The manual therapies, which in the present context means mainly osteopathy and chiropractic, developed from the work of 'bonesetters' in 19th-century America. Long frowned on by established medicine as forms of quackery, they have in recent years become increasingly respectable as a result of the growing popularity of alternative or complementary medicine. This change in turn has led many practioners of these therapies to emphasize their basis in physiology; they are represented as essentially physiological procedures and their effects on patients' psyches, if not exactly downplayed, are regarded as secondary to the physical manipulations.
Bevis Nathan, who is himself an osteopath, seeks to redress the balance by showing that physical manipulation has very profound psychological effects on patients. Conversely, psychological treatments can have a reciprocal effect on the body; the two approaches, he suggests, have a final common path and are complementary to each other. He realizes that this is a view that many manual therapists will not feel enthusiastic about, which is doubtless true, for they fear that it can all too easily be used by critics to claim that manipulation has no 'real' effects on the body; it is 'all in the mind'.
Central to Nathan's argument is the importance of touch, and he devotes a lot of space to this. Manual treatments, by definition, involve the therapist touching the patient, but this occurs in a very special context, which has many unspoken implications for both parties concerned. For example, the therapist has to distance himself or herself emotionally from what, in other circumstances, would be an aggressively or sexually charged situation; the same is true of the patient, who often tends to regard what is happening as analogous to taking a piece of equipment in for repair. But, of course, it is a person who is being treated, not a machine which is being repaired. It is an egregious mistake to regard the mind and the body as separate categories, to be approached from different standpoints.
The key to understanding the therapeutic relationship, according to Nathan, is touch. His contention is that the perception of touch "triggers characteristic and unique psychological memories, feelings and other mental phenomena in each person, due to each's peculiar history." Indeed, the book could be seen as an extended meditation on the nature of touch. This idea is developed at length, with numerous references to other writers who have written on similar lines. One of the ideas referred to, not surprisingly in view of its relevance to his argument, is the contentious theory of 'body armouring' advanced by Freud's notably eccentric follower Wilhelm Reich. But Nathan is not afraid to introduce what might appear dubious notions of this sort into what is essentially a scholarly work, for there is also mention of 'subtle energy theory'. Expressions like these would be likely to put off many readers with a scientific background, which is a pity because I think Nathan is actually saying something important.
Anyone who has worked with any sort of manual therapy will recognize the reality of the phenomena he describes. And his remarks on the role of touch in psychotherapy are also worth attention. Many patients who come for psychotherapy suffer physical symptoms such as pain. Touch is generally regarded as taboo for psychotherapists, and for good reasons; it could easily be misunderstood or lead to embarrassing or potentially disastrous consequences. Yet, by excluding touch from their approach to patients, psychotherapists are tending to foster or perpetuate the patient's belief that body and mind are separate entities that need to be treated in different ways. Some schools of psychotherapy have recognized this and are seeking for ways to incorporate touch into their treatment.
The argument advanced in this book is persuasive, to me at least, but it suffers from the weakness that it is largely based on subjective impressions. Much of the evidence that Nathan quotes in support of his views comes from clinical experience (his and other people's) in the consulting room. In the nature of things, scientific validation will be difficult or perhaps impossible to obtain. This is not to dismiss Nathan's argument as worthless but to point out that it will not carry much conviction for readers who demand independent objective evidence before they accept ideas. This may not matter too much, given that Nathan is writing mainly for fellow manual therapists, who are presumably already satisfied with clinical evidence of the kind he quotes. But here I find a different problem with the book.
I've already said that I think the book is important, and so I do; it deserves to be widely read by people using manual therapies. Unfortunately, I'm not sure that it will be, because it's not easy to read. Nathan's style is scholarly and intellectual;indeed, he writes at times almost like a professor of philosophy. I get the impression that he knows he is dealing with a subject that is capable of eliciting strong emotions from his readers and wants to forestall rejection of his views by supporting them with careful arguments and ample reference to the literature, for he has read very widely around his subject. He is, in other words, an intellectual. Therapists of all persuasions, orthodox and unorthodox, tend generally to be practical people rather than intellectuals, and I am not sure how many will be willing to undertake the fairly demanding reading that Nathan seems to expect. But I hope I'm wrong.
And, in spite of my sympathy with Nathan's main thesis, I have to say that I part company with him pretty radically when it comes to his endorsement of "energetics, field theory, subtle-body theory, spirituality and even theosophy" as ideas that deserve to be researched and taken seriously. He thinks that these speculations offer "the only possibility for a comprehensive understanding of human life—one that explicitly allows for the wealth of history of human experience". I can't follow him in this. It seems to me that to allow oneself to be involved in these murky areas is to risk submerging beyond hope of rescue in a sea of confusion. I prefer to think that we will ultimately be able to offer an explanation of the psychological and emotional effects of the manual therapies in neurophysiological terms, though this will entail a considerably better understanding of the way placebos work than we have at present.