After 26 years as a non-DC attempting to serve chiropractors by advocating the patient's point of view, it still astonishes me how much this profession is held back by its fractured in-fighting. And no wonder. After a recent seminar, in which I heard chiropractors using sloppy language while asking questions, it prompted me to identify some of the many distinctions that chiropractors make—either consciously or unconsciously, that produce the bifurcation in chiropractic:
D.D. or B.J. Are you more comfortable with the fundamentals advanced by the founder of chiropractic, with its metaphysical tenets and century-old philosophy, or are you aligned with the charismatic developer of chiropractic and his strange writings, thots and innate philosophy? Or neither, because these historical figures embarrass you or you prefer making chiropractic what you think chiropractic is?
Upper cervical or full body. I wasn’t around in the early days as B. J. Palmer attempted to herd this profession of cats, but way back when, chiropractors had to choose sides. Is the atlas/axis subluxation the only one worth attending to, or could you venture further down the spine, even to Logan Land in the sacrum?
Straight or mixer. Should you do anything other than reduce subluxation? Or can you provide other supportive services to enhance physical, mental or social well-being? Is heat, cold, electricity and light legitimate healing modalities? Or should chiropractic be limited to adjustment only?
Hands or instrument. You’d think that the word chiropractic, which comes from the Latin meaning “done by hand,” would be clear enough. But what if the hand is holding an instrument? What if your hands are so beat up after 20 years you need an instrument to assist you?
Subluxation or dysfunction. Does chiropractic address a neurological phenomenon or merely a mechanical dysfunction? Every chiropractor has to choose. Are you okay with the s-word” or would you prefer to see it disappear?
Manipulation or adjustment. Generally defined as less specific than an adjustment, will you use the term manipulation instead? Many of the research articles affirming chiropractic-like interventions use this term. Language matters. Are you being specific or general? Are you intentioned or hazy? Focused or unsure?
Bones or nerves. Is the goal of chiropractic to “fix” patients and restore alignment, balance, symmetry and ideal curve? Or does chiropractic concern itself with the integrity of the nervous system? This is a huge distinction that is often lost on chiropractors who use adjusting techniques that they think put bones that are “out,” back where they belong—virtually ignoring why the body might have put the bones there in the first place. Have you considered going spineless?
Force or tonal. Can subluxations (or whatever you call your particular bogyman), be reduced only by applying force along facetal joint planes, or can you use a touch or sustained pressure? Can you talk them out? Can you pray them out? Is one way superior to another? Are both approaches equally chiropractic?
Local or whole body. Is chiropractic merely a way of reducing the obvious symptoms local to the spine, or is it a discipline that mediates the integrity of the nervous system, which can have visceral, organic and whole-body effects? Is chiropractic appropriate when there are no symptoms present? Or must one wait for symptoms to manifest first?
Episodic or lifestyle. Is chiropractic allopathic or a lifestyle decision? In other words, is chiropractic merely a short-term diet to deal with bouts of obvious neuromuscular-skeletal problems, or a healthy, life-long habit? Is it appropriate to reduce non-symptomatic subluxations? Is it okay to adjust children even if they don’t yet have a “bad back”?
Patient or practice member. What will you call the people who show up in your office? The word “patient,” which comes from the Latin word meaning, “to suffer,” is probably where most people start. Or, do you have people who begin care observing that they’re “feeling great and want to be even better?” If you see people with these two different motives, you may need to make a clearer distinction with your language.
Treatment or care. Treatment, which is defined as a procedure to relieve illness or injury, is clearly medical languaging. The term “care” implies giving attention and direction, yet recognizing that the patient is the one doing the healing. Which one will you use?
Compliance or follow-through. This choice reveals the “headspace” of the chiropractor. Compliance suggests surrendering power; submitting to the wishes of another. Therefore, compliance is a doctor-centric view of the relationship. Follow through acknowledges the sovereignty and free-will choice of each patient and reflects the degree to which the patient chooses to complete or finish the suggested recommendations.
Self-pay or third party. And who will be your boss? The patient with whom you actually have a relationship, or a distant third party who doesn’t understand, respect or even like chiropractic and sees reimbursing for your services as a needless drain on corporate profits?
Diagnosis or analysis. This is where brushing up against the allopathic third-party industry has rubbed off onto many chiropractors. Analysis is defined as procedures designed to reveal the presence, location and character of a vertebral subluxation along with any contraindications to chiropractic adjustments. Diagnosis is a medical procedure to identify a disease by its signs and symptoms. Which is fascinating, since most state chiropractic licensure laws specifically prohibit chiropractors from engaging in the treatment of disease.
Mechanism or vitalism. Are the people who show up in your office merely mechanisms and chemical reactions with a limited number of cellular replications and they die, or are they greater than the sum of their parts, respond to prayer, are self-healing and regulating and have nervous systems that learn and adapt?
Anecdotal or evidence-based. What will you choose to believe about chiropractic? Is the linear, double-blind “gold standard” used in medicine, especially drug testing, appropriate when judging chiropractic? Or will case studies and anecdotal reports be sufficient in proving the value of chiropractic?
Integrated or separate. Is chiropractic something that should fit into the mainstream health care paradigm or is it an entirely different healing discipline? Before you answer, be sure to check the language of the practice act that grants you the right to be a chiropractor. (Clue: chiropractic wouldn’t even exist if it weren’t for B.J.’s foresightedness to make it separate and distinct.)
Sorry to burden you, especially since you probably got into chiropractic because you just wanted to help others—not be a pawn in some esoteric philosophical battle! But you are. In fact, your inclination to keep your head down, use sloppy language and ignore its implications, not only blunts the impact of what you do, but your carelessness could jeopardize the profession!
My guess is that no other healing art offers so many choices of what to believe. And while there are strategies currently in play to eliminate many of these choices in an effort to bring unity to chiropractic, my fear is that the result will be more mechanism and less vitalism, more spine and less nervous system, more Newtonian and less quantum and sadly, more therapeutic and less chiropractic.
Or have I missed something?