I am sure I am not the only one wrestling with this challenge: Where do we draw the line between science-based practice, and ‘airy-fairy’ or alternative techniques and practices? To me, it feels as if there is often more evidence supporting the alternative practices than there is supporting our science-based practices.
A comparison between acupuncture and therapeutic ultrasound illustrates the point. Until recently, acupuncture was considered alternative, lacking any real evidence to support its claims. Therapeutic ultrasound, on the other hand, has long been standard practice. The difference between the two is that we understood how therapeutic ultrasound was probably working on a mechanical and cellular level, while the explanation for how acupuncture works involves concepts such as energy flow, meridians and chakras – things we cannot really understand and quantify. The truth is, research heavily supports the use of acupuncture, while there is barely any research to support the use of ultrasound in a therapeutic setting, and ample research that rejects its value as a therapeutic modality.
(for more information on therapeutic ultrasound, you can watch the Research Refresh in the Small Animal Members Portal, and for research on Acupuncture, a pubmed search will give you a great deal of information, and I will soon be delving specifically into some of this research as well.)
Faith vs Understanding
So many healing modalities have been rejected because they require a level of faith or trust as opposed to a detailed intellectual understanding of the mechanisms of action. We have been trained to expect healing and recovery to slot into a formula: If problem A exists, add solution B, and the outcome will be C.
Yet we know life does not work this way, much as we might wish it to. Healing is linked to the body, which is made up of cells, which are made up of atoms, which are held together by energy.
Do you remember sitting in a science class learning about atoms, and being told that the table you were leaning on was made up of particles linked by nothing but energy? In fact the majority of the table or any other item comprises space rather than particles, and only energy holds those particles together.
Or how about electricity: The transfer of electrons from atom to atom allows an electrical charge to move through a conductor. I don’t know about you, but I don’t truly understand how that works; it doesn’t matter how well I know the subject matter, or how you illustrate it, it makes no logical sense and at the end of the day I just have to accept it as the truth.
If we can accept these things as fact – whether we understand them or not – why is it far-fetched to believe that energy plays a part in the healing process? Should we really accept only the modalities whose mechanical and physiological properties we can understand in an A – B – C fashion? We may well be reducing our efficacy by only considering the mechanical effects of our modalities.
I would venture so far as to say that if we insist on only using modalities that we can mechanically understand and that fit into our learned mindset and way of thinking, we may well be denying the evidence. Can our training have prejudiced us, clouded our judgement and caused us to actually stop the advance of our skills?
We have all experienced the spontaneous effects of colour, fragrance and sound on the body, and in turn, on the emotions. Most of us design and decorate our practices to encourage calm and relaxed behavior; we may have soft blues or greens on the walls, a lavender diffuser in the corner, and gentle, relaxing music playing in the background. We sense its value without understanding much about it. We may find ourselves retreating into our consulting room between patients just to take a breath and prepare ourselves for the next patient. Those calming colours, that lavender fragrance and that gentle music are physical ‘modalities’ evoking a physiological response which affects our emotional state – which in turn affects our entire body.
Most of us can accept this without understanding the mechanism of action. In the same way as we recognise the effect of colour, smell and sound, we also know that our mindset and attitude has an influence on the people and animals around us. When we are negative, we carry that feeling with us and it ‘seeps into’ the people we interact with, affecting them negatively, and not necessarily through words or gestures. People just ‘pick it up’. The same holds true in the opposite direction – when we are positive and joyful, our emotional state affects those around us.
Intention and Visualisation
We can take this a step further with intention and visualization (a concept that I really struggle to believe could hold value), but it may not be as far fetched as I think. Have you ever received a great massage from someone who focussed entirely on your physical and emotional wellbeing for the duration of the massage, who exuded calm and acceptance and who visualised your healing?
One can feel the difference between this kind of massage and one given by someone whose mind is elsewhere, perhaps considering their financial or marital problems, or their child’s school performance. They do not have to be particularly stressed or agitated for you to feel the difference. The mental intent and the emotional state of the one acting affects the one acted upon – we know this better than most, because our patients are particularly sensitive to our mental state.
The role of visualisation in healing is impossible at this stage to quantify, although I have no doubt that studies will eventually seek to understand it. It seems that people have healed themselves from cancer, become millionaires, and who knows what else by diligently and regularly visualizing the desired state. Whether or not it truly works, I have no idea, but how difficult is it for us to hold a strong intention in our hearts and minds when we treat a patient, seeing them healed, fully functional and living their best lives? Even though to me this seems like nonsense, I owe it to my patients to add this to my tool box and incorporate it into my practice, simply because it could make a difference!
As I write this, one of my favorite patients come to mind. One Tuesday evening, my last session for the day, a woman walks into the practice with a lovely Chow-Chow with a strained cruciate ligament (she has had the strain diagnosed by her general vet and sought out a second opinion from a specialist, already). Her goal – she is Showing on Saturday, and her Chow needs to be sound so that she can win.
I was dumbstruck. Was she serious? Was it all about winning? What about just getting her healed so she doesn’t need to undergo the ordeal of surgery? I collected myself and stopped myself from judging her, focussing on getting to know and understand her better through the course of the evaluation and treatment. She was already very well informed on the condition. I managed to squeeze in a second treatment before that Saturday, and sure enough, that gorgeous Chow won her class. I continued to treat her for many months after that, and I can assure you that this dog was by no means just a trophy to her owner, but a much-loved companion. Her Chow-Chows are her life. Nevertheless, she had a clear goal and outcome in mind, and managed to achieve it – literally the impossible, in my mind. Her determination and focus to achieve the impossible meant that she did.
The point I really want to make is that energy is a fact of life, albeit hard to quantify and understand. We accept its central role in shaping tables, chairs, and buildings, and can surely not deny, therefore, the role it plays in the physical and emotional states of animals and human beings. Energy keeps everything together, allows and facilitates communication within objects and between cells, and between our environments and all living things. It can be transferred from one living thing to another. We may not understand this, but it is true.
The ‘Whole-Dog’ Approach
Can we truly call ourselves holistic, or say that we have a ‘whole-dog’ approach, if we do not consider the spiritual, emotional and behavioral aspects of our patients? If we deal only with the physical component of the animal in front of us, are we not stepping into our Western medical prejudices, limiting ourselves by insisting that condition A requires solution B, leading to outcome C? We know very well that this approach often leads to breakdown or damage in another part of the system. Our thinking is flawed, we recognise it’s flaws, and yet we tend to trust this approach without question.
My view is that if we truly want the absolute best for our patients, we cannot afford to dismiss what we do not understand as hocus-pocus. I propose we start to open our minds and allow ourselves to question, not to blindly accept anything, whether an accepted practice or an alternative one – and not to blindly reject anything either.
If we based our practices only on what we understood, I for one would be living in a house without electricity. The narrow way of thinking would be to say, ‘How can I use a thing that I don’t understand; it could be dangerous and lead to the death of my child!’
Fortunately we all trust in processes we don’t understand a lot more than we pretend to.
I hope I have challenged your thinking today! Over the last few weeks, I have been truly challenged in the area of why I trust certain modalities and not others, and what factors cause me to accept or reject a practice that claims to heal.
I would love to hear your thoughts on this.