Thomas L. Northup Lecture AOA Convention, October 1999 33

Accepting the death of osteopathy: A new beginning by James S. Jealous, DO Cn m 0 My commentary on accepting the of our professional lives, watching the necessity for a safer, more effec- death of osteopathy, is a difficult topic osteopathy be defiled, degraded, for- tive, more wholistic profession 0 to follow, unless you have lived in the gotten and turned more and more into founded it. Osteopathy was a gift to daily practice of traditional osteopa- humanity. It was help. We have al- thy. Traditional osteopathy is a term OMM and the AAO lowed ourselves to fail in our respon- I use that means one is in a family sibilities to our fellow man. are, in fact, the only practice setting, treating all types and My argument is not against allo- ages of people with all types of dis- campfires still burning pathic methods, but for the richness eases, using the perceptual skills of upon the vigilant plains of osteopathy. Osteopathy is gone; it osteopathy. It means using one's of waiting; waiting for has died. Today many will point to hands as a primary therapeutic tool osteopathic manipulative medicine to find the health and therapeutic pro- a change that will free (OMM) as osteopathy. However use- cess in the patient. Traditional prac- osteopathy and allow it ful OMM is, it is not osteopathy! tice is living the precepts of osteopa- to resurrect itself and Osteopathic practice is for the treat- thy in oneself. It is the striving to learn serve humanity. ment of all diseases, not just somatic from nature the laws of healing. It is dysfunction of the neuromusculosk- the augmentation of an innate heal- eletal systems. OMM and the AAO ing power within the patient. It is an an allopathic clone. My goal today is are, in fact, the only campfires still act of devotion to a specific body of not to degrade but to state the facts burning upon the vigilant plains of knowledge that is clinically safe, ef- that we all know are true. I am not waiting; waiting for a change that will fective and guided by reason perched speaking out of anger but out of love free osteopathy and allow it to resur- upon the Mystery of the Divine. for the true spirit of osteopathy. I am rect itself and serve humanity. Our My relationship with osteopathy also speaking out of a desire to see it schools do not teach osteopathy as a has been the central axis of my pro- living again in its fullness. primary education. Many are fessional and spiritual life. It is a lim- Osteopathy has died, what remains ashamed of traditional principles. The itless and beautiful truth. This lecture is only an empty skeleton of the dy- few students who really want oste- focuses upon accepting the death of namic gift we were once given. The opathy (and who do not lie on their osteopathy as an individual. It is not essence of osteopathy is gone extin- applications) spend their free time try- about the action to be taken by com- guished. Today we are relating to a ing to find osteopathy, but it is gone. mittees, groups, or institutions; it is ghost, co-dependently and neuroti- The majority of students ridicule about oneself, one's relationship to cally fixated upon imitating allopathic these few for being osteopaths. Many osteopathy, and deepening one's per- medicine. Many believe this illusion faculty and professors trivialize their sonal insight and sense of direction. to be an evolution for the profession. interest in osteopathy. The school It is a topic I have lived and have It is not evolution it is cloning. It is administrations generally lack social found very healing. Accepting the completely irresponsible to the suf- integrity, because they do not under- death of osteopathy opens the way to fering individuals in this world to re- stand they are not giving the general a newfound inspiration, which re- duce their options for healing; oste- public the gift of osteopathy. The places an old pattern of grief. opathy is an alternative method of schools are teaching allopathic medi- We all have lived in despair most practicing medicine. A MD who saw -r Winter 1999 AAO Jouma1/19 cine. We do not need more allopathic patients coming into a family prac- relationship creates a sense of balance doctors; we need the alternative of tice setting in the 1990s have diseases in the physicians degree of self-im- osteopathy. We owe it to humanity to or symptoms that are the result of portance. Osteopathy by its very na- be osteopaths, but who remembers sympathetic overload? Perhaps 80 ture could mold the ego into a posi- how to do a full practice using osteo- percent or more of disease is directly tion of compassion; compassion being pathic principles? Are there any traceable to ANS imbalance. Where not empathy but the capacity to see the teachers who remember the whole are the insights and tools to treat this divine in one's patients. This principle sense of living osteopathy? If I say epidemic? Drugs do not cure cause. places