In conventional medicine, psychosomatic medicine has existed as a distinct specialty since the 1930s. Why was Psychosomatic Osteopathy not developed earlier?
Firstly, Psychosomatic Osteopathy (PSO) has little in common with so-called “psychosomatic medicine” – from its scope of indications, the understanding of underlying mechanisms of action, and risk factors, to osteopathic diagnostic and therapeutic interventions. PSO was not developed earlier because the underlying research findings were not available to early osteopaths. PSO models, approaches, diagnostics, and techniques are based, in addition to expanded osteopathic principles, particularly on research findings regarding etiological factors, health and allostasis risk factors, and insights into mechanisms of action and interactions with all body systems and organs – most of which only became known in the last 20 to 30 years.
Shouldn’t osteopathy fundamentally take psychosomatics into account?
As already mentioned, PSO is not psychosomatic medicine, and its indications are not limited to so-called psychosomatic illnesses. It is not just about a little “psyche” in osteopathy. Rather, PSO considers the dynamic interactions between the soma, physiology, patients’ experiences, and their contextual influences. In clinical practice, we therefore speak of “soma-physiology-experience-context dynamics or patterns.” PSO is based on expanded principles of osteopathy, for example, the principle of energy. All chronically ill patients share the characteristic that their energy balance and ATP production are impaired, which should be considered during the course of treatment. The five osteopathic models, developed by my teachers Philip Greenman and Fred Mitchel Jr. in 1987, and further developed by Hruby in 1991 and by me in recent years, also form the basis of PSO. Key practice-relevant questions include: Which factors actively fuel the allostatic process in the respective patient or prevent the inhibition of pathophysiological processes? To what extent are which body systems in allostasis? Which changes are still functional, epigenetic, anatomical, or already pathological? And as a therapeutic conclusion: Where are the access points in the respective patient that allow healing processes? Furthermore, all afferences – exteroception, proprioception, interoception – play a much larger role than they otherwise do in osteopathy. I first published approaches for reorganizing the treatment sequence in 2006 in the book “Morphodynamics in Osteopathy,” for example, that evolutionarily and ontogenetically early structures are more fundamental, and newer evolutionary structures are more significant. This has high clinical relevance: When multiple dysfunctions are present, evolutionarily older structures should be treated first, as newer ones build upon older ones. Simultaneously, the activation of newer evolutionary networks can relativize older ones and be used as co-regulation. Top-down and bottom-up diagnostics allow for the identification of interactions of “big players” in pathophysiological effects as well as resources in the healing process, and for deriving courses of action. This can improve mapping processes, e.g., of joints, bones, and organs, and resource-rich co-regulation. Patient proactivity is a central component of the new approaches – many times more so than in previous osteopathy. Effective diagnostic and treatment approaches and techniques have thus emerged, such as 15-step multimodal bifocal integration, which incorporates many exteroceptors, 6-step emotional regulation reset, or integral OMT pain relief approaches. These are also being investigated in studies regarding their efficacy. PSO makes it possible to understand and effectively treat chronic complex clinical pictures. All previously acquired osteopathic repertoire remains essential – only the references for application are expanded and refined.
A psychosomatic osteopathic treatment, as you write, requires further specialized knowledge and perception tools, is carried out in five phases, and the therapist also acts as a co-regulator. Is all of this feasible in terms of learning and practical implementation?
New understanding leads to new courses of action and treatment approaches. This can, of course, be taught and learned. An example: Especially when pathophysiological patterns have existed for many years, it is not enough to eliminate original causes or triggers. Instead, mechanisms of action must be identified, differentiated, and actively inhibited. At the beginning of osteopathy’s development, these mechanisms of action were hardly known. Yes, five phases can be distinguished, which also interact: 1. therapeutic relationship 2. diagnostics with particular importance of proprioception, interoception, and exteroception, resources, co-regulation, and feedback loops in the treatment setting 3. stabilization phase 4. integration-confrontation including new techniques, co-regulation, and a resource-rich flow state 5. implementation in daily life, because it is not necessarily true that just because something worked or was resolved in practice, or reference experiences were made, these will also work in daily life.
In your opinion, should future osteopathic treatment always be psychosomatic osteopathic treatment?
PSO could be the osteopathy of the future. The limited view of the term “somatic dysfunction,” which underlies previous osteopathic actions and reflections, and the frequently chosen analogy “precision mechanic and machine” by A.T. Still and the action description “find it, fix it, leave it alone,” must be relativized. I also consider the dichotomy of health and illness to be outdated, or at least it needs to be relativized. The consideration of “mechanisms of action” for health as well as for allostatic processes plays a significant role in the osteopathic approach.
