Topic: Medical Care
Taking Patients Down A Very Dark Garden Path- Part 2
Fibromyalgia, Chronic Fatigue Syndrome and Repressed and 'Recovered' Memories- Part 2
Dottie's MFR Journey in Sedona: Repressed Memories of Sexual Molestation
A woman named Dottie who attended a two-week Myofascial Release retreat at John Barnes' center in Sedona, Arizona in 2005, wrote a blog chronicling her experiences (some entries include disturbing and graphic detail) of her MFR therapy and her newly 'discovered' repressed memories of childhood sexual molestation at the hands of strangers, which she believes took place as a result of her MFR therapy treatments.
Dottie's “My MFR Journey” blog: http://mfrjourney.blogspot.com/
Physical Therapists Weigh In on the Controversy
Excerpts from “Not in Kansas Anymore”, by Barrett L. Dorko, P.T.:
I have been a member of the physical therapy profession for nearly thirty years. During that time I’ve watched the nature of healthcare change in a number of ways. Of greatest interest to me is the movement from a modernist to a postmodernist view of physical reality (see What Went Wrong: Postmodern Thought and Physical Therapy Practice at http://barrettdorko.com). Many feel that this has resulted in a movement toward the acceptance of supposedly therapeutic practices that are not supported by any rational theory. Predictably, their proponents advocate a reliance on “intuition,” “positive energy,” “ancient knowledge,” and other similar entreaties to faith and belief. The technique proposed is typically claimed to require many years (and many expensive continuing education courses) to perfect and the deep model of its theoretical construct (when one is offered) is compiled from obscure, esoteric and questionable “research” well out of the medical mainstream. Not surprisingly, the nontraditional nature of the technique and theory are proposed to be a positive aspect of the therapy, considering the “corrupt, close-minded, and prejudicial” nature of modernist science.
Given that physical therapists are college graduates, and assuming that physical therapy programs do, at least to some extent, teach the principles of modern scientific inquiry (heck, high schools do this), you wouldn’t expect the profession to easily accept any sort of care that contained all the attributes listed above. You would expect resistance from the academic community, written commentaries from the profession’s theorists and clinicians regarding the dangerous nature of using any modality of care that could not possibly do what it proposed to do, and, eventually, a dissipation of the modality’s popularity over time. This has been a recurrent cycle of response, witnessed during my career at least, and I never anticipated that anything else would happen when techniques without reasonable theory appeared. I was wrong....
I was wrong about a certain form of irrational therapy because I had not taken into account three things; the neediness of many in the profession, the influence of postmodern thought in our culture, and the power of charisma. All of these have combined to perpetuate a method and theory of management that makes no real scientific sense and is, arguably, quite dangerous.
Physical therapy can be a frustrating and difficult way to make a living, especially when the therapist is asked to solve problems that are poorly understood and notorious for their persistently painful nature. Complaints of pain for which there is no clear-cut pathologic origin form a large percentage of the nominal diagnoses seen by thousands of therapists each day. If the therapist finds him or herself in a situation that affords them little opportunity to customize programs of care, or (as is increasingly common) they are not given any time to actually touch patients in any meaningful way, this frustration may certainly grow. Some would characterize this as a situation in which the therapeutic instincts of the practitioner have been rendered irrelevant. I think it’s fair to describe these instincts as those attributes of observational, manual and diagnostic skill that are acquired as the end result of study, experience and time. “Therapeutic intuition” in this context is the final result of understanding the effect of processes that cannot be seen but have their effect nonetheless. It is not some sort of magically derived guess based entirely upon our “feeling.” Its accuracy grows over time as long as we study...
.....I’m sure there are more than a few of my regular readers know exactly what I’m referring to when I speak of a modality of care without a rational theoretical basis; John Barnes Myofascial Release (MFR).
Why do feel I this way? Well, consider this quote from his book: "The medical, dental, and therapy professions have been based on Newtonian physics, which is 300 years old and was proved to be totally inadequate over 50 years ago by Einstein, physicist Niels Bohr, and Max Planck, the father of quantum physics. Yet the very foundation of our scientific training is based on this inadequate information. When the model is created on an inaccurate assumption, many other assumptions will also be incorrect, leading us to misunderstand how our bodies function in vivo. Too many health professionals have become captivated by the obvious, the symptom, paying no attention to the possible cause, fascial restrictions. How could we have missed something so fundamental?"
