Articles

Technology, Change, and Massage Governance Activism

Technology, Change, and Massage Governance Activism

Keith Eric Grant, Ph.D.

08 October 2000

Having a foot in both the worlds of high tech (physics and numerical math) and high touch (massage) often provides me with contrasting perspectives. In the high tech side of my life the other day, I attended a lecture on Thriving on Change by Carol Kinsey Goman, a speaker and corporate consultant specializing in assisting individuals and businesses navigate increasingly unstable and often ambiguous environments. In this vein, she has authored the books Adapting to Change, This Isn't the Company I Joined, and The Human Side of High-Tech. I believe there are talking points that can be drawn and extended from her lecture prompting more activism in negotiating with local and state governing agencies on how massage practices will be restricted or encouraged. Let us first take a look at how technology is increasing our opportunities for such grassroots activism.

Technology and Grassroots Activism

Internet technology has shifted and will further change the balance of information power between customer and consumer and likewise between massage practitioners and traditional massage organizations and governing agencies. Consider the impact of one disgruntled United Airlines customer who started Untied Airlines, a gadfly site aimed at United Airlines that is receiving, according to recent newspaper articles, about 17,000 visits a month and collecting and forwarding thousands of complaints on to UAL. In the world of modern technology, those previously dismissed as being powerless can rapidly develop into activists with a voice and a movement. In a recent book, Christopher Kush provides tactics for such cyber-activism. A collection of such links can be found on the Massage Therapy Activist page.

Also, consider the recent success of the Minnesota Natural Health Coalition in promoting the passage and signing of the Complementary and Alternative Health Freedom of Access Act. Clearly, the ability to collect and disseminate information rapidly and inexpensively has moved the balance of information handling and thus political power from traditional, hierarchical organizations and towards grassroots efforts. Powerful changes include the ability to search state legislative information by keyword (California example) and subscribe to e-mail updates on individual bills or to visit web sites giving meeting schedules and agendas provided by local counties and cities. Is is noteworthy that these same web sites will often provide substantial useful data on the changes and challenges being experienced within local and regional venues. These are new political realities providing tools for us to take a fresh and more grassroots look at the perspectives and wording of massage governance.

Processes of Change —Stress, Loss and Opportunity

Rapid change has become a pervasive characteristic of western culture and technology. To stay current requires continual “just in time” learning, reinforcement of needed skills, and unlearning of what is no longer useful —extensive front-loading of learning has become a wasteful and expensive venture in futility. Goman notes, “Now and in the future, their [managers and workers] value to the organization depends less on what they know, and more on how quickly they can learn and respond to changing conditions”. In a recent column, Michael Vizard, editor in chief of InfoWorld, underscored these thoughts:

The bottom line in this world today is that too much experience can be just as big a problem as too little experience. In an ideal world, most companies prefer to assemble teams made up of people with a diverse level of experience -- to overcome being too dependent on one mind-set. But the reality is that maintaining that level of balance in your organization is incredibly difficult to do because it involves more art than science. In the current world of business, we live in extremely perilous times where a single misstep can cause your company to drop market share, to occupy the second, third, or even fourth market-share position in your industry. And as we all know, once you fall below third place in terms of market share, it's hard to justify your existence. So buckle up. If you thought what has transpired in the last two years was fast and exciting, you haven't seen anything yet.

Ironically, what we have been hearing most frequently in the realms of massage training are those determinedly trying to standardize on static concepts of training and competence that fail to meet today's fluid needs or match today's fluid models of learning. Considerable lobbying has been brought to bear to push for training that is not designed by content, not supported by studies of how we learn effectively and, because it is all required before entry to the massage profession, not tax-deductible. It is seemly easy to play poker with someone else's money and time; a fact of which many small business owners are much more aware of than they would like to be.

