Models of Medicine and the Feldenkrais Method

Deborah Bowes, GCFT, and Cliff Smyth, GCFT

How can a method of somatic education, like the Feldenkrais Method, be considered and integrated into medical contexts? A new model of medicine may provide a conceptual frame for the integration of the Feldenkrais Method and other complementary approaches that incorporate learning and awareness.

Old paradigm medicine
In its simplest form the current dominant model of medicine, the biomedical or biotechnological model, looks for specific, usually single, causes to illness. The cause could be chemical, mechanical, structural, infectious, genetic, or physical. The therapy or treatment for the illness is also specific and related to the identified single causative agent. The patient is passive; the practitioner is the expert. The patient's experience is often denied, seen as purely subjective or even as an impediment to treatment of the illness. This model developed most strongly since World War II with the arrival of new drugs and the application of new technologies.

However, many of the advances claimed for the biomedical model, such as defeating many infectious diseases, were achieved in conjunction with social and environmental programs such as sanitation, improved nutritional education, changed social behaviors (eg. no spitting to reduce the transmission of tuberculosis), clean food laws, etc. Recently, there has been a decline of the effectiveness of the biomedical model as some drugs become less effective. This model has become less effective and even failed in the treatment of complicated conditions such as, heart disease, diabetes, HIV, chronic pain, obesity, and drug addiction. These conditions have complex interactions between one's biology, psychology and environment and culture. Concerns about declining effectiveness, time, and financial constraints - along with the clinicians' dissatisfaction with their role - led to a search for other ways of approaching these kinds of conditions

The Biopsychosocial Model
Dr George Engel developed an expanded model of healing based on principles of general systems theory. Engel described this in an article published 30 years ago in Science entitled The Need for a New Medical Model: A Challenge for Biomedicine (April 1977, Vol. 196, No. 4286, pp. 129-136.) and a number of subsequent articles in various journals.

This model considers illness or health as a result of the interacting effects of a person's biology, psychology, and the social context in which she lives.

In this model, instead of seeing the patient as passive, the patient is an active partnership with the provider. She is guided towards health and her self-healing processes are facilitated with consideration of all aspects of her life and her experience of her illness or condition.

Examples of programs that could be seen to be consistent with the biopsychosocial model include: the mindfulness-based stress reduction programs developed by Jon Kabat Zinn and his colleagues, Dean Ornish's heart health programs, Andrew Weil's program toward optimum health, and many pain management programs. Also many programs for people with conditions such as HIV, diabetes, cancer recovery, smoking cesation, weight loss and others, operate in the context of a biopsychosocial model. Such programs may include elements such as: movement, meditation and other awareness practices, cognitive information about the condition, nutrition, psychological and communication processes, expressive arts, group support, etc.

The new medical model
This new model can include what many practitioners know to be helpful in accessing people's own ability to heal. A degree of self-healing is within the capacity of each person. Not everything is 'curable', but our behaviors and beliefs influence everything. By considering and accounting for the interaction of our biology (eg. chemistry, infectious agents, structure and biomechanics, genetics), our psychology (eg. (eg. self-image, emotional habits, values and attitudes, and schemas), and our social context (eg. environment, culture, family, biography and history), the biopsychosocial model integrates a person's experience with the process of healing or wellness.

Using this approach as a working model allows for more individualized approaches to health.

The Feldenkrais Method is used in many contexts; with high performers such as athletes, dancers, musician and actors; people learning new skills; for general physical flexibility and well-being; as well as for developing one's potential for personal growth in all areas of one's life. When made available to people with medical conditions and in medical contexts, Feldenkrais Method could be viewed as fitting within the biopsychosocial model.

The Feldenkrais practitioner enters the model from the doorway of movement, action and awareness. From this perspective it is impossible not to see into and influence the other domains of experience, knowledge, and action. Movement dances at the intersection of biology, psychology, and sociology. Through movement we learn about our environment, our selves, our thoughts, beliefs, perceptions and feelings in action. The differences between the physical, psychological and environmental are purely linguistic or practical: in our lives they are integrated in every action.

The Biopsychosocial model and the Feldenkrais Method
Individual Doctors, Osteopaths, Chiropractors, Dentists, nurses, acupuncturists and other medical professionals have been prescribing individual Feldenkrais sessions of Functional Integration and sending people to Feldenkrais Awareness Through Movement classes for many years - and some have employed practitioners in their offices. Feldenkrais is also found in rehabilitation centers, in many Physical Therapy and Occupational Therapy clinics in hospitals and health maintenance organisations (insurers and providers) in the United States, Australia, Germany, Sweden, Switzerland and many other countries. The biopsychosocial model provides a way of contextualizing how Feldenkrais contributes to injury prevention, healing, rehabilitation, health maintenance and well-being.