Newtonian physics inadequate? In a word, this statement is absurd. Newtonian physics works in the macroscopic world we occupy and experience with a precision and predictability that is literally beyond the comprehension of any but those well trained in the discipline. Barnes proposes that what he refers to as “quantum mechanics” (I put it in quotations because it is not evident to me that he understands what the term actually means) allows us to exist in a way that permits astounding changes to occur in anatomy, psychology and physiology instantaneously, even if the impetus to do so is merely the thought of another a vast distance away. In short, Barnes says the research demonstrating that connective tissue changes in accordance with the laws of Newtonian physics can be ignored. I guess he says this in order to explain the changes seen with gentle pressure while maintaining that the fascia is the organ primarily involved in illness and change. He’s stuck with a piece of anatomy that can’t account for the symptoms he hears and doesn’t explain the changes that occur with care, so he evokes the generally unknown and misunderstood world of quantum mechanics. His students seem to go along quite willingly. What’s amazing to me is not just that Barnes says this (and it is well documented), but that I’ve not read much in opposition to it. I’ve personally written a few things about such thinking (see The Quantum Scam and No More Mister Nice Guy Part II at http://barrettdorko.com). Although these essays have been widely distributed on the Internet, I’ve never heard one word of defense from Barnes or his people. There are so many, I can’t believe several haven’t read this. Why is there no response? Is it because they can’t think of one?
Barnes has a theory of fascial distortion, adherence and permanent elongation that not only confuses me; it strikes me as completely implausible. If it were true, our connective tissue structure would be so easily deformed by the slightest prolonged pressure that it would acquire the shape of just about anything it leaned upon. I, for instance, would be shaped mainly like my recliner. I’m not.
I see that over the years the MFR community has begun to rely less and less on this theory of fascial change and use instead the wild assertions of “energy medicine” to explain any and all phenomena surrounding the application of their technique. This makes even less sense. I’ve criticized this theory and practice repetitively for years, and I’ve never heard any sort of defense beyond anecdotal evidence and testimonials of experiential learning. To me, this is pathetic.
Finally, and perhaps most importantly, there is this quote from Barnes first book: "Recent evidence and my experience have demonstrated that embedded in our structure, particularly the fascial system, lie memories of past events or trauma. These stored emotions can produce lessons in literal or symbolic form from which the patient can discover blocks that may have been hindering his or her improvement. ...It appears that not only the myofascial element, but also every cell of the body has a consciousness that stores memories and emotions...It has been demonstrated over and over that when a fascial barrier is engaged or when the person reaches a significant position during myofascial unwinding, the tissue releases and a memory or emotion surfaces. This electrophysical event produces a positive change and improvement in the patient. Myofascial release and myofascial unwinding are not linear but result in a whole-body effect, capable of producing a wide variety of physical, emotional, and mental changes…I have discovered that when we quiet our minds and bodies, our proprioceptive senses act like a mirror image, detecting the subtle motions occurring in patients' bodies. This activity allows us to discover fascial restrictions, feel when they release, and feel the motion that will take the patients' bodies into the three-dimensional position necessary for structural release or for bringing disassociated memories to a conscious level…The link between mind-body awareness and healing is the concept of state-dependent memory, learning and behavior (also called deja vu)...I would like to expand this theory to include position-dependent memory, learning, and behavior, with the structural position being the missing component in the state-dependent theory. Studies have shown that during periods of trauma people make indelible imprints of experiences that have high levels of emotional content. The body can hold information below the conscious level, as a protective mechanism, so that memories tend to become dissociated or amnesic. This is called memory dissociation, or reversible amnesia. The memories are state or position dependent and can therefore be retrieved when the person is in a particular state or position. This information is not available in the normal conscious state, and the body's protective mechanisms keep us away from the positions that our mind-body awareness construes as painful or traumatic. It has been demonstrated consistently that when a myofascial release technique takes the tissue to a significant position, or when myofascial unwinding allows a body part to assume a significant position three-dimensionally in space, the tissue not only changes and improves, but also memories, associated emotional states and belief systems arise to the conscious level...This release of the tissue, emotions, and hidden information creates an environment for change that is both consistent and effective."
But there is a larger and even more troubling issue here. For the past 15 years the phenonmenon known as False Memory Syndrome has been carefully documented and studied. Without question, this circumstance of a specific form of psychotherapy has proven to be both tragic and dangerous for all involved. For anyone interested in the consequences of requesting or fully expecting the patient to suddenly "remember" or "recover" past experiences of trauma or abuse, I'd recommend the website of Elizabeth Loftus <http://faculty.washington.edu/eloftus/> the most highly regarded authority on the nature of memory. Whatever anyone may say about this controversial situation, the fact remains that many therapists have been successfully prosecuted for doing precisely what Barnes suggests be done. I mean they've lost their licenses to practice and now owe their patients a great deal of money. This fact is not in dispute. ...
