full article 1700 words
There’s a certain kind of health care professional who likes to be known as a “healer.”1 In the worst case scenario, they actually use the title, like this: “Hi, my name is Joe, and I’ll be your healer today.” I know a massage therapist here in Vancouver who actually refers to herself as a “healer” on a regular basis. She seems to go out of her way to use the word, looking for excuses to mention that she’s a healer.
It’s arrogant and distasteful, obviously. It’s an absurd conceit, incompatible with competence and professionalism. Humility is an essential ingredient in health care: if you don’t have it, it’s almost impossible to do a good job. Anyone who uses the “healer” label probably isn’t actually healing anyone. Most chronic pain is extremely difficult to treat anyway: more on this below.
I’m appalled at the number of massage therapists—and others—who will introduce themselves as healers. I just want to gag, and I’ve felt that way since long before my Reformation. They honestly believe they are helping people. And when I was doing it, I honestly believed it, too.
Laura Allen, Excuse me, exactly how does that work? Hocus pocus in holistic healthcare, 2014
When therapists wear the healer identity on their sleeve, it makes them easy to avoid! Unfortunately, not all of them do. Acute healer syndrome is just the tip of an iceberg of less obvious ego problems among freelance therapists. For every therapist who actually uses the word “healer,” there are a dozen who have the attitude without being foolish enough to put it right on their business card.
All self-employed health care professionals — “freelancers” — must make a good impression on patients in order to make a living. I speak from experience.2 That need for self-promotion can be corrosive and corrupting. It often clashes with what patients need.3 Living with this conflict of interest for many years can lead to some mental gymnastics and major motivated reasoning. [Wikipedia]
It is difficult to get a man to understand something when his job depends on not understanding it.
The ego kicks in: we start believing that we can treat practically anyone, that every patient does need us, that we do offer a unique and therapeutically potent service. Selling our services turns many of us into “true believers” in our own methods and pet theories, incapable of recognizing problems with them.
In other words, we start thinking of ourselves as “healers,” even if that word never crosses our minds. Self-serving behaviours can be justified by self-confidence: it’s all good when you really can help almost everyone … right? This is the most dangerous form of healer syndrome — a subtle and insiduous attitude problem.
The human mind is hopelessly vulnerable to profit-motivated bias (among others), and most self-employed professionals will start to err in favour of their egos eventually. The best and only medicine for it is an education in critical thinking4 and constant vigilance and self-reflection. We must overcompensate in the opposite direction even if it means turning people away. We must cultivate a self-sacrificial pride in doing so.
Ironically and delightfully that turns out to be good for business.5
Trying to turn patients away actually attracts them. Patients love humility. They respect candid self-deprecation. They place a high value on health care professionals who undersell themselves. It’s a major selling point. It may not sell as well as claims of miraculous healing powers, but it does sell.
And there is so much cause to be humble…
Never mind healers: even just the idea of a “good therapist” is largely a myth, as measured in terms of the ability to produce results for people people with chronic pain. I’ve been studying therapies for a wide variety of pain problems for a long time now, and I have seen a lot of well-intentioned but egotistical practitioners claiming to be (a lot) better than the competition. But I have yet to see any evidence that any professional or treatment is actually capable of producing dramatically better results than any other. Indeed, there’s good evidence of the opposite.678
Chronic pain is often stubborn by nature, not simply for lack of a fix.9 There’s an entire category of serious pain that’s common, but so poorly understood it doesn’t even have a name.10 There simply are no known treatments for most of these people. They carry right on suffering from pain chronically, no matter who they pay for help. (Nowhere is that story of disappointment told more charmingly than in Paula Kamen’s dazzling book, All in My Head: An epic quest to cure an unrelenting, totally unreasonable, and only slightly enlightening headache.)
And they will pay almost anyone who promises to help.
I have a low opinion of the ethics of health care “professionals” who give false hope to chronic pain patients. Nothing is easier to sell to people in pain than hope — they are one of the most motivated groups of potential customers imaginable. Half mad from their symptoms, their minds are pried too far open to bad ideas by agony. They will grasp at any straw, consider anything, and pay for anything, if there is the slimmest possibility of relief.Nothing is easier to sell to people in pain than hope — they are one of the most motivated groups of potential customers imaginable.
Exploiting people in that mental state is morally equivalent to the work of faith healers. It’s low. It’s cruel. Good intentions and the occasional placebo effect11 cannot give it honour. Even if no direct harm is done.
Many honest health care professionals will tell you the ugly truth that a lot of pain has no solution, but “healers” will never tell you that. A century of genuine scientific miracles, one after another for decades, has given us all a collective case of medical overconfidence, and it seems as though there “must” be a treatment out there, somewhere, for every problem. But the only miraculous thing about most quack cures for pain is the astonishing size of the egos behind them. So much for “humility” in alternative medicine.
Over the years, I have been told by a few manual therapists that it would “put them out of business” if they were honest about their limitations. That’s a strange combination! Admitting in one breath that you have limitations, but concluding in the next that you dare not admit it — how tragic and untrue! Patients deeply appreciate candid honesty, even self-deprecation. A therapist’s practice can easily be built on overt humility.
Pain is tough to treat, period. In your search for relief, stick to professionals who are candid about that: they are the ones who are actually more likely to find a way to take the edge off a little, and not take your money for bogus treatments. That’s mostly what makes a “good therapist.”
And what makes a “healer”? Nothing at all.
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.
— Sigificant revision: many nice little adjustments and polishing, especially several important citations and useful links. Added related reading section. Added a new featured image.
— Editing, modernization, added some footnotes.
— Added section “Chronic pain may not have a solution.”
This is a meticulous, sensible, and readable analysis of the very best studies of back pain treatments that have ever been done: the greatest hits of back pain science. There is a great deal of back pain science to review, but authors Machado, Kamper, Herbert, Maher and McCauley found that shockingly little of it was worth their while: just 34 acceptable studies out of a 1031 candidates, and even among those “trial quality was highly variable.” Their conclusions are derived from only the best sort of scientific experiments: not just the gold-standard of randomized and placebo-controlled tests, but carefully choosing only the “right” kind of placebos (several kinds of placebos were grounds for disqualification, because of their known potential to skew the results). They do a good job of explaining exactly how and why they picked the studies they did, and pre-emptively defending it from a couple common concerns. The results were sad and predictable, robust evidence of absence: “The average effects of treatments … are not much greater those of placebos.”BACK TO TEXT
Although the authors of this review conclude from 18 “high quality” trials that manual therapies “contribute usefully,” none of them was actually any better than any other therapy, either alone or in combination — never a good sign — and the evidence is “limited” for practically everything (most treatments, all long-term effects, and chronic neck pain). The one bright point here was the short-term effects of upper thoracic mobilization, where the positive evidence was judged “moderate.”BACK TO TEXT
A fascinating letter (plus replies) to the editor of Physical Therapy, regarding the October 2001 issue, which published the “shocking” results of the Philadelphia Panel, showing that “so few of the modalities that we have come to believe in actually show evidence of efficacy in controlled trials.” See “Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology”.BACK TO TEXT