTBOK report to help identify the difference between “massage” and “massage therapy” and lay the groundwork for future discussion.

First, let’s start with the report’s definition of “Bodywork” on page 39. It notes, correctly I believe, that bodywork includes all forms of massage therapy. Indeed, bodywork is the umbrella term for all forms of skilled touch some of which are massage, and others of which are clearly not (e.g. Reiki, Therapeutic Touch).

Where the report fails is that it doesn’t make clear that the subset of bodywork that includes massage can be further subdivided, only one category of which is massage therapy. That is to say, while all massage therapy is massage, not all massage is massage therapy [See The Realms of Massage].

What part of massage is not massage therapy? That’s easy—personal care massage.

The MTBOK paper, like the industry as a whole, defines massage therapy (meaning all massage) exclusively as “a healthcare and wellness profession” and goes on to say, “The practice of [massage] involves a client/patient-centered session, intended to support therapeutic goals.” Really? That is not the massage I have been doing for 30 years.

I don’t serve “clients” or “patients,” I serve customers. The personal care service I perform has more in common with cosmetologists (“If you feel good, you look good”), tour guides (“Let me show you your body from the inside out”) and aerobics instructors (“Let’s get fit”) than with physical therapists or athletic trainers. Indeed, the Bureau of Labor Statistics places the largest concentration of massage professionals, by far, in the personal care service industry, not the health care industry.

So, clearly, there is personal care massage and there is health care massage therapy. Is the body of knowledge required for safe, effective practice the same for both occupations?  Obviously not, but inadvertently here is where the MTBOK paper has done us a great service. Since all massage therapy is a subset of all massage then, if they did their work well, within the body of knowledge of massage therapy must be the core knowledge, skills and abilities to perform all massage, including the subset of personal care massage.

It’s all about touch

Let’s start with one of their definitions on page 6: “Massage therapy at its essence is human touch with clear intention, focused attention and the attitudes of compassion and non-judgment.” I would maintain that this is also a perfectly serviceable definition for personal care massage so let’s take the word “therapy” out of the sentence and we can all agree that the primary KSAs of all massage should revolve around touch.

So, what does it take to be a professional touch provider? Clearly far less than is required to become a massage therapist. In fact, separating personal care massage from massage therapy will finally allow massage therapy to have the growth path it so justifiably deserves—that of becoming medical massage, a health care specialty—while allowing basic massage training to focus on the simple but profound benefits of touch.

The MTBOK sections on Boundaries, Ethics and the Therapeutic Relationship along with Body Mechanics, Self Care and Massage Techniques contain a wealth of relevant suggestions about learning to be a good skilled touch provider. The in-depth knowledge outlined in Anatomy, Physiology, Pathology, Kinesiology, Assessment, Treatment Planning, Documentation, Research and Information Literacy however, are far more suited for a massage therapist.

Massage therapy training has always been too much and too little. If you read through the MTBOK recommendations, you can come to no other conclusion than that 500 hours is a woefully inadequate number of hours for training a qualified massage therapist. The 2,100-hour standard in Ontario province or the 3,000-hour standard in British Columbia are much closer to the mark.

However, 500 hours is far more than is necessary for me to train a world-class chair massage practitioner doing personal care massage. I could accomplish it in 300 hours and half of that would be supervised practice.

At this point there is ample evidence that the effort to attract the marketplace to high-priced massage therapy has failed. The only significant growth markets for the industry are the chair massage provided by the current wave of Chinese immigrants in malls and low cost suburban table massage offered by Massage Envy and its clones. Neither of those approaches, by and large, requires the full training and skill set outlined in the MTBOK. Each of those avenues could rightly be called “entry level” for both the practitioners and the consumers. I would suggest there is little point in training thousands of massage therapists for jobs that don’t exist. Better to train personal care service massage practitioners for jobs that do.

Let’s first teach all our massage students to do one thing really well—skilled touch. If they later want to specialize in massage therapy in all of its many, varied and glorious forms, great, but that is advanced training for a clearly limited market.

Toys for Touch

Touch is far more important for childhood development than technology. I was reminded of that while reading an article in Sunday’s San Francisco Chronicle about innovative local toy companies.A number of them explicitly sing the praises and benefits of tactile play.

One successful company featured is Folkmanis Puppets which notes that a “a puppet encourages imaginative, open-ended play, endearing hugs, and snuggly companionship.” Have you ever noticed how much puppets love to touch themselves and each other? I’ve been wondering why I have this compulsion to see the new Muppets movie.

Only in the Bay Area would there be a company called Plushy Feely Corp. that designs and promotes cuddly Kimochi dolls that helps kids learn to understand and express their feelings. The product that caught my eye was Huggtopus, a multi-limbed creature who is “very affectionate and strong and sometimes gets a little carried away by her big friendly personality. Huggs always means well but has to learn about boundaries.”

Learn about boundaries. I love it! Their animated video about hugs is  priceless.

Tactile sensitivity is a learned motor skill essential to neurological development. Touch appropriateness is a learned social skill essential to the formation and maintenance of healthy relationships. Carefully selected toys can help develop both.

Of course, there is no substitute for human touch, so don’t forget to pass plenty of that around this holiday season as well.

Should hugs be banned?

Admittedly, since my oldest grandchild just entered second grade this year, I have been out of the loop regarding school board policies dealing with public displays of affection (PDA) between students. I guess, after watching Glee for three years, I had thought schools were getting more enlightened about the subject of consensual, non-sexual touch.

That must be why I was taken by surprise when a Florida middle school recently suspended two students for a quick hug. Naive little me. There it was in black and white in the school district’s policy manual: No kissing, hand holding or hugging. I took note of the fact that it didn’t prohibit sex, which presumably was the ultimate goal.

This issue surfaced when the Latina parent of one of the kids objected to the suspension saying it is part of their culture to hug. She looked a bit stunned that hugging would be stigmatized. This was clearly a clash of cultures and guess which culture won? Why the dominant culture with the most pathological relationship to touch, of course.

View the original brief news story below and let me know what you think? Should hugs be banned in middle school? How about elementary school? Kindergarten? When, exactly is a hug at school appropriate?

Students suspended for hugging: MyFoxORLANDO.com