published 3/04/09, updated 8/17/11

Therapy Babble

Another warning sign of therapy of dubious quality

by Paul Ingraham, Vancouver, Canada

Therapy babble is an irritating combination of jargon/bafflegab and pseudoscience or “abused” science that sounds impressive but means little. Therapy babble often always starts with a folksy preamble that clarifies or confirms something fairly obvious in a charming way — “So the spine is like a stack of bricks, see?” This is a tactic to build credibility and engage the audience, before moving decisively into wild speculation presented as though it is actually a serious professional opinion.

A fine, common example of therapy babble is the “deepity.” Seattle Rolfer Todd Hargrove has written about some of the “deepities” of therapy recently, and they the most obvious examples of what I’m talking about: vague ideas that shift their meaning, dodging from profound-but-false to true-but-trivial, like the “power of intention” or “energy work.”1

A little more commonly, the therapy babbler loves nothing better than a theory that sounds vaguely plausible or appealing, but can’t or likely won’t be tested experimentally, ever, because it’s actually outlandish.

The therapy babbler is full of big talk about things that cannot possibly be known (or done) with any confidence, such as absurdly complex dot-connecting theories, or “all pain comes from a single source” theories. This is a general failing of alternative health care: assigning great significance to things that are really subtle, strange, and/or complex, to the point of absurdity.

For instance, many a therapy babbler has babbled about craniosacral therapy — a treatment that asks us to believe that therapists are not only able to “manipulate the cerebrospinal fluid circulatory rhythm” but to do it with such mastery that they can reliably produce a therapeutic effect.

Is anyone that smart? No — no one is that smart. No one is actually capable of therapeutically manipulating your nervous system by lightly touching your head. Anyone who claims that they can do so has an inflated self-esteem.2

Do you have a license for that babble?

The therapy babbler is highly prone to producing theories just for the sake of being contrary, for the sheer joy of putting down science and so-called “mainstream” medicine, and always with the side benefit of trying to look impressive by comparison.3 One of the all-time best examples I have ever seen of this is this cranky attack on science in Massage Magazine in August, 2009.

And yet the therapy babbler is a dilettante. Most kinds of hands-on therapists are just not trained all that well compared to physicians and scientists — and even physicians and scientists often make significant logical errors! Even with much more extensive training than most massage therapists, a great many of my former colleagues still talk seriously about energy work.4

While it’s true that physicians in general practice lack knowledge of musculoskeletal health care,5 it’s equally true that therapists (physiotherapists, massage therapists, chiropractors) are limited to knowledge of musculoskeletal health. Speaking as a former therapist, we just don’t know much about science or physiology in general. Oh, sure, some of us studied it some in school … but it’s nothing like what doctors learn. They spend about twice as long in school, specialists much more than that, and they typically get much greater direct experience with a wider array of health problems — residencies are where the serious learning happens, as any doctor will tell you.

They are definitely much better educated than therapists.

And yet, even with all that training, there are still many doctors who are not particularly good critical thinkers, don’t know their scientific method, get way behind on their journal reading, and so on. Even those who go into research still suffer from serious biases, pride and illogic, sloppy methods and hallucinatory optimism, all the usual human failings that make science an imperfect endeavour that requires peer review and other checks and balances — and so such doctors get criticized by their colleagues for it, their research gets marginalized, it gets referenced only by people who share the bias, and so on. Even within that world of science and true medical expertise, many still aren’t smart enough to play with the big boys, and never make a valuable contribution — entire careers of half-assed science leading exactly nowhere. Yikes.

My point: therapists are not generally qualified to participate in scientific discussions, let alone to promote complex or dubious untested theories. Most of us should not be babbling about therapy at all. We should be curiously, humbly reading books written by scientists and science journalists for a general audience, and a few therapy journals maybe. We should be starting practically every we say with “maybe” or “perhaps,” and saying “I don’t know” more often than anything else — because we usually don’t. And that’s true even after studying the science deeply for many years.

When therapy babble verges on making sense

A lot of babble is easy to spot … and dismiss. But there’s a large gray zone of pseudo-babble, and it’s more problematic because it’s harder to identify. The bane of my professional existence is therapy theories that are mostly ridiculous, but just reasonable enough that it would be impolite to laugh, and too vague and slippery to choke them to death rhetorically.

They’re everywhere! They are at least half the reason I quit my day job as a massage therapist, and started writing full time. They drive me bonkers.

Consider this fine gem of an example, recently obtained from a discussion on Facebook (an excellent source of such material). What it means and whether it is correct or not is beside the point. What matters is the style of thinking: superficially plausible and sciencey, a complex chain of reasoning and assumptions. Behold the pretension to precision about so many largely unknowable things:

The infraspinatis [sic] is often overstretched by pec minor, pec major, abs, and if the person is right handed, usually the R QL [right quadratus lumborum] and R Erector spinae ....but instead of using myfacial [sic] release or trigger points on infraspinatus (which would effectively lengthen or stretch an already overstretched muscle) and fighting under the scapula to give it 'some love' which will unstabilize [sic] the joint even more, I would recommend addressing the contracted muscles prior to shortening the infraspinatus so that it can contract back to a regular length without adding pressure to the glenohumeral joint or shifting the acromialclavicular [sic] joint.

