June 23rd, 2008
So let’s continue with our series of interviews:
Dr. George Russell D.C. is bodyworker, teacher and chiropractor in New York City with a focus on the mind-body connection in physical medicine. More information is available at www.georgerusselldc.com. He can be contacted at george@georgerusselldc.com or 646-654-9529.
Q: As both a chiropractor and bodyworker, what sort of information is most important when a patient first comes to see you?
Dr. George Russell: When I first meet a patient, my question is of course some version of “what is that brought you to my office today?”. Sometimes the client is not seeking a diagnosis, but rather wellness, connection to their body, or information about anatomy or activities. Sometimes they want higher function in a specific activity.
But no matter what the patient says, I am watching to see how it is that the client sees their own problem, what lens they are looking at it through. Some people are all bones and muscles and joints; others see their issues in behavioral terms; still others have a psychological or spiritual lens through which they see their problem.
I’m looking to cast the net wide in terms of information, because a couple of minutes of open-ended talking usually reveals to me the terms in which the patient him or herself experiences the problem. Often she or he knows what those terms are. Interestingly, the client’s language and choice of details often reveal deeper connections to their set of symptoms. A person who described her speed skating work in detail unwittingly made it clear that she was extremely unhappy in her marriage; that fact ended up playing a big role in her neck pain. Another patient said “I know I created this problem through my traumatic experiences after 9/11″; while that information was crucial to my assessment of her, her consistent slumping in her chair and extreme pelvis-forward gait as she walked into and sat in my office revealed a more immediate — and immediately treatable — aspect to her pain which probably helped her the most to come back into physical comfort.
Q: So how does the way a patient sees their own problem change the way you treat them? Do you modify the physical techniques you use based on a patients’s underlying emotional issues?
Dr. George Russell: This is complicated, I guess. I don’t think about it rationally, and yet I’m aware of doing it every time I see a patient. I guess I’d say that I listen to what they say to get an idea of their way into the issue; I observe them to see what underlying assumptions, feelings, attitudes are contributing to the problem or available to help empower them; and I’m looking on the physical/anatomical/behavioral level for concrete referents to what’s going on.
If a patient, for example, is terrified of losing physical function, I keep that in mind and I will use different rhetoric to talk with them. I may not, for example, mention arthritis, but instead talk in terms of joint stiffness and restriction, inflammation, etc. These are things that may be present in arthritis; but unless I’m required by their insurance company to list arthritis, it’s not helpful to make that diagnosis. Luckily for me, my treatment per se isn’t changed. I’d do the same stuff whether or not there is an objective finding of arthritis on, say, an X-ray. But in characterizing the situation to the client, I’d speak more in terms of what may be possible for them.
With another person, they may be have an attitude/intention to use “mind over matter” no matter what the diagnosis. In that case, I might put on the “patriarchal doctor” hat, and seriously describe to them that i believe they have, say, arthritis and that it’s important for them to keep the awareness of their limitation in mind so that they can support their movement, keep their joints within a normal range of motion, and prevent excessive pressure. Because the worst place this patient is going to go is into denial and willfulness, and they may actually can use the information to modify their behavior. In contrast, the earlier-described patient is most likely to be terrified and to limit movement and activity where that may actually be the most helpful thing for them.
So awareness of personality type and attitude/feelings actually changes my diagnosis in some cases. Diagnosis is nothing more than a hunch based upon which a particular treatment will be attempted or proposed. It’s not reality; and it’s never fixed. It can change, just as patients can change, which is what makes treatment worthwhile and practice interesting.
Q: That’s interesting, that a diagnosis isn’t fixed. Do you find that the opposite is true, that a treatment for, say a knee problem, can change a patient’s mental outlook?
Dr. George Russell: Absolutely. Knee suppleness, freedom and ease can mean any number of things to a patient, from the ability to enjoy a beloved annual family ski trip to the symbolic issue of support for the self at all levels, not to mention the ability to move freely through life. There is no way to change the body without changing numerous relationships in the body — one joint affects all the others, and the leg joints are more influential because they support all the ones above. And there’s no way to change the body without having different feelings. Emotions and thoughts are grounded in physical experience… that’s why the word “feelings” is a term that describes physical sensation.
I think we all know this implicitly and intuitively. There’s an awful lot of talk in our language that creates the illusion that the mental field and the physical body’s experience are separate side-by-side processes. But honestly, how could that possibly be true?
Q: So to support that, do you think psychological work is necessary when a patient is trying to heal a muscular or skeletal condition? Are there any particular approaches that you prefer or recommend to patients you are working with?
Dr. George Russell: Really, it’s an issue of what facet of experience is most applicable to the client’s issue. Since all the facets (including psychological, neuromusculoskeletal, etc. etc.) are ways of approaching the same phenomenon, it follows that you can get to anything through any approach. Finding the quickest and most effective approach is always a part of diagnosis and treatment.
Most of the time, when people come to me, they’ve self-selected my approach. And I believe that all health care professionals (really, all humans) are counselors if they’re doing it right. Because you can’t separate thinking and feeling from any other aspect of human experience. If a doctor is not addressing that level of experience, there’s a gap. Overtly or implicitly, I am always attending to the psychological, spiritual, energetic and emotional states of my patients.
Having said that, I do refer patients for psychological and spiritual work when that seems relevant, from 12 step groups, to Rosen Work (a psychological and spiritual form of bodywork that incorporates talk and touch together), to psychotherapy, and sometimes back to a religion or spiritual practice that’s been abandoned due to the demands of life, trauma, or other influences.
Generally this kind of recommendation has to be done with a light touch, since people personalize their emotional and thought patterns more than their physical ones. People feel less shame about how they stand and walk than how they think and feel, even though the two are directly and indirectly related, and even though changes in one effect changes in the other.
Speaking of trauma: trauma occurs at many levels, from what we categorize as physical to what we categorize as emotional. But the ramifications of trauma are always present on all levels: physical, neurological, emotional, cognitive, energetic, conscious as well as unconscious, etc. Also, trauma can be big or small, but it’s present in every life, and addressing its manifestations is part of any healing process, no matter what angle the practitioner or affected person chooses.
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