Today marks the one hundred and fiftieth anniversary of Dr. Andrew Taylor Still’s ‘discovery’ of osteopathy. “On the 22nd June [1874] I saw a small light in the horizon of truth,” he wrote of that memorable day. “It was put in my hand, as I understood it by the God of nature.” That small flash of illumination has grown into a worldwide profession. As we celebrate Dr. Still’s achievements, I cannot help wondering how he would feel about the current state of the profession he founded, and what he would expect of us as its current custodians. So I wrote an article, mainly from the perspective of osteopathy in the United Kingdom, but pertinent to every country.
THREAT OR OPPORTUNITY
Osteopathy’s sesquicentennial
“There is an alarm at the door of all osteopathic schools,” A. T. Still wrote to American Osteopathic Association president O. J. Snyder prior to the 1915 AOA Convention in Portland, Oregon. “The enemy has broken through the picket. Shall we permit the osteopathic profession to be enslaved to the medical trust? ¼ We must weed out the chocolate spines, drones and misfits, as their support only gets back to us in the way of a boomerang. Hold up the pure and unadulterated osteopathic flag. ¼ If we cannot have the pure osteopathic principles taught in our schools, I hope the faithful will rally around the flag and we will build an international school that will offer no compromise unless it is golden truth.”
Schools have since appeared internationally, but they continue to face similar threats towards medicalisation and loss of osteopathic fundamentals. In the UK, draconian regulations imposed by the UK government’s Office for Students have heaped financial pressures on the colleges, forcing some to merge with other health bodies in order to survive. The European School of Osteopathy has combined with the British College of Osteopathic Medicine to form the BCOM Group, with an undergraduate course to be taught solely at the latter, and postgraduate education at the former; the University College of Osteopathy (formerly the British School of Osteopathy) is soon to shelter under the umbrella of the Health Sciences University, along with chiropractic and other health professions.
The tendency appears to be global. A colleague across the Atlantic writes, “There is a current move afoot here in the US similar to what is happening in Europe to take out anything that does not adhere to the dominant medical science. These are the power brokers with the authority to regulate and finance only those who uphold their ideology.” Another colleague down under writes, “what they are planning in Australia is to combine chiro, osteo and physio, and make a single course that would be under the guidance of medicine – then we all end up working for the medical profession.” Harshly stated, perhaps, but reflecting a genuine worry.
In his article, “Grow to Thrive: Protecting the future of osteopathy” for the Summer 2023 issue of Osteopathy Today, Institute of Osteopathy chief executive Maurice Cheng asserted that there is a “99% chance” that soon the UK will “no longer have a single-profession regulator,” so can we assume that similar moves are afoot here too?
Cheng mentions significant problems facing the profession: poor student recruitment, osteopathy’s identity in the “marketplace” being “vague and lack[ing] differentiation,” and he suggests we need to attain greater “recognition, growth and access.” One omission is striking, though: the essential feature that gives osteopathy its unique identity, the “pure osteopathic principles” that Still was so jealously guarding, upon which osteopathy secured its initial meteoric rise.
On the eve of osteopathy’s one hundred and fiftieth anniversary, perhaps we should reflect on the profession’s origin: the loss of three of his children and an adopted girl during an 1864 epidemic of meningitis, despite him, his father and two elder brothers being physicians. This devastating tragedy spurred Still to embark on a lifetime quest to decipher the riddles of life and death, health and disease. Delving into the cutting-edge science of the day, he found inspiration in Rudolf Virchow’s Cellular Pathology, a book that also revolutionised medicine. Virchow defined disease as altered physiology and established that it began in the cell, but did not know why it began or what initiated the process.
It was Still that put the pieces together. Osteopathy, though not yet named as such, was initially a biological explanation for the origin of disease, beginning with the cell and its requirements for normal function: an unimpeded supply of nutrients and oxygen, removal of metabolic wastes, and freedom of the nerves that regulate this process. One further piece was needed to complete the puzzle: a profound insight, at 10 a.m. on 22 June 1874: “I saw a small light in the horizon of truth. It was put into my hand, as I understood it, by the God of nature. That light bore on its face the inscription: ‘This is My medical library, My surgery, and My obstetrics. This is My book with all the directions, doses, sizes, and quantities to be used in every case of sickness, and birth, the beginning of man; in childhood, youth and declining days.’”
Quaint, dated, with scriptural overtones, his writings might easily be dismissed as of little relevance to today’s more scientifically-minded profession, and Still as a man whose original ideas have been superseded.
Such notions derive from a historic lack of understanding of what the word “osteopathy” actually represents, a trend that began even during Still’s lifetime. As reflected in the titles of two of his books, he taught osteopathy as primarily a philosophy, and only secondarily as a system of manual medicine. Expressed another way, the osteopathic approach relies upon a philosophical understanding of how the body works, and, as a consequence, what to do when health gives way to disease.