It is the “unwinding” taught by Barnes that most directly addresses the issue of (supposedly) repressed memory. Through their MFR Chat Line <http://vll.com/lists.html> his students encourage others rather new to the process not to be discouraged when this seems to only make people worse. For example, one recently wrote about his patient’s response and asked for help: “…when they went home some of them had some emotional release and some could not sleep for a few days. Some complained about increase in their pain level. I had warned them about some changes they might feel emotionally and physically. Now they are apprehensive about unwinding treatment and are scared about the releases they might have and they say that they do not want to f eel upset. I do not know if I am doing anything wrong or not. I also feel guilty thinking that I am hurting them since their pain level has increased. Most of my patients are under a lot of emotional stress. Should I insist on continuation of unwinding treatment every time they come for therapy? Please help me.”
The next day this request was answered: “The unwinding process only brings out what is already present inside themselves. In my experience, PWF (people with fibromyalgia) are full of repressed/suppressed emotional issues. Most PWF will heal only when they start dealing with their issues. Should you insist that they participate in unwinding? No. Not everyone is ready to deal with their demons now. I would lovingly plead with them to hang on a little longer and see what possibilities unfold. By the time PWF are officially given their label, they have suffered for years without much hope or relief. Another avenue is to ask them to seek professional psychological help. The important point here is get someone who is open for change, not someone who will help them live more comfortably with their condition. The therapist's job is to introduce Chaos, purposely and with great compassion. People in chronic pain are stuck-physically, emotionally, mentally, and spiritually.”
I emphasized the part about introducing “chaos,” which, I gather, is the term Barnes uses to explain any worsening of the patient’s physical or emotional life after a session of MFR. And I should point out that a massage therapist offered this advice, though I’ve seen no objection from any of the physical therapists on the listserv. In fact, over the course of several months, I’ve never seen anybody object to anything posted to the list. This includes descriptions of astral projection, teleportation and clairvoyance.
Let me quote the editor of the APTA Journal, Jules Rothstein, in a recent discussion about what constitutes evidence in evidence-based practice: "...at best, we have an argument that a treatment makes sense, that is, a case for `biological plausibility.' This is not evidence of effectiveness, and it proves nothing other than the treatment is derived from an idea." (Physical Therapy Vol. 80 No. 1 Jan. 2000) He goes on to say that others might not find the idea "reasonable.”
There is virtually nothing reasonable or biologically plausible about the theory of Barnes MFR. Not only that, its practice appears to be potentially dangerous for patient and therapist alike...
Notes
The “MFR Chat” listserv exemplifies what is taught and believed by those who have attended Barnes’ courses. I read one recently that displays an attitude common to those who’ve been asking others to behave during “unwinding” in the fashion suggested:
When we do this MFR work, whoever touches us and whomever we touch has the capability to KNOW everything there is to know about us, the rawest stuff.
There are no longer secrets. I think that might be one reason there is such a growing bond among us. It's all laid out there bared to the barest.
In Recovered Memories of Child Sexual Abuse: Psychological, Social and Legal Perspectives on a Contemporary Mental Health Controversy (Charles C. Thomas 1998) Anita Lipton documents the legal ramifications of the “repressed memory” movement. Those who claim to have been falsely accused of illegal conduct because a therapist encouraged their client to “remember” trauma they may have repressed have brought over 150 lawsuits against the therapist involved. In a number of these suits, large monetary awards have been given the plaintiffs and the therapists have lost their licenses to practice. Specific information about these cases and others can also be found on <http://www.memoryandreality.org/>.
However anyone might feel about the controversy surrounding repressed memories of trauma, it is a fact that qualified psychotherapists have gotten into trouble (to say the least) when delving into this. Statistical analysis in the aforementioned book indicates that the use of this type of “therapy” has all but disappeared in that community for obvious reasons. Teaching totally unqualified (in terms of psychological training) physical or massage therapists that the revelation of “repressed” memories is common, therapeutic, necessary for “healing” or progression in therapy is a terrible idea. Not telling them what is known about the consequences of this type of dialogue with patients is unforgivable.
http://www.barrettdorko.com/articles/not_in_kansas_anymore.htm
Debating FMR and repressed memories
A group of physical therapists debate the controversy surrounding Barnes' methods and the concept of repressed memories resurfacing during FMR treatments at the SomaSimple forum, which is a discussion board dedicated to the professional physical therapist community.