osteopathic thinking and prac- osteopathy has died, perhaps I should We have failed in our responsibility tice in an unorthodox position. define the character of osteopathy as to humanity by letting this truth die. In order to be brief, I will explore I have learned it and perceived it in Today we worship only the ashes; the only one more principle of practice thirty years of practicing traditional living osteopathy is gone. and that is that osteopathy prevents osteopathy. disease. Understanding and helping First, osteopathy is an alternative Osteopathy is about the ANS to balance plays an impor- to orthodox medicine. This truth finding the "health" tant role in interrupting the momentum should be obvious, if is not, it died. of involutionary patterns of living. Un- Osteopathy is about finding the in the patient. This is derstanding diet, exercise, perception "health" in the patient. This is a di- a direct perceptual skill: and the ANS are incredibility power- rect perceptual skill; it is not just the it is not just the idea ful tools in preventive medicine. idea of making the person healthy. Realizing osteopathy has died of making the person Finding the health in the patient is the brings us as individuals to a point of learned art of directly perceiving healthy. Finding the health fact where we must reconcile this something other than disease in the in the patient is the learned loss. Dr. Elisabeth Kubler-Ross, an patient, a skill that therapeutically art of directly perceiving outstanding clinical researcher and engages laws of healing not recog- practitioner, has written extensively nized by orthodox medicine. The gift something other than on the subject of death and dying.' of this wisdom is all but forgotten. It disease in the patient, a Her research reveals that in order to was part of the lifeblood of osteopa- skill that therapeutically accept death one passes through sev- thy and part of a challenge to us to be engages laws of healing eral stages that finally lead to a com- a truly unique profession. Secondly, pletely new relationship with living. osteopathy awoke us to the role of the not recognized by orthodox As osteopathic physicians, who have autonomic nervous system (ANS) in medicine. realized that osteopathy is dead, we health and disease. This tremendous have several choices. More impor- insight was profound. As science has Thirdly, osteopathy when alive tantly, we need to find freedom from matured, it has noticed the relation- taught us to have a sense of the whole the constant frustration that we face ship of stress to disease. Today most patient, not by engaging the parts but when realizing the fact that osteopa- Americans are aware of the role of by a direct sense of the whole. The thy cannot return and serve human- stress in upsetting the balance of whole is the least division of life. Are ity unless there is a new beginning. A health. Osteopathy, however, was these just words, medical poetry, or new beginning requires insight. It re- way ahead of even today's common has something been lost? quires that we be free from our grief medical knowledge. It had the skill Osteopathy is a relationship be- and accept death. This is not a mor- to directly interpret and influence au- tween man, nature, and the Divine. bid thought. It is a direction that per- tonomic activity using perceptual and Osteopathy professed a relationship haps will open us to new possibili- palpatory skills. The level of aware- with nature and God that had mean- ties. Let us take a brief look at Dr. ness that can be developed in this re- ing. Osteopathy did not see nature as Ross' stages of acceptance and see gard is much greater than any scien- a child of science. It saw nature as a what we can begin to understand. tific instrument. The capacity to reflection of the great and loving wis- sense, interpret, and interface with dom of the creator. This truth was not The first stage is anger autonomic nervous system control a religious cult, it was a fact of com- One is angry at the facts. One is and influence cellular trophicity with mon sense. Man is not the creator of angry that one cannot control life. a clear awareness of specific changes life, nor is he as smart as he would One yells. One is irritable. One lives is lost, it is gone from our teachings like to believe. This perspective that on the edge of neuroses. We see this and the skill has died. How many man, nature, and God are in a direct 20/AAO Journal Winter 1999 in ourselves as osteopaths. We see this becomes aware that nothing is gained. death of osteopathy, for those who anger in our communities, our teach- This leads to the next stage in the jour- have truly faced the loss, who truly ers, our schools, and our students. As ney of accepting death. have found the living spirit of oste- we feel the loss of osteopathy, indi- opathy. This living spirit can speak vidual egos fly into over load, and the Stage of depression only to individual hearts and