Osteopathy, where did it go horribly wrong, why and how? A systemic historical view.

Ricerca e scienza

Max Girardin, Founder and teacher at Evost & Morphologicum

When we try from all of Andrew Taylor Still’s books to re-establish the basic algorithm that lead him, according to his own words, to ‘the discovery of Osteopathy’; there is a clear hierarchy and chronology that emerges and outlines a real and logical basic algorithm of teaching-discovering Osteopathy:

  • Natural processes and mechanisms of all Forms and their complexity constantly expressed in Nature
  • Observation of these
  • Philosophy deducted the mechanisms out of this complexity
  • Concept (philosophy expressed and written)
  • Science (verification and further detailed elaboration of the concept: translating
  • the principles for each detailed level, system, region)
  • Application and practical adaption of the whole precedent processes resulting in
  • the development and description of specific tests and techniques.
  • What do we see today?

Osteopathic education has transformed into “the tail wagging the dog” syndrome, as this author likes to call it today. (Although this was a typical US expression in Still’s time)

  • Tests and techniques are instructed, usually after a brief reminder of the local anatomy; while this anatomy is usually merely reduced to its most basic mechanical essentials. The last part of the osteopathic algorithm, which should naturally come as logical conclusion at the end of the whole process is now positioned as principal: or as Borthoft suggested in his book ‘the Wholeness of Nature’ from 1999 “it’s a bit like trying to find milk by starting with cheese.”

If Nature is a whole, then logically so should be its mechanisms and processes. This is where this author sees the very first slip and loss of balance from the original osteopathic path.

This is of major importance, a basic algorithm has to be executed in the right order (chronology) or the end result will be different. Any intervention or change within the basic algorithm will carry unintended consequences and lead to a final result that is completely different.

Clarifying through the example of setting coffee

example: The basic algorithm to make coffee with a ‘George Cluny Nespresso’ goes a follows:

  1. pose the machine on a stable underground
  2. branch it to the electricity net
  3. fill the reservoir with water
  4. put the machine on, as the water can heat
  5. choose the kind of coffee pad you want
  6. open the lid and insert the pad in the right direction close the lid
  7. put a cup or recipient under the machine
  8. push the button ‘espresso’ or ‘lungo’ depending on the type of pad and cup you have placed.
  9. wait until the machine has stopped before taking your cup away
  10. enjoy your well made coffee

Any major swap in this chronology or exclusion of action in this algorithm’s chronology will lead to a different end result.

Even when osteopaths or others intellectually know an excerpt of Nature’s processes and mechanisms doesn’t mean that they KNOW them in a holistic way: meaning by this SEE – EXPERIENCE and RECOGNIZE them as such as these processes demonstrate themselves to us in all aspects of daily life.

This lack of holistic integration of intellectual knowledge is a major problem which is not easy to solution… This can be partly done or compensated within the professional context as with guided practical clinics, but then everything depends on the guiding practicians who have themselves suffered of the ‘tail wagging the dog’ syndrome as it is at least going viral with increasing speed since 1908… ( As we’ll demonstrate later)

Within the Evost Fellowship we have tried another way which is pricey but efficient, taking our postgraduate osteopaths into real Nature (Radical change of the familiar environment : The African Bush and Namibian deserts: Kalahari, Namib, Damaraland, Kuiseb delta and Kaokoveld- Kunene) and let them See-Experience and Recognize Nature’s processes and mechanisms at work, in a context where they are not so handicapped by professional tunnel vision or “the tail wagging the dog syndrome” as they find themselves in unfamiliar terrain and circumstances (Bush and Desert camping). Most who made this experience more readily converse this holistic experience into their professional and personal life.

A.T.Still forgot (?) or did not see how to integrate (?) this in his original schooling system, and the result of this first slip, in fact opened the door for all later missteps and deviating paths, further and further away from his original osteopathic algorithm.

It is interesting to notice again that the slightest error in any basic algorithm, becomes gigantic as the fractal or algorithm is reiterated and thus complexifies while increasing in size or mass…

A.T. Still was famous for not teaching treatments’ or ‘It is my object in this work to teach principles as I understand them, and not rules. I do not instruct the student to punch or pull a certain bone….’despite these or similar quotes which are legion in early osteopathic literature, the deviating path was ‘chosen’ or ‘taken’ by inadvertence?

System theory and complexity theory as well as memetics and fractal mathematics , all demonstrate that this ‘deviating path’ phenomenon is usually the result of minor changes in the basic algorithm but which lead to big consequences as the basic algorithm is re-iterated or reproduced. (Fractal iterations) As complexity of the whole profession increases by the shear increase of professionals’ thinking-writing- teaching- doing osteopathy and the decreasing number being osteopaths.

This phenomenon is the very probably the main -actual why-, but what about the how?

Returning to the basic osteopathic algorithm:

  1. Natural processes and mechanisms of all Forms and their complexity
  2. constantly expressed in Nature
  3. Observation of these
  4. Philosophy deducted the mechanisms out of this complexity
  5. Concept (philosophy expressed and written)
  6. Science (verification and further detailed elaboration of the concept:
  7. translating the principles for each detailed level, system, region)
  8. Application and practical adaption of the whole precedent processes
  9. resulting in the development and description of specific tests and techniques.

