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Stephen Paulus, Doctor of Osteopathy

What is Normal?

By Stephen Paulus, Doctor of Osteopathy (DO)

“Dr. Still could not speak of all the things he understood about the living human body. We were not ready to hear him”.[1]    William Sutherland, DO

When you know the difference between the normal and the abnormal structure you have learned the all-absorbing first question, that you must take your abnormal case back to the normal, lay it down and be satisfied to leave it. Never leave your case until you have obtained such results. Thus it is far better to familiarize your eye and your hand with the normal before you can approach the abnormal intelligently. [2]  A. T. Still

Of course, “normal” does not simply mean a readjustment of bones to a normal position in order that muscles and ligaments may with freedom play in their allotted places. Beyond all this lies the still greater question to be solved: How and when to apply the touch which sets free the chemical of life as Nature designs? [3] — A. T. Still

A. T. Still, the founder of Osteopathy was not just a skilled physician, he was not only a gifted teacher, he was an expansive thinker and explorer. Still anchored the Osteopathic profession in both, the material realm of anatomy and in a rich philosophy that remains ingenious and relevant to this day. Certain amounts of Still’s writings are dated and not fitting for a “modern physician,” but a surprisingly large amount of his teachings are timeless and appropriate. Reading A. T. Still for the first time exposes an individual to the surface, mechanical and linear approach of a man living in the Age of Reason during the late 1800’s. This was a time when scientific thinking was emerging into the forefront of American consciousness.
William Sutherland, DO, the man who developed the Cranial concept said that, “The concept of Osteopathy lies deeper than the usual material interpretation . . .” [4] Sutherland had the benefit of studying directly with the “Old Doctor,” as Still was affectionately called, and was able to personally receive teachings not recorded in any of the four books written by our founder. We too are students of A. T. Still and receive the gift of his teachings through his publications and by the lineage of teachers who pass the torch of Osteopathy to each generation. As we read Still’s writings we must ask ourselves, are we ready to hear him? If we are receptive then we can think in between the lines of Still’s printed texts to expand our understanding of the most basic principles of this living, breathing science called Osteopathy.

Emily Dickinson, the great 18th century American poet wrote, “Tell the Truth but tell it slant . . . The Truth must dazzle gradually or every man be blind.”

[5] I believe that A. T. Still disguised the truth or “told it slant” in his printed texts because to blatantly come out and expose his true insights would have been “too bright” for the newly birthed Osteopathic profession. Both the institution of Osteopathy and the students of this profession have needed to continually evolve and become expansive. Sutherland was one of the earliest Osteopathic scholars to reveal some of the treasures buried by A. T. Still. When each generation is ready, additional elucidations become available.

When Still said that “Man’s power to cure is good as far as he has a knowledge of the right or normal position . . .” [6] the persistent interpretation has been within the mechanical and material paradigm. Utilizing the mechanical model is not wrong, it has been the mainstay of our public expression of Osteopathic Manipulation. However, to use exclusively a mechanical approach is antithetical to Still’s diverse philosophy.

I believe that Still used overt mechanical and material explanations, partially because he knew them to be one aspect of the truth of Osteopathy. This approach also allowed his message to be more easily received by the widest and most diverse audience. Dr. Still had the near impossible task of putting into words experiences that defied definition and were almost incapable of being expressed. I agree with Sutherland, and my personal exploration confirms, that A. T, Still’s “concept of Osteopathy lies deeper than the material interpretation.”

[7]
What did Still mean when he invited us to “compare the work of the abnormal body with the work of the normal body”? [8] He was not just asking us to palpate and initiate structural alignment. He was not just telling us to restore a full range of motion to joints and articulations. I believe, and have validated in my own continuing perceptual investigations, that the First Teacher of Osteopathy was asking us to experience something beyond what can be measured or calculated.
When A. T. Still discussed normal I don’t think he implied a strict definition of an approximate average. He did not imply that normal is a state of being free from
all disease, infection, or malformation. Etymologically, normal was originally derived from the Latin norma denoting a set of squares used by carpenters and masons. Later it was extended metaphorically to a include a rule, pattern, or precept. The more familiar modern sense of a normal as a standard did not emerge until the early 19th century.