Hmm, really? Can anyone actually know that it all works like that? Is the pectoralis minor really an antagonist to the “infraspinatis”?6 More to the point: can $100/hour therapy be justified with that kind of talk?

Aside from all the egregious spelling failures with key terminology — never a confidence builder! — the problem here is not exactly that it’s obviously silly or wrong — because it’s not obvious, certainly not to the average person — but that it is so outrageously overconfident, so completely opposite of humble. It is a stack of sloppy assumptions, delivered with a glib certainty that is not remotely appropriate.

It’s like listening to someone talk breezily about the reagents and steps required to cast a spell, just exactly as if it were all real.

It’s not plausible to a well-educated professional who puts on a thinking cap. But it sounds impressive to the average patient, and even to the most professionals. This is exactly what the mainstream of clinical reasoning in the professions of massage therapy and chiropractic sounds like, and (alas) to a great extent in physiotherapy as well.

Indeed, talk like this powers a huge continuing education industry, and emanates routinely from many professional “gurus” and workshop instructors, and seems to be almost universally accepted as the way any serious therapist is actually supposed to talk.7

And if you challenge it? If you dare to poke it with a rhetorical stick? Why, it gets louder, longer, and more elaborate and confident! People pushing logic like that never back down, never show a trace of the humility that most alternative medicine practitioners decry the lack of in doctors.

Many of my readers will be outraged — as usual — by my impertinence. How dare I denigrate some of the most respected thinking in the profession?

It just comes naturally to me, I guess.

Notes

If the deeper, grander meaning of either of these was taken at face value, it would be like saying that The Force from Star Wars is a real thing — which is probably going just a wee bit too far. On the other hand, there is a sense in which both are obviously true — but a rather boring sense, which probably wasn’t worth mentioning in the first place. Nevertheless, the therapy babbler will cheerfully shift the emphasis to make a deepity sound either profound or obvious, whatever suits the situation: profound as a rationale for expensive therapy or just when trying to sound like Deepak, or obvious when trying to sound humble or when challenged by a critic. BACK TO TEXT
See Does Craniosacral Therapy Work? Craniosacral therapists make big promises, but can’t agree on diagnoses and have failed to pass fair scientific tests of efficacy. BACK TO TEXT
Despite the common label “alternative and complementary” medicine, a great many massage therapists and chiropractors emphasize the “alternative,” and not the “complementary.” They perceive a rivalry with scientific medicine, and are hostile about it. See Alternative to What? “Alternative” health care professionals need to decide what they are really the alternative to. BACK TO TEXT
Massage therapists in British Columbia, Canada, are trained quite well, a 3-year program. However, the extra training seems to have virtually no impact on their belief in “flaky” things like energy therapy. The point is that really quite a lot of training and education is needed to become a good critical thinker, as well as other factors.

Massage therapists in British Columbia, Canada, are trained quite well, a 3-year program. However, the extra training seems to have virtually no impact on their belief in “flaky” things like energy therapy. The point is that really quite a lot of training and education is needed to become a good critical thinker, as well as other factors.

BACK TO TEXT
Most doctors are well aware that there are serious shortcomings in the medical management of most musculoskeletal problems, especially chronic pain cases. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton, explains that “undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.”

Medical researchers have done many studies showing that most doctors do not understand aches and pains or heed expert recommendations. A good recent example is a paper in the Archives of Internal Medicine showing that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al.

More generally, the Journal of Bone and Joint Surgery, and the Journal of the American Osteopathic Association, have both published papers recently showing that physicians simply do not have an adequate understanding of musculoskeletal medicine. In 2002, Freedman et al felt that “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” Then again in 2005 in JBJS, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.” Most recently, in 2006, Stockard et al wrote “82% of allopathic graduates ... failed to demonstrate basic competency in musculoskeletal medicine.”
BACK TO TEXT
No! The infraspinatus cannot be over or under-stretched by the pectoralis minor. Or the abdominals. Or the right quadratus lumborum. Or indeed any muscle whatsoever except its actual antagonists, primarily the subscapularis, and other muscles that internally rotate the humerus. So, right out the gate, the first statement in the chain of reasoning is totally wrong. But, like I said, that’s kind of beyond the point. It’s the style of trying to connect dots like this that’s problematic, and it would still be problematic even if the anatomical relationships were correct. BACK TO TEXT
One of the first times I ever really got frustrated with therapy babble was at a workshop, where’d I’d paid hundreds of dollars for someone to sermonize at me like this all weekend. Shudder! But half the participants swallowed it hook line and sinker, and to be honest — even though I was irritated — I still actually tried hard to make use of the information, and I remember quite a deliberate effort to integrate “the best of” the ideas into my practice for several months afterwards. This is what I mean when I say that therapy babble can actually be semi-plausible. BACK TO TEXT

Therapy Babble

Another warning sign of therapy of dubious quality

Do you have a license for that babble?

When therapy babble verges on making sense

Further Reading

Notes