Critical Thinking Myofascial Release; The Great Conversation:
http://www.somasimple.com/forums/showthread.php?t=1841
Fibromyalgia Physician-Authored Self-Help Books Which Support the Physical Therapy- Repressed/Suppressed Memories and Emotions Connection
Many patients have also found a technique called myofascial release to be effective. If you decide to see a physical therapist, make sure that you pick someone who is both knowledgeable and gentle....I have seen too many patients made worse by physical therapists who were too rough. With fibromyalgia, gentleness is often much more effective than roughness.
Acupuncture is another type of treatment that can be helpful. Because it approaches health and illness from a different perspective that traditional medicine does, it can often be effective for illnesses that resist traditional measures....
Chiropractic also can be helpful in releasing the muscles. Unfortunately, however, if you don't treat the perpetuating factors that causes the muscles to shorten in the first place, they'll go right back to being shortened a few days after the treatment. That's why so many excellent chiropractors add nutritional, hormonal, antifungal, and other natural treatments to their practices...
Additionally, yoga and many other forms of body and energy work have been very helpful for our patients. Try several and see which feels best to you. Many patients find that bodywork also releases suppressed feelings and memories from their muscles. Experience, feel, and embrace these. Your awareness, experience, and release of these feelings are important parts of the healing process. (pp. 208-209, "From Fatigued to Fantastic!", by Jacob Teitelbaum M.D.)
Myofascial Release
John Barnes has developed ways to release tightened and restricted myofacsia and return ground substance to its fluid consistency. I have been fortunate enough to visit both his Sedona, Arizona and Paoli, Pennsylvania centers. Both visits were times of learning and recovery....
You may experience a strong emotional release along with a myofascial release. Your body can hold information below the conscious level, as a protective mechanism. Myofascial unwinding allows your memories, associated emotional states, and belief systems to rise to consciousness as your myofascia returns to health. Your body tries to protect you against the pain, keeping you away from positions that are painful or traumatic. Each layer must be released, starting with the most superficial restrictions in the myofascia. (pp. 235-236, “Fibromyalgia & Chronic Myofascial Pain: A Survival Manual; Second Edition”, by Devin Starlanyl, Mary Ellen Copeland)
A Fibromyalgia Physician/Author Who Does Not Support the Repressed/Suppressed Memories and Emotions Connection
From the “AskDrLowe” webpage, of Dr. John C. Lowe, a physician who specializes in treating fibromyalgia and is the author of “The Metabolic Treatment of Fibromyalgia”:
December 22, 2002
Question: My family doctor has treated me no success for fibromyalgia with amitriptyline and some other drugs. Since my fibromyalgia hasn’t gotten better, and I also have chronic headaches, he referred me to a neurologist. The neurologist spent about fifteen minutes examining and talking with me. He told me that fibromyalgia is caused by emotional conflicts patients have pushed out of memory. He said he was going to refer me to a psychiatrist. I got angry and left. Aside from my fibromyalgia and headaches, I’m as mentally well adjusted as anybody else I know. Now my family doctor is upset with me for being rude to his neurologist friend. I told him I read in your book how unscientific that kind of psycho babble is, and if he doesn’t want to treat me anymore, I’ll find a new family doctor. I’m not a doctor, but I have better sense than to listen to doctors who think that way. Why do doctors like the neurologist keep telling patients that kind of crap?
Lowe: The concept that repressed, unresolved emotional conflicts cause disease is Freud’s reformulation of a Middle Age belief—that demons cause disease. "Hysteria" is the name he gave the imaginary psychopathological process. He wrote that in formulating the concept, he substituted his id, ego, and superego for the hypothetical disease-causing demons of the dark ages.
The concept is a mixture of metaphysics and pseudoscience and has no scientific credibility. In the US, it’s mainly some neurologists, psychiatrists, and personal-injury chiropractic physicians who perpetuate the concept. As I explained in The Metabolic Treatment of Fibromyalgia, these doctors subscribe to the concept for one or more of three reasons. First, they lack the education to understand the concept within a historical context. Second, they’re so bereft of knowledge of logic and science that they can’t see the bankruptcy of the concept. And third, insurance companies or law firms pay them well for using the concept in court to block litigating patients from getting compensation for their injuries.