[9]
For A. T. Still, Normal was also the non-mechanical, non-material “standard” from which we must initiate diagnosis, eventuate with treatment, and then leave it alone for Nature to process. When Still said, “I love my fellow man, because I see God in his face and in his form,” [10] he was not beholding a material body in perfect mechanical alignment or lacking disease. He was celebrating the earthly expression of the Divine in a human being. He was directly experiencing the Health as a perceptual event. Normal or the Normal Body is analogous to Health in A. T. Still’s philosophy.

In a treatment session my primary intention is to engage and synchronize my attention with any aspect of the living system which is Normal (where the feel or texture is positive and creative). Once I have an identifiable perceptual matrix of Normal (or Health) then a reference point has been established and can be utilized in any aspect of treatment. This method of diagnosis and treatment is entirely congruent with the most basic tenant of Osteopathy, i.e., “To find health should be the object of the doctor. Anyone can find disease.” [11] As Osteopaths, it is our duty and responsibility to find Health and use this living principle in treatment.

The Normal Body has a distinct perceptual feel that is not a part of the palpatory examination. To perceive the Normal Body, or any aspect of it, we must drop from our field of attention the material, kinesthetic neurologic sense. Many times we are able to only metaphorically perceive an edge or piece of the “fabric of Health.” This is enough to open the door to “the object of the doctor.” Occasionally, we can actually embrace the entire fabric of Health (or the Normal Body) and our treatment becomes transformational.

With the perceptual knowledge of the Normal Body, there are several different treatment approaches. Two distinctly different methods of using the Normal Body are implied by Still and are listed in the following two paragraphs.
In the first method, A. T. Still directs us to “admit the abnormal parts to the normal” [12] and to explore minutely any variation from the “standard.” My experience of this teaching is to perceive a phase-shift, or variance between the perceivable Normal Body and the palpable material body. The disease, or abnormal is a condition where Health and some aspect of the material body are out-of-phase, or are no longer joined in function. Treatment restores the orientation to an in-phase alignment. This alignment is not a positional restoration of mechanical parts. It is a coming together, or a union of that which “feels right,” i.e. the Health, with the elements that have become abnormal. When normal position (or an in-phase state) is achieved, a therapeutic process is engaged and the proper condition for the full expression of Health occurs.

A second approach involves going directly to the lesion and finding the Health within the dysfunction. Contained within the word ab-normal is “normal”; included in the word dis-ease is “ease”; and locked within the word dys-function is “function.” Just as normal, ease, and function are contained within their opposites, so is Health contained within what we call an Osteopathic lesion (or what some may call a somatic dysfunction). When we engage the Health within a lesion, we effect a change allowing for the lesion to express Health, thus triggering a therapeutic response.

What would happen to the Osteopathic profession if every Osteopath began each evaluation by first engaging the Health or the Normal Body? Isn’t this the all absorbing first question for our profession? I believe that A. T. Still gave us all the tools necessary to participate in the healing of our friends and neighbors. Though the “Old Doctor” passed on in 1917, he continues to not only teach us but to inspire our growth and maturation.

[1] Sutherland, W. G. Contributions of Thought, Second Edition (COT) Rudra Press, 1998, p. 351

[2] Still, A. T. Autobiography of A. T. Still, American Academy of Osteopathy, 1981, p. 190

[3] Still, A. T. Quoted in: Webster, George V. Concerning Osteopathy, Plimpton Press, 1919, p. 37

[4] Sutherland, COT, p. 213

[5] Dickinson, Emily The Complete Poems of Emily Dickinson, Little Brown & Co., 1960, p. 506

[6] Still, A. T. Osteopathy Research and Practice (R&P) Eastland Press, 1992, p. xxiii

[7] Sutherland, COT, p. 213

[8] Still, R&P, p. 7

[9] Ayto, John Arcade Dictionary of Word Origins, Arcade Publishing, 1990, p 366

[10]Still, A. T. Quoted in: Webster, George V. Concerning Osteopathy Plimptom Press, 1919, p. 2

[11] Still, A. T. Philosophy of Osteopathy (PO), American Academy of Osteopathy, 1977, p. 28

[12] Still, R&P, p. 9