We can see that:

  • the first two steps decreased severely not to say that they were disqualified from the origin or at least very early in the history of osteopathic teaching…
  • The third and fourth steps which are the logical resultants of the two first, are now usually summarized in a few “ex-cathedra” teaching units, and probably because they got prematurely cut off from their origins or roots: are today reduced to some loosely and randomly chosen quotes like the mostly overstated and completely misunderstood “the rule of the artery is supreme”. ( Which is an incorrect and incomplete citation by the way)
  • This brings us, as observers, to the fifth point: the science.

As most of the published science on Life and Form is from medical origin, and being the most accessible, it was from the beginning used gratefully in the osteopathic teachings. Fact which was not a problem in those early days (1870’s) as anatomy was in its ‘hay days’. But this tradition was set forth without questioning or observing what was the evolution of anatomical publications… another inadvertence that was going to have big consequences for osteopathic schooling. As an anatomist and osteopath, this author did his homework…

In brief: since the medical curriculum grew exponentially in the last hundred years and that the educational time did not follow equally, the science and education time in which was cut with a chainsaw was … yes… anatomy.

The biggest problem however is that the chainsaw massacre was not only carried through in the anatomy teachings worldwide, but found its way also in most of the study books and atlases… Anatomy, so dear to the basic osteopathic study, is the only medical science that is decreasing majorly in the curriculum, in the detail and exactitude of its publications since the approximatively the 1920’s or First World War.

The other ‘medical’ sciences publications are not or very poorly adapted to the osteopathic philosophical teaching; which makes the being cut off of its basic algorithmic roots worse, at least on an educational level…

  • And so we arrive to that last part (6) of the original basic algorithm that has grown disproportionally and is totally over-rated and overstated in today’s osteopathic schooling, at least in this author’s opinion.

The second serious set of slips was in this author’s opinion that what brought most of the profession 180° astray from the original observations-philosophy and concept of osteopathy…

Actually one could state that today the commonly used algorithm is almost exactly opposite to its origin, from a philosophical and focus point of view.

A.T. Still « Philosophy of Osteopathy » 1899, page 28, chapter ‘The osteopath should find health’

‘To find health should be the object of the doctor. Anyone can find disease.

He should make the grand tour among the sentinels… ’

A.T. Still « Philosophy of osteopathy » 1899 Kirksville Missouri, preface pp1

‘When I saw others who had not more than skimmed the surface of the science (osteopathy), taking up the pen to write books on osteopathy… …found they were drinking from the fountains of old school drugs, dragging back the science to the very systems from which I divorced myself so many years ago, and realized that hungry students were ready to swallow such mental poison…’

Review of some random key words and how often they appear in the books of A.T.Still (1899, 1902, 1908, 1910) this under the motto : “Ce dont le cœur est plein, la bouche déborde…” Of what the heart is full the mouth overflows…on 1293 pages

  • Form: 907
  • Normal: 476
  • Principles: 432
  • Health: 416
  • System: 409
  • Lesion: 28
  • Adjustment: 13

A.T. Still « Philosophy of osteopathy » 1899 Kirksville Missouri, preface pp2

It is my object in this work to teach principles …and not rules. “

J.M. Littlejohn: 1908 publication “the principle of Osteopathy”:

Osteopathy represents a principle, not a set of principles…” and “the underlying principle, as applied to osteopathy, is expressed in the word ‘ADJUSTMENT’”

Edythe F. Ashmore: 1915 in her book Osteopathic Mechanics

“The central thought of the science of osteopathy is the Lesion, which has been defined as any structural perversion which produces or maintains functional disturbance.”

How did we come so far from our professions roots?

A.T.Still : A focus on a set of Nature’s principles, with health-normality or harmony of Form as goal in 1899, gets turned into one principle by J.M. Littlejohn: 1908 publication “the principle of Osteopathy” and the lesion and her adjustment by Edythe F. Ashmore, D.O. in her book Osteopathic Mechanics, 1915 .

Within two generations of osteopathic teachers and authors the basic algorithm of osteopathy was turned 180°.

Two generations meaning two iterations of the algorithm… today we are at what 10 to 12 iterations?

How can we make this wrong right again?

It is only in mathematics that multiplication of two negatives makes a positive again, in osteopathic schooling this rule clearly does not function…

So what can be done?

In this author’s opinion and as complexity science demonstrates: the solution lies in the history and complexification of the profession itself.

Our proposition is:

Each individual osteopath, each student, each teacher, each school or educational organization, and all the levels of professional organizations, should re-investigate for themselves with a critical mind set: the basic osteopathic algorithm, as well as Still’s original publications and the professions history…

and then ask themselves the question: how far am I into the trendy virtuality and thus away from: Natural processes and mechanisms of all Forms and their complexity constantly expressed in Nature…?

This could mean a possible beginning of an individual and professional reset or reboot of the whole system, or grass root movement and not a top down decision…

And think about the old doctor A.T. Still saying in 1894

“Osteopathy is found in nature;

Osteopathy is founded on nature;

Osteopathy is NATURE.”


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