The Hydra’s Head: Fallout of Professionalizing the Care Industry

Redefining “massage” as “massage therapy” as the AMTA did in 1983 was mostly a defensive move. The thinking went, if massage is a health care profession, no one will mistake us for prostitutes. But we are, for the most part, past that issue. It is time to get back to our roots and highlight what we are better at than anyone else in the culture.: touching people safely, unconditionally, with clear intentions, significant training and experience. – David, TouchPro International (source)

This afternoon I read this statement in a blog and it totally opened a mega juicy can of worms in my brain. Mega. Juicy. Worms. Yea, it was intense for me too.

Before I dive into this issue concerning massage, I’d like to take a quick trip down memory lane. In social work school we had classes that analyzed the pros and cons of professionalizing social work, and how social/historical context brought us there. The reason why I’m bringing this up is because what’s happened to the massage field as noted above has parallels to what happened to the social work field. In case there is any need for clarification, I’m referring to professionalization, not prostitution.

Sorry for the awkwardness. Now that’s outta the way …

Social work in the US is credited largely to Jane Addams and the Settlement House Movement. Jane had the idea that charity and philanthropy weren’t enough, that reform and action was needed in order to address social inequities. The Settlement House Movement was founded on the notion that housing the rich and poor together with access to daycare, education, healthcare  made for stronger communities. The underlying theory was that causes of social inequities were mainly rooted in the social order and that people’s “problematic” behaviors were only symptoms. The SHM was a deep immersion tactic that blurred the lines between client and provider. Some criticized this approach for fear that it would harm the professionalism of social work. In an effort to maintain this professionalism, another branch of social work heavily emphasized clear boundaries between client and provider, a dispassionate bureaucratic demeanor, and a focus on direct individual service/treatment (as opposed to social reform).

What I find interesting when comparing massage and social work is that the professionalization of both fields seemed to have led to similar fallouts. While professionalization may have “legitimized” both fields with a heavy scientific approach, it also led to other casualties (or hydra’s heads, metaphorically speaking):

(1) socioeconomic access, and

(2) what I will refer to as the original spirit

 

On socioeconomic access

It is little mystery to most people that both massage therapy and clinical social work services are beastly expensive. That’s because these services are now in the healthcare category. You’re not just getting engaging in touch or talk that is soothing, but you now are receiving treatment. Additionally, most insurances aren’t very good with providing sustainable coverage in a meaningful way, assuming that they provide anything at all. The “socio,” or social, component of “socioeconomic” is something I find quite interesting. Due to the economic barrier to these services, there is also a social component of who specifically tends to have more drastic restrictions to economic resources. I say “more drastic” because I think there is a difference between people who can’t afford massages or counseling since they are loaded with other high expenses, and people who can barely put food on the table (if at all). Not to discount anyone’s financial hardships, but I do think there needs to be special consideration for a level of financial hardship that tends to be overlooked. Now back to the “social” aspect. I find this especially tragic since the people who would benefit the most from things like massage and counseling are also, arguably, the people who need it the most. The public health data has been consistent over the test of time: target communities* (People of Color, LGBTQ, disabled, low-income etc.) are disproportionately impacted by economic hardships, violence, various traumas, and health/mental health issues.

If care bases services were created to alleviate suffering and provide some level of care and nourishment, it isn’t right that it’s access is restricted from those who need it the most. I’m not only talking about massage and counseling here. Think of access to other care services that provide for personal wellness: childcare, yoga, spas etc. Moreover, the restriction isn’t only economic. Even when a member from a target community gains economic access to these services, there is a huge socio-cultural barrier. Per demands of commerce, businesses are designed to cater to their highest paying and most consistent customers, which happen to usually be White, middle-to-upper class, cis-gender, heterosexual, without disability, non-indigenous, and with citizenship status. Imagine the alienation and difficulty with navigating spaces that will accommodate your differences for sake of political correctness and good business, but otherwise take no interest in affirming your identity. So you fight tooth-and-claw to show up for care services that you need. Then the people there display body language and eyes that tell you that you don’t belong there. They might say the right words, but the unspoken language is all wrong. The silent truth in the air says that you are a disturbance to the peace, that you are something meant to be tolerated briefly, and that people can breathe the clean air once again when you leave. I mean … that totally sucks. That really, really sucks. There are no high-caliber snobby words to describe it. That. Sucks.

On Original Spirit

Earlier I referred to original spirit as one of the casualties of professionalization. When I think of the care that people need, whether it’s bodily or mental, I believe that human beings are also equipped to address these needs for each other. As social creatures we have a natural affinity to provide needed care for those close to us. Ideally, they aren’t done as transactions (quid pro quo), but as authentic displays of companionship and familial affection. Somewhere along the way the original spirit of this exchange became commodified, commercialized, and professionalized. It lost its original spirit. It lost its humanness. It became a paid service. You have to give me this, and then I have to give you this. That’s not authentic care, what friends and family do for each other. That’s a transaction, a consumer-seller relationship.  Then in the process of professionalization, things like touch and talk become treatment. To receive treatment, you must have a diagnosis. To administer it, you must learn the technicalities and get a certificate. You don’t have to learn and become skilled in the emotional, social, historical, and cultural implications. What’s important here is only the science, right? Everything else is considered fluff and unprofessional. Make no mistake, I am not advocating for lack of skill and study. However, I think one can be highly-skilled and well-informed without being a professional.

At the end of the day, not everyone needs treatment. And if you do have a diagnosis, your connection to your provider (regardless of what type of therapy) is just that, your diagnosis. Your identity and your diagnosis become one and the same. If you pay attention in various clinics, you will often hear this reflected in the language. Patients (or clients) are often reduced to their diagnosis or deficiency. For instance, you hear people say things like “I work with homeless veterans” … or “today I saw a broken knee” … “So-and-so is an addict” … “So-and-So is depressed.” There is an effort to make artificial changes by asking professionals to instead refer to their clients/patients as “a person with [fill in the blank].” This attempt doesn’t’ get far since it’s generally regarded as PC nuisance. The reason being is the culture and mindset is still stuck in identifying people with their diagnosis/deficiencies. It’s the provider’s main association and connection to who they treat/serve.

Most people just want to connect and be cared for. As a society we are incredibly deprived of nourishing physical and emotional connection. If the only way people can find these things is through sex, drugs, and violence … well, the environment (the social order) is accountable for making connection inaccessible and stripping it of its original spirit. If the only way I can be loved and cared for is to have a diagnosis, then I better find one. Just touching and just talking have lost its status. But more than ever, it’s what we need. To touch and be touched. To acknowledge and be acknowledged. That’s human. That’s who are are. There are many things that contribute to suffering and misery. And not being yourself is definitely among those at the top of the list.

 

What this means for My Praxis

These are some of the critical questions and considerations that I hope to integrate into the development of My Praxis. As this project moves through concept and design, it is paramount to me (and I imagine, to a lot of other people) that what we do makes a difference by stepping back from professionalism and a few steps towards humanism.

 

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* Some people use the term “marginalized” or “minority” communities. I use “target” communities to refer to a social analysis that identifies systematic oppression that specifically targets certain groups of people in order to maintain the status quo.

 

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