The work of the Feldenkrais practitioner often includes working with or teaching people who have pain, or a medical diagnosis. Indeed the majority of people come to the Feldenkrais Method with pain or other dysfunction. Often they are surprised to discover, through the process of working with their practitioner, that differentiation, flexibility, creativity, self-awareness, and learning can guide them to realize their hopes for overall health and well-being.

Just as there are different models of medicine, so there are different models of education. The traditional model of education involved the teacher as expert, deciding on and imposing a fixed body of knowledge, in a standardized curriculum, divided up into rigid disciplines, regardless of the interests and culture of the students - and often using a very authoritarian style of delivery. The image of the be-suited lecturer holding forth in front of hundreds of bored students only sitting there to get a grade is not the model of education we are thinking of - although unfortunately it is sometimes evoked when we talk about the Feldenkrais Method as an 'educational' process!

When we use the word 'education' in the Feldenkrais professional field, we mean educational processes that are experientially based and directed by the learner's interest. These are educational processes where the teacher is the facilitator of the student's individual learning and growing awareness, by fostering curiosity and the ability to learn how to learn. This approach to learning has much to offer the kinds of emergent medical and health education programs being discussed here.

Moshe Feldenkrais called the kind of learning he promoted ' "organic learning" to differentiate it from "academic learning", [or] "social learning" ...'. (Schafarman, 1997, p. 189.) It is the kind of learning when the whole organism - the whole person - is engaged in learning that involves sensory, motor and cognitive processes simultaneously. It is the kind of learning we engage in as children learning to drink, grasp things, stand, walk and feed ourselves. Injury and illness can disrupt not only our functioning but also our ability to learn in this way. The Feldenkrais practitioner can facilitate this process of organic learning in both children and adults.

Moshe Feldenkrais wrote, "Organic learning is essential. It can also be therapeutic in its essence." (Feldenkrais, 1981) Learning how to improve how we move, act, and react can help us not only to deal with a current injury, illness, or condition but also help us prevent and recover from new difficulties as they arise. Feldenkrais practitioners give their clients a tool-kit of awarenesses and practices they can use throughout their lives.

The physical and mental flexibility and awareness that people gain from the Feldenkrais Method can help them to deal with, and recover from, the shocks of stress, injury and illness that are an inevitable part of life. As Feldenkrais practitioner and author, Steven Schafarman, puts it, "awareness heals" (Scharfarman, 1997).

Somatic approaches such as Feldenkrais Method, Alexander Technique, and Ideokinesis, for example, developed at a time when the idea of 'therapeutic' in medicine was of purely physical interventions and the 'doctor-patient relationship itself was more hierarchical', while the medical-psychiatric and Freudian models predominated in psychotherapy. The lack of a contemporary understanding of the mind-body relationship meant 'psychotherapy and physical therapy stood at a greater distance from one another' (Steinmuller, in Bernard, Steinmuller and Sticker, 2006).

Since then, new models of psychotherapy have emerged that see therapy as a personal learning process (involving the development of insight and skills) engaged with the person's being in the world and done in collaboration with the practitioner. The biopsychosocial model presents a similar shift in medical thinking.

The biopsychosocial model is substantially congruent with the principles, values and practices of the Feldenkrais Method. Such as:

considering the whole person in the context of their whole life and intentions
considering the client as an active participant
the clinician/teacher as a partner, facilitator and guide
the importance of self-responsibility in recovery and health
the role of awareness in improvement.

What Feldenkrais practitioners have to bring to this model of medicine
The biomedical model has the view of 'alternative' or 'complementary' modalities as being out on their own or on the fringe. However in the last 10 years the discussion has begun to focus on ideas of 'integrative medicine' - or 'integral medicine'. This includes not only the integration of Western medical science and practices with what were seen as 'alternative' or 'complementary' - but also the integration of the patient or the client as an active participant in the process, and the integration of all aspects of the person's life in the process. The biopsychosocial model provides a framework to integrate these different elements that can contribute to health and well-being. The Feldenkrais Method has much to offer in this evolving approach.

Feldenkrais practitioners understand that the environment includes gravity and space, society and culture, and the importance of the ability to move within them. As a method of somatic education, we contribute our understanding and practices that bring forth one way to come to know what it means to have a body; that life is an embodied experience. The Feldenkrais Method applies systems thinking in Awareness through Movement and Functional Integration lessons. Feldenkrais practitioners working in an integrative health setting, within a biopsychosocial model of medicine, can bring:

concrete learning practices
ideas and theory
an appreciation of the possibilities of human awareness and action.