only to community yells out, "give us more In the stage of depression one is a mind that is peaceful. A mind that osteopathy"! The war rages between apathetic, withdrawn, and gives up is free from fear, free to listen, and knowing and loss. One is at war hoping. One has found no peace in free to follow the truths of traditional against the unresolved. The pain of compromise. Many DOs are apathetic osteopathy. These questions must be the facts remain hidden in the turmoil and have lost interest in supporting pondered very deeply and without of trying to escape the loss. the efforts of the AAO or other os- motive. One perhaps only needs to teopathic groups. They have seen the remember that osteopathy came to Stage of denial futility of efforts to resuscitate oste- help and to serve mankind. Let us One says to oneself or to others, opathy. They live in isolation from pray that it comes into a new life. "No, No, it is not true, osteopathy is their profession not because they do I would like to end my commen- alive, it is not dead, I will fight for it. not practice osteopathy, but because tary by reading you a story, an old I will change the profession. Osteopa- they are unable to support the illusion story, reported by the author Laurens thy cannot die, I will not let it, and it that osteopathy is alive. I do not agree Van der Post in a small pamphlet en- lives. I have seen it. . ." One senses with this form of relationship, but I titled, Patterns of Renewal. It was a the remaining life. One finds a part can sympathize with the integrity story told to him by his nanny as he of oneself not yet embraced by death. with which they meet this very seri- grew up in South Africa. I will give One has false hope for changing the ous and difficult question. Depression my own paraphrase of this meaning- fact but one lives with the reality of is the last stage. It is the bottom of ful tale. The story begins like this: death. Denial is a heavy load. One the abyss and it is in this emptiness Once in the days of the early race, begins to bend. feeling that one has nothing left. In there was a man who captured a su- "One cannot accept not having a our individual practices we have all perb herd of cattle. The cattle were cure". For a physician this is a diffi- seen terminally ill patients who magnificently stippled black and cult truth. struggle, agonize, and finally accept white and he loved them very much. the fact of death. But, we have also Every day he took the cattle out to Stage of bargaining seen something quite dramatic some- graze and brought them home in the evenings. He put them in his thorn I find this stage the most interest- thing quite beautiful that occurs when shelter each evening and milked them ing because the urge to survive over- the patient accepts the loss and ac- in the morning. One morning, he rides the essence of the individual. cepts the unknown. It is in this ac- found that they had already been Bargaining is a form of begging. One ceptance that one gains access to an milked. Their udders, which had been asks the school for more time; less is entirely new world; a world that is full sleek the night before, were wrinkled ultimately given. The disease is ac- of freedom, continuity, and the ex- and dry. He thought, "Well, this is celerating; the patient is losing pression of love. Our dying patients very extraordinary. I couldn't have ground, they beg. I will do anything, have taught us the greatest lesson of looked after them very well yester- I will change, I will act like a MD, living, resolution, and problem solv- day." Therefore, that day he took and I will compromise myself. Please ing. They have taught us that beyond them to better grazing. But again, the do not let this death happen. But it all the chaos, fear, denial, bargaining, next morning, he found that they had has happened. We worship the and apathy; there is another reality. It been milked. That night, bringing memory of another time, another day, is from this reality that osteopathy them back after a good feed, he sat when osteopathy lived through the was given to Dr. Still. It was a gift to up to watch. About midnight, he saw heroic efforts of individual DOs. Os- mankind. An alternative method of a cord come down from the stars. teopathy has expired. There is no one healing. We can not find it living in Down this cord, hand over hand, to blame; there is no cause to be de- the places where we look, but it's came young women from the stars. fined. Bargaining is only a symptom spirit is alive. Perhaps waiting for a He saw them with large buckets and of the unaccepted, unrealized aware- new opportunity to come into the baskets creeping into the shelter and ness that the unique gift of osteopa- world and help mankind. The answer milking his cattle. He took up his stick thy to humanity has been hopelessly to this question can only be encoun- and he ran for them. Immediately they lost. The bargaining continues but one tered by those who have accepted the —o