Osteopathic philosophy is not scientific materialism. It is not the philosophy that underpins medicine. It is not a philosophy contrived by man, but the unwritten philosophy of nature itself. Still even asserted, “Osteopathy,” Still even emphasised, “is Nature.” Nature composed of what his favourite philosopher, Herbert Spencer, called the Knowable and the Unknowable. “In this one form you will find,” he paraphrased Spencer’s philosophy, “matter, motion and mind, blended by the wisdom of Deity.” To this day no scientific law can explain how body, mind and life associate together, or how every living cell throughout nature tends towards order and health.
The Knowable aspect of “matter” is represented by anatomy, physiology and biochemistry; the Unknowable aspect represents the unknown laws that govern the creation of the body’s form. The Knowable aspect of mind is rational thought; the Unknowable aspect is the wisdom of the body, with its uncanny ability to unite trillions of individual cells into one common expression. The Knowable aspect of motion is not only physical movement but also physiological and mental processes; the Unknowable aspect is life, the body’s mysterious animating power.
From this philosophy derive two complementary principles, one explainable, the other unexplained: cause and effect, and nature’s inexorable tendency towards health. “Find it, fix it, and leave it alone,” Still paraphrased. “Nature will do the rest.”
Still’s student John Deason, original head of the A. T. Still Research Institute in Chicago, elaborated,
To grasp the osteopathic concept of health and disease required first a complete ecdysis or molting of conventionalistic medical thought because the two are antithetical, conflicting, dissentient, incompatible. Years of osteopathic thinking, practice and clinical research by an investigative, untrammelled mind are necessary to begin to comprehend what osteopathy is.
When Still’s philosophy and principles are properly understood, it can be seen why “evidence-based medicine,” serving only the “matter” aspect of “matter, mind and motion,” is inadequate for osteopathy. What Still wanted us to learn might be termed “evidence-informed osteopathy.”
Medicine and osteopathy deal with the same anatomy, physiology, biochemistry, and related subjects, but because of their radically different philosophies, each has their own concept of cause and cure. Still’s student and early textbook author Carl McConnell wrote,
Probably the most interesting part of the scientific teachings of Dr. Still is that of etiology. Herein is revealed the divergence of the osteopathic school from other methods of the healing art. We are too prone to look upon the art of osteopathy, the technique, as the characteristic feature of this system. Of course, technique is only a means to an end. It must be based upon the viewpoint of disease causation.
Still never intended osteopathy as a mere therapy for musculoskeletal complaints, but as a complete system of drugless medicine, sufficient in itself, applicable across the whole disease spectrum. “Osteopathy,” he asserted, “can be applied to all conditions of diseases.” In his day he even applied it to, “all of the contagious diseases, such as mumps, chicken-pox, scarlet fever, measles, diphtheria, or whooping-cough; also flux [dysentery], constipation, diseases of the kidneys and of the spine. In short, every division of the whole body, with all its parts.” Not everything can be cured, but when one understands Still’s teachings there is nothing that osteopathy cannot treat.
The UK’s Advertising Standards Authority, however, allows mention of only a narrow range of conditions, and these are enforced by our regulator, despite forming only a sliver of what osteopaths treat daily.
Perhaps it does not matter. Still himself did not believe in advertising. He exhorted his students “to excel,” and taught that success in practice depends upon developing oneself as a sensitive instrument. “The body is the engine, nature the engineer, and you are the master mechanic,” was his dictum. An osteopath must know the form and function of the marvellous machine run by the unseen force of life, possess a keen sense of touch and, above all, acknowledge that nature heals, not man.
From their very first lecture, he oriented his students towards the wisdom of nature: “The first step in Osteopathy is a belief in our own bodies. ¼ You will learn that the body is self-creative, self-developing, self-sustaining, self-repairing, self-recuperating, self-propelling, self-adjusting, and does all these things on its own power. It will use only those things which belong in the realm of foods.” He told them that osteopathy is nature’s healing system, a “science of Truth, grafted into man’s make-up and his very life.” Their role was to correct the structure to free the nerves that control the circulation, and allow the blood to convey the body’s endogenous remedies to precisely where they are needed, without side-effects.
Because of its distinct philosophy osteopathy’s path has never been smooth, with constant pressure to conform to the dominant system. A dedicated nucleus has always kept the faith, but osteopathic teachings have been medicalised for so long that most graduates have been exposed only to a dilute, philosophically incorrect version. In the current climate the problem is likely to become more acute.
The Osteopathic Alliance, a UK organisation representing diverse providers of postgraduate education, recently circulated an open letter. “As we move into the 150th year anniversary of osteopathy and 30 years of regulation,” it reads, “we also move into a period of NHS [National Health service] reform. This NHS workforce solution involves the AHP [Allied Health Professions] educational landscape ¼ to support an NHS workforce supply pipeline.” What this implies may be deduced from the narrow description of of osteopathy provided by the NHS England website: “Osteopaths are experts in the musculoskeletal system. They detect, treat and prevent health problems by moving, stretching and massaging a person’s muscles and joints.”