Let us look at change a little more closely. Change is often experienced paradoxically as both a sense of loss and a sense of opportunity. According to the work of Dr. Elizabeth Kubler-Ross, there are five stages of coping with loss:

• Denial
• Anger
• Depression
• Bargaining
• Acceptance

For those who can better negotiate the twists of this grieving process and accept the loss of stability, the potential for positive change implicit in times of chaos and discontinuous change provide great opportunities. Those who cope successfully with rapid change are found to have five key characteristics for creating a successful change environment:

• Confidence:  know how your belief systems impact your future
• Challenge:  view change as both a challenge and opportunity
• Coping:  thrive on change without necessarily liking it, yet accepting it.
• Counterbalance:  compensate for the demands and pressures of organization change by developing counterbalance in other areas of your life
• Creativity:  contribute beyond the limits of your job description

For those who are experiencing more stress than they can deal with, Bernard J. Didde notes three stages of the general adaptation syndrome: alarm stage, resistance, and exhaustion. A presentation by Resource Systems similarly notes that while moderate levels of stress can act as a beneficial challenge, stress beyond the coping level becomes a vicious downward spiral of negative effects. This presentation also notes that increasing coping mechanisms allows managing greater pressure and can shift what would have been a negative cycle into a positive one. Being overloaded beyond one's ability to cope successfully with stress has obvious personal consequences. However, the full costs are far more pervasive.

What are the Economic, Productivity, and Litigation Consequences of Not Actively Remediating Stress?

In an article on the growth of employment stress claims, Albert M. Drukteinis notes the consequences of unremediated stress on productivity and economic loss:

Stress related illness is an increasing problem in the work place. A recent Gallup Poll of 201 U.S. corporations revealed the extent of this problem, showing significant percentages of the work force affected by disorders ranging from fatigue and difficulty concentrating, to substance abuse problems, to actual mental illness. In these companies, nearly 60% of all managers felt that stress related illness was pervasive among their workers and decreased productivity at an estimated cost of 16 days of sick leave and $8,000.00 per person per year.

Among stress related illnesses, depression or depressive disorders are estimated alone to cost the American work place a staggering 43 billion dollars per year, including the cost for absenteeism, lost productivity, treatment and rehabilitation, and loss of earnings from accidents and suicide. In addition, work place violence has increased dramatically in the last fifteen years with homicide accounting for 17% of all occupational fatalities. Furthermore, claims of physical and sexual assault, verbal threats or intimidation, and harassment have risen at alarming rates. In conjunction with these claims, the diagnosis of post-traumatic stress disorder has emerged as validation of the harm suffered, and is probably one of the most popular diagnoses in litigation today. Finally, these stress related illnesses do not even begin to take into account physical disabilities such as low-back pain or repetitive motion injury which can have strong psychological and psycho social influences.

Similar consequences of not actively coping with stress are noted by Jean Sapeta on stress related litigation in the U.K.:

The Department of Health estimates that between five and six million working days are lost every year through workplace stress. This costs British business over £5bn every year. A survey carried out by IRS Employment Review in June 1998 revealed that 58% of the respondent companies regarded stress as one of the top three health priorities. On a more human level, researchers at Warwick University have found that British workers are some of the most stressed in Europe, coming second only to the Germans. Apparently, half of all British workers suffer from lack of sleep and one in five have feelings of worthlessness caused by worrying about work. According to Union Trends, a fifth of all unions have reported increases in stress cases among members and stress continues to be the largest single cause of all legal disputes fought by unions. Stress is fast becoming one of the biggest causes of litigation and, as such, is a major concern for employers.

Dr Angelica M. Vecchio-Sadus concludes in an article on occupational health and safety for CSIRO Minerals, Australia:

Reported cases of stress-related illness have almost doubled in the Australian Public Service since 1989-90 and are growing at a rate of 20% a year. The average liability associated with a stress claim is more than double that involved with other forms of work-related injuries. The estimated cost to the Commonwealth is $50 million. Research by Comcare has revealed that people with stress-related illnesses have longer periods of absence and that their rehabilitation costs about $25,000 compared with $9000 for other illnesses. The research also indicates that the cost of stress-related absences is likely to increase, and the number of cases may double again before the year 2000.