Apparently, many doctors in Scandinavian countries, Austria, and Germany also subscribe to the concept. They claim that repressed emotional conflicts cause fibromyalgia. These doctors and their American counterparts don’t use the older Freudian terms "hysteria" and "hysterical conversion." Instead, they use synonyms such as "somatization" and "somatoform disorder." I suppose these modern terms allow the doctors to slink away from recognition that they subscribe to Freud’s concept of hysteria and, by extension, to medieval demons. But the modern terms confer no legitimacy on the concept; it is and will always will be dark-age-derived, Freudian-drivel.
In my view, for doctors to use the concept is intellectually self-debasing, for the effects on patients are altogether bad. But alas, some doctors will continue to use the concept as a basis for diagnoses! When a doctor gives a patient of diagnosis of somatization or somatoform disorder, I believe she should protect herself by emulating your courage. She should regard his conduct as witch-doctoring, resolutely reject the diagnosis as unscientific, and, if he won’t straighten up, fire him and find a doctor with a mind undemonized by medieval and Freudian concepts.
February 16, 2002
Question: I read this statement on another website: "In Dr. Northrup's view, fibromyalgia has an emotional element such that negative feelings of despair and resentment, from job stress, family problems, or even childhood memories, get ‘trapped’ in the muscles and constrict them." Do you think this is true?
Dr. Lowe: I don’t know which Dr. Northrup is credited with this conjecture, but I vehemently disagree with it. The conjecture is a revival of old Freudian psychoanalytical thinking. Freud once speculated how the symptoms we now diagnose as fibromyalgia develop. He wrote that patients had traumas and unresolved emotional conflicts that were too disturbing for the patients to deal with. So the traumas and conflicts sneakily hid away in the patients’ muscles and caused them to hurt. He also speculated that an occasional patient already had a painful muscle condition, and a "neurosis attached itself to this and made it seem of exaggerated importance."[1,p.138]
This concept of Freud’s, called "hysteria," was debunked long ago by logicians, philosophers of science, and researchers. The concept was nothing more than a delusion of Freud’s cocaine-ravaged brain.[3][2, pp.60&115] The notion of hysteria was rich fodder in the 20th century for novelists, most of whom couldn’t compete with Freud in weaving tales. But as fruitful as the concept was for novelists, psychiatrists, and neurologists, it has no credible place—and never did—in science or medical practice.
The concept of hysteria is unfortunately perpetuated today in some doctors’ minds. One reason is that the Diagnostic and Statistical Manual of the American Psychiatric Association still implies the concept has credibility. Apparently, the Manual does this to appease the few remaining psychoanalytic thinkers within their ranks.[4] Tragically, as I’ve explained elsewhere,[2,p.51] some fibromyalgia researchers have now fallen back on the concept for explaining fibromyalgia. Blaming fibromyalgia on this refuted "cause" serves as a psychological refuge that protects the researchers from the harsh reality that they’ve failed to learn the biological cause of the disorder. With all due respects to Dr. Northrup, the speculation is utter nonsense and has no scientific credibility whatever. http://www.drlowe.com/QandA/askdrlowe/psychology.htm
The Dangers of False Memory Syndrome
A link to the article, “Creating False Memories” by Elizabeth F. Loftus, which originally appeared in Scientific American Magazine, September 1997; that explains the legal history of false memory syndrome, and how false memories are created:
http://faculty.washington.edu/eloftus/Articles/sciam.htm
Fibromyalgia, being the current fad diagnosis, along with Chronic Fatigue Syndrome are considered by far too many in the medical and psychosocial fields as abuse-trauma/memory and emotion repression caused illnesses. Unfortunately Fibromyalgia and CFS has been made into cause celebre psychosomatic disorders caused by child battery and child molestation victimization as a means to call attention to the horrors of child abuse, and some members of the adult survivors of child abuse community have fallen for this scheme and have readily embraced the fibromyalgia-chronic fatigue psychosomatic illness labels to support their cause of child abuse prevention. It's very easy to find such material written by adult survivors of abuse on the web. Memory and emotion repression, suppression, and dissociation are deemed to be key players in what transforms child abuse into adulthood chronic pain illnesses.
The flip side of this is- Fibromyalgia and CFS patients who don't have child abuse histories, but who are emotionally vulnerable, who are pushed into psychotherapy, counseling, or Myofascial Release Unwinding therapy with caregivers who strongly believe in and push the abuse-illness connection could potentially be at higher risk for False Memory Syndrome victimization.