Feldenkrais practitioners can offer not just a component of a program, but ways of using Feldenkrais Method thinking to develop and organize such programs: for example:

the relationship between thinking, sensing, feeling and movement in all human action
how learning in one domain of action can be transferred to others
the importance of learning through experience
the role of curiosity and self-directed learning in discovering one's personal path to health.

In the USA, Feldenkrais Method has been integrated into pain management, health education, cardiac rehabilitation and injured worker rehabilitation programs from the San Francisco Bay Area to Madison, Wisconsin.

It is early days in the development of outcomes research into the use of the Feldenkrais Method in these kinds of programs. However, initial evaluations and research into the use of Feldenkrais in integrative medicine programs, and stand alone Feldenkrais programs, show that Feldenkrais Method can contribute to:

a shift in the locus of control to the client/patient
in increase in the sense of self-efficacy in dealing with pain and dysfunction
increased retention rates of participants
reduction in reported pain, use of medications and utilization of medical services (and therefore costs).

In conclusion: The Feldenkrais Method is a learning process, which has been shown to have significant therapeutic effects and value. The Method can function as an effective complement to medical care, and as a vital aspect of recovery and rehabilitation, healing and well-being

Deborah Bowes and Cliff Smyth, 2007

An earlier version of this article was published with the title 'Feldenkrais Method, Education and Medicine' in InTouch the newsletter of the Feldenkrais Guild of North America, 2nd Quarter 2002, pp. 1, 3 & 4.

References

David Bearman, MD and Steven Schafarman. (1999, January). 'The Feldenkrais Method in the Treatment of Chronic Pain: A Study of Efficacy and Cost Effectiveness. American Journal of Pain Management, 9(1).
Patricia Buchanan and Beverly Ulrich. (2003). 'The Feldenkrais Method: a dynamic approach to changing motor behavior'. Research Quarterly for Exercise and Sport, 74(2), 116-123; discussion, 24-126.
Theodore Dimon, Jr. (1999). The Undivided Self: Alexander Technique and the Control of Stress. Berkeley, CA: North Atlantic Books.
George Engel. (1977, April) 'The Need for a New Medical Model: A Challenge for Biomedicine'. Science, 96(4286), 129-136.
Moshe Feldenkrais. (1972). Awareness Through Movement: Health Exercises for Personal Growth. San Francisco, CA: Harper, San Francisco.
Moshe Feldenkrais (1981). The Elusive Obvious (Or Basic Feldenkrais). Cupertino, CA: Meta Publications.
Moshe Feldenkrais. (1977). Adventures in the Jungle of the Brain: the Case of Nora. New York, NY: Harper and Row.
Moshe Feldenkrais. (1995). Amherst Feldenkrais Training Program, 1980. [video recording] Paris, France: International Feldenkrais Federation.
Marcia Germaine Hutchinson. (1985). Transforming Body Image. Freedom, CA: The Crossing Press.
I. Lundblad, J. Elert, B. Gerdle (1999). 'Randomized controlled trial of physiotherapy and Feldenkrais interventions in female workers with neck-shoulder complaints', Journal of Occupational Rehabilitation, 9(3), 179-194.
David B. Morris. (1998). Illness and Culture in the Postmodern Age. Berkeley, CA: University of California Press.
Marilyn Schlitz and Tina Amoroik, with Marc S. Micozzi. (2005). Consciousness and Healing: Integral Approaches to Mind-Body Medicine. St Louis, MO: Elsevier/Churchill Livingston.
Steven Schafarman. (1997). Awareness Heals: The Feldenkrais Method for Dynamic Health. Reading, MA: Addison-Wesley.
Wolfgang Steinmuller. (2006). 'Preface', in A. Bernard, W. Steinmuller and U. Sticker, Ideokinesis: Creative Approach to Human Movement & Body Alignment. Berkeley, CA: North Atlantic Books.
J. Stephens, S. Call, M. Glass, et al., (1999). 'Responses to ten Feldenkrais awareness through movement lessons by four women with multiple sclerosis: improved quality of life', Physical Therapy Case Reports, 2(2), 58-69.
Frank Wildman, Jim Stephens and Leya Aum, 'Feldenkrais Method', in Donald W. Novey, MD, Clinician's Complete Reference to Complementary and Alternative Medicine, St Louis, MO: Mosby/Harcourt Health Sciences.

Deborah J Bowes and Cliff Smyth, 2007