The stress management information compiled for the wellness program at Duke University notes that: Stress takes a toll on our health and quality of life. If stress is unmitigated on the job or at home, if there are limited community resources with which to create a personal support group, it will directly reflect on the regional quality of life and work. This can have profound effects on the ability of a region to attract and retain desirable employers, employees, and small businesses. Providing for adequate and diverse stress management resources does not necessarily mean that additional public expenditures are required. Given a favorable governance environment, small business wellness care can play a big role in providing resources while simultaneously adding to the local economy. We will next take a look at stress management massage in this dual role of wellness care resource and small business.

Massage as a Stress Coping Intervention

Given the above effects of an overload of stress, it is an easy jump to realize that promoting a high availability of massage directed primarily at relaxation and coping with stress can promote a healthier, more productive, population. For communities, having an activist program for promoting stress management resources and training will produce both positive economic consequences and will have a positive impact on perceived quality of life. In this context of stress and coping, relaxation massage becomes an important member of the set of coping tools. Moreover, actively promoting the availability of basic massage facilitates the extension of outreach programs to literally touch those otherwise out of reach —the aged, and those physically, emotionally, or economically challenged. As with medical care, general practitioners of massage are can be more accessible than the specialists. Massage literally becomes one of the tools available for building community while, as a small business, adding to the economy.

Massage for relaxation and stress management should be considered as preemptive wellness care, not as healthcare. The skills required for such wellness care require only general knowledge of anatomy and physiology combined with the basic kinesthetic skills of Swedish massage. More critical to the outcome of a massage session are the ability to establish rapport and the patience to encourage muscles to relax via the slow application of nurturing touch — in short, kinesthetic and communication skills. The beneficial effects obtained are partly mechanical, partly due to input to the entire nervous system, and partly due to the very humanness of having someone there to provide support.

It is only when such wellness care has not been provided or in cases of acute injury that massage moves into the realm of healthcare. Depending on the nature of the breakdown, this either requires referral to a mental health professional or use of a more extensive set of anatomical knowledge and orthopedic skills. Where chronic tension and resultant shortening of postural muscles has resulted in tissue breakdown or injury, advanced massage can address minor chronic and acute injuries to muscles, tendons, and ligaments. While such advanced interventions are important in providing effective relief to those in such pain, this is neither the optimal mode of intervention or the largest market for massage. As chair-massage originator David Palmer notes from comparing Canadian and US surveys of massage usage (Massage Magazine, March/April 2000), the market for wellness care massage greatly exceeds that for healthcare massage. A little prevention goes a long way.

As long as one is dealing in the realm of wellness care, a massage therapist can successfully practice with very modest hours of training. While life and prior business experience can reduce the training needed to practice the small business and trade of massage, massage school owner Ramona Moody provides a starting point that is based on examining the content of needed training:

I participated in a task force initiated by the BPPVE [Bureau for Private Postsecondary and Vocational Education, California Dept. of Consumer Affairs], which legislates massage schools among others. The purpose of the task force was to decide what the absolute minimum requirements should be for massage training. The massage school owners who participated in the task force decided that rather than develop a curriculum for the 250 hours suggested by the Bureau representatives as a minimum, we would discuss what knowledge we feel the students really need, and how many classroom hours does it realistically take to impart that knowledge. It was a really interesting discussion, carried out over several meetings, and the conclusion we came to was that it takes about 200-300 hours in the classroom to impart to students the minimum education we felt they really need in the marketplace. This included more than one massage modality, along with health and safety, anatomy and physiology, business practices and ethics, as well as communication skills. We felt this would make the student competitive in the marketplace, as well as no danger to the public.