Winter 1999 AAO Journal/21 scattered and ran for the cord. The young women went up as fast as they could. However, he managed to catch AAOs Bookstore one of them by the leg and pull her back. She was the loveliest of them adds (3) Books all, so he married her. Their life would have been happy but for one thing. She had with her a tightly woven bas- Osteopathic Principles in Practice, ket with a lid that fit tightly into its Revised Second Edition neck. She said to him, "There is only by William A. Kuchera, DO, FAA() and Michael A. Kuchera, DO, FAAO one thing I ask of you and that is, you will never look into this basket with- "Learning to be an osteopathic physician is a cooperative venture between the student and out my permission." He promised. the faculty. There is no way that the faculty, through lecture and demonstration, can give the Every day she went out to cultivate student all the information that will be needed as a physician. The student must have or the fields as women did in those days develop a driving desire to learn, to know, to read about and to practice the basic osteopathic philosophy, principles, techniques, and procedures presented during the training years. and he went to look after the cattle This text is designed and presented with the expectation that each student will graduate as and to hunt. This went on for some a sensitive, well-trained physician who puts their osteopathic principles into practice months, but gradually the sight of this basket in the corner began to really providing the latest indicated text, pharmaceutical and surgical aids, recognizing the fact that even though illness today may be caused by stress, disease, and annoy him. One day, coming back for accident. clues to dysfunction in the body will be found in the neuromusculoskeletal a drink of water in the middle of the system: day, when his wife was away in the designing treatment to maximize structure function relationships and homeostatic fields, he saw the basket standing responses with the body unit." there and he said, "Well, really. this is too much. I am going to have a look Easy OMT' into the basket." He pulled up the lid An easy to use, step-by-step photo reference guide of the basket, looked inside, and be- gan to laugh. In the evening, his wife to manual medical care by William H. Howard. DO came back and with one look at him Retired Kirksville College of Osteopathic Medicine Professor William L. Kuchera. she knew what had happened. She DO, FAAO writes in the foreword: said. "You have looked in the basket "Easy OMT presents the basic HVLA, muscle energy, and indirect osteopathic manipu- didnt you." He said, "Yes, I have," lative techniques following the outline of the Kimberly Manual of Manipulation as taught and then added, "You silly, silly in the osteopathic medical colleges in the United States. woman. The basket is empty." She "The presentations are concise and clear. The professional photos orchestrated b y Dr. said, "you saw nothing in the basket?" Howard clearly illustrate the position of the patient, the position of the physician and intent He replied, "no, nothing." Thereupon of the technique.. . "It is my recommendation that this new edition be in the reference library of every looking very sad, she turned her back osteopathic medical student and physician." on him and vanished into the sunset. The old nurse telling the story then said to the child listening. "you know, Osteopathic Considerations in Systemic Dysfunction it did not matter so much his break- by M. L. Kuchera, DO, FAAO and W. A. Kuchera, DO, FAA() ing his promise not to look in the bas- This text encourages the reader to examine familiar medical facts, anatomic relation- ket. What was so awful was that look- ships and physiologic functions from the osteopathic perspective. This perspective can ing in the basket he saw nothing in then be carried into the diagnostic and therapeutic decisions which will repeatedly be it." required of the medical student and the osteopathic physician for the rest of their profes- sional lives. This text does not propose to replace the many reference texts of medicine and does not 1. Elisabeth Kubler-Ross. The Wheel of Life. include a complete differential diagnosis or a complete treatment plan for the clinical situ- pg 277; paragraph I ations that are discussed. Its purpose is to explore selected structural and functional con- 2. Laurens Van der Post. Patterns of siderations which may produce symptoms or compromise homeostasis. It also demonstrates, Renewal.Pendle Hill Pamphlet; Number by example, clinical application of the osteopathic philosophy in selected situations. Lastly. 121:pgs 4-51 it attempts to show where osteopathic manipulative treatments can be prescribed as pri- mar• or adjunctive modalities available to the physician as they assist patients in reaching their maximum health potential.

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