The soon-to-be-formed Health Sciences University (currently the AECC University College), the umbrella organisation to shelter the University College of Osteopathy, will be a specialist AHP provider for the NHS. “UCO’s plans to adopt many of the AHP educational reform frameworks of musculoskeletal focused education,” the Osteopathic Alliance states, “delivered through multidisciplinary interactions and apprenticeships, and European School of Osteopathy’s plans for an AHP multidisciplinary clinic, align closely to NHS workforce supply specifications.”
Though this “may facilitate entry into NHS careers,” the Alliance worries that it may not adequately prepare osteopathic students for private practice, or to possess the requisite entry-level standards for postgraduate courses:
The OA has noticed a decline in standards in these areas for many years. Our experiences of UK and international graduates on our courses and within teaching clinics evidences that this decline already affects the ability of many graduates to grasp the foundations of osteopathic thinking expected for osteopathic practice and ongoing development. Our insights also emphasise the benefit of courses strengthened with more, not less osteopathic content, [and] the necessity of interaction with tutors and mentors experienced in osteopathic practice.
Alongside this, it transpires that the threat of osteopathy losing its single-profession regulator comes from the government, who want to bring all AHPs under one regulatory body.
Still always warned that the future of osteopathy depended on it remaining a wholly independent system. He added that its greatest threat comes not from external aggression, but from the actions of individuals within its own ranks. “You need not fear our enemies, who have contested every advancement we have undertaken,” he once told his trusted acolyte Arthur G. Hildreth. “They cannot harm us; their kicks are only blessings in disguise. Our great danger, in fact the only danger that could threaten the future of osteopathy, is the mistakes of those who profess to be our friends.”
Another early graduate, Edwin C. Pickler, spoke of responsibility: “You must be either an asset or a liability to your profession, and there is no middle ground.” Disease in one part affects the whole; health is found through harmony. Just as the cells of the body are interrelated and mutually dependent, so are the component parts of the osteopathic profession.
Still would seek to inspire the General Osteopathic Council, the Institute of Osteopathy, the osteopathic schools, and individual practitioners to “rally around the osteopathic flag,” cloak themselves with the raiment of his assertiveness and determination, and focus solely on what made osteopathy successful in the first place, without any advertising, by sheer force of results.
The future of osteopathy, perhaps its very existence, depends on one fundamental issue: osteopathy must be taught and regulated under its true philosophy and principles, otherwise the practice has no real justification, except a legal one, to call itself osteopathy.
“Keep it pure, boys. Keep it pure, boys,” Still admonished at the 1913 AOA Convention, the last one he attended. This did not mean concretising his teachings into dogma. He insisted that osteopathy was only in its infancy, and wanted all of us to add to its store of specialised knowledge, insisting that we are all capable of making new discoveries. “It is my hope and wish that every osteopath will go on and on in search for scientific facts as they relate to the human mechanism and health,” he exhorted, “and to an ever-extended unfolding of Nature’s truths and laws.” Dedicated osteopaths, for example those at the postgraduate Sutherland Cranial College of Osteopathy, are constantly researching and applying the latest scientific knowledge to understand the body’s workings better and inform new approaches to treatment.
Still also recognised the necessity to get involved in politics. He liked to quote St. Peter in Acts 10:34: “God is no respecter of persons.” We are all equal in the eyes of the Creator. But Western society operates in hierarchies of experts and laymen, authorities and subjects. Political decisions are made by those at the top, while those at the bottom often have no knowledge of what is being decided on their behalf. As in 1915, he would admonish us to “weed out the chocolate spines, drones and misfits” – those entrusted with the reins of the profession – whose political decisions could result in us becoming “enslaved to the medical trust.”
As we approach the science’s sesquicentennial, we should honour the memory of its founder, a man ahead of his time, a man who anticipated the science of immunity by a generation, a true scientist who might have won the 1905 Nobel Prize in Medicine or Physiology had the medical profession put his name forward. A man who spent a lifetime trying unsuccessfully to disprove the truth of the principles he discovered.
If you feel passionate about osteopathy, make your voice heard. Engage with your representative schools and organisations, engage in research, engage in discussions with colleagues. Make it your responsibility. As early graduate Hugh H. Gravett warned in 1948. “Teach it, preach it, and practise it, or you will not survive.”
The profession’s revered teachers – Sutherland, Becker, Fulford, Jealous, and others – remain those who followed in the founder’s footsteps. If like them we recognise the magnitude of the founder’s timeless teachings, and assert a collective will to pass them on uncorrupted, it will inspire a revival of true osteopathy. This will strengthen the profession globally, promote its unique identity and, by demonstrating its real scope of practice, benefit many patients who might be unaware that help is available. As an American colleague expressed it, “If we champion the tried and tested truth of Still’s osteopathy, people will beat a path to our clinics and schools.”
Is there any reason not to strive for that?
© John Lewis. May 2024.
www.atstill.com