This exercise in evaluating needed training based on content and practitioner marketability is a refreshing departure. More often, hours of training required for obtaining a practice license purely stem from “round hour syndrome”, a love of zeros at the end of numbers, or from financial considerations of the minimum hours a vocational program must have to secure federally guaranteed student loans. Neither of these methods shows much respect for the prospective practitioner's time or money, an observation that seemingly will only be brought home to agencies governing massage by in-your-face activism. The task force conclusions related by Moody provide a much sounder basis for evaluating entry level training needs.

Legends and Facts on Public Harm

Within some alcoves of the massage industry, there is a persistent urban legend that those practicing entry level massage with minimal training harm the public. While these are important concerns, I believe that we can dispense with this specter of harm. Despite considerable effort, I have not found any factual basis for these projections of harm. Around 1997, I did an extensive search of the medical database Medline and of newspaper archives without finding incidence of such harm. Albert Schatz has commented in letters to massage journals that Doug Alexander, editor of the Journal of Soft Tissue Manipulation, did a similar search in the early '90s with the identical negative conclusion. Schatz also notes Alexander's conclusion on his web site:

In 1993, I learned that Doug Alexander, in Ontario, Canada, did a database survey on the Internet to find out what harm had been caused by massage therapists. He found no such harm and concluded that massage was "relatively safe.

In a letter dated February 7, 2000 to the Minnesota Touch Movement Network, Will Green, president of the IMA Group (International Massage Association,Warrenton, Virginia) also commented on the lack of documented harm for massage:

It is only logical that there be some validation of these [alleged] claims of physical harm, or frankly, they are probably fiction. Our insurance agent insured the AMTA in 1984, the ABMP in 1987, the NAMT in 1993 and now the IMA since 1994. We would be very interested in these claims as they would affect our insurance premium rates. Please let us know if, in fact, these claims can be validated. The cost of our malpractice coverage has been reduced by 50% over the past five years due to the lack of claims. We cover over 5,000 members with 100 hours of training in California, the largest massage state in America.

The full text of Will Green's letter is available on the web site on healing and the law maintained by Albert Schatz.

Even those pressing the need for extensive entry level training and competency testing seem to implicitly deny the presence of factual harm by the vagueness of their actions. In short, I have found no evidence of the kind of integrated risk management in massage training that would be associated with a significant incidence of actual physical risk. In the existence of such risk I would expect to see evidence of: identifying the scope of massage in which harm is occurring, assessing the mechanisms of harm, instituting specific training to remediate specific harm, and continuing to collect data on the effectiveness of these remedies. The lack of such actions and the continuing vagueness of training requirements is extremely telling as to the lack of harm from massage directed at wellness care. None of this is to imply that more advanced orthopedic techniques addressing forefronts of injury and chronic pain can not have risks as well as substantial benefits, but these are specialist practices requiring specific training and lying beyond the scope of the general practice of entry level massage —in the medical realm, one differentiates between the primary care physician and the heart surgeon.

In 1997, the Georgia Occupational Regulation Review Council, concluded that there was minimal likelihood of recognizable potential for harm and recommended that a proposed licensure measure be killed. In the recent passing and signing of the Complementary and Alternative Health Freedom of Access Act, the Minnesota state government seems to also have concluded there is no evidence of harm from noninvasive practices. In the absence of such data, they have taken the very commendable approach of requiring that clients be provided with information on therapist training and practices and that any reports of malpractice, fraud, or misconduct be collected and acted upon. I would conclude that the substantial evidence for lack of harm opens wide the door for a much more activist integration of massage into community based programs for stress management and touch outreach.

Having a Program of Local Stress Activism

In working with local or state governing agencies to promote a rational permit system, we should emphasize the stress being accumulated and the coping skills needed by their constituents and how massage can be a benefit. This becomes even easier if the area has a tourist industry attracting people who are already determined to shed some of their accumulated stress and anxiety.

Taking again from the technical side of my life, those who started out creating computer and network hardware and software have discovered that it is to their advantage to offer more integrated solutions. This has created a new industry of application service providers (ASPs). I believe we can learn from this, do our research, and walk through the negotiating or lobbying door prepared to address the full range of potential concerns about massage and be equally prepared to offer a package of our solutions. We are thus reframing massage from being a problem to being a community asset that has some occasional difficulties of administration. Once the practice of massage is seen as an active benefit to a community, negotiations for governance have a much better chance of producing a positive result. Our strategies should include:

• Being able to walk in the door familiar with the attitudes and concerns of all the players
• Knowing more about their problems and potential solutions than they do
• Effectively advocating massage training requirements as something to be based on need of content rather than as an expensive (to the student) means of separating legitimate practitioners from those using massage as a facade.
• Negotiating the removal of onerous practice and zoning restrictions and working flexibly to address concerns and create solutions.
• Promoting language that requires having liability insurance rather than organizational memberships.
• Providing, as for the MN law, processes for dealing with complaints and problems rather than assuming them up front.

All of this requires doing the research necessary so that you are aware of the kinds of changes local to the venue with which you are working to improve the climate of massage governance. Be aware of, prepared to discuss, and resolve historical local issues regarding massage. Emphasize that the changes and stresses being experienced within the boundaries of their jurisdiction include (as appropriate):

• Growth
• Increases in traffic and noise
• Adoption of new technologies
• Global competition faced by both large and small businesses
• Rapid changes in business roles
• Acquisitions and mergers of corporations
• School redistricting
• Parenting, including the challenges of special needs and gifted and talented.
• Care concerns for aging parents (eldercare)

Question them that as a city (county, state), what plans do they have in place to attract and support businesses whose business is helping your citizens cope with change? Smile, then offer them the benefits, of your research, thoughts, and talent.

References

AIS, Home Page of the American Institute of Stress, (http://www.stress.org/).

Bernard J. Didde, 1998: Occupational Stress And What We Can Do About It, Emporia State University, (http://www.emporia.edu/mmfe/jour/jour26bam/didde.htm).

CCOHS, 2000: Workplace Stress, Canadian Centre for Occupational Health & Safety, (http://www.ccohs.ca/oshanswers/psychosocial/stress.html).

Albert M. Drukteinis, M.D., J.D., The Growth of Employment Stress Claims: Workers' Compensation, Discrimination, Harassment, and Accommodation Problems, New England Psychodiagnostics, (http://www.psychlaw.com/nep/growth1.htm).

Hartford Hospital, Is Stress Stressing You Out?, Womens' Health Page, Hartford Hospital, Hartford, Connecticut, (http://www.harthosp.org/womens/emotion/stress.htm).

Christopher Kush, 2000: Cybercitizen : How to Use Your Computer to Fight for All the Issues You Care About, Griffin Trade Paperback; ISBN: 0312263058

Ramona Moody, 2000: Desert Resorts School of Somatherapy, (http://www.somatherapy.com/), private communication.

NIOSH, 1999: Stress at Work, National Institute of Occupational Safety and Health, (http://www.cdc.gov/ niosh/stresswk.html).

David B. Posen, MD, April 1995: Stress Management for Patient and Physician, The Canadian Journal of Continuing Medical Education, (http://www.mentalhealth.com/mag1/p51-str.html).

Resource Systems, Understanding Stress —the Positive and Negative Outcomes of Stress, Resource Systems Harrogate, U.K. (http://www.stressweb.com/pres.htm).

Jean Sapeta, Distress Signal, Bevan Ashford Solicitors, U.K. (http://www.bevanashford.co.uk/ distresssignal.htm).

Angelica M. Vecchio-Sadus, M.D., Stress in the Workplace, CSIRO Minerals Box 312 Clayton South VIC 3169 AUSTRALIA (http://www.minerals.csiro.au/winc/stress.htm).

 

© Keith Eric Grant — The Ramblemuse^SM, 09 October 2000. All rights reserved.

 

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